The burden of disease in older people and implications for health policy and practice

Global and Regional Patterns in Edentulism (1990-2021) With Predictions to 2040

AIMS

Edentulism's impact on overall well-being is widely recognized, but there is limited information on regional and sex disparities in its global burden. This study aims to fill this gap by providing an updated picture of edentulism's burden by region and sex and predicting its global trend for the next 2 decades.

METHODS

This study analyzed and reported Global Burden of Disease (GBD) data on the prevalence, incidence, and disability adjusted life years (DALYs) of edentulism, with a breakdown by sex and sociodemographic index (SDI). Epidemiological trends from 1990 to 2021 were characterized using Joinpoint regression analysis. An Autoregressive Integrated Moving Average (ARIMA) model was used to forecast edentulism prevalence trends from 2022 to 2040.

RESULTS

A double increase was found in the number of people with edentulism during the last 30 years. A decrease in the incidence rate of edentulism was found in younger age groups, and a shift in the peak age of prevalence from 70-74 in 1990 to 75-79 in 2021. Females had a higher prevalence rate of edentulism than males globally, with a disproportionate burden in regions of high SDI countries. The global prevalence rate is projected to increase to 5,004 individuals per 100,000 in 2040.

CONCLUSION

These results indicate that edentulism continues to be a significant global public health concern, particularly as its prevalence is expected to rise with the aging population.

CLINICAL RELEVANCE

Public and clinical preventative measures against edentulism is imperative for the welling being of the population, especially in female group.

Lifestyle behaviours and physical, psychological, and cognitive multimorbidity among older hypertensive population in remote areas of China

OBJECTIVES

With the intensification of aging, the proportion of people affected by multimorbidity is steadily increasing worldwide. In remote areas of China, where economic development is lagging and healthcare resources are limited, the older hypertensive population may experience a higher burden of multimorbidity. However, comprehensive evidence is still lacking on how specific combinations of lifestyle behaviours (LBs) impact particular multimorbidity health outcomes in older hypertensive individuals.

STUDY DESIGN

A cross-sectional study was conducted among the older hypertensive population (aged ≥65 years) from 1 July to August 31, 2023 in Jia County, a remote area of China.

METHODS

A total of 40 diseases were categorized into physical, psychological and cognitive disorders. Multivariable-adjusted logistic regression models were used to estimate ORs and 95 % CIs for the associations between LBs and multimorbidity.

RESULTS

Among 17,728 participants, the prevalence of physical, psychological, cognitive, physical-psychological multimorbidity (PPsM), physical-cognitive multimorbidity (PCM), psychological-cognitive multimorbidity (PsCM), and physical-psychological-cognitive multimorbidity (PPsCM) were 63.55 %, 30.12 %, 64.55 %, 22.31 %, 42.03 %, 22.57 %, and 16.74 %, respectively. Compared to participants without any healthy LBs, those with five healthy LBs were associated with a lower risk of physical, psychological, cognitive, PPsM, PCM, PsCM, and PPsCM. Overall, the risk of adverse outcomes decreased with the number of healthy LBs (Ptrend<0.001). However, combinations of healthy LBs of the same quantity but from different categories exhibited varying impacts on the outcomes.

CONCLUSIONS

Multimorbidity involving physical, psychological, and cognitive disorders poses a significant challenge for managing hypertention. Strengthening the capacity of primary healthcare workers to promote healthy lifestyle practices and identifying the optimal LB combinations should be prioritized in the management of hypertensive individuals in remote areas of China.

Associations Between Cognitive Performance and Self-Efficacy for Pain Management in Older Adults With Chronic Pain

BACKGROUND

Self-efficacy for pain management is the key to successful pain management, yet little is known about the effect of cognitive performance on self-efficacy for pain management. This study aimed to examine to what extent cognitive performance is related to self-efficacy for pain management in older adults with chronic pain.

METHODS

The analyses utilized data from the baseline assessment of the MOBILIZE Boston Study. Five neuropsychological tests-the Clock in the Box Test, Letter Fluency Test, Trail-making Test, Hopkins Verbal Learning Test, and WORLD Test-were performed to measure the cognitive performance domains of 458 participants, aged 70 years and reporting chronic pain and self-efficacy for pain management. We measured self-efficacy for pain management using the Chronic Pain Self-Efficacy Scale. Statistical analyses were done using multiple linear regression analysis.

RESULTS

After adjusting for sociodemographic factors, general cognitive performance, executive function, as measured by the Clock in the Box Test, and attention, as measured by the Trail-Making Test Part A, were significantly associated with self-efficacy for pain management in older adults with chronic pain. However, after controlling for sociodemographic factors, chronic conditions, pain interference, and physical performance, the associations between cognitive performance measures and self-efficacy for pain management weakened.

CONCLUSION

Greater cognitive performance in attention and executive function might be associated with better self-efficacy for pain management. Future longitudinal research is required to investigate the long-term implications of cognitive performance changes on the progress of self-efficacy for pain management in community-dwelling older adults.

3D printing personalized orally disintegrating tablets with complex structures for the treatment of special populations

Individuals with special needs, such as children, the elderly, and the visually impaired, encounter significant hurdles in the field of personalized pharmacotherapy due to their distinctive medication needs. 3D printing technology, a novel approach for preparing drug products with intricate personalized designs, has shown considerable promise in improving the safety and adherence to patient medication regimens. This study chose acetaminophen, a commonly employed antipyretic analgesic, as the model drug and employed binder jetting 3D printing (BJ-3DP) to manufacture oral disintegrating tablets (ODTs) with multiple specifications and complex structures. The study initiated with an assessment of the printable properties of powder and ink formulations, proceeding to craft ODTs with individualized dosages and surfaces embedded in QR codes, cartoon figures, textual information, and raised braille. These tablets are internally designed with spaces that do not eject ink, resulting in a loose powder structure. The results of tests including porosity, surface roughness, Micro CT scanning, mechanical properties, and in vitro drug release of the printed product indicate that the personalized ODTs with complex structures designed in this study can offer treatment solutions for specific populations.

Influence of masticatory function on food preferences and cognitive performance in centenarians: an observational study

INTRODUCTION

Demographic projections forecast that centenarians' population growth will continue. "CaT: Centenari a Trieste" is an ongoing study featuring the collection of demographic and anamnestic data, including the analysis of oral variables.

AIMS

evaluate of the possible influence of past food preferences, taste perception and masticatory function on current cognitive status in a cohort of centenarians.

DESIGN

Observational transversal study.

MATERIALS AND METHODS

31 participants with mean age 102 ± 2 performed an examination of the oral cavity including the measurement of DMFT (Decayed Missing Filled Teeth), FTUs (functional teeth units), FOUs (functional occlusal units) and 6-n-propylthiouracil (PROP) taste perception assay. Results were correlated with dementia, subjective perception of oral health and food preferences.

RESULTS

Masticatory function did not correlate with dementia but had a significant impact on oral health perception. When analyzing variables affecting food preferences, PROP taste perception profile and DMFT resulted significantly correlated. Early edentulism didn't show to affect past dietary preferences.

CONCLUSIONS

our data suggest that in centenarians masticatory function doesn't seem to correlate to cognitive function, but influences the self-perception of oral health. Such results are an interesting addition to knowledge on the topic as they refer to a population which has never been considered before.

Association of birth weight, midlife obesity, and transition patterns with mild cognitive impairment and brain MRI indices: A prospective population-based study

BACKGROUND

To evaluate associations of birth weight, midlife weight, and their transitions with mild cognitive impairment (MCI) and brain MRI indices.

METHODS

This prospective cohort study included 200,726 UK Biobank participants. Self-reported birth weight and measured midlife anthropometrics were used to classify obesity (waist circumference [WC]/waist-to-hip ratio [WHR]). We constructed nine weight transition patterns from birth to midlife WC, six from birth to midlife WHR. Cox proportional hazards models and linear regression models were used to examine associations of birth weight, midlife body size and their transitions with MCI and brain MRI indices.

RESULTS

Compared to normal birth weight, low birth weight (HR: 1.29, 95 % CI: 1.16-1.44) and high birth weight (1.11, 1.01-1.22) were both associated with increased risk of MCI, showing a U-shaped relationship. Compared to normal weight at midlife, midlife central obesity [WC (1.25, 1.15-1.37) and WHR (1.27, 1.17-1.37)] were significantly associated with elevated MCI risk. Compared to individuals with normal weight at birth and midlife, those with low birth weight who transition to central obesity at midlife, defined by WC (1.51, 1.27-1.78) or WHR (1.42, 1.22-1.66), showed the highest risk of MCI. Weight transitions were also associated with brain structure, individuals who had low or high birth weight and developed midlife obesity showed significant reductions in total brain volume and grey matter volume, as well as increases in white matter hyperintensity volume.

CONCLUSIONS

Birth weight exhibited a U-shaped association with MCI risk. Individuals transitioning from low birth weight to midlife central obesity demonstrated the highest MCI susceptibility.

Impact of geriatric syndrome burden on healthcare services utilization and mortality among community-dwelling older adults: is it still too late to do something?

PURPOSE

The increasing longevity of the population emphasizes the need for a deeper understanding of geriatric syndromes and their implications for healthcare usage and mortality among older adults. This study aimed to identify risk factors associated with healthcare service utilization and mortality of community-dwelling adults aged 80 and older in YASAM project.

METHODS

This prospective cohort study was part of the HEAT-YASAM trial, which focused on the community-based integrated healthy aging program for individuals aged 80 years and older in Balıkesir, Türkiye. The burden of geriatric syndromes was assessed based on a comprehensive evaluation at least two domains of the nutrition, cognitive, physcological and locomotor capacities. The study outcome was healthcare services utilization (inpatient, outpatient, emergency admission) and all-cause mortality data obtained during follow-up period (9 months).

