Taking up physical activity in later life and healthy ageing: the English longitudinal study of ageing

Associations Between Divorce Histories and Unhealthy Alcohol Use Among Middle Aged and Older Adults

Background: Unhealthy alcohol use has been considered a coping strategy related to stressful and traumatic life events such as relationship loss. Yet, the effects of marital status on health behaviors are generally studied cross-sectionally or over one transition. We explored associations between the frequency and quantity of alcohol use with the number of episodes and duration of separation/divorce events across adulthood among English adults in mid to later life. Methods: This study used life history data from wave 3 (2006/07) of the English Longitudinal Study of Aging to compute marital sequences based on marital status at each year of age from 18 years of 6,355 adults aged 50-80 years. These sequences were used to compute the portion of adulthood spent separated/divorced and the number of episodes of divorce. These variables were used as predictors in logistic regressions predicting unhealthy alcohol use, while also controlling for current marital status. Results: We found that the number of episodes of separation/divorce increased the odds of drinking ≥5 days/week and binge drinking (≥6 drinks/occasion for women; ≥8 drinks/occasion for men), whereas the portion of adulthood spent divorced was not associated with drinking frequency or binge drinking. Some nuances by gender were also noted. Conclusions: Recurrent transitions into separation/divorce over adulthood appears to increase risk of unhealthy alcohol use in mid to later life beyond the risks associated with current marital status.

Healthy lifestyle and cognitive decline in middle-aged and older adults residing in 14 European countries

Studies examining lifestyle and cognitive decline often use healthy lifestyle indices, making it difficult to understand implications for interventions. We examined associations of 16 lifestyles with cognitive decline. Data from 32,033 cognitively-healthy adults aged 50-104 years participating in prospective cohort studies of aging from 14 European countries were used to examine associations of lifestyle with memory and fluency decline over 10 years. The reference lifestyle comprised not smoking, no-to-moderate alcohol consumption, weekly moderate-plus-vigorous physical activity, and weekly social contact. We found that memory and fluency decline was generally similar for non-smoking lifestyles. By contrast, memory scores declined up to 0.17 standard deviations (95% confidence interval= 0.08 - 0.27) and fluency scores up to 0.16 standard deviations (0.07 - 0.25) more over 10 years for those reporting smoking lifestyles compared with the reference lifestyle. We thus show that differences in cognitive decline between lifestyles were primarily dependent on smoking status.

Sedentary Behaviors, Light-Intensity Physical Activity, and Healthy Aging

Importance

Sleep duration and moderate-to-vigorous physical activity (MVPA) are associated with healthy aging, but the associations of sedentary behaviors and light-intensity physical activity (LPA) with healthy aging are still unclear.

Objective

To examine the independent association of sedentary behaviors and LPA with healthy aging, and to estimate the theoretical association of replacing sedentary behavior with LPA, MVPA, or sleep with healthy aging.

Design, Setting, and Participants

In this cohort study using data from the Nurses' Health Study, participants aged 50 years or older and free of major chronic diseases in 1992 were prospectively followed up for 20 years. Data were analyzed from January to May 2022.

Exposures

Three measures for sedentary behaviors (hours watching television, sitting at work, and other sitting at home) and 2 measures for LPA (hours of standing or walking around at home [LPA-Home] and at work [LPA-Work]).

Main Outcomes and Measures

Healthy aging was defined as survival to at least age 70 years with maintenance of 4 health domains (ie, no major chronic diseases and no impairment in subjective memory, physical function, or mental health). The isotemporal substitution model was used to evaluate the potential impact on healthy aging of replacing 1 hour of 1 behavior with equivalent duration of another.

Results

Among 45 176 participants (mean [SD] age, 59.2 [6.0] years), 3873 (8.6%) women achieved healthy aging. After adjustment for covariates including MVPA, each increment of 2 hours per day in sitting watching television was associated with a 12% (95% CI, 7%-17%) reduction in the odds of healthy aging. In contrast, each increase of 2 hours per day in LPA-Work was associated with a 6% (95% CI, 3%-9%) increase in the odds of healthy aging. Replacing 1 hour of sitting watching television with LPA-Home (OR, 1.08; 95% CI, 1.05-1.12), LPA-Work (OR, 1.10; 95% CI, 1.07-1.14), or MVPA (OR, 1.28; 95% CI, 1.23-1.34) was associated with increased odds of healthy aging. Among participants who slept 7 hours per day or less, replacing television time with sleep was also associated with increased odds of healthy aging.

Conclusions and Relevance

In this cohort study, longer television watching time decreased odds of healthy aging, whereas LPA and MVPA increased odds of healthy aging and replacing sitting watching television with LPA or MVPA, or with sleep in those who slept 7 hours per day or less, was associated with increased odds of healthy aging, providing evidence for rearranging 24-hour behavior to promote overall health.

