Machine Learning-Assisted Optimization of Drug Combinations in Zeolite-Based Delivery Systems for Melanoma Therapy.

Two independent artificial neural network (ANN) models were used to determine the optimal drug combination of zeolite-based delivery systems (ZDS) for cancer therapy. The systems were based on the NaY zeolite using silver (Ag+) and 5-fluorouracil (5-FU) as antimicrobial and antineoplastic agents. Different ZDS samples were prepared, and their characterization indicates the successful incorporation of both pharmacologically active species without any relevant changes to the zeolite structure. Silver acts as a counterion of the negative framework, and 5-FU retains its molecular integrity. The data from the A375 cell viability assays, involving ZDS samples (solid phase), 5-FU, and Ag+ aqueous solutions (liquid phase), were used to train two independent machine learning (ML) models. Both models exhibited a high level of accuracy in predicting the experimental cell viability results, allowing the development of a novel protocol for virtual cell viability assays. The findings suggest that the incorporation of both Ag and 5-FU into the zeolite structure significantly potentiates their anticancer activity when compared to that of the liquid phase. Additionally, two optimal AgY/5-FU@Y ratios were proposed to achieve the best cell viability outcomes. The ZDS also exhibited significant efficacy against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus); the predicted combination ratio is also effective against S. aureus, underscoring the potential of this approach as a therapeutic option for cancer-associated bacterial infections.

Optimization of iron-ZIF-8 catalysts for degradation of tartrazine in water by Fenton-like reaction.

Optimization of iron zeolitic imidazole framework-8 (FeZIF-8) nanoparticles, as heterogeneous catalysts, were synthesized and evaluated by the Fenton-like reaction for to degrade tartrazine (Tar) in aqueous environment. To achieve this, ZIF-8 nanoparticles were modified with different iron species (Fe2+ or Fe3O4), and subsequently assessed through the Fenton-like oxidation. The effect of different parameters such as the concentration of hydrogen peroxide, the mass of catalyst and the contact time of reaction on the degradation of Tar by Fenton-like oxidation was studied by using the Box-Behnken design (BBD). The BBD model indicated that the optimum catalytic conditions for Fenton-like reaction with an initial pollutant concentration of 30 ppm at pH 3.0 were T = 40 °C and 12 mM of H2O2, 2 g/L of catalyst and 4 h of reaction. The maximum Tar conversion value achieved with the best catalyst, Fe1ZIF-8, was 66.5% with high mineralization (in terms of decrease of total organic carbon - TOC), 44.2%. To assess phytotoxicity, the germination success of corn kernels was used as an indicator in the laboratory. The results show that the catalytic oxidation by Fenton-like reaction using heterogeneous iron ZIF-8 catalysts is a viable alternative for treating contaminated effluents with organic pollutants and highlighted the importance of the validation of the optimized experimental conditions by mathematical models.

To Sample or to Specialise? Sport Participation Patterns of Youth Team Sport Male Players.

This study characterised the sport participation patterns of 546 male youth team sport players. A retrospective questionnaire was used to identify the sport starting age (general sports and main sport) and the quantity and type of sports undertaken during the early years of development. A mixed-ANOVA and Chi-square tests were implemented. All participants started involvement in sports at the same age (~5 years) and participated in the same number of sports during their early years (1 to 2 sports). However, football players started participating mainly in team games (football, futsal) and water polo players in CGS sports (swimming). Participants reported different ages for initial participation in: (i) main sport (football players started participating earlier, around 5-6 years), (ii) onset of specialisation (football players specialised earlier, around 7 or 8 years), (iii) types of sports engaged in (football players were involved in more team games and water polo in more CGS sports), and (iv) variations in weekly training hours (water polo reported more hours of training). This study provided empirical evidence for understanding the effects of different sporting pathways on long-term athlete development. Some key incongruities between contemporary knowledge and practice are acknowledged. Further investigations should be developed by examining the trajectories in different sports, countries, genders, and cultural contexts.

The Influence of Parents, Coaches, and Peers in the Long-Term Development of Highly Skilled and Less Skilled Volleyball Players.

