Early detection of cognitive decline is crucial for timely intervention and prevention. Even in individuals with normal global cognitive performance, subtle domain-specific deficits may serve as “red flags” (RF) that predict future cognitive impairment. This study analyzes the presence of such red flags in cognitively normal individuals, their association with sociodemographic and clinical variables, and their potential predictive value for different dementia profiles.To identify early cognitive alterations in patients with normal total SAGE scores (≥17); to evaluate their relationship with age, sex, education, and COVID-19 history; and to explore possible cognitive profiles (Alzheimer’s, vascular, Lewy body) associated with specific patterns of red flags.A cross-sectional observational study was conducted between 2024–2025 at XXXXXX. The Self-Administered Gerocognitive Examination (SAGE) was administered to 380 participants aged ≥14 years. Cases with scores ≥17 but with ≥2 altered sensitive items (memory, clock drawing, money, sequence, triangles) were classified as red-flag positive. Sociodemographic data, COVID-19 history, depression, and functional status (ABVD) were recorded. Statistical analyses included chi-square, t-tests, relative risk (RR), and odds ratios (OR), with p<0.05 considered significant.Red flags were identified in 84 participants (28.7%) despite normal SAGE scores. RF prevalence increased with age (40.5% in 60–79 years) and was twice as high in participants with primary education compared to those with university studies (RR=2.1–2.25; p<0.001). The most affected items were clock drawing, immediate memory, and visuospatial reasoning. Among those <60 years, 42.9% presented at least one RF: 66.7% with memory deficits (suggestive of early Alzheimer’s), 21.1% with executive dysfunction (vascular profile), and 12.2% with visuospatial impairment (Lewy body profile). COVID-19 history showed no significant association. Functional and depressive symptoms were more frequent in red-flag positive cases.Cognitive red flags reveal early domain-specific deficits that may precede global decline. Education emerged as the strongest protective factor, supporting the role of cognitive reserve. The SAGE test’s item-level analysis enhances sensitivity for early detection in Primary Care.Red flags in cognitively normal individuals may identify prodromal cognitive decline. Their systematic detection and follow-up in Primary Care could improve early diagnosis, guide tailored interventions, and reduce future clinical and social burden.

Primary health care must undergo a transformation to address population ageing and remain sustainable. Population ageing entails more complex health problems, which must be faced with fewer professionals and resources. This makes it necessary to seek new care models.We present an innovative, frailty‑focused basic care unit (BCU) in a rural area of XXX, with 700 patients (100 of them receiving home care) accounting for one fifth of the centre’s visits but responsible for 70% of the pharmacy budget. The unit is integrated and self‑managed by two nurses, a case manager, a family physician, an internist and an administrative officer, coordinated with a social worker, a clinical psychologist and a social one, a physiotherapist, an occupational therapist and a dietitian, the palliative care team, an intermediate‑care geriatrician and a hospital‑at‑home service.​This BCU makes it possible to provide comprehensive, proactive, patient‑centred care tailored to the needs of an ageing rural population, improving quality of life, reducing polypharmacy, decreasing the burden on the health system and improving the unit cost per patient.​Despite sub‑specialisation in frailty care, there are significant differences between patients requiring hospital‑level care at home and the rest of the BCU caseload, such as high multimorbidity, risk of institutionalisation and a high dependency burden. International experience suggests that specialised home‑based services reduce hospital days and readmissions, but are highly sensitive to organisation, staffing and professional skill mix; without this sub‑specialisation, the potential for efficiency and sustainability of the overall model is weakened, so it must be considered in the immediate future.​This is a scalable solution for other health regions that offers answers to the threefold complexity (clinical, social and system‑level) posed by these patients.

Loneliness is highly prevalent among home care patients and is associated with worse physical and mental health outcomes, increased healthcare utilization and higher mortality risk. In a rural primary care centre in XXX, around 80% of the home care population report unwanted loneliness, adding emotional and social complexity to already fragile clinical situations. There is a need for innovative, low‑cost, relationship‑centred interventions that can be integrated into routine domiciliary care.We structured construction‑block therapy programme for home care patients who explicitly expressed loneliness. Sessions are guided by life‑story headings (identity, childhood and youth, favourite places, memorable anecdotes, future plans), using construction bricks as symbolic and metaphorical tools to build personal narratives. The facilitator poses sequential challenges, individually or in small groups, and patients respond by creating models that serve as anchors for emotional expression, active listening and practical problem‑solving around social support.Construction‑block therapy facilitates emotional disclosure, improves perceived social connection and helps patients reformulate negative internal narratives into more hopeful life stories. Collaborative building fosters a sense of belonging and supports the emergence of informal micro‑networks among patients, relatives and community resources. Professionals report that this enriches clinical understanding and can be combined with other psychosocial and medical interventions without increasing technological demands.Narrative‑based positive psychological interventions are promising for loneliness, but evidence in adults and in rural contexts remains limited and methodologically heterogeneous. This experience suggests that structured, story‑centred brick therapy can operationalise key mechanisms of loneliness interventions within routine primary care home visits.A rural, home‑based construction‑block therapy model appears to be a scalable, context‑adaptable approach to address unwanted loneliness among frail home care patients, enhancing emotional wellbeing, social connection and personal meaning.

