Ageing, genes, environment and epigenetics: what twin studies tell us now, and in the future

Treatment Adherence and Health-Related Quality of Life Among Patients with Hypertension at Tertiary Healthcare Facility in Lalitpur, Nepal: A Cross-Sectional Study

Background

Measurement of medication adherence and health-related quality of life is extremely important when planning different health policies. Drug therapy and adherence to medication are critical to prevent complications of hypertension, especially in countries like Nepal, where hypertension is one of the most prevalent diseases. However, this has not been studied in Nepal. This study, hence, aimed to explore medication adherence, factors affecting medication adherence, health-related quality of life, and the correlation between medication adherence and health-related quality of life in hypertensive patients visiting tertiary care health facilities in Lalitpur district of Nepal.

Methodology

This quantitative cross-sectional study was conducted among 380 hypertensive patients at KIST Medical College and Teaching Hospital, Lalitpur, Nepal. The Nepali version of the European Quality of Life tool EQ-5D-5L and the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBCTS) were used. Intergroup differences in medication adherence, the EQ-5D index and EQ-VAS scores were assessed for statistical significance using either the Mann-Whitney or Kruskal-Wallis tests for numerical data. Spearman correlation coefficient was used to identify the relationship among medication adherence, EQ-5D-5L index values, and EQ-VAS scores.

Results

The mean treatment score was 22.43 ± 4.12. Age, sex, and occupation were significant factors that affected treatment adherence. The EQ-5D score was 0.72 with age, sex, income, and educational status as significant factors and marital status as an insignificant factor. A slightly negative correlation was found between the total treatment adherence score and the EQ-5D index.

Conclusion

The treatment adherence of patients to antihypertensive therapy was suboptimal, which could affect the outcome of therapy. Better treatment adherence was correlated with a better health-related quality of life. Hence, both health-care providers and patients should make efforts to increase treatment adherence to attain better HRQOL.

Gerontology and Geriatrics in Undergraduate Nursing Education in Portugal and Spain: An Integrative and Comparative Curriculum Review

Nurses play a critical role in caring for elderly patients; however, the emphasis on aging care in undergraduate programs may be insufficient. The present study aims at identifying the relevance given to theoretical and/or practical gerontological and geriatric contents in undergraduate study plans in Portugal and Spain. Presenting a two-part investigation, an integrative review approach examines nursing education on a global scale and a comparative analysis, using Bereday's comparative method, to assess the nursing curricula between Portugal and Spain. The search found 117 documents, with 16 being included. Studies covered diverse educational practices in geriatric and gerontological nursing, emphasizing curriculum development, faculty expertise, practical training, attitudes towards elderly care, and future directions. The comparative analysis of nursing curricula revealed that Portugal places a priority on building foundational theoretical knowledge in the first year and then gradually integrating practical training. In contrast, Spain emphasizes an extensive and integrated approach with a strong focus on practical skills and comprehensive assessments. Our research emphasizes the need to incorporate aging-focused education into nursing curricula and update the curriculum, providing hands-on training with early exposure to these environments. Additionally, simulation classes can enhance critical thinking by allowing students to experience aging effects firsthand.

Geographical accessibility of medical resources, health status, and demand of integrated care for older people: a cross-sectional survey from Western China

BACKGROUND

The World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to help healthcare providers cope with the population aging crisis. However, the relevant evidence on the demands of older people and the compensatory capacity of the environment is limited. This study reports for the first time the level of the ICOPE demand in Western China that includes the impact of geographic accessibility of medical resources (GAMR) on ICOPE demand and the potential mechanism of health status.

METHODS

A cross-sectional questionnaire survey was conducted among 1200 adults aged 60 years and older selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demand, health status, and GAMR. Propensity score matching (PSM) was used to analyze the impact of GAMR on ICOPE demand among older people and those with different health statuses.

RESULTS

Among the prospective research participants, 1043 were eligible for the study. The mean score of ICOPE demand among all participants was 3.68 (standard deviation [SD] = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (average treatment effect on the treated [ATT] = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345, p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of older people with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01).

CONCLUSIONS

The older population in Western China has a relatively high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both older people with multimorbidity and self-perceptions of health.

Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines

Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

Daily activity patterns in older adults receiving initial support: the association between daily steps and sitting in bouts of at least 60 min

BACKGROUND

Aging has a significant impact on health, underlining the importance of maintaining physical function and reducing time spent sitting among older adults. To understand how to reduce prolonged sitting or increase physical activity, factors related to the daily living and observed daily activity patterns should be explored. This study aimed to investigate the association between daily steps, self-rated health, physical activity, sedentary behavior, motivation to exercise and fear of falling among older adults receiving initial support.

METHOD

Cross-sectional design with total population questionnaire data from adults aged ≥ 60 years (n = 917), living at home with initial support from municipal care in southern Sweden. The older adults were offered to participate in a follow-up study measuring daily activity patterns with accelerometers (n = 72). Linear regression was used to analyze associations between daily steps and possible predictors.

RESULTS

The linear model ([Formula: see text]0.478) showed that sitting in unbroken bouts of > 60 min (β = -0.313, p < 0.05), walking independently outdoors (β = 0.301, p < 0.05), intending to increase physical activity (β = -0.294, p < 0.05), sex (β = 0.279, p < 0.05), relative autonomy index (β = 0.258, p < 0.05), fear of falling (β = -0.238, p < 0.05), and self-rated health (β = 0.213, p < 0.05) predicted daily steps.

CONCLUSION

The model of predictors brings new understanding regarding daily steps among community-dwelling older adults. The association between sitting in bouts of > 60 min and daily steps is interesting as 35% of participants had a number of sitting bouts that on average, showed 30% less steps taken. Minimizing long sitting bouts and maintaining physical functioning to promote independence when walking outdoors can be tools for clinical practitioners devising interventions to break prolonged sitting among community-dwelling older adults. Future research should prioritize studying older adults' outdoor walking independence, including its relation to walking with or without assistive devices and its impact on physical activity and sedentary behavior.

Measuring functional ability in Healthy Ageing: testing its validity using Japanese nationwide longitudinal data

BACKGROUND

The United Nations Decade of Healthy Ageing 2021-2030 suggests nations should monitor functional ability as an indicator of healthy ageing progress. Functional ability is the attribute of people to do something they value and consists of five domains. We examined its validity in terms of a construct, cross-validation across multiple waves' data, and predictivity for subsequent well-being.

METHODS

Using panel data from 35,093 community-dwelling adults aged ≥65 years from the Japan Gerontological Evaluation Study, we performed factor analyses to explore the construct of functional ability domains in both 2013 and 2016. A modified Poisson regression analysis was employed to test their associations with well-being (subjective health and happiness) in 2019.

RESULTS

The mean age (standard deviation) of participants was 72.1 (5.0) years, and 52.0% were women. A total of 85.0% reported good subjective health, and 50.6% reported high happiness levels. Factor analyses with 31 logically checked candidate items from 2016 data suggested a three-factor model comprising 24 items, which were compatible with the 2013 data results. Based on the World Health Organization's original domains, we named domains as domain #1: ability to build and maintain relationships; domain #2: ability to meet basic needs + ability to move around and domain #3: ability to learn, grow and make decisions + ability to contribute. All three domains predicted both subjective health and happiness in 2019.

