Digital health literacy was directly associated with self-efficacy (β = 0.21, p < .05) and indirectly associated through social support (β = 0.10, 95% CI 0.06–0.14) and life satisfaction (β = 0.17, 95% CI 0.12–0.22) among 1,016 community-dwelling older adults across six Chinese provinces. A sequential mediation pathway ran from digital health literacy to social support to life satisfaction to self-efficacy (β = 0.05, 95% CI 0.01–0.09). Health consciousness significantly moderated these relationships, with stronger associations among participants high in health consciousness (direct path β = 0.32 vs 0.09; sequential indirect path β = 0.06 vs 0.01). Qualitative analysis of 30 interviews identified information-processing strategies, social validation processes and goal-directed feedback loops that translated digital competencies into psychological resources.

Individuals reporting higher satisfaction with insurance coverage, ongoing relationships with primary care providers, and greater financial literacy were more likely to engage in preventive health behaviors. Cost-related barriers were initially associated with increased utilization but their direct influence diminished once financial knowledge was accounted for. Once structural and informational dimensions were considered, traditional demographic variables such as race and gender lost statistical significance, underscoring the greater impact of systemic and educational factors.

Adequate care literacy was associated with preference for mixed or formal care services. Economic status, subjective health and community involvement also affected care preferences. The authors concluded that it is important to improve care literacy and support informed care choices among older adults.

Participants valued comprehensive advance directives and structured ACP conversations in general practice. Key motivators for seeking facilitation were maintaining autonomy and reducing family burden. Trustworthy discussions with professional facilitators, structured guidance and clear communication — particularly involving healthcare proxies — were essential to a satisfying ACP process. Despite prior interest in discussing care preferences, some participants had still not initiated those conversations. Based on interviews with eight German ambulatory patients (six female, two male; mean age 63.6) across two general practices, conducted before, immediately after and 12 months after facilitation.

Advance care planning significantly improved completion of advance directives (OR 7.93, 95% CI 2.76–22.77, p = 0.0001) and palliative care utilization (OR 1.39, 95% CI 1.08–1.78), but was not effective in improving anxiety, depression or decisional conflict. The authors concluded that ACP may have desirable impacts on advance directive completion and palliative care utilization for patients with advanced cancer.

Psychiatric advance directives were found to improve autonomy in decision-making, reduce coercion in crisis interventions, and lower involuntary hospitalization rates, and were legally recognized in many U.S. states and other countries. Barriers included inconsistent legal recognition across jurisdictions, lack of provider understanding and training, and low awareness among persons with psychiatric conditions. Promising practices included clinician training and awareness programs, facilitation with peer worker or clinician support, and clear legal mandates. The authors concluded that PADs are a promising tool for people with serious mental illness, but implementation requires clear legal guidance and clinician buy-in.

Kidney supportive care interventions were found effective in improving patient outcomes, especially end-of-life care and symptom management, though significant gaps remained, across 60 included studies of which one-third were randomised controlled trials. The most common Effective Practice and Organisation of Care domain was care delivery (58/60); end-of-life care (33/60) and physical aspects of care (19/60) were the most common quality palliative care domains; multidisciplinary shared care featured in 26 studies; cultural (0/60) and ethical aspects (3/60) were least described.

Hospitalization rate did not differ between groups (IRR 1.0, 95% CI 0.97–1.1) and declined similarly in both during COVID-19, across 44 nursing homes of which 23 received the intervention. Care consistency with preferences was similar (OR 0.9, 0.4–1.9), though exploratory analysis suggested greater consistency in the 6 of 23 homes meeting adherence criteria (OR 1.9, 0.7–5.3). Written emergency plans were significantly more common in the intervention group (IRR 11.6, 8.2–16.4) and in adherent homes (IRR 30.1, 15.7–57.6). The authors noted the intervention did not permeate sufficiently, largely due to the pandemic, so the trial was not conclusive.

The intervention did not change the proportion receiving a goals-of-care conversation in the ED (38.2% vs 40.3%, p = 0.79) across 153 included cases (76 pre-intervention, 77 post-intervention), and only 6.5% had a DNR order before the ED visit. Cancer-related complaints (OR 12.9, 95% CI 4.15–39.92) and respiratory emergencies (OR 3.02) were associated with increased odds of a GOC conversation. Of the 60 GOC conversations that occurred, 76.7% resulted in a change in code status, care plans, hospice, or updated ACP documents.

The experimental group showed significant improvement in perceived good death (Good Death Inventory), quality of relationships, and end-of-life care knowledge, with no such improvements in the control group, across 122 enrolled participants. The authors recommended early initiation of the program to optimize benefits.

Receiving ACP was associated with lower hospitalization costs of USD 23,928.84 overall. Compared with non-Hispanic Whites, hospitalization costs among Hispanic elders were higher by USD 14,232.40, while costs for non-English speakers and those with increased comorbidities were higher by USD 27,346.60 and USD 26,072.70 respectively. Dementia patients seen by providers trained to offer telehealth ACP realized significant cost savings, with marked differences among those of non-White racial backgrounds.