RESULTS

The cohort consisted of 5018 participants with a mean age of 85.8 years, predominantly female (53.1%). On the multivariable analysis, geriatric syndrome burden and Deyo Charlson Comorbidity index (D-CCI) score significant on independent predictors of 9-month mortality (p = 0.01). Higher geriatric syndrome burden was linked to an approximately 10% lower risk for outpatient admissions (p = 0.01) and every point increase in the D-CCI score was associated with a 1.3-fold increased risk of utilizing outpatient services (p = 0.01). For multimorbidity, every point increase corresponded to a 2.6-fold higher risk of inpatient admissions (p = 0.01) and a 1.2-fold higher risk of emergency admissions (p = 0.01).

CONCLUSIONS

This study demonstrate that a geriatric syndrome burden and multimorbidity has a significant impact on healthcare utilization and mortality in adults aged 80 years and older. Integrated comprehensive, coordinated, and patient-centered care models for this population facing multiple geriatric syndromes could positively impact the healthcare system.

TRIAL REGISTRATION

The trial was prospectively registered at ClinicalTrials.gov. Identifier: NCT05993572 Registered on 15 July 2023.

Exploring the Association Between Physical Activity, Regulatory Emotional Self-Efficacy, Perceived Self-Burden, and Social Isolation Among Older Adults in China

Background: As people age, their physical functions decline, and changes in social roles and life experiences put older adults at a higher risk of social isolation. Methods: In this study, we employed both snowball and purposive sampling techniques to collect valid data from 237 seniors aged 60 to 75 residing in Hunan Province. Using structural equation modeling (SEM) with the partial least squares (PLS) method, we examined the relationship between physical activity and social isolation among this elderly population. Result: Findings from this study indicate a positive association between physical activity and regulatory emotional self-efficacy, while revealing a negative association with the perception of being a burden to others. Moreover, a higher regulatory emotional self-efficacy is linked to reduced social isolation, whereas an increased sense of self-perceived burden is associated with greater social isolation. This study also uncovers that the link between physical activity and reduced social isolation is influenced by both regulatory emotional self-efficacy and the perception of self-burden. Conclusion: It is imperative for a collaborative effort involving government entities, societal groups, family units, and individuals to meticulously address and cater to the diverse requirements of senior citizens.

Adherence to the planetary health diet reduces dietary costs by 21% supporting affordable healthy eating among older adults in Iran

Poor dietary patterns among older adults are significantly influenced by socioeconomic status (SES) and food prices, impacting both diet quality and food choice. This study examines how dietary costs relate to the Planetary Health Diet Index (PHDI) and assesses the role of SES in Iran's elderly population. In this cross-sectional study, 398 elderly individuals from southern Tehran were sampled. Dietary data were collected using a validated food frequency questionnaire, and adherence to the PHDI was evaluated based on EAT-Lancet guidelines. Food costs were derived from the Iranian Statistics Center and retail prices. Multivariable linear regression analyzed the relationship between PHDI adherence and dietary cost. PHDI adherence varied significantly across demographics. Higher adherence was observed in females (OR = 0.82, 95% CI: 0.71-0.95) and those with a BMI ≤ 27.5 (OR = 0.84, 95% CI: 0.73-0.97), while single individuals had higher scores (OR = 0.85, 95% CI: 0.74-0.98). Higher PHDI tertiles were linked to lower daily dietary cost, with a significant decrease observed in the highest tertile compared to the lowest (β = - 708,367 Rials, 95% CI: - 1,060,371 to - 356,362). However, this association was not significant among single and low-income participants. The study reveals that higher adherence to the PHDI is associated with reduced dietary costs, a key barrier to obtaining a healthy, balanced diet among older adults, and may thereby support better health outcomes, including malnutrition prevention and functional independence. Future research should focus on longitudinal studies to develop equitable public health strategies that promote affordable and sustainable dietary practices.

Association of systemic immune-inflammatory index with all-cause and cancer mortality in Americans aged 60 years and older

Background

This research delved into the association between the systemic immune-inflammatory index (SII) and both all-cause and cancer-specific mortality among individuals aged 60 years and above in the United States during the period from 1999 to 2018, with follow-up extending until 31 December 2019. The data utilized was sourced from 4295 population-based participants in the National Health and Nutrition Examination Survey (NHANES).

Methods

To analyze the relationship between SII and mortality, the study employed Cox proportional-risk models, restricted cubic spline curves, survival curves, and subgroup analyses.

Results

The average age of the participants was 70.7 (±7.6) years, the median follow-up duration was 131.7 (±59.8) months, and the all-cause mortality rate stood at 50.5%. Findings from the Cox regression model indicated that, after adjusting for covariates, SII was significantly and linearly related to all-cause mortality (hazard ratio HR = 1.31, 95% confidence interval CI = 1.15-1.48). Moreover, the relationship between SII and cancer mortality exhibited a U-shaped pattern. Results from the survival curves suggested that a higher SII was associated with an augmented risk of both all-cause mortality and cancer mortality.

Conclusion

There is a significant association between higher SII levels and increased risk of all-cause and cancer-specific mortality in the US population aged 60 years and older.

Failure to improve-identifying risk factors for poor functional recovery following chronic subdural hematoma surgery

BACKGROUND

Chronic subdural hematoma (CSDH) is a common condition among older people living with frailty. Outcome after surgery is generally good, but there is a significant proportion of patients who do not benefit from surgery. This study aimed to identify predictors of failure to improve functional outcomes after CSDH surgery.

METHODS

This is a post-hoc analysis of the nationwide FINISH trial, which enrolled 589 adult patients undergoing burr-hole drainage for symptomatic CSDH during 2020-22. Functional outcome was assessed using the modified Rankin Scale (mRS). Failure to improve was defined as unchanged or worsened mRS at 6 months compared to preoperative mRS. Multivariable logistic regression was used to identify factors associated with failure to improve.

RESULTS

Of the 568 patients with available mRS data at 6 months, 20% (n = 115) showed no improvement in mRS between the preoperative and 6-month period. Factors associated with failure to improve included pre-existing dementia (OR 2.62, 95% CI 1.21-5.66), use of a walker (OR 3.19, 95% CI 1.64-6.23), smaller hematoma width (OR 0.96, 95% CI 0.93-0.99), and lesser midline shift (OR 0.91, 95% CI 0.86-0.97). Despite this, 88% of patients had stable or improved residence status, and 85% maintained or improved mobility.

CONCLUSION

A substantial proportion of surgically treated CSDH patients do not improve in functional status. Dementia was a significant predictor of poor outcomes. Future research should focus to better identify patients at risk of poor outcomes in order to avoid overtreatment and explore possible alternative treatment strategies.

Essential competencies of nurses working with AI-driven lifestyle monitoring in long-term care: A modified Delphi study

BACKGROUND

As more and more older adults prefer to stay in their homes as they age, there's a need for technology to support this. A relevant technology is Artificial Intelligence (AI)-driven lifestyle monitoring, utilizing data from sensors placed in the home. This technology is not intended to replace nurses but to serve as a support tool. Understanding the specific competencies that nurses require to effectively use it is crucial. The aim of this study is to identify the essential competencies nurses require to work with AI-driven lifestyle monitoring in long-term care.

METHODS

A three round modified Delphi study was conducted, consisting of two online questionnaires and one focus group. A group of 48 experts participated in the study: nurses, innovators, developers, researchers, managers and educators. In the first two rounds experts assessed clarity and relevance on a proposed list of competencies, with the opportunity to provide suggestions for adjustments or inclusion of new competencies. In the third round the items without consensus were bespoken in a focus group.

FINDINGS

After the first round consensus was reached on relevance and clarity on n = 46 (72 %) of the competencies, after the second round on n = 54 (83 %) of the competencies. After the third round a final list of 10 competency domains and 61 sub-competencies was finalized. The 10 competency domains are: Fundamentals of AI, Participation in AI design, Patient-centered needs assessment, Personalisation of AI to patients' situation, Data reporting, Interpretation of AI output, Integration of AI output into clinical practice, Communication about AI use, Implementation of AI and Evaluation of AI use. These competencies span from basic understanding of AI-driven lifestyle monitoring, to being able to integrate it in daily work, being able to evaluate it and communicate its use to other stakeholders, including patients and informal caregivers.

CONCLUSION

Our study introduces a novel framework highlighting the (sub)competencies, required for nurses to work with AI-driven lifestyle monitoring in long-term care. These findings provide a foundation for developing initial educational programs and lifelong learning activities for nurses in this evolving field. Moreover, the importance that experts attach to AI competencies calls for a broader discussion about a potential shift in nursing responsibilities and tasks as healthcare becomes increasingly technologically advanced and data-driven, possibly leading to new roles within nursing.

Technology for sustainable living: The impact of digital inclusion on the health of China's elderly living alone

Enhancing elderly health has become an important measure for coping with population ageing and building a healthy China. Among them, older adults living alone seem to suffer from greater loneliness and psychological stress. We analyzed data from the China Health and Retirement Longitudinal Study in 2015, 2018, and 2020, and carried out an empirical investigation into the impact of digital inclusion on the health of elderly individuals living alone, using two-way fixed effects models and two-stage least squares. The findings suggest that digital inclusion could positively impact the health of older people living alone. Specifically, for a one-standard-deviation increase in digital inclusion, the depression scale score decreases by 0.48 (α = -0.21, p < 0.01); the cognitive function score increases by 0.27(α = 0.12, p < 0.01); the instrumental activities of daily living score would decrease by 0.11 (α = -0.05, p < 0.01). An increase of 1 in the digital inclusion score decreases the self-rated health score by 0.02 (α = -0.02, p < 0.01). It can significantly enhance the health status of elderly people who live alone through mechanisms of improving life satisfaction, increasing the utilization of preventive health care services, and promoting social participation. Subsequent analyses identified varying effects of digital inclusion on older adults living alone, influenced by their income and education levels. In particular, digital inclusion substantially enhanced instrument activities of daily living among the aged who lived alone and with higher income and educational backgrounds. However it had no significant effect on older people living alone with lower incomes and educational backgrounds. The insights from this study could be invaluable for policymakers in promoting broader adoption of digital technologies among older adults living alone.