CONCLUSIONS

Empirical data from Japan supports the functional ability concept among older individuals. Validating this concept with data from other nations is warranted.

Protective Actions of Cannabidiol on Aging-Related Inflammation, Oxidative Stress and Apoptosis Alterations in Liver and Lung of Long Evans Rats

BACKGROUND

Aging is characterised by the progressive accumulation of oxidative damage which leads to inflammation and apoptosis in cells. This affects all tissues in the body causing the deterioration of several organs. Previous studies observed that cannabidiol (CBD) could extend lifespan and health span by its antioxidant, anti-inflammatory and autophagy properties. However, research on the anti-aging effect of CBD is still in the beginning stages. This study aimed to investigate the role of cannabidiol (CBD) in the prevention of age-related alterations in liver and lung using a murine model.

METHODS

15-month-old Long Evans rats were treated with 10 mg/kg b.w./day of CBD for 10 weeks and compared to animals of the same age as old control and 2-month-old animals as young control. Gene and/or protein expressions, by RT-qPCR and Western blotting, respectively, were assessed in terms of molecules related to oxidative stress (GST, GPx, GR and HO-1d), inflammation (NFκB, IL-1β and TNF-α) and apoptosis (BAX, Bcl-2, AIF, and CASP-1). In addition, MDA and MPO levels were measured by colorimetric assay. Results were analysed by ANOVA followed by Tukey-Kramer test, considering statistically significant a p < 0.05.

RESULTS

GST, GPx and GR expressions were significantly reduced (p < 0.01) in liver samples from old animals compared to young ones and CBD treatment was able to revert it. A significant increase was observed in old animals compared to young ones in relation to oxidative stress markers (MDA and HO-1d), proinflammatory molecules (NFκB, IL-1β and TNF-α), MPO levels and proapoptotic molecules (BAX, AIF and CASP-1), while no significant alterations were observed in the antiapoptotic molecules (Bcl-2). All these changes were more noticeable in the liver, while the lung seemed to be less affected. In almost all the measured parameters, CBD treatment was able to revert the alterations caused by age restoring the levels to those observed in the group of young animals.

CONCLUSIONS

Chronic treatment with CBD in 15-month-old rats showed beneficial effects in lung and more significantly in liver by reducing the levels of inflammatory, oxidative and apoptotic mediators, and hence the cell damage associated with these three processes inherent to aging.

Advanced Activities of Daily Living in Community-Dwelling Older Adults: A Cross-Sectional Study of the Mexican Health and Aging Study (MHAS 2018)

BACKGROUND

The advanced activities of daily living (AADLs) in old age is a key indicator of the mobility domain for the intrinsic capacity of older adults living in the community; for this reason, it is relevant to know the prevalence and risk factors related to performing fewer AADLs in different populations.

AIM

To determine the prevalence and factors associated with the ability to perform AADLs in older adults reported in the Mexican Study of Health and Aging (MSHA 2018).

METHODS

A secondary cross-sectional analysis of the MSHA 2018 data was carried out, including a convenience sample of 6474 subjects ≥ 60 years of age, for both sexes, without cognitive deficits. Nine questions related to AADLs were selected from the database. Multiple logistic regression analysis was performed to determine factors associated with <3 AADLs, including sociodemographic, lifestyle, and health status factors.

RESULTS

The prevalence of the ability to perform <3 AADLs was 63%. Age is the most important risk factor for <3 AADLs, which increases by the decade, followed by sedentary lifestyle (OR = 2.15, 95% CI: 1.91-2.42, p < 0.0001).

CONCLUSIONS

Our findings suggest that age, schooling, urban residence, sedentary lifestyle, and comorbidity are the main risk factors for <3 AADLs in older Mexican adults.

Comparison of mortality and hospitalizations of older adults living in residential care facilities versus nursing homes or the community. A systematic review

Residential care facility may provide a transition between living at home and a nursing home for dependent older people or an alternative to nursing homes. The objective of this review was to compare mortality and hospitalizations of older adults living in residential care facilities with those living in nursing homes or in the community. We searched Medline, Scopus and Web of Science from inception to December 2022. Fifteen cohort studies with 6 months to 10 years of follow-up were included. The unadjusted relative risk (RR) of mortality was superior in nursing homes than in residential care facilities in 6 of 7 studies (from 1.3 to 1.68). Conversely, the unadjusted relative risk of hospitalizations was higher in residential care facilities in 6 studies (from 1.3 to 3.37). Studies conducted on persons with dementia found mixed results, the only study adjusted for co-morbidities observing no difference on these two endpoints. Compared with home, unadjusted relative risks were higher in residential care facilities for mortality in 4 studies (from 1.34 à 10.1) and hospitalizations in 3 studies (from 1.12 to 1.62). Conversely, the only study that followed older adults initially living at home over a 10-year period found a reduced risk of heavy hospital use (RR = 0.68) for those who temporarily resided in a residential care facilities. There is insufficient evidence to determine whether residential care facilities might be an alternative to nursing homes for older people with similar clinical characteristics (co-morbidities and dementia). Nevertheless, given the high rate of hospitalizations observed in residential care facilities, the medical needs of residents should be better explored.

Patient-centered care and geriatric knowledge translation among healthcare providers in Vietnam: translation and validation of the patient-centered care measure

BACKGROUND

People are living longer, and the majority of aging people reside in low- and middle-income countries (LMICs). However, inappropriate healthcare contributes to health disparities between populations of aging people and leads to care dependency and social isolation. Tools to assess and evaluate the effectiveness of quality improvement interventions for geriatric care in LMICs are limited. The aim of this study was to provide a validated and culturally relevant instrument to assess patient-centered care in Vietnam, where the population of aging people is growing rapidly.

METHODS

The Patient-Centered Care (PCC) measure was translated from English to Vietnamese using forward-backward method. The PCC measure grouped activities into sub-domains of holistic, collaborative, and responsive care. A bilingual expert panel rated the cross-cultural relevance and translation equivalence of the instrument. We calculated Content Validity Indexing (CVI) scores at both the item (I-CVI) and scale (S-CVI/Ave) levels to evaluate the relevance of the Vietnamese PCC (VPCC) measure to geriatric care in the Vietnamese context. We piloted the translated instrument VPCC measure with 112 healthcare providers in Hanoi, Vietnam. Multiple logistic regression models were specified to test the a priori null hypothesis that geriatric knowledge is not different among healthcare providers with perception of high implementation compared with low implementation of PCC measures.

RESULTS

On the item level, all 20 questions had excellent validity ratings. The VPCC had excellent content validity (S-CVI/Ave of 0.96) and translation equivalence (TS- CVI/Ave of 0.94). In the pilot study, the highest-rated PCC elements were the holistic provision of information and collaborative care, while the lowest-rated elements were the holistic attendance to patients' needs and responsive care. Attention to the psychosocial needs of aging people and poor coordination of care within and beyond the health system were the lowest-rated PCC activities. After controlling for healthcare provider characteristics, the odds of the perception of high implementation of collaborative care were increased by 21% for each increase in geriatric knowledge score. We fail to reject the null hypotheses for holistic care, responsive care and PCC.