Physical activity, low-grade inflammation, and psychological responses to the COVID-19 pandemic among older adults in England

Mental health responses to the COVID-19 pandemic have been widely studied, but less is known about the potentially protective role of physical activity (PA) and the impact of low-grade inflammation. Using a sample of older adults from England, this study tested (1) if pre-pandemic PA and its changes during the pandemic were associated with mental health responses; (2) if older adults with low-grade inflammation experienced greater increases in depression and anxiety, compared to pre-pandemic levels; (3) if PA attenuated the association between inflammation and depression/anxiety. The study used data from the English Longitudinal Study of Ageing, a cohort study following a national sample aged 50+. Information on mental health and PA were collected before the pandemic (2016/17 and 2018/19) and during November and December 2020. Inflammation was ascertained using pre-pandemic C-reactive protein (CRP). Analyses were adjusted for sociodemographic and health-related factors and pre-pandemic mental health. Increasing PA from before to during the pandemic was linked to reduced odds of depression (OR = 0.955, 95%CI [0.937, 0.974]) and anxiety (OR = 0.954, 95%CI [0.927; 0.982]). Higher pre-pandemic PA was associated with reduced odds of depression (OR = 0.964, 95%CI [0.948, 0.981]) and anxiety (OR = 0.976, 95%CI [0.953, 1.000]), whereas elevated CRP was associated with 1.343 times higher odds of depression (95%CI [1.100, 1.641]). PA did not attenuate the inflammation-depression association. The findings suggest that PA may contribute to psychological resilience among older adults, independently of inflammation. Further research is needed to explore the psychobiological pathways underlying this protective mechanism.

Association between physical activity, body composition, and cognitive performance among female office workers

Regular physical activity can potentially prevent cognitive decline. While most studies focused on the general decline of the elderly and child and adolescent population, aging is a gradual process and cognitive decline can commence in middle age. Other than the middle-aged working population, gender-specific nuances are another overlooked area regarding the relationship between physical activity and cognitive performance. Therefore, this study examines the associations and benefits of maintaining regular physical activity habits with cognitive function and body composition in middle-aged female office workers. The results show that middle-aged females exhibited age-related declines in working memory, while no significant age-related changes are observed in reaction time and executive function. However, the regular exercise group demonstrates the ability to maintain their cognitive performance across age, unlike the sedentary group, who experiences declines in reaction time and executive function with age. Our findings highlight the significant impact of age on specific cognitive functions in middle-aged females and the positive influence of regular exercise on cognitive performance. Furthermore, this study demonstrates the potential of "the Brain Gym" App for efficient cognitive function assessment. The findings underscore the importance of regular exercise for cognitive well-being in middle-aged females and provide valuable insights into the relationship between body composition and cognitive function.

Implementation of exergaming for people with dementia: facilitators, barriers, and recommendations

OBJECTIVES

To identify facilitators, barriers, and formulate recommendations for the implementation of exergames for people with dementia (PWD) in day-care centers (DCCs).

METHODS

Within a randomized controlled trial into the effectiveness of exergaming, 73 PWD with their informal caregivers (IC) from 11 DCCs in the Netherlands and two exergame providers participated in a process evaluation. This was a mixed-methods study using focus groups, semi-structured interviews, the Measurement Instrument for Determinants of Innovations, forms for DCC staff, and a short satisfaction questionnaire. We used descriptive statistics for the quantitative outcomes, and thematic analysis for qualitative data. The Medical Research Council guidance for process evaluation was used to identify facilitators and barriers to the implementation, mechanisms of impact, and context.

RESULTS

Implementation-related facilitators and barriers were the availability of budget, staff, equipment, instructions, location, and supervision. Mechanisms of impact-related facilitators were experienced positive effects on physical functioning and mobility, cognitive, emotional, and social functioning, and quality of life. Barriers were mainly linked to the need to customize the intervention for each participant. Contextual facilitators were support and enthusiasm from others; barriers were costs and planning. Recommendations by DCC staff involved technical support, instructions, responsibility, location, supervision, planning, and exergaming as a group or individually.

CONCLUSION

Users, IC, and staff positively valued exergaming. We found various facilitators and barriers leading to recommendations for successful implementation. We recommend further research into tailoring exergaming to specific users and contexts, and into usability and cost-effectiveness. This may contribute to further dissemination and implementation of exergaming for PWD.

Incorporating Physical Activity Assessments and Behavior Change Techniques Into Geriatrics

Ninety-one percent of adults 65 years and older do not perform the recommended levels of physical activity (PA), resulting in increased risk of disability, morbidity, and mortality. Despite knowing the benefits of PA and acknowledging the importance of assessing and addressing inadequate PA levels, 50%-75% of health care providers do not incorporate behavior change techniques into clinical practice. This clinical gap can be explained by a lack of knowledge or confidence in (1) assessing PA levels; (2) addressing inadequate PA levels; and (3) justifying the time needed to use these techniques in clinical practice. In this special communication, we address this gap by providing a 3-step theoretical-based clinical decision pathway that guides health care providers on how to identify older adults with inadequate PA levels, determine readiness to increase PA, and empower patents to develop an action plan that will increase their PA levels. We also provide a conceptual model that supports the use of techniques that assess and address inadequate PA by tying PA to the Age-Friendly Health System's 4Ms (ie, What Matters to the older adult, Mentation, Mobility, and Medications).

