Patient navigation, a concept that originated in the United States in the 1990s, aims to reduce barriers to care by guiding patients through screening, diagnosis, treatment, rehabilitation, survivorship and end-of-life care. Navigators may be nurses, social workers or trained lay people, and their work spans education, barrier assessment, care coordination, psychosocial support and referrals. Yet while navigation has become a fixture of American cancer care, the European evidence base remains fragmented, inconsistently evaluated and rarely tailored to the ageing patient.

The review, conducted as part of the EU-funded EU-NAVIGATE project (2022–2027), followed PRISMA-ScR guidelines and searched PubMed, CINAHL and Web of Science for studies published between 1993 and 2025, supplemented by grey literature and manual reference screening. Of 4,249 records identified, 215 studies met the inclusion criteria. Only 28 of these reported patient navigation interventions conducted in Europe, spanning 11 countries, with Denmark contributing the most studies (six), followed by France (five) and the United Kingdom (four). The United States accounted for 153 studies, reflecting its far longer tradition of navigation research and implementation.

The numbers for older adults are stark. Across the 28 European studies, only one exclusively targeted adults aged 65 and over, and just one focused on adults aged 75 and over — the latter being the EU-NAVIGATE project itself, which is testing a navigation intervention for older people with cancer and their family caregivers across six European countries. Six further studies targeted pre-elderly populations aged 50 and above, while the remaining 20 involved general adult populations that included older participants. Only eight studies worldwide specifically investigated navigation programs for adults aged 65 and over.

The content of European programs varied with the age group served. Among interventions for adults aged 50 and over, education and barrier assessment dominated, with six of the eight programs operating at the cancer screening stage, one in treatment and one in supportive, palliative and end-of-life care. In contrast, programs for broader adult populations most often operated during treatment and placed greater emphasis on education, emotional support, barrier assessment and care coordination, with additional activities including skills building, symptom management, appointment assistance and referrals.

Navigator profiles differed sharply by age group. In European studies involving adults aged 50 and over, lay navigators (50 percent) and social workers (38 percent) predominated, with nurses accounting for just 13 percent. The pattern reversed in studies of general adult populations, where nurses delivered navigation in 16 of the studies and lay navigators were almost absent. In the United States, lay navigators were also the most frequently reported group among programs for people 50 and over, whereas nurses dominated in studies from other regions. The authors suggest that lay and social-work navigators may be particularly suited to addressing the social, practical and community needs of older patients, while professional navigators contribute clinical expertise and familiarity with treatment pathways.

Training practices revealed both promise and inconsistency. Nearly all European studies targeting adults 50 and over reported navigator training, typically lasting from two hours to one week, and European studies in this age group more frequently documented training in psychosocial skills, medical knowledge and the navigation process than did studies from the United States or elsewhere. Training content ranged from communication skills, motivational interviewing and coaching to healthcare system knowledge, nutrition, exercise and disease-specific topics. By contrast, in studies of broader adult populations, training was reported in only half of cases, and competencies were usually inferred from professional qualifications rather than defined by explicit frameworks.

Perhaps the most troubling finding concerns evaluation. Fewer than half of the European studies — 12 of 28 — described any form of evaluation, and only a handful used structured methodological approaches. Where assessment occurred, it often relied on participants’ subjective satisfaction rather than objective outcomes. Systematic evaluation was reported in 38 percent of European studies involving adults 50 and over, compared with just 2 percent in the United States and none elsewhere. Only two European studies assessed cost-effectiveness, and standardized outcome measures, such as quality-of-life instruments and the Work Ability Score, appeared only rarely.

The authors argue that the scarcity of age-tailored navigation may amount to a form of elder neglect in cancer care research, echoing broader concerns about ageism and the underrepresentation of older adults in clinical studies. Older people account for the majority of cancer diagnoses, yet recent ASCO guidelines recommending routine geriatric assessment for patients aged 65 and over have rarely been reflected in the design of navigation programs. Navigation during palliative and end-of-life care — where coordination needs are most acute — was almost entirely absent from the literature, with only one identified program specifically serving adults aged 70 and over.