CONCLUSION

The VPCC is a validated instrument that may be utilized to systemically evaluate the practice of patient-centered geriatric care in Vietnam.

Home-care nursing controlled mobile robot with vital signal monitoring

This study describes the development (design, construction, instrumentation, and control) of a nursing mobile robotic device to monitor vital signals in home-cared patients. The proposed device measures electrocardiography potentials, oxygen saturation, skin temperature, and non-invasive arterial pressure of the patient. Additionally, the nursing robot can supply assistance in the gait cycle for people who require it. The robotic device's structural and mechanical components were built using 3D-printed techniques. The instrumentation includes electronic embedded devices and sensors to know the robot's relative position with respect to the patient. With this information together with the available physiological measurements, the robot can work in three different scenarios: (a) in the first one, a robust control strategy regulates the mobile robot operation, including the tracking of the patient under uncertain working scenarios leading to the selection of an appropriate sequence of movements; (b) the second one helps the patients, if they need it, to perform a controlled gait-cycle during outdoors and indoors excursions; and (c) the third one verifies the state of health of the users measuring their vital signs. A graphical user interface (GUI) collects, processes, and displays the information acquired by the bioelectrical amplifiers and signal processing systems. Moreover, it allows easy interaction between the nursing robot, the patients, and the physician. The proposed design has been tested with five volunteers showing efficient assistance for primary health care. Graphical Abstract Main stages of the home-care nursing controlled mobile robot.

A Unified Model of Cohort Mortality

We propose a dynamic production function of population health and mortality from birth onward. Our parsimonious model provides an excellent fit for the mortality and survival curves for primate and human populations since 1816. The model sheds light on the dynamics behind many phenomena documented in the literature. Simple extensions of the model can reproduce (1) the existence and evolution of mortality gradients across socioeconomic statuses documented in the literature, (2) nonmonotonic dynamic effects of in utero shocks, (3) persistent or scarring effects of wars, and (4) mortality displacement after large temporary shocks, such as extreme weather.

Socioeconomic inequality in health in older adults in Brazil

Objective

This study analyzed socioeconomic inequality in self-rated health for older adults (aged fifty or over) in Brazil.

Methods

Data from the 2015-2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). Socioeconomic inequality in self-rated health was measured using the concentration index, which was decomposed to analyze the contribution of different factors.

Results

This study revealed that 11.5% of the older adults interviewed reported their health as poor and very poor. For the complete sample, the estimated concentration index, -0.2434, indicated that there is a concentration of poor and very poor self-rated health among older and poorer adults. Income, education and having a private health insurance plan are the factors that contributed most to the observed inequality.

Discussion

The decomposition showed that there are avoidable inequalities in relation to socioeconomic status for older adults in Brazil. These factors can guide the formulation of social and health policies aimed at reducing health inequalities.

HIV and AIDS in Older Adults: Neuropsychiatric Changes

PURPOSE OF REVIEW

Patients diagnosed with HIV can now survive well into their old age. Aging with HIV is not only associated with comorbid medical illnesses but also with neuropsychiatric conditions that can range from cognitive changes to severe behavioral manifestations. This paper reviews mood, anxiety, and cognitive changes in older patients with HIV, as well as some of the treatment challenges in this population.

RECENT FINDINGS

Most recent findings show that untreated HIV illness over a long period of time may further worsen both preexisting neuropsychiatric illness and may cause new onset behavioral and cognitive symptoms. HIV induces immune phenotypic changes that have been compared to accelerated aging Low CD 4 counts and high viral counts are indicative of poor prognosis. Evaluation for potential HIV infections may be overlooked in older adults and require screening. Older adults experience accelerated CD4 cell loss. Older adults endorsing new onset mood or cognitive changes must be screened for HIV infection. New onset neurobehavioral symptoms should be carefully screened for and treated simultaneously in patients with HIV infection.

Creative dance associated with traditional Portuguese singing as a strategy for active aging: a comparative cross-sectional study

BACKGROUND

Multimodal forms of exercise can influence several physical and mental factors important for successful aging. In the present study, we introduce a new type of multimodal intervention, combining movement (creative dance) with traditional singing. This study aims to compare physical fitness, functional physical independence, depressive symptoms, general cognitive status, and daytime sleepiness among older adults participating in multimodal exercise, those participating in traditional physical exercise, and those not actively engaged in physical exercise.

METHODS

This cross-sectional study included 112 people aged ≥ 65 years (75.3 ± 0.7 years) living independently in the community, divided into 3 groups: multimodal exercise (n = 34), traditional exercise (n = 41), and no physical exercise (n = 37).

RESULTS

The multimodal exercise group showed greater flexibility of the lower limbs and upper limbs/shoulders and better general cognitive status than the traditional exercise group (p < 0.05). The traditional exercise group had better agility and dynamic balance, aerobic endurance, and strength of the lower and upper limbs than the no-exercise group (p < 0.05).

CONCLUSIONS

The results suggest that the two types of programs studied may have different impacts on some of the variables investigated and support the design of future experimental studies that include interventions based on the combination of creative dance and traditional Portuguese singing.

Effects of polyphenols in aging and neurodegeneration associated with oxidative stress

Aging is defined as the functional loss of tissues and organs over time. This is a biological, irreversible, progressive, and universal process that results from genetic and environmental factors, such as diet, physical activity, smoking, harmful alcohol consumption, and exposure to toxins, among others. Aging is a consequence of molecular and cellular damage built up over time. This damage begins with a gradual decrease in physical and mental capacity, thus increasing the risk of neurodegenerative diseases such as Alzheimer's and Parkinson's disease. Neuronal, functional, and structural damage can be explained by an imbalance among free radicals, reactive oxygen species, reactive nitrogen species, and antioxidants, which finally lead to oxidative stress. Due to the key role of free radicals, reactive oxygen species, and reactive nitrogen species, antioxidant therapy may reduce the oxidative damage associated with neurodegeneration. Exogenous antioxidants are molecules that may help maintain the balance between the formation and elimination of free radicals, thus protecting the cell from their toxicity. Among them, polyphenols are a broad group of secondary plant metabolites with potent antioxidant properties. Here, we review several studies that show the potential role of polyphenol consumption to prevent, or slow down, harmful oxidative processes linked to neurodegenerative disorders.

Transitions of disability, disability-free life expectancy and health insurance among adults aged 50 and older in Mexico: a multistate life table analysis

OBJECTIVES

To analyse the transitions of disability onset and recovery, estimate life expectancy (LE) with and without disability and explore the relation between insurance and disability patterns in the population aged 50+ in Mexico.

DESIGN

Multistate life table analysis of data from a longitudinal cohort survey.

SETTING

Data came from the Mexican Health and Aging Study, a longitudinal and representative survey of older adults in Mexico.

PARTICIPANTS

10 651 individuals aged 50+ interviewed in 2012 and 2015, including those who died between waves.