Is Cognitive Reserve a Determinant of Functional and Mental Health in Older People of the Sardinian Blue Zone? A Mediational Approach

The main purpose of this study was to examine the mediating role of cognitive reserve in the relationship between functional health (expressed through the amount and intensity of performed physical activity objectively assessed using wearable accelerometers) and psychological well-being (i.e., assessed in terms of self-reported depressive signs) of older people living in an area of exceptional longevity, the so-called Sardinian Blue Zone. A further goal was to investigate the impact of gender on the cognitive reserve and physical health of our participants, using global cognitive functioning as a covariate. A battery of tests assessing motor efficiency, cognitive reserve, global cognitive functioning, and self-reported depressive symptoms was individually presented to 120 community dwellers (Mage = 82 years, SD = 8.4 years) of the Sardinian Blue Zone. Significant associations were found between cognitive reserve, motor efficiency, and self-reported depressive signs. Moreover, three mediation analyses documented that distinct indexes of cognitive reserve and motor efficiency explain 27.2-31% of the variance in the self-reported depression condition. Following this, it was also found that people with scarce cognitive reserve tended to exhibit significant signs of depression and showed worse motor abilities. In addition, after controlling for the effect of global cognitive functioning, motor efficiency, and cognitive reserve were generally more preserved in males than in females. Overall, these findings suggest that cognitive reserve is a compensatory resource that contributes significantly to the enhancement of health-related quality of life in the last decades of life.

12-week concurrent brisk walking and Taijiquan (Tai Chi) improve balance, flexibility, and muscular strength of Chinese older women

Healthy aging is a global goal to enhance the quality of life for older persons. This study evaluated the benefits of 12-week concurrent brisk walking and Taijiquan. Healthy Chinese women aged 60 years and above were enrolled to the control (n = 26) and intervention (n = 25) groups. Participants in the intervention group engaged in three exercise sessions per week for 12 weeks, whereas control group engaged in free-living activities. Each exercise session consisted of 20-45 minutes of walking and 20-45 minutes of Yang style 24-form Taijiquan. 12-week exercise improved (p < 0.05) the sit and reach test (within-group mean difference: +5.6 cm; Hedges' g = 0.77), handgrip strength (mean difference: +3.1 kg; g = 0.89), arm curl (mean difference: +2.1 repetitions; g = 0.69), chair stand (mean difference: +2.6 repetitions; g = 0.63), and one-legged standing (mean difference: +2.2 seconds; g = 1.07). There was no improvement in the circulatory health, body composition, or life satisfaction. Therefore, this concurrent brisk walking and Taijiquan training, which targets major whole-body muscle groups, could improve aging-critical flexibility, muscular fitness, and balance in older women. The exercise meets the current WHO guideline, is safe to perform, and could be campaigned as a health promotion for older persons.

How are hearing loss and physical activity related? Analysis from the English longitudinal study of ageing

Although cross-sectional studies suggest that hearing loss in middle- and older-aged adults is associated with lower physical activity, longitudinal evidence is limited. This study aimed to investigate the potential bi-directional association between hearing loss and physical activity over time. Participants were from the English Longitudinal Study of Ageing (N = 11,292) who were 50-years or older at baseline assessment (1998-2000). Individuals were followed-up biannually for up to 20-years (2018-2019) and were classified as ever reporting hearing loss (n = 4946) or not reporting hearing loss (n = 6346). Data were analysed with Cox-proportional hazard ratios and multilevel logistic regression. The results showed that baseline physical activity was not associated with hearing loss over the follow-up. Time (i.e., wave of assessment) by hearing loss interactions showed that physical activity declined more rapidly over time in those with hearing loss, compared to those without (Odds Ratios = 0.94, 95% Confidence Intervals; 0.92-0.96, p < .001). These findings highlight the importance of addressing physical activity in middle- and older-aged adults with hearing loss. As physical activity is a modifiable behaviour that can reduce the risk of developing chronic health conditions, individuals with hearing loss may need additional, tailored support to be more physically active. Mitigating the decline in physical activity could be essential to support healthy ageing for adults with hearing loss.

The physical activity implications of retirement across occupational activity groups

Retirement is an important later life transition which may represent a critical period for physical activity in older age. Past findings on the association between retirement and physical activity are inconclusive and there is some evidence that the physical activity implications of retirement may differ by occupational activity level. This study used data from waves 4-9 (June 2008-July 2019) of the English Longitudinal Study on Aging to evaluate whether there is an association between retirement and physical activity, and whether this varies across occupational activity groups. Retirement was associated with a significant increase in physical activity (n = 10,693; β: 0.602 METhrs/wk. [95% CI: 0.490, 0.713], p < 0.001). There were significant interactions between retirement and past occupational activity level (n = 5109; X2 (3)=32.59, p < 0.001), such that people retiring from sedentary or standing occupations experienced a significant increase in physical activity with retirement but retirement from an occupation involving heavy manual labour was associated with a decrease in physical activity. This study quantified the importance of retirement for later life physical activity. With demographic aging, the population health importance of later life physical activity will likely become more important. These findings should inform the design of public health interventions to increase physical activity around the retirement transition.

Sudden Cardiac Arrest During Sports Activity in Older Adults

BACKGROUND

Sports activity among older adults is rising, but there is a lack of community-based data on sports-related sudden cardiac arrest (SrSCA) in the elderly.

OBJECTIVES

In this study, the authors investigated the prevalence and characteristics of SrSCA among subjects ≥65 years of age in a large U.S.

POPULATION

METHODS

All out-of-hospital sudden cardiac arrests (SCAs) were prospectively ascertained in the Portland, Oregon, USA, metro area (2002-2017), and Ventura County, California, USA (2015-2021) (catchment population ∼1.85 million). Detailed information was obtained for SCA warning symptoms, circumstances, and lifetime clinical history. Subjects with SCA during or within 1 hour of cessation of sports activity were categorized as SrSCA.