The review concludes that patient navigation holds genuine promise across the cancer care continuum but must be adapted to the complex, individual needs of older patients, including frailty, cognitive and functional impairment and caregiver burden. The authors call for age-sensitive navigation models with clearly defined competencies, standardized evaluation using outcomes such as quality of life, functioning and independence, and well-structured training for lay navigators as a promising route to expanding navigation within European cancer care systems. Until such models are built and rigorously tested, they warn, Europe’s fastest-growing group of cancer patients will continue to navigate a fragmented system largely on their own.

Subject of Research: Patient navigation interventions for older adults with cancer in Europe

Article Title: Scoping review on navigation interventions for older adults with cancer in Europe and beyond

Article References: Stodolska, A., Wójcik, G., Reigada, C., Ashford, K., Miranda, R., Van den Block, L., Malmur, E., Drapała, N., & Szczerbińska, K. (2026). Scoping review on navigation interventions for older adults with cancer in Europe and beyond. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01609-5

Image Credits: AI Generated

DOI: 10.1007/s41999-026-01609-5

Keywords: patient navigation, older adults, cancer care, geriatric oncology, care coordination, navigator training, psychosocial support, scoping review, Europe, frailty, Scoping, review

The study arrives at the intersection of two defining challenges of the twenty-first century: climate change and population ageing. Their convergence is particularly acute in China, which faces both a rapidly ageing population and an escalating frequency of devastating floods that cause annual economic losses exceeding ten billion US dollars. For older adults, floods carry risks well beyond immediate physical danger, including heightened rates of injuries, post-traumatic stress disorder, depression, and the exacerbation of diabetes and cardiovascular and respiratory conditions. These outcomes directly undermine healthy ageing, defined by the United Nations Decade of Healthy Ageing as the process of developing and maintaining the functional ability that enables well-being in older age.

To capture how nature-based solutions might counteract these harms, a research team led by Binhua Fu and Joseph Kimuli Balikuddembe of Sichuan University’s Institute for Disaster Management and Reconstruction conducted a scoping review following the Arksey and O’Malley framework and the PRISMA-ScR reporting guidelines. The team searched PubMed, Scopus, and Google Scholar for qualitative studies published between 2000 and early 2025, focusing on research that examined nature-based solutions for flood risk reduction—such as Sponge City infrastructure, green infrastructure, wetland restoration, and ecosystem-based adaptation—in settings across mainland China. Of 622 retrieved records, only 13 studies met the eligibility criteria, a finding that itself underscores how nascent and fragmented this evidence base remains.

The analytical machinery behind the review is worth noting for its technical sophistication. The researchers extracted data into six healthy ageing outcome domains aligned with the World Health Organization’s conceptual framework: physical activity and mobility, mental health, cognitive functioning, well-being and social support, environmental quality, and economic security. They then employed narrative synthesis alongside a Sankey diagram analysis, generated in R using the networkD3 package, to visualize weighted flows connecting geographical context, flood type, intervention type, and health co-benefit. This multi-level edge-list approach, in which each conceptual connection was weighted by its frequency across eligible studies, provided a quantitative representation of the dominant pathways within the qualitative literature.

Geographically, the evidence base spans at least nine provinces and provincial-level municipalities, with case studies concentrated in major urban centers such as Wuhan, Shanghai, and Guangzhou, and in designated pilot Sponge Cities including Guiyang and Ningbo. Temporally, the field is moving fast: ten of the thirteen included studies were published from 2020 onwards, coinciding with the scaling of China’s Sponge City Program amid mounting climate risks. Urban or pluvial flooding dominated the literature, addressed in ten of the thirteen studies, with fluvial, riverine, and general flooding covered by single investigations. Permeable pavements, rain gardens, bioswales, green roofs, and wetland restoration were consistently perceived as effective at reducing surface runoff and easing pressure on drainage networks.

The synthesis’s central revelation is the breadth of co-benefits these interventions deliver. The most prominently documented domain was psychosocial well-being and social support: aesthetically pleasing, accessible green spaces became hubs for conversation, leisure, and recreation, directly strengthening social and peer support networks and mitigating loneliness among older residents. Mental health benefits followed closely, with one study in Guangzhou linking the use of urban green infrastructure to measurable decreases in anxiety, dysphoria, and emotional exhaustion, and other studies reporting stress relief, relaxation, and high perceived aesthetic and health value. Physical activity and mobility improved as Sponge City features provided convenient, walkable spaces after rain, while urban parks encouraged walking and cycling.