PRIMARY AND SECONDARY OUTCOME MEASURES

Disability is measured using the activities of daily living (ADL) scale. Transition rates between disability free, ADL disabled and death were employed to estimate total life expectancy (TLE) and disability-free life expectancy (DFLE).

RESULTS

46% of the individuals who reported an ADL limitation in 2012 recover from disability by 2015. TLE at age 60 for people without ADL limitations is 30 years (95% CI 28.9 to 31), out of which 4.7 years (95% CI 4.1 to 5.4) are lived with ADL limitations, while TLE at age 60 in the initially disabled is 18.7 years (95% CI 17.3 to 20), with 9.4 years (95% CI 8.4 to 10.3) lived with disability. DFLE at age 60 in people with social security is 24.2 years (95% CI 23.3 to 25.2), in people with public insurance is 24.6 years (95% CI 23.7 to 25.4) and in uninsured people is 26.9 years (95% CI 25.9 to 27.9).

CONCLUSIONS

In Mexico, a substantial proportion of ADL disabled individuals recover from disability. Nevertheless, initially disabled individuals have a considerably lower DFLE regardless of age when compared with initially active individuals. There appeared to be no differences in terms of disability and LEs between the individuals with social security and public insurance.

Effect of peri-implant disease on oral health-related quality of life in geriatric patients

OBJECTIVE

This study aimed to evaluate the effect of peri-implant disease on the quality of life in geriatric patients using implant-supported overdentures.

BACKGROUND

Peri-implant disease and bone loss are two main complications of dental implant treatment that can impact the quality of life in the geriatric population.

MATERIALS AND METHODS

This cross-sectional study included 109 geriatric individuals treated in the prosthodontics and periodontology departments. On clinical examination, periodontal pocket depth, gingival index (GI) and plaque index (PIn) were measured to determine peri-implant status. Marginal bone loss was measured by radiological examination, using ImageJ software. Moreover, the Oral Healthy Impact Profile-14 (OHIP-14) questionnaire was used to evaluate participants' perceived oral health-related quality of life.

RESULTS

Peri-implantitis (PI) and peri-implant mucositis (PM) prevalence were 30% and 24%, respectively. Only 44% of patients had healthy implants. Although total OHIP-14 scores were higher in the PI group than in the healthy and PM groups, this difference was not statistically significant (P = .148). Total OHIP-14 score was significantly correlated with PIn and GI.

CONCLUSIONS

Within the limitations of this study, it can be said that on quality of life in patients using implant-supported overdenture related to clinical parameters such as PIn and GI. Results also indicated that geriatric patients should take action to improve their oral health. Further longitudinal studies are needed to support our results and should include control groups that use conventional removable dentures.

Regional Diets Targeting Gut Microbial Dynamics to Support Prolonged Healthspan

In the last 150 years, we have seen a significant increase in average life expectancy, associated with a shift from infectious to non-communicable diseases. The rising incidence of these diseases, for which age is often the largest risk factor, highlights the need for contemporary societies to improve healthy ageing for their growing silver generations. As ageing is an inevitable, non-reversing and highly individualised process, we need to better understand how non-genetic factors like diet choices and commensal gut microbes can modulate the biology of ageing. In this review, we discuss how geographical and ethnic variations influence habitual dietary patterns, nutrient structure, and gut microbial profiles with potential impact on the human healthspan. Several gut microbial genera have been associated with healthy elderly populations but are highly variable across populations. It seems unlikely that a universal pro-longevity gut microbiome exists. Rather, the optimal microbiome appears to be conditional on the microbial functionality acting on regional- and ethnicity-specific trends driven by cultural food context. We also highlight dietary and microbial factors that have been observed to elicit individual and clustered biological responses. Finally, we identify next generation avenues to modify otherwise fixed host functions and the individual ageing trajectory by manipulating the malleable gut microbiome with regionally adapted, personalised food intervention regimens targeted at prolonging human healthspan.

Association Between Disability Trajectory and Health Care Service Utilization Among Older Adults in China

OBJECTIVES

This study aimed to identify the heterogeneous disability trajectories among older Chinese adults and examine the association between disability trajectories and health care service utilization.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

A community-based study including older adults aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey.

METHODS

Disability was assessed by the difficulties in activities of daily living and instrumental activities of daily living between 2002 and 2018. Health care utilization was measured by the expenditures on outpatient and inpatient services in 2018. Growth mixture modeling was conducted to estimate heterogeneous disability trajectories. A 2-part model was used to analyze the association of disability trajectories and health care utilization. Covariates were included based on Andersen's behavioral model.

RESULTS

Three classes of disability trajectories were identified: the progressive (7.9%), late-onset (13.7%), and normal classes (78.4%). Older adults who followed the late-onset trajectory of disability were more likely to use inpatient services compared with the normal class (odds ratio = 1.47, P < .010), after controlling potential confounders. Compared with the normal class, the progressive class on average spent US$145.94 more annually (45.2% higher) on outpatient services (P < .010) and $738.99 more annually (72.6% higher) on inpatient services (P < .001); the late-onset class reported higher annual expenditures on outpatient and inpatient services of $215.94 (66.9% higher) and $1405.00 (138.0% higher), respectively (all P < .001).

CONCLUSIONS AND IMPLICATIONS

Heterogeneous disability trajectories exhibited distinct health care service utilization patterns among older Chinese adults. Older adults affected by late-onset disability incurred the highest health care needs. These findings provide valuable policy-relevant evidence for reducing health care burden among older adults.

Active Ageing across the Life Course: Towards a Comprehensive Approach to Prevention

"Active ageing" has become the leading scientific and policy conceptualization of a later life over the past two decades in the European Union (EU). It has been used as a key strategy for responding to demographic ageing. In the United States, in contrast, discourses around successful ageing have been more prevalent. This review article charts the development of active ageing responses to demographic change, showing how the concept compares with the notion of successful ageing and other terms associated with "ageing well." It identifies how, in practice, active ageing has been dominated by a narrow economic or productivist interpretation that prioritizes the extension of working life (to reduce the "burden" of population ageing). Such interpretations of active ageing undermine its value and emphasize the need for a more comprehensive approach which is set out. The development of the Active Ageing Index in 2012 provided a new analytical tool to promote evidence-based strategies towards population ageing. However, in practice, we show how it has not yet engaged fully with a comprehensive approach to active ageing or with the critical role of the life course in shaping the experience of old age. Nonetheless, this review article shows that the concept of active ageing still has an important role to play in our understanding of and responses to population ageing.

Aging and CMV discordance are associated with increased immune diversity between monozygotic twins

Background

Broadly, much of variance in immune system phenotype has been linked to the influence of non-heritable factors rather than genetics. In particular, two non-heritable factors: aging and human cytolomegavirus (CMV) infection, have been known to account for significant inter-individual immune variance. However, many specific relationships between them and immune composition remain unclear, especially between individuals over narrower age ranges. Further exploration of these relationships may be useful for informing personalized intervention development.

