Physical and social changes that occur through aging affect the quality of life of elderly individuals and lead to limitations in their daily activities. With the growing elderly population, it is essential to diversify and enhance the healthcare services offered to this group. Home visits are an important practice to meet the health needs of older people, improve health and reduce demand on the health system.To assess the needs of individuals aged 80 years and over for home visits, the rates of utilization of these services and the implementation status of the services.The study was conducted with a cross-sectional design on a sample of individuals aged 80 and over residing in a district of  Istanbul. Demographic information, health status, home visit experiences, and dependency levels of the participants were collected by survey method. Katz Activities of Daily Living (ADL) Scale and Loneliness Scale for the Elderly (LSE) were used for data collection.Of the participants 40.3%  requested home visits and 83.3% of these requests were fulfilled. Of the fulfilled requests, 82.9% were provided by home healthcare services, 13% by family physicians, and 3.3% by municipal services. It was observed that individuals who needed home visits were mostly women, widowed, living with a family caregiver, and with low income levels. Individuals with lower ADL scores had a higher need for home visits.When the loneliness levels were analyzed, 43.5% of the participants stated that they did not feel lonely, while 24.5% stated that they felt intense or very intense loneliness.It was observed that the rate of dependent individuals requesting home visits and utilizing from this service was higher than other groups. So we easliy can tell that the need for home visits among individuals aged 80 and above is directly associated with dependency levels.The need for home visits among individuals aged 80 and above is directly associated with dependency levels and sociodemographic factors. Primary care physicians can dentify and prioritize the groups with the greatest needs and to increase the public awareness and knowledge about home visit services.  Key words:aging, daily living activities, loneliness, home care

Home care delivered by primary care teams plays a key role in the follow-up of frail and complex patients. The systematic assessment of patient and caregiver experience remains limited in routine practice, even though such information is essential for quality improvement of person-centred care models. Validated Patient-Reported Experience Measures offer an opportunity to integrate experiential data into everyday clinical practice.To assess caregiver experience in a primary care home care programme using the PPE-15 PREM questionnaire and to explore the feasibility and added value of routine experience measurement in family medicine.A cross-sectional observational study was conducted within a primary care-led home care programme. All caregivers (n = 79) were invited to complete an anonymous survey. The questionnaire assessed accessibility, communication, continuity of care, professional competence, emotional support and overall satisfaction. Data were collected using Google Forms. Items were rated on 5-point Likert scales. Descriptive analyses were performed overall.A total of 38 surveys were analysed, yielding a response rate of 48.1%. Most responses were provided by informal caregivers. Experience ratings were consistently high across all dimensions, with mean scores up to 4.76 (SD 0.48). Professional competence (9.6 ± 1.035), respectful treatment (9.93 ± 0.4), and clarity of communication (9,87+/-0.7) received the highest ratings. Accessibility and understanding of care pathways were also rated very positively. Overall satisfaction and willingness to recommend the programme were high (mean recommendation score: 4.76/5). Qualitative comments highlighted feelings of safety, trust, and continuity of care.These findings suggest that measurement of caregiver experience is feasible in a primary care home care setting and yields meaningful, practice-relevant information. High ratings across domains reflect the importance of relational continuity, communication and professional competence in home-based care for complex patients. The qualitative feedback provides complementary insights that may help teams identify specific areas for improvement. Incorporating experiential data into routine evaluation may strengthen person-centred care.The integration of validated PREMs into a primary care home care programme provides valuable insights into caregiver experience and supports continuous quality improvement. This approach may inform the design and scalability of similar home care models across primary care settings.

An aging society faces rapid population growth of elderly with 12.2% experiencing activity limitations. Despite 16,092 long-term care beneficiaries in the study city, only 5 home visits were recorded in 2020. Existing community-based integrated care initiatives showed fragmented service delivery with only 0.4% physician participation, highlighting critical gaps in home healthcare coordination.To develop and evaluate a patient-centered integrated home healthcare model linking regional hub hospitals with primary care physicians through multidisciplinary team-based care coordination for homebound patients.This three-year pilot study (August 2021-December 2023) established a Home Healthcare Support Center at a regional hub hospital. The model featured six core components: multilevel integration of hub hospital-primary care-nursing-welfare services; care coordination hub with multidisciplinary team; enhanced accessibility through digital platforms; daily interdisciplinary team meetings with individualized care plans; patient-tailored service delivery using standardized assessment tools; and home healthcare education programs. Primary care physicians provided home visits while the hub hospital offered multidisciplinary backup including emergency visits and specialist consultations. Outcomes included service linkage rates, satisfaction surveys, and healthcare utilization. Interrupted time series analysis assessed intervention impact on expenditure trends.One hundred ninety-five homebound patients were enrolled (mean age 80.4 years, 65.6% female). Service linkage rates were high: visiting nurse services 96%, long-term care services 86%, and welfare services 71%. Patient/caregiver satisfaction reached 96%; physician satisfaction 93%. Interrupted time series analysis demonstrated statistically significant trend changes: overall healthcare costs shifted from increasing to decreasing (p<0.001). Hospitalization costs showed pronounced effects with the same pattern (p<0.001), indicating prevention of unnecessary hospitalizations through appropriate home management.The model demonstrated that hub hospital-based coordination can effectively support community primary care through multidisciplinary integration. The care coordinator role emerged as essential for managing patient assessment, service linkage, and crisis intervention. The model influenced national policy development, informing primary care development initiatives and contributing to national primary care innovation pilot programs.This patient-centered integrated model represents a viable approach for community-based integrated care in aging societies, demonstrating both high satisfaction and cost-effectiveness through prevention of avoidable hospitalizations. Successful implementation requires payment model innovation, home patient management fees, and information-sharing platforms.