ACP interventions significantly increased completion of ACP documents, occurrence of ACP and end-of-life care discussions, consistency between preferred and actual end-of-life care, and ACP engagement among older populations, across 32 included studies.

ACP adoption increased overall by more than 10% since 2016 (p < 0.001) across 6,037 respondents surveyed over three years. Upward trends appeared across all racial groups, but statistically significant increases were found only among White and Hispanic residents (p < 0.001). Increased odds of ACP adoption associated with the campaign were found for residents aged 65 and under, White residents, married individuals, and those with a regular health care provider (e.g. OR 1.35, p < 0.001). The authors concluded that community-based campaigns can increase ACP awareness and adoption, though more work is needed in diverse communities.

Self-efficacy and self-management had significant direct effects on health-related quality of life; diabetes knowledge influenced HRQoL indirectly through self-efficacy. No variables showed a significant effect on HbA1c.

Medical record documentation of end-of-life values and goals was significantly higher in the intervention group at 3 months (24.3% vs 9.9%, p = .03) and 6 months (31.4% vs 12.7%, p = .008) among 141 randomized patients (mean age 66.7, 51.8% female, 60.3% metastatic cancer). At 1 month there was no difference in patient-reported ACP engagement (3.32 control vs 3.37 intervention, p = .58), though 17.1% of intervention patients versus 7.0% of controls had discussed care preferences with physicians (p = .07).

Herth Hope Index and ACP Attitude Scale scores did not differ significantly by group, time, or group × time among 72 older adults. STAI-S anxiety scores did not differ between groups, though both groups decreased significantly over time. The experimental group showed higher ACP behavioral intention scores over time than the control group. The authors concluded that fear of patient hopelessness should not be used to postpone ACP conversations.

The 'in-home palliative care' model was the most researched, with good evidence of positive benefit, across 66 reviews screened from 6,683 papers. Specialist and integrated models showed evidence of improved patient and service-utilisation outcomes, while cost-effectiveness evidence was lacking. Meta-level evidence supported provision of in-home palliative care, with most review-level evidence showing a positive effect on patient outcomes.

Dementia palliative care did not significantly improve neuropsychiatric symptoms through 24 months: NPI-Q severity was 9.15 versus 9.39 (between-group difference −0.24, 95% CI −2.33 to 1.84), with no significant difference in rate of change, among 201 enrolled dyads (patients 67.7% female, 43.3% African American, mean age 83.6). No significant differences were found in secondary outcomes except fewer combined ED and hospitalization events with palliative care (1.06 vs 2.37 events per patient; difference −1.31; RR 0.45).

Patients at clinics receiving the bundled intervention had significantly more ACP documentation than those at usual-care clinics (25.3% vs 20.8%) across 13,800 unique patients at 29 clinics in three health care systems, suggesting that video decision aids plus clinician communication training improve ACP documentation for older adults with advanced cancer.

The initiative increased new EHR-documented end-of-life preferences but also increased potentially burdensome care at end of life among a subgroup of decedents with serious illness. Among 64,915 older patients at 51 primary care practices, 4.6% of those in intervention practices engaged in facilitator-led ACP.

E-health literacy affected the patient-physician relationship, the patient-physician relationship affected treatment adherence, and e-health literacy affected treatment adherence, among 425 adults surveyed in Istanbul. The patient-physician relationship played a mediating role between e-health literacy and treatment adherence.

E-health literacy correlated with all self-care components (r = .46–.59, p < .001) among 110 Korean COPD patients, as did attitudes toward internet health information (r = .45–.66, p < .001). E-health literacy was the strongest predictor of maintenance (B = 0.44) and monitoring (B = 0.45), while attitudes toward internet health information most strongly predicted management (B = 0.63). Models explained 27.4%–48.9% of variance.

Digital tools were found to offer unprecedented opportunities to disseminate health information and facilitate care, but their effectiveness was contingent on addressing underlying issues of digital access, ensuring cultural relevance, and empowering individuals to critically appraise information.

Digital health literacy technology was significantly associated with both the use of e-health services (r=0.56) and quality of life (r=0.42). Regression analysis indicated that both DHL technology (β=0.28, p=0.003) and e-health use (β=0.39, p<0.001) significantly predicted quality of life. Mediation analysis revealed a statistically significant indirect effect (B=0.20) of digital health literacy technology on quality of life through the use of e-health services.

Poorer digital health literacy and health literacy were significantly associated with older age, lower educational attainment and lack of internet access. The findings suggested a link between DHL/HL levels and treatment adherence and quality of life in NMIBC patients.

Self-rated digital skills robustly predicted improvements in physical, mental and social health among older adults; benefits operated via social participation, health behaviors and digital health engagement, with larger returns for vulnerable groups.