Results

To address this need, we evaluated 41 different cell type frequencies by mass cytometry and identified their relationships with aging and CMV seropositivity. Analyses were done using 60 healthy individuals, including 23 monozygotic twin pairs, categorized into young (12–31 years) and middle-aged (42–59 years). Aging and CMV discordance were associated with increased immune diversity between monozygotic twins overall, and particularly strongly in various T cell populations. Notably, we identified 17 and 11 cell subset frequencies as relatively influenced and uninfluenced by non-heritable factors, respectively, with results that largely matched those from studies on older-aged cohorts. Next, CD4+ T cell frequency was shown to diverge with age in twins, but with lower slope than in demographically similar non-twins, suggesting that much inter-individual variance in this cell type can be attributed to interactions between genetic and environmental factors. Several cell frequencies previously associated with memory inflation, such as CD27- CD8+ T cells and CD161+ CD4+ T cells, were positively correlated with CMV seropositivity, supporting findings that CMV infection may incur rapid aging of the immune system.

Conclusions

Our study confirms previous findings that aging, even within a relatively small age range and by mid-adulthood, and CMV seropositivity, both contribute significantly to inter-individual immune diversity. Notably, we identify several key immune cell subsets that vary considerably with aging, as well as others associated with memory inflation which correlate with CMV seropositivity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12979-021-00216-1.

Behavioral factors associated with utilization of healthcare services among elderly in Pakistan: evidence from a nationally representative survey

BACKGROUND

In Pakistan, health system is facing unprecedented challenges to deal with the healthcare demand of the growing ageing population. Using conceptual framework, this study aims to analyze the factors associated with the utilization of healthcare services in private and public hospitals by the elderly population.

METHODS

This study used a sample of 5319 individuals aged 60 and above extracted from the Pakistan Social and Living Standards Measurement Survey 2014-15. We followed the Anderson's Behavioral model of healthcare utilization. The behavioral factors, including predisposing, enabling and need factors, associated with the use of healthcare care were analyzed using exploratory data analysis and binary logistic regressions. The utilization of healthcare service in the study refers to the visits to private and government hospital.

RESULTS

Out of total 5319 participants around three-fourth or 72.4% of participants visited private hospitals for their healthcare needs. Multivariate analysis showed that older age-group (80 years and above) and participants from urban were 1.35 and 1.53 times more likely to avail healthcare service in private hospitals, respectively. The elderly persons from Khyber Pakhtunkhwa were three times (AOR: 3.29, 95%CI 2.5-4.8) more likely to visit government hospitals than their peers in Punjab. Participants who attended school (AOR: 1.21, 95%CI 0.82-1.31) were more likely to utilize healthcare service in private hospitals. Elders from rich (AOR: 1.04, 95%CI 0.84-1.13) and richest (AOR: 1.29, 95%CI 0.89-1.87) wealth quintiles were more likely to use healthcare in private hospitals. The likelihood of the utilization of healthcare service in private hospitals was 1.7 times higher for three or more consulting visits than the single visit, and 1.5 times higher in the public hospital.

CONCLUSIONS

Our findings underscore a dire need for expanding the outreach of healthcare services for the elderly population. It calls for effective implementation of policies which aim at improving equitable access to private healthcare services, and upgrading of government hospitals Moreover, the knowledge generated through this research may be employed to make social protection programs more responsive to age-related healthcare needs, and focused on caregiving for elderly living without spouse.

Intergenerational Mobility in Self-Reported Health Status in the US

We present estimates of intergenerational mobility in self-reported health status (SRHS) in the US using data from the PSID. We estimate that the rank-rank slope in SRHS is 0.26. We show that including both parent health and income in models of intergenerational mobility increases the explanatory power of child outcomes. We construct a monetary metric for health and then use this to combine income and health into a measure of welfare and estimate the rank-rank slope to be about 0.4 for this new measure. Finally, we document striking health mobility gaps by race, region and parent education.

The Effect of Material and Social Deprivation on Well-Being of Elderly in Europe

In this work, attention is paid to 2 explanatory factors of successful aging. The first is material deprivation. There is growing evidence that poverty is associated with the onset of physical and mental disorders and, broadly, with aspects such as life satisfaction and happiness. The second factor is social deprivation. Social exclusion affects health due to lack of emotional and concrete support; moreover, participation in social activities among older people is associated with greater longevity and a lower risk of disability. The study describes the effect of material and social deprivation on depression (measured through the EURO-D scale) and quality of life (through CASP-12 scale), for individuals aged 50 and older in 14 European countries. Data is derived from Wave 5 of the SHARE project. To estimate the effect of material and social deprivation on outcomes and to determine whether it is moderated by the country in which people live, we apply 2 multi-group path models, respectively, for people aged 65 or younger and for those aged 66 years or older. Findings indicate that higher material and social deprivation is associated with greater levels of stress and worse quality of life. The effect of social deprivation would be stronger than that of material deprivation, and this result seems to be valid in all countries considered, although their intensity varies significantly between them.

Poor level of knowledge on elderly care despite positive attitude among nursing students in Zanzibar Island: findings from a cross-sectional study

Background

It is estimated by the year 2050, 80% of the global elderly population will be from the low-and middle income countries. Elderly care requires health workers with skills associated with an understanding of the biological, psychological, social and cultural theories related to aging. Nurses with better knowledge, skills and positive attitudes towards elderly care are highly needed and critically important for better healthcare and wellbeing of the elderly population. Therefore the objective of this study was to assess the level of knowledge and attitude of nursing students towards elderly care in Zanzibar Island.

Methods

A cross-sectional study was conducted in Zanzibar involving three out of five nursing training institutions. Participants were selected by systematic random sampling. Facts on Aging Quiz 2 and Kogan’s Attitudes Toward Old People scale were used to assess the level of knowledge and attitude towards elderly care among the students respectively. Simple and multivariable logistic regressions were applied to determine the predictors of knowledge and attitude among the participants.

Results

A total of 393 students participated in this study. Only 17% (69) of the participants had good level of knowledge and about 67.9% (267) had positive attitude towards elderly care. Living in an extended family and with an elderly person at home were both associated with good level of knowledge and positive attitude towards elderly care. Furthermore, living in a rural area (adjusted odds ratio = 2.23; 95% confidence interval: 1.22, 4.10) and studying at public institution (adjusted odds ratio = 2.59; 95% confidence interval: 1.41, 4.63) were associated with positive attitude towards elderly care.

Conclusion

This study has shown that the majority of nursing students in Zanzibar have positive attitude but poor level of knowledge towards elderly care. The current findings have demonstrated that past experience with an elderly person can help in influencing good knowledge and shaping positive attitudes towards elderly care. Low level of knowledge shown in the study suggests for further research on adequacy of nursing curriculum and/or its implementation.