RESULTS

Of 4,078 SCAs among subjects ≥65 years of age, 77 were SrSCA (1.9%; 91% men). The crude annual SrSCA incidence among age ≥65 years was 3.29/100,000 in Portland and 2.10/100,000 in Ventura. The most common associated activities were cycling, gym activity, and running. SrSCA cases had lower burden of cardiovascular risk factors (P = 0.03) as well as comorbidities (P < 0.005) compared with non-SrSCA. Based on conservative estimates of community residents ≥65 years of age who participate in sports activity, the SrSCA incidence was 28.9/100,000 sport participation years and 18.4/100,000 sport participation years in Portland and Ventura, respectively. Crude survival to hospital discharge rate was higher in SrSCA, but the difference was nonsignificant after adjustment for confounding factors.

CONCLUSIONS

Among free-living community residents age ≥65 years, SrSCA is uncommon, predominantly occurs in men, and is associated with lower disease burden than non-SrSCA. These results suggest that the risk of SrSCA is low, and probably outweighed by the high benefit of exercise.

Joint associations of physical activity and sleep duration with cognitive ageing: longitudinal analysis of an English cohort study

BACKGROUND

Physical activity and sleep duration are key factors associated with cognitive function and dementia risk. How physical activity and sleep interact to influence cognitive ageing is not well explored. We aimed to examine the associations of combinations of physical activity and sleep duration with 10-year cognitive trajectories.

METHODS

In this longitudinal study, we analysed data from the English Longitudinal Study of Ageing collected between Jan 1, 2008, and July 31, 2019, with follow-up interviews every 2 years. Participants were cognitively healthy adults aged at least 50 years at baseline. Participants were asked about physical activity and nightly sleep duration at baseline. At each interview, episodic memory was assessed using immediate and delayed recall tasks and verbal fluency using an animal naming task; scores were standardised and averaged to produce a composite cognitive score. We used linear mixed models to examine independent and joint associations of physical activity (lower physical activity or higher physical activity, based on a score taking into account frequency and intensity of physical activity) and sleep duration (short [<6 h], optimal [6-8 h], or long [>8 h]) with cognitive performance at baseline, after 10 years of follow-up, and the rate of cognitive decline.

FINDINGS

We included 8958 respondents aged 50-95 years at baseline (median follow-up 10 years [IQR 2-10]). Lower physical activity and suboptimal sleep were independently associated with worse cognitive performance; short sleep was also associated with faster cognitive decline. At baseline, participants with higher physical activity and optimal sleep had higher cognitive scores than all combinations of lower physical activity and sleep categories (eg, difference between those with higher physical activity and optimal sleep vs those with lower physical activity and short sleep at baseline age 50 years was 0·14 SDs [95% CI 0·05-0·24]). We found no difference in baseline cognitive performance between sleep categories within the higher physical activity category. Those with higher physical activity and short sleep had faster rates of cognitive decline than those with higher physical activity and optimal sleep, such that their scores at 10 years were commensurate with those who reported low physical activity, regardless of sleep duration (eg, difference in cognitive performance after 10 years of follow-up between those with higher physical and optimal sleep and those with lower physical activity and short sleep was 0·20 SDs [0·08-0·33]; difference between those with higher physical activity and optimal sleep and those with lower physical activity and short sleep was 0·22 SDs [0·11-0·34]).

INTERPRETATION

The baseline cognitive benefit associated with more frequent, higher intensity physical activity was insufficient to ameliorate the more rapid cognitive decline associated with short sleep. Physical activity interventions should also consider sleep habits to maximise benefis of physical activity for long-term cognitive health.

FUNDING

UK Economic and Social Research Council.

Associations between Physical Activity and Health-Related Quality of Life among Community-Dwelling Older Adults: A Cross-Sectional Study in Urban Greece

Physical activity is an important factor in achieving healthy aging, offering older persons multiple benefits in terms of maintaining and improving their health and wellbeing. The aim of this study was to investigate the effect of physical activity on the quality of life of older adults. A cross-sectional study was conducted from February to May 2022, using the Short-Form Health Survey (SF-36) and the International Physical Activity Questionnaire (IPAQ). A total of 124 people aged 65 and over participated in the survey. The average age of the participants was 71.6 years, and 62.1% were women. Participants showed a moderate quality of life with regard to the physical health dimension (mean score 52.4) and a higher quality of life with regard to the mental health dimension (mean score 63.1) compared to the expected values of the population. Low levels of physical activity were recorded among older adults, reaching a rate of 83.9%. A moderate or high level of physical activity has been found to contribute to a better physical functioning (p = 0.03), vitality (p = 0.02) and general health (p = 0.01). Finally, comorbidity had a negative impact on physical activity (p = 0.03) and quality of life regarding mental and physical health in older adults. The study showed very low levels of physical activity in older Greek adults. The management of this problem, which was intensified during the COVID-19 pandemic, should be a high priority in public health programs focusing on healthy aging, as physical activity affects and promotes many of the basic aspects of quality of life.

Positive impacts of leisure-time physical activity on cardiorespiratory fitness, co-morbidity level, cardiovascular health and quality of life among midlife adults: a cross-sectional study of a Nigerian population

BACKGROUND

Regular physical activity (PA) improves general health and quality of life (QoL) of the general population. It is however not known if leisure-time PA (LTPA) behaviour will reduce co-morbidity and adiposity, and improve cardiorespiratory fitness and QoL in midlife men. This study explored the impacts of regular LTPA behaviour on co-morbidity, adiposity, cardiorespiratory fitness and QoL among male midlife sports club members in a Nigerian population.