The purpose of this study was to understand the perceptions of highly skilled and less skilled volleyball players about the influences that parents, coaches, and peers had on their sport development and performance achievement. Highly skilled (n = 30) and less skilled (n = 30) volleyball players participated in semi-structured retrospective interviews to explain how parents, coaches and peers may have influenced their sport participation. Data was analyzed through a process of content analysis. Results indicated that parents, coaches, and peers had an important influence in player's sport development but differing according to players' expertise level. Concerning to parental influences, tangible support during the early years of development was mentioned by all players. However, parents' level of involvement and parenting styles revealed interesting differences between highly skilled and less skilled players. Highly skilled players perceived a moderate parental involvement and an autonomy-supportive parenting style, while less skilled players referred a excessive parental involvement in players' sport participation. Coaches influences showed to have some similarities in the early years with all players mentioning coaches as caring and recognizing their value as an athlete. However, highly skilled players described a different training environment characterized by a demanding coach, individualized instruction, and specific goal setting. Regarding peers' influence, all players recognized that friends were not only one of the main reasons to start playing volleyball, but also an important source of support to remain engaged and staying motivated to do sport. Highly skilled players, however, mentioned the importance of teammates' positive push and critiques during practice for enhancing their motivation, team cohesion and friendship. They also highlighted the importance of friends outside of sport in the later years of their career by acting as an escape from all the pressure that emerged from volleyball training and competition demands. Overall, these findings highlight different social influences according to the players' expertise level suggesting the need to examine more extensively the nature of significant others' support on athlete and talent development.

Surface functionalization of zeolite-based drug delivery systems enhances their antitumoral activity in vivo.

Zeolites have attractive features making them suitable carriers for drug delivery systems (DDS). As such, we loaded the anticancer drug 5-fluorouracil (5-FU), into two different zeolite structures, faujasite (NaY) and Linde Type L (LTL), to obtain different DDS. The prepared DDS were tested in vitro using breast cancer, colorectal carcinoma, and melanoma cell lines and in vivo using the chick embryo chorioallantoic membrane model (CAM). Both assays showed the best results for the Hs578T breast cancer cells, with a higher potentiation for 5-FU encapsulated in the zeolite LTL. To unveil the endocytic mechanisms involved in the internalization of the zeolite nanoparticles, endocytosis was inhibited pharmacologically in breast cancer and epithelial mammary human cells. The results suggest that a caveolin-mediated process was responsible for the internalized zeolite nanoparticles. Aiming to boost the DDS efficacy, the disc-shaped zeolite LTL outer surface was functionalized using amino (NH2) or carboxylic acid (COOH) groups and coated with poly-l-lysine (PLL). Positively functionalized surface LTL nanoparticles revealed to be non-toxic to human cells and, importantly, their internalization was faster and led to a higher tumor reduction in vivo. Overall, our results provide further insights into the mechanisms of interaction between zeolite-based DDS and cancer cells, and pave the way for future studies aiming to improve DDS anticancer activity.

Internalization studies on zeolite nanoparticles using human cells.

Zeolites are crystalline porous materials with a regular framework which have non-toxic effects on a variety of human cell lines and have been explored for cell imaging and drug delivery. Understanding the interaction between zeolite nanoparticles and cells is imperative for improving their potentialities, since the process of internalization of these particles is still poorly understood. In this study, the intracellular trafficking and internalization kinetics of zeolite L into breast cancer cells and normal epithelial mammary cells were analysed using scanning electron microscopy (SEM), confocal microscopy and transmission electron microscopy (TEM). We also studied the involvement of endocytic pathways using two pharmacological inhibitors, chlorpromazine and dynasore. Zeolite nanoparticles were taken up by both cell types and the cellular uptake was fast, and started immediately after 5 min of incubation. Interestingly, the uptake was dependent on the cell type since in breast cancer cells it was faster and more efficient, with a higher number of nanoparticles being internalized by cancer cells over time, compared to that in the epithelial mammary cells. TEM results showed that the internalized nanoparticles were mainly localized in the cell vacuoles. The data obtained upon using endocytic pharmacological inhibitors suggest that the zeolite L uptake is mediated by caveolin.