Genetic basis of falling risk susceptibility in the UK Biobank Study

Both extrinsic and intrinsic factors predispose older people to fall. We performed a genome-wide association analysis to investigate how much of an individual’s fall susceptibility can be attributed to genetics in 89,076 cases and 362,103 controls from the UK Biobank Study. The analysis revealed a small, but significant SNP-based heritability (2.7%) and identified three novel fall-associated loci (P_combined ≤ 5 × 10⁻⁸). Polygenic risk scores in two independent settings showed patterns of polygenic inheritance. Risk of falling had positive genetic correlations with fractures, identifying for the first time a pathway independent of bone mineral density. There were also positive genetic correlations with insomnia, neuroticism, depressive symptoms, and different medications. Negative genetic correlations were identified with muscle strength, intelligence and subjective well-being. Brain, and in particular cerebellum tissue, showed the highest gene expression enrichment for fall-associated variants. Overall, despite the highly heterogenic nature underlying fall risk, a proportion of the susceptibility can be attributed to genetics.

Katerina Trajanoska et al. report a genome-wide association study of self-reported falls in UK Biobank participants. They identify three novel fall-associated loci and find that risk of falling shows patterns of polygenic inheritance and a SNP-based heritability of 2.7%.

Bibliometric analysis of core journals which publish articles of physical therapy on aging

OBJECTIVE

Increase in population's longevity has led to considerable efforts worldwide on physical therapy aging research. The aim of this study is to identify which are the main scientific journals, as well as the most productive authors, institutions and keywords related to the journals, that have published about physical therapy and aging.

METHODS

Original articles published from 1990 to 2014 were retrieved from the bibliographic database Science Citation Index Expanded of Web of Science Core Collection. After standardization of the bibliographic information, a series of bibliometric indicators was obtained regarding authors, institutions, citation and keywords of the core journals using bibliometric software. The PAJEK network analysis program was used for graphic representation.

RESULTS

A total of 2,237 original articles are included in this analysis. The number of identified journals is 573, with an average growth of publishing journals throughout the studied period of 9.41%. Bradford's distribution shows 12 core journals, out of which 41.67% have published constantly all throughout the 25-year period, being the most productive one Physical Therapy. Fritz, Julie M is the most productive author, and University of Sydney the most productive institution. The keyword exercise is used in an outstanding way.

CONCLUSIONS

The productivity trends provided an indication of the greater scientific interest of physical therapy in aging as a line of research. Collectively, the data indicated that physical therapy-specific journals are being consolidated but non-specific are still a significant research source, and that a fundamental element of their research includes exercise and movement.

Association with subjective measured physical activity (GPAQ) and quality of life (WHOQoL-BREF) of ageing adults in Hungary, a cross-sectional study

BACKGROUND

It is well known that physical activity (PA) has health benefits. This study aimed to examine physical activity carried out by the senior (over 50) participants and its relation to their quality of life (QoL).

METHODS

Surveillance of PA and QoL was measured by using questionnaires (GPAQ, WHOQoL-BREF) in this study. Descriptive data were presented as means and standard deviations (SD) for continuous variables and as percentages for categorical variables. Multivariate linear regression analysis was conducted. The significance level was set at p ≤ 0.05.

RESULTS

Overall, 250 participants were recruited, the mean age of the study population (n = 243) was 70.2 (SD 7.1) years. The results clearly showed that the Hungarian participants aged over 50 years were more likely to do PA if they had university degree and lower age (p ≤ 0.001) and used more active transportation (p = 0.035) if they had low education. The results of WHOQoL-BREF showed that the Hungarian individuals have better QoL if they have university degree (p ≤ 0.001) and lower age (p ≤ 0.001). Using multivariate linear regression analysis to examine the effect of PA patterns on QoL adjusted for demographic variables (age, education, BMI, place of living), the result showed significant correlation between WHOQoL-BREF dimensions and GPAQ (p ≤ 0.001).

CONCLUSION

Higher amount of PA among aging population can result in better QoL in all dimensions.

Genetic and environmental determinants of variation in the plasma lipidome of older Australian twins

The critical role of blood lipids in a broad range of health and disease states is well recognised but less explored is the interplay of genetics and environment within the broader blood lipidome. We examined heritability of the plasma lipidome among healthy older-aged twins (75 monozygotic/55 dizygotic pairs) enrolled in the Older Australian Twins Study (OATS) and explored corresponding gene expression and DNA methylation associations. 27/209 lipids (13.3%) detected by liquid chromatography-coupled mass spectrometry (LC-MS) were significantly heritable under the classical ACE twin model (h2 = 0.28-0.59), which included ceramides (Cer) and triglycerides (TG). Relative to non-significantly heritable TGs, heritable TGs had a greater number of associations with gene transcripts, not directly associated with lipid metabolism, but with immune function, signalling and transcriptional regulation. Genome-wide average DNA methylation (GWAM) levels accounted for variability in some non-heritable lipids. We reveal a complex interplay of genetic and environmental influences on the ageing plasma lipidome.

Ecological Gait as a Fall Indicator in Older Adults: A Systematic Review

BACKGROUND AND OBJECTIVES

Falls represent a major threat for elders, affecting their life quality and expectancy. Clinical tests and questionnaires showed low diagnostic value with respect to fall risk. Modern sensor technology allows in-home gait assessments, with the possibility to register older adults' ecological mobility and, potentially, to improve accuracy in determining fall risk. Hence, we studied the correlation between standardized assessments and ecological gait measures, comparing their ability to identify fall risk and predict prospective falls.

RESEARCH DESIGN AND METHOD

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guidelines.

RESULTS

From a total of 938 studies screened, nine articles with an observational study design were included. Evidence from selected works was subcategorized in (i) correlations between ecological and clinical measures and comparative statistics of (ii) prospective fall prediction and (iii) fall risk identification. A large number of correlations were observed between single ecological gait assessments and multiple clinical fall risk evaluations. Moreover, the combination of daily-life features and clinical tests outcomes seemed to improve diagnostic accuracy in fall risk identification and fall prediction. However, it was not possible to understand the extent of this enhancement due to the high variability in models' parameters.

DISCUSSION AND IMPLICATIONS

Evidence suggested that sensor-based ecological assessments of gait could boost diagnostic accuracy of fall risk measurement protocols if used in combination with clinical tests. Nevertheless, further studies are needed to understand what ecological features of gait should be considered and to standardize models' definition.

Activities of daily living, life orientation, and health-related quality of life among older people in nursing homes: a national cross-sectional study in China

PURPOSE

This study aimed to explore the current status of activities of daily living (ADLs), life orientation, and health-related quality of life (HRQoL) among older people in nursing homes and to further examine the mediating role of life orientation in the impact of ADLs on HRQoL.

METHODS

A national cross-sectional study was conducted among older people aged 60 and above in nursing homes by the randomly stratified cluster sampling method. The status of ADLs, life orientation and HRQoL were measured using an ADL scale, a life orientation scale and the SF-12v2 scale, respectively. Multiple linear regression models were used to identify explanatory factors associated with ADLs, life orientation, and HRQoL. The potential mediating role of life orientation in the relationship between ADL and HRQoL was explored by mediation analysis.

RESULTS

The overall prevalence of ADL disability was 52.67%, and 84.37% of older people in nursing homes had a negative life orientation. The mean scores of physical health and mental health among older people in nursing homes were 45.44 ± 6.46 and 42.67 ± 8.48, respectively. Some sociodemographic characteristics were associated with poor physical health and mental health. After adjustments were made for covariates, the life orientation score mediated 13.81% of the total effect of the ADL score on physical component score of HRQoL and mediated 45.33% of the mental component score of HRQoL.