METHODS

This cross-sectional study involved 174 age-matched male midlife adults: 87 engaging in LTPA (LTPA group) and 87 not engaging in LTPA (non-LTPA group). Information on age, body mass index (BMI), waist circumference (WC), maximal oxygen uptake (VO₂max)_, resting heart rate (RHR), QoL and co-morbidity level was collected using standardized procedures. Data were summarized using mean and standard deviation, and explored using frequency and proportion. Independent t-test, Chi Square and Mann-Whitney U test were employed to determine the impacts of LTPA at 0.05 significance level.

RESULTS

The LTPA group had lower co-morbidity score (p = 0.05) and RHR (p = 0.004), and higher QoL (p = 0.01) and VO₂max (p = 0.003) than non-LTPA group. While heart disease (χ² = 10.99; p = 0.01) and hypertension (χ² = 15.24; p = 0.004) severity levels were associated with LTPA behaviour, hypertension (p = 0.01) was the only co-morbid condition that had a significantly lower score in the LTPA group than in the non-LTPA group.

CONCLUSIONS

Regular LTPA improves cardiovascular health, physical work capacity and QoL in the sample of Nigerian mid-life men. Regular LTPA behaviour is recommended for cardiovascular health promotion, and improved physical work capacity and life satisfaction in midlife men.

The Relationship between Social Support for Physical Activity and Physical Activity across Nine Years in Adults Aged 60-65 Years at Baseline

Physical activity is consistently recognized as a key component of healthy aging. The current study aimed to investigate the prospective association between social support specific for physical activity (SSPA) and physical activity across nine years among adults aged 60-65 years at baseline (n = 1984). An observational longitudinal design was used, with mail surveys administered to a population-based sample across four waves. SSPA was measured using a score ranging from 5-25, and physical activity was assessed as time spent in walking, or engaging in moderate and vigorous activity, during the previous week. Data were analyzed using linear mixed-effects models. The results demonstrated a positive significant relationship between SSPA and physical activity, accounting for sociodemographic and health variables. Each unit of increase in SSPA was associated with 11 extra minutes of physical activity per week (p < 0.001). There was a significant interaction between SSPA and wave at the final timepoint, such that the relationship was weaker (p = 0.017). The results highlight the value of even small increases in SSPA. SSPA could be targeted to promote physical activity among older adults, but may be more impactful in young-old adults. More research is needed to understand impactful sources of SSPA, underlying mechanisms between SSPA and physical activity, and potential moderation by age.

A Scoping Review on Community-Based Programs to Promote Physical Activity in Older Immigrants

Older immigrants are at higher risks for inactivity due to cultural, environmental, and social barriers in the postmigration context. Community-based physical activity (PA) programs increase PA in older adults, yet little is known about approaches that specifically target older immigrants. This scoping review explores the literature on community-based programs that increase PA and physical fitness in immigrant older adults and identifies barriers and facilitators to PA program participation in this population. A systematic search of electronic databases and gray literature was conducted, and a total of 11 articles met the inclusion criteria after full-text screening. A range of populations and PA program characteristics are described, yet there is a lack of studies on older immigrant men, Black older immigrants, and immigrants from Arab and African countries. There is a need for further research to develop evidence-informed PA programs for this diverse population.

Physical activity's impact on rural older adult health: The multiple mediating effects of education, income, and psychological capital

Introduction

This study aims to explore the influence mechanism of rural older adult health. By examining the mediating roles of education, income, and psychological capital in physical activity's impact on health, this study provides a reference for lifestyle interventions to improve the health level of rural older adults.

Methods

The analysis was conducted on a sample of 1778 rural older adults from CGSS2017, and data were analyzed using PROCESS V4.2 for multiple mediating effects.

Results

The findings indicate that physical activity impacts rural older adult health through multiple mediating pathways. The mediating role includes seven paths, comprising the independent effects of three mediating variables of income, education, and psychological capital, and the chain mediating effects generated together.

Discussion

Based on the influence mechanism of health on rural older adults, optimizing policy focus and developing a precise, interconnected, and sustainable health security system for older adults is necessary. These research results are of practical significance for advancing healthy aging in rural areas.

Dynapenic Abdominal Obesity as a Risk Factor for Metabolic Syndrome in Individual 50 Years of Age or Older: English Longitudinal Study of Ageing

OBJECTIVES

To analyse whether dynapenic abdominal obesity is a risk factor for Metabolic syndrome (MetS) and its components in individuals 50 years of age or older.

DESIGN

A longitudinal study was conducted with an eight-year follow-up.

SETTING

Representative sample of community-dwelling participants of the English Longitudinal Study of Ageing (ELSA).

PARTICIPANTS

3,952 individuals free of MetS at baseline.

MEASUREMENTS

Dynapenic abdominal obesity was defined based on waist circumference (> 102 cm for men and > 88 cm for women) and grip strength (< 26 kg for men and < 16 kg for women). The participants were classified as non-abdominally obese/non-dynapenic (NAO/ND - reference group), abdominally obese/non-dynapenic (AO/ND), non-abdominally obese/dynapenic (NAO/D) and abdominally obese/dynapenic (AO/D). The outcome was the incidence of MetS based on the presence of three or more of the following criteria: hypertriglyceridemia, hyperglycaemia, low HDL cholesterol, arterial hypertension or body mass index ≥ 30 kg/m2 throughout eight-year follow-up. Additionally, the incidence of each component of MetS was also analyzed. Poisson regression models were run and controlled for sociodemographic, behavioural and clinical variables.