Factorial invariance of the satisfaction with life scale in adolescent from Spain and Portugal / Invarianza factorial de la Escala de Satisfacción con la Vida en adolescentes de España y Portugal

BACKGROUND: The Satisfaction with Life Scale is one of the most widely used scales to measure the global cognitive judgment of satisfaction with one's life. METHOD: This study assesses the equivalence of the SWLS across Spanish and Portuguese adolescents, using multi-sample Confirmatory Factor Analysis. Participants were Spanish (N = 2183) and Portuguese (N = 4082) junior high school. RESULTS: The results provide high support for the internal consistency of both the Spanish and Portuguese versions of this scale. The results also showed that factor structure, factor loadings, could be considered invariant across groups. However, the full scalar invariance between Spanish and Portuguese samples was not found, with the intercept for SWLS item 5 varying across countries. CONCLUSIONS: Similar findings have also been found in other cross-national studies with this scale. Implications of the findings are discussed and we conclude that the Spanish and Portuguese versions of the SWLS can be used for cross-national comparisons with Spanish and Portuguese adolescents

ANTECEDENTES: la Escala de Satisfacción con la Vida es una de las escalas más utilizadas para medir el juicio cognitivo global sobre la propia satisfacción con la vida. MÉTODO: este estudio evalúa la equivalencia de la SWLS en adolescentes españoles y portugueses con Análisis Factorial Confirmatorio multi-muestra. Los participantes fueron alumnado español (N = 2.183) y portugués (N = 4.082) de Educación Secundaria. RESULTADOS: los resultados proporcionan un elevado apoyo a la consistencia interna de las versiones en español y portugués de esta escala. Los resultados también mostraron que la estructura factorial y pesos factoriales podría considerarse invariable entre los grupos. Sin embargo, no se obtuvo la invariancia escalar completa entre las muestras de España y Portugal, con el intercepto para el ítem 5 variando entre los países. CONCLUSIONES: otros estudios internacionales con esta escala han encontrado resultados similares. Se discuten las repercusiones de las conclusiones y se establece que las versiones en español y portugués de la SWLS pueden ser utilizadas para las comparaciones entre países con adolescentes españoles y portugueses

Factorial invariance of the Satisfaction with Life Scale in adolescents from Spain and Portugal.

BACKGROUND: The Satisfaction with Life Scale is one of the most widely used scales to measure the global cognitive judgment of satisfaction with one’s life. METHOD: This study assesses the equivalence of the SWLS across Spanish and Portuguese adolescents, using multi-sample Confirmatory Factor Analysis. Participants were Spanish (N = 2183) and Portuguese (N = 4082) junior high school. RESULTS: The results provide high support for the internal consistency of both the Spanish and Portuguese versions of this scale. The results also showed that factor structure, factor loadings, could be considered invariant across groups. However, the full scalar invariance between Spanish and Portuguese samples was not found, with the intercept for SWLS item 5 varying across countries. CONCLUSIONS: Similar findings have also been found in other cross-national studies with this scale. Implications of the findings are discussed and we conclude that the Spanish and Portuguese versions of the SWLS can be used for cross-national comparisons with Spanish and Portuguese adolescents.

Microbial growth inhibition caused by Zn/Ag-Y zeolite materials with different amounts of silver.

Different loadings of silver exchanged on bimetallic Zn/Ag-NaY zeolite materials were studied for antimicrobial properties against four reference microorganisms. The sensitive indicator strains used were two bacteria (Escherichia coli and Bacillus subtilis) and two yeast species (Saccharomyces cerevisiae and Candida albicans). The bimetallic materials were compared with the monometallic materials prepared with the same concentrations of silver. A synergistic effect between the two metals, zinc and silver, was evidenced on the antimicrobial activity of the materials. All mono and bimetallic materials showed strong efficacy against bacteria and yeasts, although the later overall displayed lower MIC values. The results of X-ray photoelectron spectroscopy (XPS) confirm the presence of silver and zinc as ions, not homogeneously distributed throughout the zeolite framework, which implies that the metal ions are located in different sites of the faujasite structure.

Ethical decision making in intensive care units: a burnout risk factor? Results from a multicentre study conducted with physicians and nurses.