Rural primary care faces a growing burden of unwanted loneliness in an ageing population, especially among home‑care patients with multimorbidity and functional dependency. Loneliness is linked to higher mortality, depression, cognitive decline and service use, making it a key target for community‑based, low‑intensity interventions that can complement overstretched health services.In a rural basic health area in XXX, a peer‑to‑peer companionship programme has been implemented within the home‑care service since 2025. Non‑professional peers with similar lived experiences offer emotional support, active listening and practical help to home‑care patients reporting unwanted loneliness, following four phases: structured training, matching of peers and users, regular telephone or digital contacts, and monitoring by the primary care team. The programme is grounded in principles of empowerment, recovery, horizontality and community participation, aligning with European evidence on peer support and group‑based psychosocial interventions for loneliness.Early experience suggests positive impact on both recipients and peers, with perceived improvements in emotional wellbeing, reduced social isolation and the creation of informal support networks. The structured training and careful matching process are critical to sustain motivation, prevent overload of peers and maintain a safe, non‑hierarchical relationship.International evidence indicates that peer‑based and psychosocial group interventions can reduce loneliness and depressive symptoms in older adults, especially when embedded in primary care and community networks. However, these programmes are sensitive to organisational support, supervision and role clarity; without adequate integration into multidisciplinary teams, their potential for improving mental health and system efficiency is diminished.A rural peer‑to‑peer companionship model for unwanted loneliness in home‑care patients appears feasible, acceptable and potentially scalable to other regions and conditions, provided that training, coordination and evaluation are ensured.

Global life expectancy has reached 73.5 years, and the population aged 80 years and over is projected to triple by 2050, reaching 426 million. Population aging is associated with multimorbidity, functional decline, cognitive impairment, frailty, and increased social care needs. Therefore, accessible and continuous healthcare models for older adults are essential. In response, XXX launched the Healthy Aging Centers (XXX) in 2023 as an innovative healthcare service model for individuals aged 80 years and over. This study aims to introduce the XXX outpatient clinic model, and emphasize the role of primary healthcare and family medicine in supporting healthy aging through screening, follow-up, and risk assessment.XXX outpatient clinics operate within Ministry of Health–affiliated facilities and provide comprehensive medical, functional, and psychosocial assessments. Care is delivered by multidisciplinary teams including a geriatrician (if available), a family physician or internist, a nurse, and elderly care staff, with additional professionals involved as needed. Assessments are conducted in outpatient clinics, at home, or via telehealth, addressing frailty, fall risk, nutrition, cognition, depression, medication use, and chronic diseases.XXX clinics have improved quality of life through early diagnosis and continuous follow-up. However, limited staffing and inadequate technological infrastructure currently restrict coverage and telehealth effectiveness. Expanding human resources and strengthening digital health infrastructure may enhance the model’s impact.From a family medicine perspective, early diagnosis of chronic diseases, monitoring of polypharmacy, assessment of frailty and fall risk, and screening for malnutrition, cognitive decline, and depression are essential components of healthy aging. XXX outpatient clinics support early risk detection and strengthen preventive care services.The XXX outpatient clinic model provides an accessible, integrated, primary care–based health service for older individuals in XXX. Aligned with the holistic principles of family medicine, it supports healthy aging and equitable access to healthcare, promotes independence, and improves care coordination within the healthcare system. Keywords: Frail Elderly, Healthy Ageing, Health Equity, Preventive Care, Primary Health Care

Vitamin K antagonists (VKA) have a narrow therapeutic margin and are associated with a high risk of iatrogenic complications. In nursing homes, 13% of patients are treated with VKAs, often with a time in therapeutic range (TTR) below the recommended 65%. International Normalised Ratio (INR) measured by capillary puncture allows more frequent assessment than venous sampling.To compare the difference in TTR and number of venous and haemorrhagic events between INR monitoring by weekly capillary (INRc) testing versus monthly venous (INRv) testing.This prospective, superiority, cluster-randomised study recruited patients living in French nursing homes treated with VKA for > 6 months with a target INR range of 2.5 [2-3] or 3 [2.5-3.5]. Exclusion criteria were life expectancy < 1 month and Karnofky index ≤ 20%. Nursing homes were randomised to control group (monthly INRv) or intervention group (weekly INRc). The primary outcome was TTR, calculated using Rosendaal’s method and compared using mixed linear regression. Patients were recruited from November 2022 to November 2023 and followed for 6 months.Fifteen nursing homes were randomised: nine in the intervention group (26 residents, 429 venous INR measurements) and seven in the control group (19 residents, 226 venous INR measurements). The sample size was not reached due to recruitment difficulties during the Covid-19 pandemic. The TTR increased by 25%, (95% CI :[5.1; 45], p < 0.05), with capillary monitoring. No major bleeding or thrombotic events and no hospitalisations were reported. There is no difference based on age (under or over 90 years). The intracluster correlation coefficient between INRv and INRcap is excellent at 0.89 [0.84; 0.92].Few studies in primary care focus exclusively on frail, dependent older adults, despite their higher risk of iatrogenic harm. Despite not reaching the anticipated sample size, the increase in TTR was statistically significant with INRc. The TTR with the weekly monitoring was 68%, exceeding the level of 65% recommended by NICE Guideline.Weekly INRc monitoring improves anticoagulation control and reduces the risk of VKA-related iatrogenic events in elderly nursing home residents.