RESULTS

The mean age of the participants was 65 years and 55% were women. The prevalence of AO/ND, NAO/D and AO/D were 35.3, 4.3 and 2.2%, respectively. At the end of follow-up 558 incident cases of MetS were recorded. The adjusted model demonstrated that although abdominal obesity was a risk factor for MetS (IRR: 2.26; 95% CI: 1.87 - 2.73), the IRR was greater in AO/D individuals (IRR: 3.34; 95% CI: 2.03 - 5.50) compared with ND/NAO group. Furthermore, ND/AO was a risk factor for incidence of hypertriglyceridemia (IRR: 1.27; 95% CI: 1.06 - 1.52), hyperglycaemia (IRR: 1.41; 95% CI: 1.18 - 1.69), low HDL cholesterol (IRR: 1.70; 95% CI: 1.32 - 2.19) and BMI ≥ 30 kg/m2 (IRR: 2.58; 95% CI: 2.04 - 3.26) while D/AO was a risk factor for hyperglycaemia (IRR: 1.78; 95% CI: 1.02 - 3.10), low HDL cholesterol (IRR: 2.36; 95% CI: 1.10 - 5.08), and BMI ≥ 30 kg/m2 (IRR: 2.79; 95% CI: 1.38 - 5.62).

CONCLUSIONS

Dynapenic abdominal obesity increases the risk of MetS, with a higher IRR compared to obesity alone. The understanding of this synergic action could guide specific clinical strategies, enabling the prevention of metabolic changes that can lead to cardiovascular disease, disability and death.

Associations of Body-Roundness Index and Sarcopenia with Cardiovascular Disease among Middle-Aged and Older Adults: Findings from CHARLS

OBJECTIVES

Sarcopenia and obesity may contribute to chronic disease. However, little is known about the association between sarcopenia, body roundness index (BRI), and cardiovascular disease (CVD). The aim of this study was to investigate the association of sarcopenia and BRI with CVD in middle-aged and older Chinese population.

DESIGN

Cohort study with an 8-year follow-up.

SETTING AND PARTICIPANTS

Data were derived from 4 waves of the China Health and Retirement Longitudinal Study, and 6152 participants aged 45 or above were included in the study.

METHODS

Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. CVD was defined as the presence of physician-diagnosed heart disease, diabetes and/or stroke. The associations of BRI and sarcopenia with CVD risk were explored using Cox proportional hazards regression models.

RESULTS

The mean age of the participants was 58.3 (8.9) years, and 2936 (47.7%) were males. During the 8 years follow-up, 2385 cases (38.8%) with incident CVD were identified. Longitudinal results demonstrated that compared to neither sarcopenia or high BRI, both sarcopenia and high BRI (HR: 1.49, 95%CI: 1.08, 2.07) were associated with higher risk of CVD. In the subgroup analysis, individuals with both sarcopenia and high BRI were more likely to have new onset stroke (HR: 1.93, 95%CI: 1.12, 3.32) and increased risk of multimorbidity (HR: 2.15, 95% CI: 1.14, 4.04).

CONCLUSIONS

Coexistence of sarcopenia and high BRI was associated with higher risk of CVD. Early identification and intervention for sarcopenia and BRI not only allows the implementation of therapeutic strategies, but also provides an opportunity to mitigate the risk of developing CVD.

Trajectories of Cognition and Daily Functioning Before and After Incident Diabetes

OBJECTIVE

The temporal pattern of cognitive and functional change before and after incident diabetes remains unknown.

RESEARCH DESIGN AND METHODS

Data from wave 2 to wave 9 (2004-2018) of the English Longitudinal Study of Ageing were used. Global cognition (assessed by orientation, memory, and executive function) and daily functioning (calculated as the sum of impaired basic and instrumental activities of daily living) were measured in each wave. Incident diabetes was defined as glycated hemoglobin A1c ≥6.5% (47.5 mmol/mol), self-reported doctor diagnosis of diabetes, or glucose-lowering medication use during follow-up.

RESULTS

Among the 6,342 participants (mean age 65.0 years, 57.8% women) included, 576 participants (9.1%) with incident diabetes were identified during a median follow-up of 13.3 years. The annual rates of change in global cognition (β = -0.035 SD/year; 95% CI -0.054 to -0.015), orientation (-0.031 SD/year; -0.060 to -0.002), memory (-0.016 SD/year; -0.029 to -0.003), and executive function (-0.027 SD/year; -0.042 to -0.013) were accelerated after diabetes diagnosis compared with before the event. The postdiabetes annual changes in daily functioning (0.093 points/year; 95% CI 0.056-0.131) were also accelerated compared with the prediabetes diagnosis. However, the rate of cognitive and functional decline before the diabetes diagnosis in participants with future incident diabetes was similar to the rate in participants without diabetes. Also, no significant acute change was observed during its onset.

CONCLUSIONS

Incident diabetes is associated with accelerated cognitive and functional decline after, but not before, the event. We suggest careful monitoring for cognitive and physical dysfunction after a diabetes diagnosis.

Middle-aged and older adults' acceptance of mobile nutrition and fitness apps: A systematic mixed studies review

BACKGROUND

To promote healthy aging, the support of digital mobile health tools such as mobile applications (apps) addressing a healthy diet or physical activity appears promising, particularly when initiated before entering old age. For such tools to be effective, middle-aged and older adults' acceptance need to be studied in depth.