Environmental improvements formed a cross-cutting co-benefit with direct implications for independent living. Studies reported enhanced air quality, noise mitigation, and cooling effects that reduce urban heat islands, creating safer and more comfortable outdoor environments for older adults. Cognitive functioning evidence was thinner but tantalizing: a single study associated urban green infrastructure use with memory enhancement, suggesting a possible pathway for NbS to support cognitive health in later life. Economic and community participation benefits emerged from multifunctional designs that integrated productive landscapes, including community engagement in risk-adaptive agriculture within flood detention zones and the use of green infrastructure spaces for vegetable and flower gardens—activities representing livelihood diversification, economic savings, and meaningful occupation for retired residents.

The review’s authors are equally candid about what the evidence lacks. Their analysis identified five principal gaps: an exclusively urban focus that neglects rural elderly populations; a methodological reliance on perceived rather than objectively or clinically measured benefits; a conceptual gap in which older adults appear only as incidental subsets of broader studies rather than central subjects of gerontological research; a thematic gap with cognitive function and nutrition severely underexplored; and an economic gap in the absence of quantified financial impacts on older persons. Sample sizes for older adult subgroups varied enormously, from as few as three retired persons to 95 participants aged 56 and above, and several key studies failed to report age-disaggregated data at all.

The policy implications are nonetheless substantial. The authors argue that the co-benefits provide a tangible pathway to operationalize China’s parallel national commitments to its “ecological civilization” vision and the Healthy China 2030 strategy, framing Sponge City rain gardens and urban wetlands not as drainage projects but as practical manifestations of a dual mandate: managing floodwater while creating the green, accessible environments that promote physical activity, mental restoration, and social connection. The economic case is compelling, the authors contend, because fostering environments that support activity, well-being, and cohesion can function as primary prevention, potentially reducing the incidence and severity of age-related chronic conditions and easing the mounting financial burden on China’s social and healthcare system—a perspective consistent with the One Health paradigm that treats investments in ecosystem health as direct investments in human health.

The rural blind spot carries particular equity weight. Rural communities in China are often on the front lines of riverine and pluvial flooding, yet they remain conspicuously absent from research on nature-based co-benefits, a disparity the authors warn risks exacerbating health inequalities among the elderly. They point to low-cost, replicable approaches such as flood-adaptive farming, grassland management, and riparian ecosystem restoration as candidates for scaling in rural settings, where older residents may be even more dependent on their immediate environment for both income and social connection.

The study’s limitations also shape its recommendations. The review was restricted to English-language publications, potentially excluding relevant Chinese-language studies, and, as is standard for scoping reviews, no formal critical appraisal of individual study quality was conducted. The predominance of qualitative and mixed-methods designs, while essential for understanding lived experiences and contextual factors, means the magnitude of health impacts remains unmeasured. The authors urge researchers to adopt longitudinal and mixed-methods designs employing validated health metrics, and call on policymakers and urban planners to intentionally design and evaluate nature-based solutions with geriatric outcomes as a primary objective, ensuring equitable distribution between urban and rural settings.

For a country that simultaneously confronts an “aging tsunami” and intensifying floods, the message of this review is that flood control and healthy ageing are not separate policy problems but two faces of the same infrastructure investment. If future research can move beyond perceived benefits to establish causal pathways and quantify costs, nature-based flood risk reduction may prove to be one of the most cost-effective preventive health strategies available to ageing societies in China and far beyond its borders.

Subject of Research: Beyond Flood Control: A Scoping Review Deciphering the Co-benefits of Nature-Based Flood Risk Reduction for Healthy Ageing in China

Article Title: Beyond Flood Control: A Scoping Review Deciphering the Co-benefits of Nature-Based Flood Risk Reduction for Healthy Ageing in China

Article References: Fu, B., Balikuddembe, J. K., Lu, Y., Yang, A., Di, B., Tian, B., & Reinhardt, J. D. (2026). Beyond Flood Control: A Scoping Review Deciphering the Co-benefits of Nature-Based Flood Risk Reduction for Healthy Ageing in China. International Journal of Disaster Risk Science. https://doi.org/10.1007/s13753-026-00741-x

Image Credits: AI Generated

DOI: 10.1007/s13753-026-00741-x

Keywords: Beyond, Flood, Control, Scoping, Review, Deciphering, Co-benefits, Nature-Based, Risk, Reduction, Healthy, Ageing