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Background and Purpose: Older adults face increased risk of loss of functional capacity both before and during hospitalization, so identifying older adults at risk for loss in functional capacity during hospitalization would help researchers and clinicians make informed decisions. This study aims to evaluate functional changes from preadmission (baseline) until discharge of hospitalized older adults and identify predictors of loss in functional capacity. Methods: This is a prospective cohort study conducted at a tertiary care hospital in Natal, Brazil, and enrolled all consecutive patients aged 60 years and older between January 1, 2014, and April 30, 2015. Independent variables included personal characteristics, instrumental activities of daily living (IADL) (evaluated by the Lawton and Brody scale), cognition (evaluated by the Leganés cognitive test), depression (assessed by the Geriatric Depression Scale—15), and in-hospital mobility (evaluated by the Short Physical Performance Battery). The dependent variable functional capacity was assessed by the Katz scale. These instruments were applied at 2 different times: upon admission (within first 24 hours) and at discharge (12-24 hours before). Functional trajectories were defined as the course of functioning from preadmission until discharge using functional capacity data. A multivariate analysis with generalized estimating equation estimated the longitudinal changes in functional capacity. Results and Discussion: The final sample consisted of 1191 older adults and 53.9% were less than 70 years of age. Regarding changes in functional capacity, 52.5% of the older adults presented worse functional capacity at discharge than at baseline. Being dependent for IADL instrumental daily living activities, the presence of depressive symptoms, low levels of cognition, and in-hospital mobility were risk factors for greater loss in functional capacity during a hospitalization event. Conclusion: Hospitalization events may be catastrophic for functional capacity in older adults in Brazil. Functional, cognitive, and emotional status and in-hospital mobility must be carefully assessed at hospital admission and monitored during hospitalization. Effective strategies for preventing loss in functional capacity in older people must improve in the Brazilian hospital system.

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BACKGROUND Therapeutic education and patient self-management are crucial in diabetes prevention and treatment. Improving diabetes self-management requires a multidisciplinary team intervention, nutrition education that facilitates self-management, informed decision-making, and the organization and delivery of appropriate healthcare services. The emergence of telehealth services has provided the public with various tools for educating themselves, evaluating, monitoring, and improving their health- and nutrition-related behaviours. Combining health technologies with clinical expertise, social support, and health professional involvement could help persons living with diabetes improve their disease self-management skills and prevent its long-term consequences. OBJECTIVE The primary objective of this scoping review was to identify the key digital-tool features of complex telehealth interventions used for type 2 diabetes or prediabetes self-management and monitoring with health professional involvement that help improve health outcomes. A secondary objective was to identify how these key features are developed and combined. METHODS A 5-step scoping review methodology following Arksey and O'Malley's methodology was used to map relevant literature published between January 2010 and March 2022. Electronic searches were performed in Medline, CINAHL, and Embase databases. The searches were limited to scientific publications in English and French that either described the conceptual development of a complex telehealth intervention combining self-management and monitoring with health professional involvement or evaluated its effects on the therapeutic management of patients with type 2 diabetes or prediabetes. Three reviewers independently identified the articles to be reviewed and extracted the data. RESULTS This review synthesizes the results of 42 studies on complex telehealth interventions combining diabetes self-management and monitoring with the involvement of at least one health professional. The health professionals participating in these studies were physicians, dietitians, and nurses. The digital tools involved were smartphone apps or web-based interfaces that could be used with medical devices (for example, a Bluetooth-connected blood glucose meter). We classified the features of these technologies into eight categories, depending on the intervention objective: 1- Glycemic monitoring, 2- Physical activity monitoring, 3- Medication monitoring, 4- Diet monitoring, 5- Therapeutic education, 6- Health professional support, 7- Other health data monitoring, and 8- Healthcare management. The patient-logged data revealed behaviour patterns that should be modified to improve health outcomes. These technologies, used with health professional involvement, patient self-management and therapeutic education, translate into better glycemic control and the adoption of healthier lifestyles. Likewise, they appear to improve monitoring by health professionals and foster multidisciplinary collaboration through data sharing and the development of more concise, automatically generated reports. CONCLUSIONS This scoping review shows that complex telehealth interventions help improve diabetes self-management and monitoring with health professional involvement. It suggests that combining digital tools incorporating diabetes self-management and monitoring features with a health professional’s advice and interaction results in more effective interventions and outcomes.