BACKGROUND: Ethical decision making in intensive care is a demanding task. The need to proceed to ethical decision is considered to be a stress factor that may lead to burnout. The aim of this study is to explore the ethical problems that may increase burnout levels among physicians and nurses working in Portuguese intensive care units (ICUs). A quantitative, multicentre, correlational study was conducted among 300 professionals. RESULTS: The most crucial ethical decisions made by professionals working in ICU were related to communication, withholding or withdrawing treatments and terminal sedation. A positive relation was found between ethical decision making and burnout in nurses, namely, between burnout and the need to withdraw treatments (p=0.032), to withhold treatments (p=0.002) and to proceed to terminal sedation (p=0.005). This did not apply to physicians. Emotional exhaustion was the burnout subdimension most affected by the ethical decision. The nurses' lack of involvement in ethical decision making was identified as a risk factor. Nevertheless, in comparison with nurses (6%), it was the physicians (34%) who more keenly felt the need to proceed to ethical decisions in ICU. CONCLUSIONS: Ethical problems were reported at different levels by physicians and nurses. The type of ethical decisions made by nurses working in Portuguese ICUs had an impact on burnout levels. This did not apply to physicians. This study highlights the need for education in the field of ethics in ICUs and the need to foster inter-disciplinary discussion so as to encourage ethical team deliberation in order to prevent burnout.

Validation and factorial invariance of children's attraction to physical activity (CAPA) scale in Portugal.

The Children's Attraction to Physical Activity (CAPA) scale assesses interest in and attraction to the physical activity (PA) of children of elementary school age. The original (25 items) and shorter versions (15 items) of the scale were developed and validated with American children. The purpose of this study was to cross-validate the shorter version of the CAPA scale for use with Portuguese schoolchildren and to examine the invariance of the multidimensional factor structure of the scale in two samples. The sample comprised 683 children (7-10 years) from public primary schools. The sample was divided into calibration and cross-validation samples. The scale was translated into Portuguese and underwent forward translation, synthesis of the translation and backward translation and was then subjected to expert committee review, pretest and reliability assessment. Internal consistency for each of the five subscales within the a priori 5-factor structure of the CAPA scale was evaluated through Cronbach's alpha, followed by a series of confirmatory factor analyses (CFAs) for both the calibration and cross-validation samples. The maximum likelihood robust estimation method was used. The CFA demonstrated that a 5-factor structural model of the Portuguese translation of the CAPA scale was invariant. The construct analysed had the same basic meaning and structural and item differences within the two samples. The results indicated that the CAPA scale is appropriate for use with Portuguese schoolchildren. The availability of a valid and reliable scale should enhance opportunities for further understanding of children's involvement in PA.

Potentiation of 5-fluorouracil encapsulated in zeolites as drug delivery systems for in vitro models of colorectal carcinoma.

The studies of potentiation of 5-fluorouracil (5-FU), a traditional drug used in the treatment of several cancers, including colorectal (CRC), were carried out with zeolites Faujasite in the sodium form, with different particle sizes (NaY, 700nm and nanoNaY, 150nm) and Linde type L in the potassium form (LTL) with a particle size of 80nm. 5-FU was loaded into zeolites by liquid-phase adsorption. Characterization by spectroscopic techniques (FTIR, (1)H NMR and (13)C and (27)Al solid-state MAS NMR), chemical analysis, thermal analysis (TGA), nitrogen adsorption isotherms and scanning electron microscopy (SEM), demonstrated the successful loading of 5-FU into the zeolite hosts. In vitro drug release studies (PBS buffer pH 7.4, 37°C) revealed the release of 80-90% of 5-FU in the first 10min. To ascertain the drug release kinetics, the release profiles were fitted to zero-order, first-order, Higuchi, Hixson-Crowell, Korsmeyer-Peppas and Weibull kinetic models. The in vitro dissolution from the drug delivery systems (DDS) was explained by the Weibull model. The DDS efficacy was evaluated using two human colorectal carcinoma cell lines, HCT-15 and RKO. Unloaded zeolites presented no toxicity to both cancer cells, while all DDS allowed an important potentiation of the 5-FU effect on the cell viability. Immunofluorescence studies provided evidence for zeolite-cell internalization.

Psychosocial correlates of physical activity in school children aged 8-10 years.