CONCLUSION

A sizeable proportion of older people had ADL disability and negative life orientation, and HRQoL was poor among older Chinese people in nursing homes. Life orientation partially mediates the relationship between ADLs and HRQoL.

Aging with HIV

PURPOSE OF REVIEW

This review points out unmet medical needs and open research questions of older adults living with HIV. Starting from the definition of aging in HIV, it explores the mosaic of this condition at epidemiological, pathophysiological, and clinical level. Antiretroviral management and diverse models of care are critically discussed.

RECENT FINDINGS

Aging cohorts suggest HIV as a paradigm of chronic inflammation and immune activation with specific aging trajectory patterns in which antiretroviral therapy may play a role. In the absence of randomized clinical trials, observational cohorts show that therapy is driven by duration of HIV infection and burden of non-infectious comorbidities. This review suggests that geriatric approach should be used to recognize the complexity of aging goes beyond the viro-immunological success and management of progressive accumulation of non-communicable diseases. This requires recognition of frailty and geriatric syndromes to stratify patients' diversity by using comprehensive geriatric assessment tools.

Epigenetic changes during ageing and their underlying mechanisms

As life expectancy increases worldwide, ageing and age-related diseases arise as a major issue for societies around the globe. Understanding the biological mechanisms underlying the ageing process is thus instrumental for the development of efficient interventions aimed to prevent and treat age-related conditions. Current knowledge in the biogerontology field points to epigenetics as a critical component of the ageing process, not only by serving as a bona-fide marker of biological age but also by controlling and conferring inheritability to cellular and organismal ageing. This is reflected by a myriad of evidences demonstrating the relationship between DNA methylation, histone modifications, chromatin remodeling and small non-coding RNAs and several age-related phenotypes. Given the reversibility of epigenetic alterations, epigenetic reprogramming may also be envisioned as a potential approach to treat age-related disorders. Here we review how different types of epigenetic mechanisms are involved in the ageing process. In addition, we highlight how interventions modulate epigenetics and thus promote health- and lifespan.

Sleep and ageing: from human studies to rodent models

Sleep duration and lifespan vary greatly across Animalia. Human studies have demonstrated that ageing reduces the ability to obtain deep restorative sleep, and this may play a causative role in the development of age-related neurodegenerative disorders. Animal models are widely used in sleep and ageing studies. Importantly, in contrast to human studies, evidence from laboratory rodents suggests that sleep duration is increased with ageing, while evidence for reduced sleep intensity and consolidation is inconsistent. Here we discuss two possible explanations for these species differences. First, methodological differences between studies in humans and laboratory rodents may prevent straightforward comparison. Second, the role of ecological factors, which have a profound influence on both ageing and sleep, must be taken into account. We propose that the dynamics of sleep across the lifespan reflect both age-dependent changes in the neurobiological substrates of sleep as well as the capacity to adapt to the environment.

Epigenetics recording varied environment and complex cell events represents the origin of cellular aging

Although a relationship between epigenetics and aging phenotypic changes has been established, a theoretical explanation of the intrinsic connection between the epigenetics and aging is lacking. In this essay, we propose that epigenetic recording of varied cell environment and complex history could be an origin of cellular aging. Through epigenetic modifications, the environment and historical events can induce the chromatin template into an activated or repressive accessible structure, thereby shaping the DNA template into a spectrum of chromatin states. The inner nature of diversity and conflicts born by the cell environment and its historical events are hence recorded into the chromatin template. This could result in a dissipated spectrum of the chromatin state and chaos in overall gene expression. An unavoidable degradation of epigenome entropy, similar to Shannon entropy, would be consequently induced. The resultant disorder in epigenome, characterized by corrosion of epigenome entropy as reflected in chromatin template, can be stably memorized and propagated through cell division. Furthermore, the hysteretic nature of epigenetics responding to the emerging environment could exacerbate the degradation of epigenome entropy. As well as stochastic errors, we propose that outside entropy (or chaos) derived from the varied environment and complex cell history, gradually input and imprinted into the chromatin via epigenetic modifications, would lead inevitably to cellular aging, the extent of which could be aggravated by hysteresis of epigenetics without error erasing and correction.

Role of Advanced Glycation End Products in Carcinogenesis and their Therapeutic Implications

Aging is one of the biggest risk factors for the major prevalent diseases such as cardiovascular diseases, neurodegeneration and cancer, but due to the complex and multifactorial nature of the aging process, the molecular mechanisms underlying age-related diseases are not yet fully understood. Research has been intensive in the last years aiming to characterize the pathophysiology of aging and develop therapies to fight age-related diseases. In this context advanced glycation end products (AGEs) have received attention. AGEs, when accumulated in tissues, significantly increase the level of inflammation in the body which has long been associated with the development of cancer. Here we discuss the classical settings promoting AGE formation, as well as reduction strategies, occurrence and relevance of AGEs in cancer tissues and the role of AGE-interaction with the receptor for advanced glycation end products (RAGE) in cancer initiation and progression.

The effects of same-session combined exercise training on cardiorespiratory and functional fitness in older adults: a systematic review and meta-analysis

Endurance and strength training are effective strategies for counteracting age-associated reductions in physical performance in older adults, with a combination of both exercise modes recommended to maximise potential fitness benefits. This meta-analysis sought to quantify the effects of same-session combined endurance and strength training on fitness in adults aged over 50 years. Five electronic databases were searched with studies required to include one of the following outcome measures: VO_2peak, 6-min walk test (6MWT), 8-ft timed up-and-go (TUG), and 30-s chair stand. Separate random-effects meta-analyses compared combined training with (1) no-exercise control, (2) endurance training, and (3) strength training with probabilistic magnitude-based inferences subsequently applied. Twenty-seven studies involving 1346 subjects with a mean age of 68.8 years (range 54–85 years) were included in the analysis. The meta-analysed effect on VO_2peak was a moderately beneficial effect for the combined training compared to no-exercise controls (3.6 mL kg⁻¹ min⁻¹; ± 95% confidence limits 0.8 mL kg⁻¹ min⁻¹) with additional increases for studies with greater proportions of female participants and shorter training interventions. Combined training also had small-to-moderately beneficial effects on VO_2peak when compared to endurance training (0.8 mL kg⁻¹ min⁻¹; ± 1.0 mL kg⁻¹ min⁻¹), 30-s chair stand when compared with strength training (1.1 repetitions; ± 0.5 repetitions) and on TUG (0.8 s; ± 0.7 s), 30-s chair stand (2.8 repetitions; ± 1.7 repetitions), and 6MWT (31.5 m; ± 22.4 m) when compared to no-exercise controls. All other comparisons were unclear. Same-session combined training can induce clinically relevant fitness improvements in older adults.

Mitochondrial DNA Sequence Variants Associated With Blood Pressure Among 2 Cohorts of Older Adults

Background

Age‐related changes in blood pressure are associated with a variety of poor health outcomes. Genetic factors are proposed contributors to age‐related increases in blood pressure, but few genetic loci have been identified. We examined the role of mitochondrial genomic variation in blood pressure by sequencing the mitochondrial genome.