Relationship between lifestyle factors and cardiovascular disease prevalence in Somaliland: A supervised machine learning approach using data from Hargeisa Group Hospital, 2024

BACKGROUND

Cardiovascular diseases (CVDs) are leading contributors to global morbidity and mortality, with low- and middle-income countries experiencing disproportionately high burdens. In Somaliland, urbanization and lifestyle transitions have increased the prevalence of CVDs, necessitating an in-depth exploration of associated risk factors.

OBJECTIVE

This study investigated the relationship between lifestyle factors and CVD prevalence among adult patients in Somaliland using data from the Hargeisa Group Hospital in 2024.

METHODS

A cross-sectional design was employed, enrolling 411 adults aged ≥ 18 years. Data were collected through structured questionnaires and analyzed using traditional statistical methods and seven supervised machine learning models: Logistic Regression, Random Forest, Support Vector Machine (SVM), Probit Regression, KNN and Decision Tree. The study assessed associations between sociodemographic variables, lifestyle factors, and CVD prevalence while evaluating the predictive model performance.

RESULTS

Age and smoking were the most significant predictors of CVD prevalence across all models, with individuals aged ≥ 60 years exhibiting the highest risk. Urban residence was associated with lower CVD prevalence, while behaviors such as khat chewing and physical inactivity increased the risk. Machine learning models, notably SVM, demonstrated robust predictive performance, achieving an accuracy of 63.4 % and an AUC of 67.1 %.

CONCLUSION

Lifestyle factors, particularly smoking, khat chewing, and dietary habits, are critical drivers of the CVD prevalence in Somaliland. These findings underscore the need for targeted public health interventions focusing on smoking cessation, dietary improvements, and culturally sensitive awareness campaigns. Machine learning techniques offer valuable tools for enhancing the predictive accuracy and guiding tailored health strategies.

Exercise prescription prescriptions for frailty improvement in older adults: An evidence-based approach based on the 2024 older adult compendium

OBJECTIVE

This study explored the dose-response relationship of exercise prescriptions for improving frailty in older adults, based on the 2024 Older Adult Compendium. It aims to provide evidence-based support for developing frailty intervention programs and their clinical application.

METHODS

A comprehensive search was conducted in PubMed, OVID, Cochrane Library, Web of Science, and Scopus from inception to November 5th, 2024. Randomized controlled trials (RCTs) related to exercise interventions in older adults were included. Relevant studies meeting the inclusion criteria were selected, and data were extracted for further analysis. The quality of the included studies was assessed. Meta-analysis was performed using R, and the standardized mean difference (SMD) with 95 % confidence intervals (95 % CI) was used to quantify effect sizes.

RESULTS

A total of 16 eligible RCTs comprising 2,716 older adults were included. The meta-analysis revealed that exercise significantly improved frailty among older adults [SMD = -0.81, 95 % CI (-1.25, -0.38), P < 0.001]. However, high-intensity exercise did not demonstrate a significant effect on frailty improvement [SMD = -0.45, 95 % CI (-0.96, 0.06), P = 0.3]. The analysis indicated a nonlinear dose-response relationship between exercise and frailty improvement. The predicted values for frailty improvement at the minimum and maximum exercise doses recommended by the World Health Organization (600 MET-minutes/week and 1200 MET-minutes/week, respectively) were -0.79 (95 % CI [-1.17, -0.41]) and -1.39 (95 % CI [-2.62, -0.15]), respectively.

CONCLUSION

Low- to moderate-intensity exercise significantly improves frailty among older adults, while high-intensity exercise programs are not recommended.

Strides towards healthy longevity: Harnessing the power of sports and elements of Kathak, an Indian classical dance form through social participation to combat cognitive frailty among older adults

Aging brings with it many health issues that can make life challenging. As much of the attention is given to non-communicable diseases, there are others which are slowly becoming a matter of great concern. One such issue is cognitive frailty, which is a high risk factor for dementia, falls, fractures and hospitalization. Though not yet declared a public health concern, it deserves early detection and prevention strategies. As it is reversible if treated on time, there is a need to look into its prevention and cure. Physical activity has proven to be very effective in the treatment of cognitive frailty. This scoping review thus aims to study the impact of physical activity through social participation on cognitive frailty. The authors recommend that focussing on one's muscular fitness through participation in sports and elements of Indian classical dance form like Kathak in groups/ communities can be a very effective way of combating cognitive frailty among older adults.

Ageism and Empathy Among Dental Students in Southern Brazil

PURPOSE

To investigate the association of ageism, empathy, and other possible explanatory factors among dental students in southern Brazil.

METHODS

An online questionnaire and in-person visits were used for collecting sociodemographic data, dental training experiences, and attitudes toward aging, and employing the validated Brazilian versions of the Ageism Scale for Dental Students (ASDS-Braz) and Jefferson Scale of Empathy (JSE). Confirmatory factor analysis (CFA) was used to validate the JSE and ASDS-Braz, and structural equation modeling (SEM) was then employed to explore the relationships between total ageism score, total empathy score, and other factors.

RESULTS

CFA for ASDS-Braz and JSE and the SEM showed marginal root mean square error of approximation (RMSEA) values and displayed expected loading directions. Among 626 predoctoral dental students (91.5% response rate), SEM revealed significant associations between the university attended and total empathy score with total ageism score, and sex with total empathy score.

CONCLUSION

Among southern Brazilian dental students, university attended and overall empathy levels are strongly linked to the total ageism score. At the same time, gender shows a significant correlation with the overall empathy score.

Sphingomonas Paucimobilis-derived Extracellular Vesicles Reverse Aβ-induced Dysregulation of Neurotrophic Factors, Mitochondrial Function, and Inflammatory Factors through MeCP2-mediated Mechanism

Recent studies have shown an increased abundance of Sphingomonas paucimobilis, an aerobic, Gram-negative bacterium with a distinctive cell envelope rich in glycosphingolipids, within the gut microbiome of individuals with Alzheimer Disease (AD). However, the fact that S. paucimobilis is a well-known pathogen associated with nosocomial infections presents a significant challenge in investigating whether its presence in the gut microbiome is detrimental or beneficial, particularly in the context of AD. This study examines the impact of S. paucimobilis-derived extracellular vesicles (Spa-EV) on Aβ-induced pathology in cellular and animal models of AD. Microarray analysis reveals that Spa-EV treatment modulates Aβ42-induced alterations in gene expression in both HT22 neuronal cells and BV2 microglia cells. Among the genes significantly affected by Spa-EV, notable examples include Bdnf, Nt3/4, and Trkb, which are key players of neurotrophic signaling; Pgc1α, an upstream regulator of mitochondrial biogenesis; Mecp2 and Sirt1, epigenetic factors that regulate numerous gene expressions; and Il1β, Tnfα, and Nfκb-p65, which are associated with neuroinflammation. Remarkably, Spa-EV effectively reverses Aβ42-induced alteration in the expression of these genes through the upregulation of Mecp2. Furthermore, administration of Spa-EV in Tg-APP/PS1 mice restores the reduced expression of neurotrophic factors, Pgc1α, MeCP2, and Sirt1, while suppressing the increased expression of proinflammatory genes in the brain. Our results indicate that Spa-EV has the potential to reverse Aβ-induced dysregulation of gene expression in neuronal and microglial cells. These alterations encompass those essential for neurotrophic signaling and neuronal plasticity, mitochondrial function, and the regulation of inflammatory processes.

Association between adults' vaccine literacy and their intention to recommend older family members for influenza vaccine

OBJECTIVE

Seasonal influenza vaccine is effective to reduce the risk of hospitalization and death in vulnerable older persons, but the coverage of influenza vaccine remains low in these population in China. This study thus aimed to investigate how adults' vaccine literacy affects their intention to recommend influenza vaccination to older family members in China.

METHODS

A cross-sectional survey was performed in China during October 7 to 16, 2023 through a web-based questionnaire. The participants' influenza vaccine literacy (IVL) was quantitatively assessed using an adapted scale, and bivariate analyses were undertaken to evaluate variable associations among the participants. Multivariable logistic regression and mediation effect model were used to analyze the target factors.

RESULTS

3027 valid respondents were included in our survey, 89.6 % of them were willing to recommend their older family members for influenza vaccine. Participants with higher IVL scores were more likely to recommend influenza vaccination (OR = 1.553, P < 0.01). In addition, participants who were living with their older family members, received annual influenza vaccinations, or whose older family members had infected influenza within the past six months, were also more likely to do so. Of note, despite of a higher level of vaccine literacy, healthcare works were more reluctant to recommend vaccination for older family members (OR = 0.496, P < 0.05).

CONCLUSION

High level of vaccine literacy is positively correlated to adults' intention to recommend influenza vaccination for older family members. We should take educational interventions of vaccine literacy among adults, and thus promoting influenza vaccination coverage among the older population.

Ten-year atherosclerotic cardiovascular disease risk score in post-menopausal women with low bone mineral density

BACKGROUND

Reports on the association between cardiovascular disease (CVD) risk and bone mineral density (BMD) remain inconsistent and hence more population-based studies on this subject are needed.

AIMS

This cross-sectional study aimed to evaluate the association between bone mineral density (BMD) at the lumbar spine (L1-L4) and femoral neck (right and left) with 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores in Saudi postmenopausal women.

METHODS

A cohort of 1,450 postmenopausal women with risk factors for bone loss were analyzed using the data from the Chair for Biomarkers of Chronic Diseases (CBCD) Osteoporosis database. BMD at the lumbar spine and femoral neck was assessed using dual-energy X-ray absorptiometry (DXA). Anthropometric and biochemical parameters, including fasting glucose and lipid profiles, were measured. ASCVD risk scores were calculated using the ASCVD Risk Estimator Plus tool. BMD tertiles were analyzed for their association with ASCVD risk.

RESULTS

Women with osteoporosis had significantly lower BMI, waist and hip circumferences, and metabolic dysfunction markers compared to those with normal BMD. Significant negative correlations were observed between ASCVD risk scores and BMD at femoral neck sites in women with osteopenia and osteoporosis. Multivariate logistic regression indicated that women in the lowest BMD tertiles had significantly higher odds of intermediate to high ASCVD risk scores, with adjusted odds ratios of 1.90 for the lumbar spine, 2.19 for the right femoral neck, and 2.04 for the left femoral neck.

