Association between the dietary obesity-prevention score and risk of gestational diabetes mellitus: an exploratory subgroup analysis.

The global aging population is rising rapidly, with one in six people expected to be aged 60 years or older by 2030 (). In Hong Kong, this situation is one of the most advanced in the world, with the proportion of older adults projected to reach 36.0% by 2046 (). Over 70% of this large demographic are affected by chronic diseases, and among the most common are hypertension (57.4%) and diabetes mellitus (19.0%) (). These challenges bring increased health service demand, rising medical costs, manpower shortages, and strain on the healthcare system (). The total health expenditure has grown to 10.0% of GDP in 2022/2023 and is continuing to grow at an annual rate of 5.6% (, ). To address these pressing aging challenges and ensure a sustainable healthcare system, a primary healthcare focused approach should be used. The Hong Kong population has a health-seeking culture that emphasize heavily on acute, episodic medical care, resulting in only 60% of the population maintaining a regular healthcare service (, ). This leads to the high reliance on secondary and tertiary care in the healthcare system, with 65.5% of health resources allocated to these sectors (, ). To mitigate the overutilization of acute care services, the Government has been working toward a shift from a treatment-focused to a prevention-oriented care (). Since 2019, District Health Centers (DHCs), have been set up in all 18 districts in Hong Kong. These centers provide primary healthcare services across four categories, including health promotion, health assessment, chronic disease management, and community rehabilitation services (, ). The enrolment these primary care centers are vital to initiate the continuity and coordination of care by a professional, interdisciplinary healthcare team (, ). It supports systematic long-term health management through advisory health counseling, early detection, and timely treatment (, ), which is particularly well-suited to the needs of the older adult population with prevalent chronic conditions (). However, our previous community study of 7,531 older adults showed a low membership rate of 28.9% for DHC, limiting the potential of this resource (, ). By increasing awareness, engagement, and utilization of primary healthcare services among this group, it can enhance individual health outcomes, strengthen population health, and contribute to the sustainability and efficiency of the healthcare system (). Face-to-face interventions are effective in improving health outcomes among older adults, especially those who are vulnerable and isolated. These interventions allow active reach to home-dwelling older adults who may not engage with healthcare resources, enabling early detection of unmet needs and timely support (). Home-based interventions directly assess the health and quality of life of participants, as well as the availability of household resources and social support. This context enables more personalized, practical, and effective care planning, ensuring that interventions are tailored to individuals’ real-life needs and circumstances ().