OBJECTIVE

The aim of this systematic review was to provide an integrative synthesis of the current state of research regarding the question in how far middle-aged and older adults (people aged 50 years and above) accept mobile nutrition and fitness apps to gain a deeper understanding of the influencing factors shaping this target group's usage behaviour and needs.

METHODS

The review process followed the PRISMA guidelines. The databases Medline, Embase, Web of Science as well as reference lists were systematically searched. Study quality was assessed using the MMAT and AXIS appraisal tools. Data of the included studies were extracted and thereupon narratively synthesized, involving thematic analysis.

RESULTS

Of N = 8823 articles screened, n = 7 studies could be identified-five quantitative, cross-sectional ones and two qualitative studies. Overall, the synthesized findings showed a lower acceptance among middle-aged and older adults compared to younger populations, which was particularly reflected in lower usage rates and more negative attitudes towards such apps (e.g., Perceived usefulness, Ease of use). The target group's acceptance of fitness apps was greater compared to nutrition apps. Findings on contextual factors and social determinants were inconsistent (e.g., regarding gender differences).

CONCLUSION

While cross-study comparability was limited, the synthesized evidence underscores the importance to target mobile nutrition and fitness apps to the distinctive and heterogeneous needs of middle-aged and, particularly, of older adults. The scarcity of the existing body of knowledge highlights the need of further (longitudinal) research.

PROSPERO PROTOCOL REGISTER NUMBER

CRD42020159409.

Physical Activity Tracker Application in Promoting Physical Activity Behavior among Older Adults: A 24-month Follow-Up Study

Objectives

To investigate whether and how PA tracker application use supports PA behavior among older adults during the first 24 months of use. Methods: The changes in PA levels (i.e., time spent in different PA intensities) and between PA categories (i.e., low, moderate, or high based on total PA) were examined between three different time points: before taking the application into use (t0), after 12 months of use (t1), and after 24 months of use (t2). The data was collected by using the International Physical Activity Questionnaire modified for the elderly (IPAQ-E). Results: A statistically significant increase was observed in walking (χ2 (2) = 29.741, p < .001), moderate PA (χ2 (2) = 6.327, p = .042), and total PA levels (χ2 (2) = 11.489, p = .003). The increase was observed between t0 and t1 as well as between t0 and t2. The overall changes between PA categories were statistically significant between t0 and t1 (χ2 (3) = 15.789, p = .001) as well as between t0 and t2 (χ2 (3) = 14.745, p = .002). There were more increasingly active (moved to a higher PA category) than decreasingly active (moved to a lower PA category) participants. Discussion: Overall, the results indicate that PA tracker application use can promote PA behavior among older adults. Stakeholders that work with PA programs and PA promotion, as well as individual users, can utilize digital wellness technologies in supporting PA promotion, especially in exceptional times, like the COVID-19 pandemic, when health care restrictions prevent general gatherings.

Benefits of sustained physical activity from middle age to early old age on quality of life in early old age

This study aimed to examine changes in physical activity (PA) over time (2009-2017) in the same participants and to determine an association between changes in PA and health-related quality of life (HRQoL) in early older adults (n = 994) using data from the Korea Health Panel Survey. HRQoL was measured using the EuroQol system, and the amount of PA was grouped into four activity levels: remained inactive, became inactive, became active, and remained active. The association of changes in PA over 8 years with HRQoL was examined using logistic regression analysis while controlling for socioeconomic and behavioral factors. Total PA decreased from 1859.72 ± 1760.01 MET-minutes in 2009 to 1264.80 ± 1251.14 MET-minutes in 2017 (P < 0.001). In 2017, 142 (14.3%) remained inactive, whereas 419 (42.2%) remained active. Participants who remained inactive in early old age were more likely to be in the lowest 10% HRQoL of the sample (odds ratio = 1.95, 95% confidence interval = 1.09-3.48). These findings indicate that health education and promotion must be prioritized for middle-aged adults, who are relatively inactive, so that they increase their current PA and improve their HRQoL to maximize the benefits of PA in old age.

Effects of Tai Chi and Walking Exercise on Emotional Face Recognition in Elderly People: An ERP Study

Both tai chi and walking can improve the physical health of the elderly, but the effect on the emotional cognitive function of the elderly is unclear. To investigate the effect of long-term walking and tai chi exercise on the emotional cognitive function of the elderly, 63 subjects were recruited in this study according to age and exercise habits, including 16 in the youth control group, 15 in the elderly non-exercise control group, 17 in the elderly walking group, and 18 in the elderly tai chi group. The “learning–test paradigm” of emotional faces was used to measure the subjects’ ability to recognize and remember emotional (negative and neutral) faces. Behavioral and EEG data were recorded during the learning and testing phases. The results showed that there is aging in emotional cognition in older adults compared with younger adults. Long-term walking and tai chi exercise can delay the deterioration of emotional cognitive function in older adults to some extent. Both walking and tai chi exercise can delay the decline in aging-related emotional face recognition function to some extent. Walking exercise can delay the decline in aging-related emotional face memory function to some extent.

THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND SEVERITY OF COVID-19 SYMPTOMS IN NON-HOSPITALISED INDIVIDUALS

Background

The study explored the relationship between physical activity (PA) behaviour and severity of symptoms in people infected by coronavirus disease 2019 (COVID-19).