CONCLUSIONS

The study identified significant associations between lower BMD at the lumbar spine and femoral neck sites and elevated 10-year ASCVD risk scores in postmenopausal women, particularly among those with osteopenia and osteoporosis. These findings demonstrate the importance of assessing cardiovascular risk in women with low BMD to enable early prevention and management strategies.

Protective and risk factors in daily life associated with cognitive decline of older adults

Background

Cognitive decline is a chronic condition which is characterized by a loss of the ability to remember, learn, and pay attention to complex tasks. Many older people are now suffering from cognitive decline, which decreases life quality and leads to disability. This study aimed to identify the risk and protective factors for cognitive decline of the older people from daily life and establish a predictive model using logistic regression.

Methods

We investigated 3,790 older people with health examination and questionnaires which included information associated with physical condition, lifestyle factors, and cognitive status. Single-factor comparison, principal component analysis with a Manova-Wilk test, multiple linear regression, and logistic regression were performed to filter the risk and protective factors regarding cognitive decline of older individuals. Then a predictive model using logistic regression was established based on the most significant protective and risk factors.

Results

We found a significant separation along the coordinate axis between people with normal and declined cognition by principal component analysis, as confirmed by the Manover-Wilk test. Single-factor comparison, multiple linear regression and logistic regression implied that gender, age, hypertension level, height, dietary habit, physical-exercise duration, physical-exercise history, and smoking history could be closely linked with cognitive decline. We also observed significant differences in height, physical exercise duration, physical-exercise years, and smoking years between the male and female of the participants. ROCs of the predictive model by logistic regression were plotted, with AUC values of 0.683 and 0.682, respectively, for the training and testing sets. Although an effective predictive model is thought to have AUC over 0.7, we still believe that the present model is acceptable because the value is close to the threshold.

Conclusion

The protective factors of cognitive decline for older people were male gender, height, keeping moderate exercising, and nicotine stimulation, and the risk factors included age, female gender, vegetarianism and hypertension. Except for the genetic factor, differences in lifestyle, such as smoking and exercise habits, may contribute to the observed differences in cognitive function between genders. The significant results could be utilized in the practice for the early intervention of cognitive decline in aged people.

Oral Health Status and Factors Associated with Oral Health in Patients with Alzheimer's Disease: A Matched Case-Control Observational Study

Background: Alzheimer's disease (AD) is a chronic neurodegenerative disease, ranking as the seventh leading cause of death in both sexes. There is increasing awareness of the role of chronic periodontal disease and severe tooth loss as a modifiable risk factor for developing AD. The aim of the present observational study was to assess AD patients with non-affected healthy controls in the context of their dental and periodontal health outcomes; additionally, the potential impact of anamnestic factors and lifestyle habits on oral health outcomes was also studied. Methods: A total of n = 41 AD patients receiving treatment at the Department of Psychiatry, University of Szeged, were compared with n = 41 age- and gender-matched controls from individuals seeking dental treatment and from retirement homes (mean age was 83.32 ± 7.82 years). Dental and periodontal status indices were assessed according to World Health Organization (WHO) criteria. Results: Overall, 51.2%, 68.3%, and 87.8% of AD patients received mood stabilizers, drugs for their non-cognitive symptoms and cognitive symptoms, respectively. Severe tooth loss was observed in 43.9% of AD patients and 56.1% of controls, respectively. There were no significant differences among AD patients and controls regarding the dental status indices studied (p > 0.05 for all indicators). AD patients had significantly higher plaque indices (%) (59.06 ± 15.45 vs. 41.35 ± 7.97; p < 0.001), bleeding on probing (BOP%) (62.65 ± 12.00 vs. 40.12 ± 10.86; p < 0.001), pocket depth [PD] (2.63 ± 0.56 vs. 2.29 ± 0.13; p = 0.002) and attachment loss [AL] (2.85 ± 0.79 vs. 2.39 ± 0.41; p = 0.026) values, compared to controls. Smoking (vs. non-smokers; 56.28 ± 12.36 vs. 51.40 ± 13.23, p = 0.038) and consumption of alcohol (vs. non-drinkers; 58.68 ± 9.86 vs. 54.78 ± 14.86, p = 0.040) were associated with higher plaque indices [%], while no similar effects were shown for dental status parameters (p > 0.05). In contrast, coffee intake and vitamin supplement use had no significant effect on dental or periodontal status parameters (p > 0.05 in all cases). Conclusions: The results of our study underscore the substantial treatment needs of AD patients, calling for heightened awareness among dental healthcare professionals.

Comprehensive geriatric assessment in nonhospitalized settings: An overview of systematic reviews

AIM

Comprehensive geriatric assessment (CGA) is a commonly used intervention for addressing the health needs of older people. Traditionally used for hospital inpatients, there is inconclusive evidence on its effectiveness in other settings. This overview of reviews aims to synthesize the current evidence regarding CGA models, their effectiveness, feasibility and acceptability in nonhospital settings.

METHODOLOGY

The overview included systematic reviews with or without meta-analysis reporting on older adults (≥50 years) undergoing CGA in primary care facilities, outpatient care, community-based programs, long-term care settings and home-based care, excluding narrow high-risk groups or specific disease conditions. MEDLINE, Embase, Cochrane CENTRAL, PsychInfo and CINAHL, were searched up to August 2023, with blinded double screening and data extraction. Review quality was assessed using Assessing the Methodological Quality of Systematic Reviews-2.

RESULTS

Of 2574 identified articles, 22 systematic reviews (478 primary studies, >136 336 participants) met the inclusion criteria. Most reviews were of moderate to good quality, 73% were based in community or home settings, and in 50% of the reviews the participants were aged ≥65 years. They identified diverse CGA models without uniform definition or domains of assessment, most delivered by nurses and multidisciplinary teams, with variation of input duration (6-36 months) and poor reporting of frequency of assessment or follow-up duration. Most reviews found no effect of CGA on rates of admission to hospitals or long-term care facilities, quality of life or function. Of the 10 reviews that reported it as an outcome, only two found that CGA reduced mortality risk by 13% and 14% at longest follow-up. Of the three reviews reporting frailty as an outcome, two showed benefit, with one meta-analysis showing significant reduction in frailty (relative risk, 0.77 [95% CI, 0.64-0.93]). The acceptability of CGA is good among care providers, but limited information was found among patients. Facilitators for implementation identified include preexisting interprofessional working, skilled staff, better informed patients and focus on patient convenience. The evidence was exclusively from high-income countries.

CONCLUSION

CGA models are highly heterogenous across domains, delivery, dosage and frequency. Most systematic reviews show little to no evidence of benefit of CGA on rates of hospitalization/long-term care admissions, functional ability and quality of life. However, CGA may have a positive effect on frailty and mortality, particularly in relatively vulnerable older people. Strategies to first identify high-risk individuals, followed by CGA, could lead to better outcomes. The lack of evidence on the effectiveness of CGA in low- and middle-income countries, despite the rapid increase in the number and proportion of older adults, means that trials in this area are urgently needed.

REGISTRATION

Registered prospectively in the Open Science Framework Registry of reviews (No. ZB69F). Protocol can be accessed at: DOI: https://doi.org/10.17605/OSF.IO/ZB69F. No amendments to the protocol were made. Geriatr Gerontol Int 2025; ••: ••-••.

Profiles and disparities of the global cancer and subtypes burden among adults aged 65 years and older: changing patterns in incidence and mortality, 1990-2021

This study aimed to elucidate the global temporal and geographic characteristics of 29 cancers in older people aged ≥ 65 years, based on data from the Global Burden of Disease Study 2021. The average annual percentage changes (AAPCs) were calculated to estimate temporal trends of age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs). Globally, there was an increase of 8.52 million cancer cases and 3.16 million cancer deaths among older people from 1990 to 2021. The ASIR of cancers combined presented an annually increased trend (AAPC: 0.49%), and regions with high sociodemographic index (SDI) experienced the highest increase (AAPC: 0.94%). Over the same period, the ASMR of cancers combined annually decreased (AAPC: -0.40 %) globally, whereas regions with low SDI (AAPC: 0.32%) and low-middle SDI (AAPC: 0.48%) exhibited significantly increased ASMRs. Prostate cancer, lung cancer, and colorectal cancer were the three most common cancers for older people globally, and decreased relative inequalities were observed in higher-SDI countries from 1990 to 2021. For these three cancers, concentration index of ASMR respectively decreased from 0.26 to 0.06, from 0.20 to 0.17, and from 0.24 to 0.18. In contrast, the ASIR and ASMR of these cancers exhibited significant upward trends in lower-SDI regions. Our findings revealed that cancer burden for older people presented disparities globally, where higher-SDI countries faced a greater burden of cancer incidence and lower-SDI countries experienced an upward trend in cancer mortality. More attention should be given to prostate cancer, lung cancer, female breast cancer, and gastrointestinal cancers, especially in lower-SDI regions.

Working life expectancy of physicians: the case of primary care physicians in Czechia

BACKGROUND

The decrease in the number of healthcare workers and the resulting deterioration in healthcare quality and availability have been subjected to intensive discussion in Czechia in recent years. Estimating future healthcare worker capacities requires a detailed analysis of their "movement" within the healthcare system. This study focuses on exits of the primary care physicians from the healthcare system in Czechia.

METHODS

Using anonymised data obtained from the largest Czech health insurance company (2012-2022), we constructed working life tables and calculated working life expectancy, which indicates the expected average number of remaining years of work at the exact age of the physician. The study focuses on primary care physicians, who are crucial for the effective functioning of the healthcare system.

RESULTS

At age 50, working life expectancy was 20 years for female physicians and approximately 21 years for male physicians. Over the monitored period, working life expectancy decreased by 1 year for both genders. Gynaecologists had the longest working life expectancy, while dentists had the shortest.