Spindle cell sarcoma is a rare malignant tumor of mesenchymal origin, comprising 1% of adult cancers and 2–5% of bone malignancies. More common in men, with median diagnosis at 62 years, it carries poor prognosis due to aggressive behavior. The pleomorphic undifferentiated subtype is most frequent, often affecting arm, leg, or pelvic bones. Occupational exposures, such as military service, may contribute to its development. This case highlights the need for integrated biomedical care, nutritional support, and occupational health in managing rare sarcoma presentation.Report a 77‑year‑old retired military officer with probable occupation‑related spindle cell myelopleiomorphic sarcoma of the right forearm. Laboratory and imaging studies guided surgical intervention, complemented by nutritional screening to address undernutrition and restore ideal body weight. A tailored plan included oral supplements, dietary adjustments, multivitamins, and trace elements. Occupational history was considered to account for long‑term exposures influencing disease progression and nutritional risk.The case underscores nutrition as a cornerstone of readiness in complex malignancies and highlights occupational context in patient care. Future implications include standardized nutrition protocols in sarcoma pathways, strengthening occupational health assessments, and embedding psychosocial support into perioperative and palliative care.The outcome illustrates that liberty in health is achieved when patients are empowered through adequate nutrition, equity is advanced when vulnerabilities are addressed through multidisciplinary care, and fraternity is embodied when families, occupational context, and healthcare providers collaborate. Success in sarcoma management is not solely technical but deeply dependent on holistic preparation.This case exemplifies how biomedical, nutritional, psychosocial, and occupational integration can transform outcomes in rare spindle cell sarcoma. It advocates liberty through patient empowerment, equity through comprehensive care, and fraternity through solidarity among families, communities, and healthcare teams principles resonant with 30th WONCA Europe Conference theme and global primary care values.

As Taiwan enters a super-aged society, demand for transitional and long-term rehabilitation is increasing. The National Health Insurance Post-Acute Care (PAC) program provides coordinated inpatient, day-care, and home-based rehabilitation for older adults after stroke, fractures, or functional decline. Unlike fragmented systems in many Western countries, Taiwan’s PAC model links hospitals, rehabilitation teams, and community services. This reflection is based on practice in a tertiary rehabilitation ward and outpatient PAC follow-up.Older adults received individualized assessments and goal setting through a multidisciplinary team. Family meetings clarified expectations, evaluated home readiness, and identified caregiving challenges. Many initially viewed rehabilitation as purely physical recovery. Through communication and shared decision-making, goals were reframed to emphasize autonomy, dignity, caregiver capacity, and quality of life. This reflection synthesizes observations across inpatient and community PAC encounters.Functional gains alone do not guarantee a successful return home. Rehabilitation outcomes depend on caregiver readiness, realistic expectations, social support, and culturally informed communication. The PAC environment promoted interprofessional learning and highlighted the need to balance medical goals with cultural values surrounding aging and family responsibility. These insights underscore the importance of integrating functional, psychosocial, and environmental factors into post-acute planning.Experiences in PAC showed that rehabilitation is both a clinical and relational process shaped by patient needs, family capacity, and community resources. The program fostered ethical reflection and collaborative problem-solving.Taiwan’s PAC system demonstrates how person-centered continuity can be implemented in an aging society. By bridging hospitals, families, and communities, rehabilitation supports not only functional recovery but also dignity, purpose, and human connection—lessons relevant to primary care worldwide.

Acute Hospital-at-Home (HaH) programs depend on family caregivers to support patients during acute illness. Despite their central role, caregiver burden at the start of HaH remains insufficiently characterized in real-world settings.To assess the prevalence of caregiver burden at HaH admission and to identify caregiver- and patient-related characteristics associated with high burdenCaregiver burden was assessed within 48 hours of admission using the Caregiver Strain Index (CSI). Caregiver sociodemographic characteristics, caregiving context, health-related quality of life (EQ-5D-5L and EQ-VAS), resilience (CD-RISC-2), and perceived social support (single adapted Social Support Questionnaire item) were collected by structured telephone interview. Multivariable logistic regression was used to identify factors independently associated with high caregiver burden (CSI ≥7).High caregiver burden at admission was common (77/125; 61.6%). Compared with caregivers with low burden, those with high burden more frequently reported problems in anxiety/depression (63.6% vs 29.2%; p<0.001), pain/discomfort (54.6% vs 27.1%; p=0.003), and usual activities (41.6% vs 16.7%; p=0.004), and had lower EQ-5D index scores (0.78 vs 0.86; p=0.003). High-burden caregivers were less likely to report perceived social support (59.7% vs 83.3%; p=0.006) and high resilience (52.0% vs 79.2%; p=0.002). Nearly all caregivers with high burden had been providing care for the same patient prior to HaH admission (97.4% vs 50.0%; p<0.001). In multivariable analysis, having a paid caregiver assisting at home was independently associated with higher odds of high caregiver burden (adjusted OR 5.23; 95% CI 1.17–23.37), whereas perceived social support (aOR 0.22; 95% CI 0.06–0.74) and high resilience (aOR 0.33; 95% CI 0.11–0.95) were independently associated with lower odds of high burden.Most caregivers enter HaH with substantial burden. Emotional distress, physical symptoms, limited perceived support, low resilience, and pre-existing caregiving responsibilities are key determinants. Early caregiver assessment at HaH admission may help identify vulnerable caregivers and guide targeted support to improve caregiver well-being and sustain safe home-based acute care.