BACKGROUND: Understanding correlates of physical activity (PA) among children in different populations may contribute to fostering active lifestyles. This study considered gender differences in relationships between biologic (body mass index, BMI), demographic (socioeconomic sport status, SES) and psychosocial correlates of PA and level of PA in Portuguese primary school children. METHODS: 683 children, aged 8-10 years, from 20 different elementary schools in northern Portugal were surveyed. Weight status was classified using International Obesity Task Force (IOTF) criteria for the BMI. Family SES was estimated from school records. PA level and psychosocial correlates (attraction to PA, perceived physical competence and parental socialization) were obtained with interview and standardized questionnaires, respectively. Sex-specific hierarchical multiple regression analyses (SPSS 18.0) were conducted and included two blocks of predictor variables (biologic and demographic, and psychosocial). RESULTS: Level of PA was significantly higher in boys than girls. Enjoyment of participation in vigorous PA was positively associated with level of PA. Perceived acceptance by peers in games and sports and parental encouragement were positively and significantly related to PA in girls. Perceived physical competence was positively and significantly related to PA in boys. Weight status and SES were not associated with PA. CONCLUSIONS: Boys and girls differed in perceived attractiveness of PA and perceived physical competence, both of which influenced level of PA. Differences in perceptions may be important aspects of motivation for PA in school children.

Gender, weight status and socioeconomic differences in psychosocial correlates of physical activity in schoolchildren.

OBJECTIVES: This study sought to assess differences in attraction to physical activity, perceived physical competence and parental socialization influences across gender, body mass index and socioeconomic status in Portuguese children. DESIGN: Cross-sectional study. METHODS: 683 children, aged 8-10 years, from elementary schools were participants. Attraction to physical activity, perceived physical competence, parental socialization influences and socioeconomic status were assessed via standardized questionnaires. The prevalence of overweight and obesity was calculated using body mass index, based on the international cut-off points. MANOVA and ANOVA models were conducted. RESULTS: Boys reported greater enjoyment of games and sports participation than did girls. Boys and normal-weight children perceived themselves as being more successful and physically competent than did girls and obese children. Normal-weight girls enjoyed participation in vigorous physical activity more than did overweight and obese girls. Obese children felt less accepted by their peers in games and sports than did normal-weight and overweight children. High and medium socioeconomic status children perceived physical activity participation as of greater importance than did low-socioeconomic status children. High-socioeconomic status girls reported greater liking of the exertional aspects of physical activity compared to low socioeconomic status girls. High socioeconomic status children were more likely to perceive their parents as positive role models and perceived that they had greater enjoyment of physical activity than did lower socioeconomic status children. CONCLUSIONS: These results suggest that physical activity promotion interventions should focus on girls, obese children and lower socioeconomic status children as these individuals tend to have lower levels of attraction to physical activity, lower perceived physical competence and less parent physical activity support, which puts them at greater risk of being physically inactive.

Evaluating the youth physical activity promotion model among Portuguese elementary schoolchildren.

BACKGROUND: The Youth Physical Activity Promotion (YPAP) model provides an integrated approach to understanding the predisposing, enabling, and reinforcing factors influencing physical activity (PA) behavior. The purpose of this study was to evaluate an adapted version of the YPAP model for explaining PA among Portuguese schoolchildren. METHODS: A random cross-sectional sample of 683 children (8-10 years of age) attending elementary public schools in the north of Portugal completed a detailed survey assessing attraction to PA, perceived physical competence, parental influences and leisure time PA. Structural equation modeling techniques were conducted (EQS6.1). RESULTS: Attraction to PA was directly associated with children's PA participation (ß = 0.271, P < .05). Perceived physical competence imposed an indirect effect on children's PA through children's attraction to PA (ß = 0.253, P < .05). Parental influence had an indirect effect on children's PA through perceived physical competence and attraction to PA (ß = 0.318 and 0.662, respectively, P < .05). Perceived physical competence and parental influence were not directly associated with children's PA (ß = 0.069 and 0.180, respectively, P > .05). CONCLUSIONS: The adapted version of YPAP model was useful in explaining PA participation in elementary Portuguese schoolchildren. Intervention programs intended to enhance attraction to PA, perceived physical competence and favorable parental influence should be developed to promote children's PA participation.

Burnout in palliative care: a systematic review.

Burnout is a phenomenon characterized by fatigue and frustration, usually related to work stress and dedication to a cause, a way of life that does not match the person's expectations. Although it seems to be associated with risk factors stemming from a professional environment, this problem may affect any person. Palliative care is provided in a challenging environment, where professionals often have to make demanding ethical decisions and deal with death and dying. This article reports on the findings of a systematic review aimed at identifying described burnout levels in palliative care nurses and physicians, and the related risks and protective factors. The main findings indicate that burnout levels in palliative care, or in health care settings related to this field, do not seem to be higher than in other contexts.