CONCLUSIONS

The decrease in the working life expectancy and the length of tenure indicates the need to create favourable conditions for the extension of the working lives of physicians to avoid early exits from the system.

Effects of whole-head 810 nm near-infrared therapy on cognitive and neuropsychiatric symptoms in Alzheimer's disease: A pilot study

BACKGROUND

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by significant cognitive and behavioral impairments. Near-infrared (NIR) light treatment has shown potential in cognitive improvement in previous studies. However, clinical trials of NIR for AD remain limited.

OBJECTIVE

This study investigated the safety and effects of whole-head 810 nm NIR therapy in AD patients, including long-term efficacy.

METHODS

An open-label pilot study on whole-head NIR treatment for AD patients was conducted. Nine AD patients completed 4-month treatment (810 nm, 100 mW/cm², 30 min/session, 6 sessions weekly). Safety and efficacy were evaluated at baseline, months 2 and 4, and 2-month post-treatment.

RESULTS

After four months of whole-head NIR treatment, mean changes from baseline on the Mini-Mental State Examination were 3.2 (p = 0.02). Mean changes from baseline on the Alzheimer's Disease Assessment Scale-Cognitive were -5.0 (p = 0.05), mean changes from baseline on the Montreal Cognitive Assessment were 1.9 (p = 0.12). Mean changes from baseline on the Neuropsychiatric Inventory were -4.2 (p = 0.47). These benefits were sustained two months at least. With no device-related adverse effects were reported.

CONCLUSIONS

Whole-head 810 nm NIR light is safe and offers promising benefits for AD patients. To fully confirm its efficacy, durability, and underlying mechanisms, further large-scale randomized controlled trials are necessary.

Global trends and projections of high BMI burden and its independent impact on atrial fibrillation and flutter

BACKGROUND

This study evaluates changes in the burden of high body mass index (BMI) and its impact on atrial fibrillation and flutter (AF/AFL) using the 2021 Global Burden of Disease database.

METHODS

Mortality and disability-adjusted life years rates were analysed globally, considering age, sex, geography and the Socio-demographic Index (SDI). Decomposition and frontier analyses assessed the impact of epidemiological drivers and SDI on the burden. The nordpred model validated the predictions.

RESULTS

The burden of high BMI is now 2.5 times greater than 30 y ago and will continue to increase over the next 20 y, heavily impacting cardiovascular and metabolic diseases. High BMI-related AF/AFL also poses a significant burden, especially in developed regions. Men's burden grows faster than women's. Decomposition analysis shows epidemiological changes mainly drive burden increases, while in women, population growth is more significant. Frontier analysis indicates that the gap between actual burden and theoretical optimal value has widened with increasing SDI, except in countries such as Bulgaria and the Czech Republic.

CONCLUSIONS

Over the past 30 y, the overall burden of high BMI and its impact on AF/AFL have increased significantly, highlighting the need for targeted public health strategies.

The protective effect and experimental research progress of pleotropic statins in intervertebral disc degeneration

Intervertebral disc degeneration (IVDD) is one of the primary causes of low back pain, significantly affecting the quality of life in the elderly population and imposing a substantial economic burden. Currently, clinical treatments for IVDD mainly focus on symptom management, with no available therapies capable of reversing or curing the disease. In recent years, statins, a class of drugs traditionally used in the treatment of cardiovascular diseases, have been shown to exert beneficial effects on IVDD through multiple mechanisms. With the advancement of research into the pleiotropic effects of statins, an increasing body of evidence suggests their potential as effective therapeutic agents for IVDD. This review summarizes the pleiotropic effects of statins and explores their potential mechanisms and actions in IVDD, with particular emphasis on changes in the expression of relevant molecular markers. Furthermore, recent advancements in the application of statins for IVDD treatment are discussed, along with the potential of combining statins with other drugs as part of multi-target therapeutic strategies. This review aims to provide a scientific reference for further investigations into the use of statins in the treatment of IVDD.

Continuity of care and mortality in patients with type 2 diabetes: a cohort study

BACKGROUND

How GP continuity of care (GP-CoC) affects mortality in patients with type 2 diabetes (T2D) is unclear.

AIM

To examine the effect of having no continuity of care (CoC) and GP-CoC on mortality in primary health care (PHC) patients with T2D.

DESIGN & SETTING

A cohort study in patients aged ≥60 years with T2D, which was conducted within the public PHC of the city of Vantaa, Finland.

METHOD

The inclusion period was between 2002 and 2011 and follow-up period between 2011 and 2018. Six groups were formed (no appointments, one appointment and Modified, Modified Continuity Index [MMCI] quartiles). Mortality was measured with standardised mortality ratio (SMR) and adjusted hazard ratio (aHR). GP-CoC was measured with MMCI. Comorbidity status was determined with Charlson Comorbidity Index (CCI).

RESULTS

In total, 11 020 patients were included. Mean follow-up time was 7.3 years. SMRs for the six groups (no appointments, one appointment, MMCI quartiles) were 2.46 (95% confidence interval [CI] = 2.24 to 2.71), 3.55 (95% CI = 3.05 to 4.14), 1.15 (95% CI = 1.06 to 1.25), 0.97 (95% CI = 0.89 to 1.06), 0.92 (95% CI = 0.84 to 1.01) and 1.21 (95% CI = 1.11 to 1.31), respectively. With continuous MMCI, mortality formed a U-curve. The inflection point was at a MMCI value of 0.65 with corresponding SMR of 0.86. Age and CCI aHR for death between men and women was 1.45 (95% CI = 1.35 to 1.58).

CONCLUSION

Patients with no CoC had the highest mortality. In patients having care over time, the effect of GP-CoC on mortality was minor and mortality increased with high GP-CoC.

Prevalence, aetiology, and service mapping of dementia in rural Uganda. Part of DEPEND Uganda (Dementia Epidemiology, unmet Need and co-Developing Solutions in Uganda)

Background

Dementia prevalence in low- and middle-income countries is increasing, yet epidemiological data from African populations remain scarce. Crucial risk factors differ in Africa from more intensively studied global areas, including a higher burden of cerebrovascular disease and HIV, but lower rates of other risk factors like physical inactivity.Understanding dementia aetiology in African settings has been limited by the expensive and invasive nature of biomarker testing. This study leverages developments in blood-based and retinal imaging biomarker technology to examine the drivers of dementia in older Ugandans.People with dementia have complex needs benefiting from multi-dimensional support. Understanding current services will allow identification of barriers and opportunities to strengthen support available to people with dementia and their families.

Methods

The study is nested within the General Population Cohort run by the Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Research Unit. All adults aged 60+ (around 1400) are undergoing brief cognitive screening.In Part 1, cohort participants are selected based on screening scores to undergo detailed cognitive assessment, using methods developed by the 10/66 Dementia Research Group. Part 2 is a case control study of people with and without dementia using antecedent data, questionnaires, physical assessment, retinal imaging, and Alzheimer's blood-based biomarkers. We will also compare disability, frailty, quality of life, and social engagement in people with and without dementia.Part 3 assesses current formal support structures for people with dementia through review of publicly available literature and expert interviews.

Conclusions

This is the first study in Africa using blood-based and retinal imaging biomarkers to examine pathological processes underlying dementia, and systematically map services available for people with dementia. This paves the way for effective policy strategies and further focused research regarding both dementia prevention and support for affected people and their families.

Association of biochemical indicators with multimorbidity in 19,624 older adult individuals with chronic diseases: a study from Jindong District, Jinhua City, China

Background

Chronic disease multimorbidity is influenced by multiple factors, but with little knowledge on the impact of biochemical indicators. This study aims to investigate the prevalence of multimorbidity of chronic diseases among older adult individuals in the community, as well as the factors related to biochemical indicators associated with chronic disease multimorbidity.

Methods

The study included 19,624 older adult individuals aged 60 and above in Jindong District, Jinhua City, Zhejiang Province, China. Participants completed a national standardized older adult health examination in the community. Chi-square tests and logistic regression were employed to evaluate the potential factors of biochemical indicators related to multimorbidity of chronic diseases.

Results

The multimorbidity rate of chronic diseases in older adult patients is 70.3%. Each chronic disease coexists with one or more other chronic diseases in over 75% of cases. Among the biochemical indicators, hemoglobin (Hb) (OR = 1.46, 95%CI: 1.13-1.90), white blood cell count (WBC) (OR = 1.25, 95%CI: 1.02-1.54), red blood cell count (RBC) (OR = 1.36, 95%CI: 1.10-1.69), urinary protein (U-PRO) (OR = 1.10, 95%CI: 1.02-1.19), urinary glucose (U-GLU) (OR = 1.44, 95%CI: 1.23-1.67), alanine aminotransferase (ALT) (OR = 1.71, 95%CI: 1.39-2.10), aspartate aminotransferase (AST) (OR = 1.22, 95%CI: 1.05-1.41), creatinine (Cr) (OR = 1.28, 95%CI: 1.16-1.42), uric acid (UA) (OR = 1.36, 95%CI: 1.22-1.51), total cholesterol (TC) (OR = 1.76, 95%CI: 1.59-1.95), triglycerides (TG) (OR = 2.63, 95%CI: 2.46-2.82), low-density lipoprotein cholesterol (LDL-C) (OR = 1.84, 95%CI: 1.60-2.11), high-density lipoprotein cholesterol (HDL-C) (OR = 10.99, 95%CI: 8.12-14.90), and fasting blood glucose (FBG) (OR = 1.89, 95%CI: 1.74-2.05) are associated with the risk of multimorbidity of chronic diseases (p < 0.05). Among these, lipid parameters demonstrated the strongest associations with multimorbidity risk, with low HDL-C showing an 11-fold increase and elevated TG a 2.63-fold increase.

Conclusion

This study found that the prevalence of multimorbidity among older adult individuals in this region reached 70.3%. Multiple biochemical indicators were significantly associated with multimorbidity, particularly lipid parameters (low HDL-C and elevated TG), glucose parameters (elevated FBG and positive U-GLU), liver function (elevated ALT), and hemoglobin levels. These findings provide important evidence for research on factors associated with multimorbidity in the older adult population.

