Managing the Needs of Older Patients with Multimorbidity—A Systematic Review of the Challenges Faced by the Healthcare Services

Research fails to provide an overview of the challenges involved in caring for older patients with multimorbidity. Multimorbidity is defined as the presence of two or more chronic conditions in the same person, leading to a high risk of care dependency. The aim of this review was to illuminate the challenges faced by the healthcare services in managing the needs of older patients with multimorbidity. A systematic review was performed, a total of 1,965 abstracts were read and nine quantitative studies included. Data were analysed by thematic synthesis, revealing six themes: A frequent problem in older female patients;High healthcare expenditure and costs, Medication management problems, Social inequities, Complex healthcare and consultation needs and High mortality. The study highlights that healthcare professionals struggle to obtain suitable guidelines for the care of patients with multimorbidity while trying to respond to their needs. Patient-centred integration across settings and coordination in clinical practice are necessary. The healthcare system today does not seem to focus on patient safety and preventing harm. Older patients should be reviewed by a healthcare professional responsible for coordinating their care. To ensure safe and effective care for elderly persons with multimorbidity, the healthcare services should abandon the current focus on managing innumerable individual diseases and conditions.

Urban forest loss using a GIS-based approach and instruments for integrated urban planning:A case study of Jo?o Pessoa,Brazil

Urban forests play an important role in the thermal comfort and overall life of local populations in large-and medium-sized cities.This study analyzes urban forest loss and maps land use and land cover(LULC)changes between 1991 and 2018 by evaluating the use of urban planning instruments for the mitigation of urban forest loss in Jo?o Pessoa,Brazil.For this purpose,satellite-derived LULC images from 1991,2006,2010 and 2018 and data on urban forest loss areas obtained using the Google Earth Engine were used.In addition,this paper also discusses the instruments used for integrated urban planning,which are(a)the legal sector,responsibility and nature;(b)the urban expansion process;and(c)the elements of urban infrastructure.The results show a clear shift in land use in the study area.The major changes in LULC classes occurred in urban areas and herbaceous vegetation,while the greatest loss was in arboreal/shrub vegetation.Thus,an increase in the pressure to occupy zones intended for environmental preservation could be estimated.Our results showed similar accuracies with other studies and more spatial details.The characteristics of the patterns,traces,and hotspots of urban expansion and forest cover loss were explored.We highlighted the potential use of this proposed framework to be applied and validated in other parts of the world to help better understand and quantify various aspects of urban-related problems such as urban forest loss mapping using instruments for integrated urban planning and low-cost approaches.