Methods and Results

Mitochondrial DNA (mtDNA) data from 1755 participants from the LIFE (Lifestyle Interventions and Independence for Elders) studies and 788 participants from the Health ABC (Health, Aging, and Body Composition) study were evaluated using replication analysis followed by meta‐analysis. Participants were aged ≥69 years, of diverse racial backgrounds, and assessed for systolic blood pressure (SBP), diastolic blood pressure, and mean arterial pressure. After meta‐analysis across the LIFE and Health ABC studies, statistically significant associations of mtDNA variants with higher SBP (m.3197T>C, 16S rRNA; P=0.0005) and mean arterial pressure (m.15924A>G, t‐RNA‐thr; P=0.004) were identified in white participants. Among black participants, statistically significant associations with higher SBP (m.93A>G, HVII; m.16183A>C, HVI; both P=0.0001) and mean arterial pressure (m.16172T>C, HVI; m.16183A>C, HVI; m.16189T>C, HVI; m.12705C>T; all P's<0.0004) were observed. Significant pooled effects on SBP were observed across all transfer RNA regions (P=0.0056) in white participants. The individual and aggregate variant results are statistically significant after multiple comparisons adjustment for the number of mtDNA variants and mitochondrial regions examined.

Conclusions

These results suggest that mtDNA‐encoded variants are associated with variation in SBP and mean arterial pressure among older adults. These results may help identify mitochondrial activities to explain differences in blood pressure in older adults and generate new hypotheses surrounding mtDNA variation and the regulation of blood pressure.

Clinical Trial Registration

URL: http://www.ClinicalTrials.gov. Unique identifiers: NCT01072500 and NCT00116194.

The burden and correlates of multiple cardiometabolic risk factors in a semi-urban population of Nepal: a community-based cross-sectional study

This study assessed the burden and correlates of three cardiometabolic risk factors, (hypertension, diabetes, and overweight/obesity), and their possible clustering patterns in a semi-urban population of Nepal. Data were obtained from a community-based management of non-communicable disease in Nepal (COBIN) Wave II study, which included 2,310 adults aged 25-64 years in a semi-urban area of Pokhara Metropolitan City of Nepal, using the World Health Organization-STEPS questionnaire. Unadjusted and adjusted binary logistic regression models were used to study the correlates of the individual risk factors and their clustering. The prevalence of hypertension, diabetes, and overweight/obesity was 34.5%, 11.7%, and 52.9%, respectively. In total, 68.2% of the participants had at least one risk factor and many participants had two risks in combination: 6.8% for 'hypertension and diabetes', 7.4% for 'diabetes and overweight/obesity' and 21.4% for 'hypertension and overweight/obesity'. In total, 4.7% had all three risk factors. Janajati ethnicity (1.4-2.1 times), male gender (1.5 times) and family history of diabetes (1.4-3.4 times) were associated with presence of individual risk factors. Similarly, Janajati ethnicity (aOR: 4.31, 95% CI: 2.53-7.32), current smoking (aOR: 4.81, 95% CI: 2.27-10.21), and family history of diabetes (aOR: 4.60, 95% CI: 2.67-7.91) were associated with presence of all three risk factors. Our study found a high prevalence of all single and combined cardiometabolic risk factors in Nepal. It underlines the need to manage risk factors in aggregate and plan prevention activities targeting multiple risk factors.

The Interplay Between Frailty and Intrinsic Capacity in Aging and HIV Infection

In the context of an emerging aging epidemic affecting people living with HIV (PLWH), we critically discuss existing data regarding two different conceptual models of aging-frailty and intrinsic capacity, respectively, both in a clinical and public health perspective. These constructs have not yet been integrated in the general population. Nevertheless, the holistic HIV care, which goes beyond the viro-immunological success, may offer an ideal setting to test a possible integration of these models in older adults living with HIV. We suggest a new framework to assess health in PLWH, shifting from an infectious disease (ID)/internal medicine approach, which includes quality of life in the definition of healthy living with HIV, to an ID/geriatric medicine approach, focused on the maintenance of functional ability in frail and geriatric PLWH.

Determinants of Health Trajectories in England and the United States: An Approach to Identify Different Patterns of Healthy Aging

Background

Aging is a multidimensional process with a remarkable interindividual variability. This study is focused on identifying groups of population with similar aging patterns, and to define the health trajectories of these groups. Sociodemographic and health determinants of these trajectories are also identified.

Methods

Data from the English Longitudinal Study of Aging (ELSA) and the Health and Retirement Study (HRS) were used. A set of self-reported health items and measured tests were used to generate a latent health metric by means of a Bayesian multilevel IRT model, assessing the ability of the metric to predict mortality. Then, a Growth Mixture Model (GMM) was conducted in each study to identify latent classes and assess health trajectories. Kaplan-Meier survival curves were obtained for each class and a multinomial logistic regression was used to identify determinants of these trajectories.

Results

The health score generated showed an adequate ability to predict mortality over 10 years in ELSA (AUC = 0.74; 95% CI: 0.72, 0.75) and HRS (AUC = 0.74; 95% CI: 0.73, 0.75). By means of GMM, four latent classes were identified in ELSA and five in HRS. Chronic conditions, no qualification and low level of household wealth were associated to the classes which showed a higher mortality in both studies.

Conclusion

The method based on the creation of a common metric of health and the use of GMM to identify similar patterns of aging, allows for the comparison of trajectories of health across longitudinal surveys. Multimorbidity, educational level, and household wealth could be considered as determinants associated to these trajectories.

Dietary Patterns, Skeletal Muscle Health, and Sarcopenia in Older Adults

In recent decades, the significance of diet and dietary patterns (DPs) for skeletal muscle health has been gaining attention in ageing and nutritional research. Sarcopenia, a muscle disease characterised by low muscle strength, mass, and function is associated with an increased risk of functional decline, frailty, hospitalization, and death. The prevalence of sarcopenia increases with age and leads to high personal, social, and economic costs. Finding adequate nutritional measures to maintain muscle health, preserve function, and independence for the growing population of older adults would have important scientific and societal implications. Two main approaches have been employed to study the role of diet/DPs as a modifiable lifestyle factor in sarcopenia. An a priori or hypothesis-driven approach examines the adherence to pre-defined dietary indices such as the Mediterranean diet (MED) and Healthy Eating Index (HEI)—measures of diet quality—in relation to muscle health outcomes. A posteriori or data-driven approaches have used statistical tools—dimension reduction methods or clustering—to study DP-muscle health relationships. Both approaches recognise the importance of the whole diet and potential cumulative, synergistic, and antagonistic effects of foods and nutrients on ageing muscle. In this review, we have aimed to (i) summarise nutritional epidemiology evidence from four recent systematic reviews with updates from new primary studies about the role of DPs in muscle health, sarcopenia, and its components; (ii) hypothesise about the potential mechanisms of ‘myoprotective’ diets, with the MED as an example, and (iii) discuss the challenges facing nutritional epidemiology to produce the higher level evidence needed to understand the relationships between whole diets and healthy muscle ageing.