Attitudes, knowledge, and interest: preparing university students to work in an aging world.

BACKGROUND: The underlying goals of the present study were (i) to assess knowledge of and attitudes towards aging in a sample of Portuguese undergraduate students undertaking various degrees in health and welfare subjects, and (ii) to analyze the extent to which knowledge, attitudes and other factors were associated with interest in working with older adults. METHODS: The study was cross-sectional in design. The sample comprised 460 Portuguese undergraduate students enrolled in degrees in nursing, social work, and psychology. They were asked to complete questionnaires and quizzes, which were analyzed using contingency tables and one way analysis of variance for inter-group comparison, and then subjected to multivariate logistic regression analysis. RESULTS: Significant differences emerged between groups on knowledge, attitudes towards aging and interest in working with older adults, with both nursing and social work students displaying more positive attitudes, knowledge, and interest in working with older adults, when compared with psychology students. A regression analysis indicated that attitudes, knowledge, and previous formal contact were significant predictors of interest. CONCLUSION: Interest in working with older adults was significantly related to positive attitudes, more knowledge and formal previous contact. Positive attitudes towards older adults can be promoted through interaction with faculty members and experts, knowledge acquisition about normative changes with age, and contact with healthy and impaired older adults.

Promoção do desenvolvimento psicológico no envelhecimento / The promotion of psychological development in the aging proce

O objetivo deste texto é apresentar as principais bases teóricas e empíricas no âmbito da promoção do desenvolvimento psicológico empessoas idosas. A orientação da psicologia do desenvolvimento para a população idosa deve-se ao interesse partilhado por um número crescentede psicólogos no uso de abordagens desenvolvimentais do comportamentohumano. Através delas tem sido possível entender melhor a plasticidade do processo de envelhecimento e a importância das relações entre os indivíduos e os seus contextos de referência para a compreensão dadiversidade no decurso do desenvolvimento humano, na segunda metade da vida. A emergência de uma perspectiva desenvolvimental aplicadaao indivíduo idoso fez-se acompanhar do aparecimento de intervençõessimultaneamente dirigidas ao próprio indivíduo e aos contextos comunitáriosa que ele pertence, tendo como elemento comum a preocupaçãocom o respectivo desenvolvimento. As bases conceituais e empíricas maisimportantes subjacentes à promoção do desenvolvimento psicológico no envelhecimento são apresentadas neste artigo, discutindo-se igualmente as implicações desta perspectiva para o desenho de programas de intervençãoe para a ciência desenvolvimental, realçando a sua pertinência para a compreensão e promoção da vida das pessoas idosas. (AU)

The purpose of this paper is to present the main theoretical and empirical foundations for the promotion of psychological development with older people. The orientation of evelopmental psychology to older people has arisen because of interest among psychologists in using developmental approaches of human behavior and developmentfor understanding the plasticity of the aging mind and development, and the importance of relations between individuals and ecological settings as a framework to understand diversity in the course of human development in the second half of life. A developmental psychology perspective applied to older people development has arisen as wellthrough the implementation of interventions designed and deliveredboth in individualized and community-based ways. The most importantconceptual foundations and empirical work being done to defi ne basesand features of developmental psychology applied to older peoplewill be discussed as well as the implications of it for applications ofdevelopmental science aimed at improving human development of older people through the provision of programs and policies predicated on theuse of a developmental psychology perspective for understanding andenhancing the lives of older people. (AU)

Working family carers in Portugal: between the duty and the burden of caring for old vulnerable people.

This paper intends to reflect on some of the predominant traits of caring for older vulnerable people in Portugal, where the most common care model is a mix of informal home-based provision and support from the public and private sectors. We shall address some issues concerning the risks and limits of informal caretaking of older dependent people based on a case study of a woman who has to fulfil multiple roles, pushing her to the limit of her ability to cope. Evidence indicates that solutions to the challenges of caring for an ageing population, especially those in a vulnerable condition, require a consideration of material, social, cultural, and psychological measures. On the basis of the nature of the links between these areas, the quality of the care provided and the consequences for the working family carers, we can define standards of caring solutions for older people and hence derive policies for preventive and optimized interventions. Our final aim is to emphasize the importance of palliative care settings to improve the quality of life and minimize the suffering of both older people and their carers.