Multicomponent rehabilitation to improve independence and functioning in elderly patients with common age-associated diseases: a scoping review

OBJECTIVE

Multicomponent rehabilitation (MR) could restore functioning in elderly patients after hospitalisation, even beyond geriatrics, but specific evidence seems lacking. This review mapped the evidence on MR in elderly patients following hospitalisation for age-related conditions regarding functioning-related outcomes.

DESIGN

Scoping review.

DATA SOURCES

PubMed, Cochrane Library, International Clinical Trials Registry Platform and ClinicalTrials.gov (searched through 24 June 2024).

ELIGIBILITY CRITERIA

We included randomised controlled trials (RCT) and controlled cohort studies (CCS) comparing centre-based MR with usual care (medical care excluding exercise training) in patients ≥75 years, hospitalised for age-related cardiac, neurological, oncological and orthopaedic diseases. MR was defined as exercise training and at least one additional component (eg, nutritional counselling), starting within 3 months after hospital discharge. RCTs and CCS were included from inception, without language restriction. Care dependency, physical function, health-related quality of life (HRQL) and activities of daily living (ADL) after ≥6 months follow-up were the outcomes of interest.

DATA EXTRACTION AND SYNTHESIS

Four reviewers independently screened titles, abstracts and full texts for inclusion and extracted data. MR components and the typology of outcome assessments used were mapped at the final data synthesis level.

RESULTS

Out of 20 409 records, nine studies were investigated in the final data synthesis. Throughout these studies, disease education was the most frequent MR component besides exercise training, while physical function, HRQL and ADL were commonly assessed outcomes. One RCT (cardiac rehabilitation, 80±0.3 years, MR/usual care n=24/23) fully met the inclusion criteria and reported improvements in physical function (2 months) and in HRQL (2, 8, 14 months post intervention) in MR patients.

CONCLUSIONS

Evidence on MR regarding functioning-related outcomes in ≥75-year-old patients is sparse beyond geriatrics. There is an essential need for studies investigating the capabilities of MR in this growing and under-represented patient population.

TRIAL REGISTRATION NUMBER

OSF (https://doi.org/10.17605/OSF.IO/GFK5C).

Association between internet use and depression among the middle-aged and elderly adults with multimorbidity in China: do gender differences exist?

Objectives

Internet use and the results of mental health are related. Numbers of studies presented the association between Internet use and depression, and the middle-aged and elderly adults with multimorbidity are of concern. The study aimed to explore the relationship between Internet use and depression in middle-aged and elderly adults with multimorbidity.

Methods

We selected 2550 respondents aged 45 years and above with multimorbidity from the China Health and Retirement Longitudinal Study (CHARLS) 2018 database. Logistic regression models were constructed to examine the effects of Internet use on depression, as well as comparing gender differences. Meanwhile, propensity score matching (PSM) was used to test the robustness of the results.

Results

Overall, 49.8% of respondents had a risk of developing depression, and 14.9% of the participants used the Internet. Internet use (OR = 0.66, P = 0.002), type of devices (one type: OR = 0.69, P = .011;≥2 types: OR = 0.53, P = 0.03), frequency of Internet use (regularly: OR = 0.67, P = 0.005) were all inversely associated with depression. Significant differences between genders were observed, Internet use was associated with a lower prevalence of depression among men, while the association was not statistically significant among women.

Conclusions

There is a significantly negative association between Internet use and depression in the middle-aged and elderly adults with multimorbidity in China, and this relationship varies across different genders. This suggests that Internet use may be a protective factor for depressive symptoms in the older population, offering a guideline for policymakers to develop specific strategies for different genders.

Large-scale audiometric phenotyping identifies distinct genes and pathways involved in hearing loss subtypes

Age-related hearing loss affects one-third of the population over 65 years. However, the diverse pathologies underlying these heterogenous phenotypes complicate genetic studies. To overcome challenges associated with accurate phenotyping for older adults with hearing loss, we applied computational phenotyping approaches based on audiometrically measured hearing loss. This novel phenotyping strategy uncovered distinct genetic variants associated with sensory and metabolic hearing loss. Sex-stratified analyses of these sexually dimorphic hearing loss phenotypes revealed a novel locus of relevance to sensory hearing loss in males, but not females. Enrichment analyses revealed that genes involved in frontotemporal dementia were implicated in metabolic hearing loss, while genes relating to sensory processing of sound by hair cells were implicated in sensory hearing loss. Our study has enhanced our understanding of these two distinct hearing loss phenotypes, representing the first step in the development of more precise treatments for these pathologically distinct hearing loss phenotypes.

Effects of population aging on quality of life and disease burden: a population-based study

BACKGROUND

As population aging intensifies, it becomes increasingly important to elucidate the casual relationship between aging and changes in population health. Therefore, our study proposed to develop a systematic attribution framework to comprehensively evaluate the health impacts of population aging.

METHODS

We used health-adjusted life expectancy (HALE) to measure quality of life and disability-adjusted life years (DALY) to quantify the burden of disease for the population of Guangzhou. The HALE and DALY projections were generated using both the Bayesian age-period-cohort models and the population prediction models. Changes in HALE and DALY between 2010-2020 and 2020-2030 were decomposed to isolate the effects of population aging. Three scenarios were analyzed  to examine the relative relationship between disease burden and population aging. In Scenarios 1 and 2, the disease burden rates in 2030 were assumed to  either remain at 2020 levels or follow historical trends. In Scenario 3, it was assumed that the absolute numbers of years of life lost (YLL) and years lived with disability (YLD) in 2030 would remain unchanged from the 2020 levels.

RESULTS

Between 2010 and 2020, 56.24% [69.73%] of the increase in male [female, values in brackets] HALE was attributable to the mortality effects in the population aged 60 and over, while - 3.74% [- 9.29%] was attributable to the disability effects. The increase in DALY caused by changes in age structure accounted for 72.01% [46.68%] of the total increase in DALY. From 2020 to 2030, 61.43% [69.05%] of the increase in HALE is projected to result from the mortality effects in the population aged 60 and over, while - 3.88% [4.73%] will be attributable to the disability effects. The increase in DALY due to changes in age structure is expected to account for 102.93% [100.99%] of the total increase in DALY. In Scenario 1, YLL are projected to increase by 45.0% [54.7%], and YLD by 31.8% [33.8%], compared to 2020. In Scenario 2, YLL in 2030 is expected to decrease by - 2.9% [- 1.3%], while YLD will increase by 12.7% [14.7%] compared to 2020. In Scenario 3, the expected YLL rates and YLD rates in 2030 would need to be reduced by 15.3% [15.4%] and 15.4% [15.6%], respectively, compared to 2020.

CONCLUSIONS

The disability effects among the elderly population hinder improvements in quality of life, while changes in age structure are the primary driver of disease burden accumulation. To mitigate the excess disease burden caused by population aging, it is essential to achieve a reduction of more than 15% in the disease burden by 2030 compared to 2020. Our proposed attribution framework evaluates the health impacts of population aging across two dimensions: quality of life and disease burden. This framework enables comparisons of these effects over time and across different regions.

Neurodegenerative Disorders in Criminal Offending and Cognitive Decline Among Aging Inmates

Dementia, including Alzheimer's disease (AD) and frontotemporal dementia (FTD), presents critical challenges for correctional systems, particularly as global populations age. AD, affecting 60-80% of dementia cases, primarily impairs memory and cognition in individuals over 65. In contrast, FTD, rarer than AD but not uncommon in those under 65, affects the frontal and temporal brain regions, leading to deficits in social behavior, language, and impulse control, often resulting in antisocial actions and legal consequences. Behavioral variant FTD is especially associated with socially inappropriate and impulsive behaviors due to frontal lobe degeneration. The prevalence of cognitive impairment in incarcerated populations is high, exacerbated by prison environments that compound distress and limited access to specialized healthcare. Studies indicate that up to 11% of United States state prison inmates over the age of 55 exhibit cognitive impairments, often undiagnosed, resulting in punitive rather than rehabilitative responses to symptoms like disinhibition and aggression. Ethical concerns around criminal responsibility for individuals with dementia are increasingly prominent, particularly regarding their ability to comprehend and engage in legal proceedings. The growing elderly prison population necessitates reform in correctional healthcare to include early cognitive assessment, targeted intervention, and tailored post-release programs. Addressing these needs is essential to ensure appropriate treatments, alleviate healthcare demands, and support reintegration for cognitively impaired inmates.

Age-period-cohort analysis of gallbladder and biliary diseases epidemiological trends from 1990 to 2021 and forecasts for 2035: a systematic analysis from the global burden of disease study 2021

BACKGROUND

Gallbladder and biliary diseases (GABD) represent prevalent disorders of the digestive system.

METHODS

Data on age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate (ASDR) were extracted from the Global Burden of Disease (GBD) 2021 study. The estimated annual percentage change (EAPC) was utilized to quantify temporal trends in GABD. Age-period-cohort analysis was conducted to determine the effects attributable to age, period, and birth cohort. Additionally, we projected global trends to 2035.

RESULTS

Globally, GABD incident cases, mortality cases, and DALYs increased by 60.11%, 71.71%, and 56.90%, respectively. However, all corresponding age-standardized rates (ASRs) demonstrated overall downward trends with estimated annual percentage changes (EAPC) of -0.32 (-0.38 to -0.26), -0.95 (-1.08 to -0.83), and - 0.69 (-0.74 to -0.65), respectively. The number of incident cases was higher in females than in males across all age groups. The age effect indicated that older individuals had higher age-specific incidence and death rates. Both period and cohort effects showed declining risk across incidence and mortality. The ASIR and ASMR of GABD are projected to continue decreasing over the next 15 years.

CONCLUSION

GABD continue to pose a significant global public health challenge, particularly affecting women and the elderly population. Consequently, the implementation of effective interventions to mitigate the GABD burden is of paramount importance.

Threshold effects of sleep duration and cognitive function in older adults with BMI ≥ 25 kg/m2

Background

It has been demonstrated that older adults' cognitive capacities can be improved with sleep duration. However, the relationship between overweight, obesity, and cognitive decline remains a subject of debate. The impact of sleep duration on cognitive performance in seniors with a body mass index (BMI) ≥ 25 kg/m2 is largely unknown. This makes it an intriguing subject to explore further.

Methods

This study used data from the National Health and Nutrition Examination Survey (NHANES) (2011-2014) with 2,243 participants. Weighted multivariate linear regression and smooth curve fitting were employed to investigate linear and non-linear relationships. A two-part linear regression model was used to determine the threshold effects. Additionally, subgroup analysis and interaction tests were conducted.

Results

Results showed that a negative association was found between sleep duration and scores in the fully adjusted model in the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) test, the Animal Fluency test (AFT), and the Digit Symbol Substitution test (DSST). A two-piecewise linear regression model was then applied to explore the threshold effect of sleep duration on cognitive performance. When sleep duration was less than 5 and 6 h per day, sleep duration was positively correlated with CERAD test scores [ß (95% CI): 2.11 (1.17, 3.05), p < 0.0001], AFT scores [β (95% CI): 0.25 (-0.17, 0.67), p = 0.2376], and DSST scores [ß (95% CI): 0.49 (-0.57, 1.56), p = 0.3654]. However, there was a threshold effect where sleep duration reached the three inflection points.

Conclusion

In overweight and obese older adults, there is a clear inverted U-shaped relationship between sleep duration and cognitive function, with consistent results across different subgroups. Sleep durations of around 5-6 h may help prevent cognitive decline in older adults with a BMI ≥ 25 kg/m2.

Predictors and prognosis of elderly hip fracture patients with perioperative atrial fibrillation: a nested case-control study

BACKGROUND

A scarcity of data exists concerning atrial fibrillation (AF) during the perioperative stage of non-cardiothoracic surgery, particularly orthopedic surgery. In addition, given the frequency and significant impact of AF in the perioperative period, therefore our aim was to identify prognosis and predictors of elderly hip fracture patients with perioperative AF.

METHODS

An examination of hip fracture patients at the Third Hospital of Hebei Medical University, who had been hospitalized from January 2018 to October 2020 in succession, was conducted retrospectively. To determine independent risk factors for paroxysmal AF in elderly hip fracture patients, univariate and multivariate logistic regression analysis were employed. The Kaplan-Meier survival curve demonstrated the correlation between all-cause mortality in the non-AF, paroxysmal AF, and permanent AF groups. An assessment of the correlation between baseline factors, complications, and all-cause mortality was conducted through univariable and multivariable Cox proportional hazards analysis.

RESULTS

Enrolling 1,376 elderly patients with hip fractures, we found 1,189 in the non-AF group, 103 in the paroxysmal AF group, and 84 in the permanent AF group. Kaplan-Meier survival curves revealed a significantly lower overall survival rate in elderly hip fracture patients with AF, especially permanent AF. Based on COX regression analysis, we found that the main risk factors for all-cause death in elderly hip fracture patients with AF were concomitant pulmonary infection(HR 2.006,95%CI 1.019-3.949, P = 0.044), hyponatremia(HR 2.417,95%CI 1.177-4.961, P = 0.016), permanent AF(HR 2.806, 95%CI 1.036-4.198, P = 0.039). Independent risk factors for perioperative paroxysmal AF in elderly hip fracture patients were hypertension(OR 2.248, 95% CI 1.415-3.571, P = 0.001), COPD(OR 4.694, 95% CI 2.207-9.980, P < 0.001) and ACCI(OR 1.436, 95%CI 1.072-1.924, P = 0.015).

CONCLUSIONS

The mortality risk is high in elderly patients with hip fractures combined with AF. The independent risk factors for their death include permanent AF, pulmonary infection and hyponatremia. The independent risk factors for perioperative paroxysmal AF in elderly patients with hip fractures are ACCI, hypertension and COPD. we should identify risk factors and optimize the treatment plan at an early stage.

Arthroscopic debridement followed by intra-articular injection of micro-fragmented adipose tissue in patients affected by knee osteoarthritis: Clinical results up to 48 months from a prospective clinical study

Purpose

Micro-fragmented adipose tissue is emerging as a promising option for the treatment of various diseases including knee osteoarthritis (OA), though clinical trials are often limited by short follow-up periods. Our aim was to evaluate the safety and clinical outcomes of an arthroscopic debridement followed by a single injection of micro-fragmented adipose tissue in patients affected by knee OA.

Methods

From 2016 to 2020, patients affected by knee OA were enroled. Micro-fragmented adipose tissue was obtained through the Lipogems® kit and intraarticularly injected after an arthroscopic debridement. Visual analogue scale for pain, Tegner score, Knee Injury and Osteoarthritis Outcome score subscales variations were assessed from baseline to 3, 6, 12, 24 and 48 months of follow-up.

Results

Forty-one patients were evaluated up to 6 months of follow-up, 39 patients up to 24 months of follow-up and 38 patients up to 48 months of follow-up. Three underwent knee replacement surgery during the time of the study. All the clinical scores analyzed achieved statistically significant changes up to the last follow-up.

Conclusions

A single intra-articular knee injection of micro-fragmented adipose tissue following arthroscopic debridement is able to provide significant clinical benefits in patients affected by knee OA up to 4 years of follow-up.The present clinical study was registered on clinicaltrials.gov (no. NCT06545266).

Level of Evidence

Level IV case series.

Prevalence and determinants of heart disease in Somaliland: An analysis of the 2020 Somaliland demographic and health survey (SLDHS)

BACKGROUND

Cardiovascular diseases (CVDs) are a leading cause of death globally, particularly in low- and middle-income countries. While data on heart disease prevalence in Somaliland is limited, the 2020 Somaliland Demographic and Health Survey (SLDHS) provides a valuable opportunity to assess this critical public health issue.

METHODS

This study analyzed data from the 2020 SLDHS, a nationally representative cross-sectional survey. We included 18,930 individuals after data cleaning and variable selection. Heart disease was the outcome variable, while demographic and socioeconomic factors, including age, sex, region, residence, wealth, tobacco use, diabetes, and hypertension, were analyzed as predictors using STATA version 17.

RESULTS

The prevalence of heart disease in Somaliland was 0.7 % (95 % CI [0.6 %, 0.9 %]). Significant associations were observed with: Sool region (AOR 1.86-6.821, p = 0.000), female sex (AOR 1.086-2.508, p = 0.019), older age groups (AOR 1.182-9.621, 1.073-11.247, 1.899-19.504 and 4.126-38.282, p = 0.023, 0.038, 0.002, 0.000 respectively), rural residence (AOR 1.025-2.198, p = 0.037), tobacco use, diabetes, and hypertension.

CONCLUSION

This study highlights the importance of regional disparities, gender differences, and the impact of modifiable risk factors like tobacco use, diabetes, and hypertension in influencing heart disease prevalence in Somaliland. These findings emphasize the need for targeted interventions and public health strategies to address these factors and improve cardiovascular health outcomes in the region.

Effects of a 12-week digital training equipment program on cognitive function and mental health in older women: a randomized controlled trial

Objective

Combined interventions of physical activity and cognitive training have been shown to effectively enhance physical and mental factors in older adults. Digital-based tools offer various social advantages and may be more effective in improving the physical and mental well-being of older adults. As digital health content can simultaneously provide physical activity and cognitive training, this study aims to investigate the effects of a digital-based physical and cognitive training program on the physical and mental health of older women and to explore the potential of digital tools for older adults.

Methods

The participants, older women, engaged in the program three times a week for 12 weeks, with each session lasting 30 minutes (10 minutes for each of the three components). The content included digital health tools such as VR, motion tracking, and touchscreens designed for cognitive and physical fitness. Measurements were taken one week before and after the intervention for both groups, assessing body composition, cognitive function, depression, and quality of life.

Results

Data from 36 participants were analyzed. Interaction effects were observed in body fat mass (P = .011) and body fat percentage (P = .01), with improvements noted in the digital intervention group. Cognitive function (P = .017) and depression (P = .017) also showed significant improvements in the digital intervention group. Quality of life subdomains, including Physical Function (P = .009), Limitation of Physical Function (P = .004), and Pain (P = .002), demonstrated significant interaction effects, though no interaction effects were found in other subdomains.

Conclusion

This study found that digital-based combined interventions did not significantly impact body comb position but did improve cognitive function and depression in older women. These findings suggest that digital tools can be effectively utilized for the comprehensive management of cognitive function and mental health well-being. Such insights contribute to promoting healthy aging and provide an efficient method for managing the mental and physical health of older adults.

A global analysis of adaptation to societal aging across low-, middle- and high-income countries using the Global Aging Society Index

We have previously presented a multidimensional Aging Society Index, a weighted summation of five domains central to successful adaptation to societal aging: well-being, productivity and engagement, equity, cohesion and security, as a tool to assess countries' adaptation to demographic transformation. As the index was based on data from developed countries and some of the individual metrics or weightings may not be well suited for application to low- and middle-income countries, we here present the scores on a modified index (Global Aging Society Index) on 143 countries distributed across the span of economic development. Only 5 out of 143 (3.5%) countries had higher scores for women than men. Countries with the most notable gender differences were primarily low-income countries. The multidimensional index permits cross-national comparisons and may facilitate the identification of targets for developing policies and programs to enhance the likelihood that older persons will age successfully.

Impact of dementia and mild cognitive impairment on bone health in older people

Mild cognitive impairment, dementia and osteoporosis are common diseases of ageing and, with the increasingly ageing global population, are increasing in prevalence. These conditions are closely associated, with shared risk factors, common underlying biological mechanisms and potential direct causal pathways. In this review, the epidemiological and mechanistic links between mild cognitive impairment, dementia and skeletal health are explored. Discussion will focus on how changes in brain and bone signalling can underly associations between these conditions, and will consider the molecular and cellular drivers in the context of inflammation and the gut microbiome. There is a complex interplay between nutritional changes, which may precede or follow the onset of mild cognitive impairment (MCI) or dementia, and bone health. Polypharmacy is common in patients with MCI or dementia, and there are difficult prescribing decisions to be made due to the elevated risk of falls associated with many drugs used for associated problems, which can consequently increase fracture risk. Some medications prescribed for cognitive impairment may directly impact bone health. In addition, patients may have difficulty remembering medication without assistance, meaning that osteoporosis drugs may be prescribed but not taken. Cognitive impairment may be improved or delayed by physical activity and exercise, and there is evidence for the additional benefits of physical activity on falls and fractures. Research gaps and priorities with the aim of reducing the burden of osteoporosis and fractures in people with MCI or dementia will also be discussed.

Four-way decomposition of the effects of nutrient supplement and physical exercise on depression among older Chinese: a nationwide cross-sectional analysis

BACKGROUND

Studies on the associations between nutrient supplement, physical exercise, and depression among persons 65 years and older in China are still lacking. We aimed to investigate the association between nutrient supplement and depression and to explore the role of physical exercise in this association.

METHODS

A total of 8,427 older Chinese adults from the Chinese Longitudinal Healthy Longevity Survey were included in this study. The Center for Epidemiologic Studies Depression Scale was used to assess participants' depression, and nutrient supplement and physical exercise were evaluated using self-reports. Linear regression and logistic regression were performed to explore the association between nutrient supplement and depression, and a four-way decomposition method was used to explore the effects of nutrient supplement and physical exercise on depression.

RESULTS

A total of 26.2% of participants suffered from depression. Prior to decomposition, multivariable linear regression and logistic regression models showed that older adults who received nutrient supplement had lower depression score (β: -0.704; 95% confidence interval [CI]: -1.004, -0.404) and a lower risk of depression (odds ratio: 0.710; 95% CI: 0.564, 0.894), especially for calcium and multivitamins. Four-way decomposition analysis suggested that physical exercise mediated the associations between nutrient (protein, calcium, iron, zinc, multivitamins, vitamin A/D, docosahexaenoic acid, and others) supplement and depression (all P < 0.05).

CONCLUSIONS

Calcium or multivitamin supplements were associated with inverse depression, and the reason why this association existed could be partly explained by the mediating effect of physical exercise.

Virtual Care Appointments and Experience Among Older Rural Patients with Chronic Conditions in New South Wales: An Analysis of Existing Survey Data

This retrospective, descriptive study, conducted in 2024, analysed Virtual Care Survey (2020-2022) data of patients' self-reported reflections on use and experiences to investigate relationships between demographics, the number of chronic conditions, and virtual care use among older rural patients (≥65 years with at least one chronic condition) living in New South Wales, and their satisfaction with virtual care. Associations between categorical variables were assessed using chi-squared tests, and Kruskal-Wallis tests were used for continuous variables. Qualitative feedback was analysed thematically. The study included 264 patients (median age 74 years; 51.1% women). Most virtual care appointments (65.3%) were for consultations, check-ups, or review of test results. Over one-third (38.3%) of the patients had multimorbidity and were 1.8 times more likely to have five or more virtual care appointments compared to the patients with one chronic condition. The oldest age group (≥80 years) preferred telephone over online mediums (Skype or Zoom) (p < 0.05). Patient satisfaction was high (65.8%), with 60.9% finding virtual care comparable to in-person consultations. Technological issues correlated with more negative experiences (p < 0.05). Key themes were enhanced accessibility and convenience, quality and safety of virtual care, and recommendations for equitable access. Despite positive responses, addressing technological complexities is important for optimising virtual care models for older rural Australians with chronic conditions.

Olfactory deficits in aging and Alzheimer's-spotlight on inhibitory interneurons

Cognitive function in healthy aging and neurodegenerative diseases like Alzheimer's disease (AD) correlates to olfactory performance. Aging and disease progression both show marked olfactory deficits in humans and rodents. As a clear understanding of what causes olfactory deficits is still missing, research on this topic is paramount to diagnostics and early intervention therapy. A recent development of this research is focusing on GABAergic interneurons. Both aging and AD show a change in excitation/inhibition balance, indicating reduced inhibitory network functions. In the olfactory system, inhibition has an especially prominent role in processing information, as the olfactory bulb (OB), the first relay station of olfactory information in the brain, contains an unusually high number of inhibitory interneurons. This review summarizes the current knowledge on inhibitory interneurons at the level of the OB and the primary olfactory cortices to gain an overview of how these neurons might influence olfactory behavior. We also compare changes in interneuron composition in different olfactory brain areas between healthy aging and AD as the most common neurodegenerative disease. We find that pathophysiological changes in olfactory areas mirror findings from hippocampal and cortical regions that describe a marked cell loss for GABAergic interneurons in AD but not aging. Rather than differences in brain areas, differences in vulnerability were shown for different interneuron populations through all olfactory regions, with somatostatin-positive cells most strongly affected.

Active social participation extends the healthy life expectancy of older men without spouses in Japan: The Yamanashi healthy active life expectancy cohort study

This study aimed to evaluate the association between family structure and healthy life expectancy among older Japanese adults, hypothesizing that social participation increases healthy life expectancy more in older men without a spouse than in older women. This study collected data on Healthy Life Expectancy from 541 older adults between 2003 and 2021 from the Healthy Life Expectancy Study, a cohort study of older adults in Yamanashi Prefecture, Japan. The Japanese long-term care insurance system serves as an indicator of a healthy life expectancy. The family structures of participants were categorized as living alone, with a spouse, and with non-spouse cohabitants, whereas social activity frequency was classified as low or high (Community participation was assessed using a 4-point scale: "often," "sometimes," "rarely," and "never."). Cox proportional-hazards regression was used to analyze the relationship between participant characteristics and the loss of healthy life expectancy. Each additional year of age for older men and women increases the risk of loss of healthy life expectancy by 13% and 16%, respectively. The risk of loss of healthy life expectancy was higher among older men who lived alone or lived with non-spouse cohabitants than older living with a spouse (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.01-3.75; hazard ratio: 1.66, 95% confidence interval: 1.05-2.64, respectively). However, older men living without a spouse and engaging in high social activity participation had a lower risk of loss of healthy life expectancy than did those with low social activity participation (hazard ratio: 0.35, 95% confidence interval: 0.17-0.71). In conclusion, older men living without a spouse with high social activity participation had longer healthy life expectancies than those living alone with low social activity participation did.

Neighborhood social environment and mental health of older adults in China: the mediating role of subjective well-being and the moderating role of green space

Introduction

With the continuous development of the global aging trend, the mental health of older adults has been a concern by the world. The living space of older adults is limited due to the decline of their activity function. Neighborhood environment, especially the neighborhood social environment, has become an important factor affecting the mental health of older adults. Therefore, this study explores the mechanism that influences the social environment of the neighborhood and the mental health of older adults, the mediating effect of subjective well-being (SWB), and the moderating effect of green space.

Methods

Based on the 2018 China Labor Dynamics Survey, this study used the structural equation model to explore the mediating effect of neighborhood social environment (neighborhood ties, social trust, community security) on the mental health of older adults through SWB and the moderating effect of green space.

Results

Social trust and community security are both directly and positively associated with older adults' mental health. At the same time, neighborhood ties, social trust, and community security can promote the mental health of older adults by positively affecting SWB, while green space has an enhanced moderating effect between neighborhood ties and mental health.

Discussion

This study enriches the empirical research on neighborhood social environment and mental health. First of all, older adults living in communities with good safety conditions and high social trust are less affected by negative emotions and tend to have good mental health. Second, deeper neighborhood ties, higher social trust, and safer community environments help older adults to be less disturbed by negative situations, have a positive effect on their SWB, and indirectly promote mental health. At the same time, green space can provide a place for older adults to socialize, enhance the positive impact of neighborhood ties on SWB, and further promote the mental health of older adults. Finally, this study suggests that the government and community managers pay attention to the construction of neighborhood social environment and green space, and provide support for "healthy community" and "healthy aging" planning.

Relationship Between Internet Use and Cognitive Function Among Middle-Aged and Older Chinese Adults: 5-Year Longitudinal Study

BACKGROUND

Cognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the older adult population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet use among middle-aged and older adults.

OBJECTIVE

This study aims to explore the association between internet use and age-related cognitive decline among middle-aged and older Chinese adults. To gain a more comprehensive understanding of the effects of internet use, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet use on cognitive function for characteristics significantly linked to cognition in stratified analysis.

METHODS

We analyzed data based on 12,770 dementia-free participants aged ≥45 years from the China Health and Retirement Longitudinal Study. We used a fixed effects model to assess the relationship between internet use and cognitive decline and further validated it using multiple linear regression analysis, generalized estimating equations, propensity score matching, inverse probability of treatment weighting, and overlap weighting. We further examined the varying effects of internet device type and frequency on cognitive function using fixed effects models and Spearman rank correlations. The Karlson-Holm-Breen method was used to estimate the mediating role of internet use in the urban-rural cognitive gap.

RESULTS

Participants using the internet (n=1005) were younger, more likely to be male, more educated, married, retired and living in an urban area and had higher cognitive assessment scores than nonusers (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function (β=0.551, 95% CI 0.391-0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases, at 2.2% (15/671), compared with nonusers, at 5.3% (379/7099; P<.001). The negative impact of aging (>50 years) on cognitive function was consistently less pronounced among internet users than among nonusers. Furthermore, increased frequency of internet use was associated with greater cognitive benefits for middle-aged and older adults (rs=0.378, P<.001). Among digital devices used for internet access, cell phones (β=0.398, 95% CI 0.283-0.495) seemed to have a higher level of cognitive protection than computers (β=0.147, 95% CI 0.091-0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2% of the total effect, P<.001).

CONCLUSIONS

This study revealed that the use of internet by individuals aged 45 years and older is associated with a reduced risk of cognitive decline. Internet use has the potential to be a viable, cost-effective, nonpharmacological intervention for cognitive decline among middle-aged and older adults.