Methods

Five hundred and thirty-three people [16% males, mean age: 45 ± 11 years, body mass index (BMI): 23.3 ± 20] took part in the study. All participants were post-COVID-19 infection. An online questionnaire was used to gather data on; participants demographics, comorbidities and treatment, symptomatology of COVID-19, quality of life (QoL) and pre- and post-COVID-19 infection PA.

Results

Logistic regression revealed that only a high BMI (>25) increased the severity of (odds ratio 1.01; 95% confidence interval, 0.99–1.03) symptoms from none to mild-to-moderate. Weekly PA behaviour (min/week) did not affect the primary outcome (symptom severity) as a predictor variable and neither differ (P > 0.05) between symptomatology for both moderate (no symptoms: 181.3 ± 202.1 vs. mild-to-moderate symptoms: 173 ± 210.3) and vigorous (no symptoms: 89.2 ± 147 vs. mild-to-moderate symptoms: 88.9 ± 148.3) PA. QoL (i.e. mobility, self-care, usual activities, pain/discomfort, anxiety/depression and perceived health) was significantly (P < 0.05) worse post-COVID-19 infection.

Conclusions

Our findings did not present an association between PA levels and mild-to-moderate COVID-19 symptoms. However, all participants exceeded the lower limit of the World Health Organization recommended, adult PA dose. This might explain the lack of PA effect, on mild-to-moderate symptoms post-COVID-19 infection. Future studies should explore the effects of PA levels in more severe cases (e.g. hospitalizations) and assess the effectiveness of PA to reduce hospitalizations, and mortality rates as a result of COVID-19 infection.

Beweg-Gründe im Alter

Hintergrund

Körperliche Bewegung gilt als ein Schlüsselfaktor für die Gesundheitserhaltung im Alter, wobei die COVID-19-Pandemie („coronavirus disease 2019“), wie Studien zeigen, zu einer Reduktion der körperlichen Aktivität beigetragen hat und es nun Überlegungen bedarf, wie eine (Re‑)Aktivierung der älteren Bevölkerung gelingen kann. Ein Ansatz ist hierbei zu fragen, welche Faktoren körperliche Aktivität bereits vor der Pandemie positiv beeinflusst haben, um diese durch Interventionen gezielt anzusprechen.

Fragestellung

Ziel der vorliegenden Untersuchung ist es, in einer multivariaten Analyse jene wichtigen Faktoren körperlicher Aktivität zu identifizieren, um so (Re‑)Aktivierungschancen aufzuzeigen.

Material und Methode

Die hierfür durchgeführte Analyse mittels multipler logistischer Regression stützt sich auf Daten einer standardisierten, repräsentativen Telefonbefragung (n = 2042) der 60-jährigen und älteren Bevölkerung im österreichischen Bundesland Niederösterreich, die im Frühsommer 2019 durchgeführt wurde.

Ergebnisse

Ein positiver Gesundheitszustand sowie motivationale Faktoren erhöhen die Chance auf regelmäßige körperliche Aktivität. Die soziale Komponente sowie die Überzeugung, dass Sport der Gesundheit guttut, steigern ebenfalls die Wahrscheinlichkeit, Bewegung zu machen. Soziodemografische Faktoren abseits des Einkommens konnten im Modell hingegen nicht als signifikante Prädiktoren identifiziert werden.

Schlussfolgerungen

Um die (Re‑)Aktivierungschancen zu erhöhen, bedarf es Maßnahmen, welche die körperliche Aktivität als Mittel zu unterschiedlichen Zwecken älterer Menschen begreifen.

Influence of current physical exercise on the relationship between aging and episodic memory and fluid intelligence

The present study examined the effects of current physical exercise and age on episodic memory and fluid intelligence, assessed with a free-recall task and the Culture Fair Intelligence Test (Cattell, 1963) respectively, while statistically controlling for other cognitive reserve factors (educational level, leisure activities, and vocabulary level). Two hundred and eight participants aged 20 to 85 participated in the study. Physical exercise level was indexed by weekly frequency over the last 12 months using self-reported measurement (from none to 4 times a week). Overall, results show a beneficial effect of physical exercise especially from a weekly practice of 2 times, and significant interaction between physical exercise and age on episodic memory and fluid intelligence capacities indicating a reduced effect of age in more physically active participants. These results reinforce the view that physical exercise is a strong and specific reserve factor that reduces decline in some cognitive functions during aging.

Cost-effectiveness of a programme to address sedentary behaviour in older adults: results from the SITLESS RCT

BACKGROUND

This study details the within-trial economic evaluation and long-term economic model of SITLESS, a multi-country, three-armed randomized controlled trial comparing a combined intervention of exercise referral schemes (ERS) enhanced by self-management strategies (SMS) against ERS alone and usual care (UC).

METHODS

A cost-utility analysis, conducted from the base-case perspective of the National Health Service and personal and social services, estimated the incremental cost per incremental quality-adjusted life year (QALY) and years in full capability (YFC). A secondary analysis combined the costs with a broad set of outcomes within a cost-consequence framework, from a societal perspective. A Markov-type decision-analytic model was developed to project short-term changes in physical activity to long-term outcomes and costs, over a 5- and 15-year time horizon.

RESULTS

The results of the within-trial analysis show that SMS+ERS is highly likely to be cost-effective compared to ERS alone (ICER €4270/QALY), but not compared to UC. Participants allocated to the SMS+ERS group also showed an improvement in YFC compared to ERS alone and UC. The long-term analysis revealed that SMS+ERS is likely to be a cost-effective option compared to ERS and UC over a 5-year, but not with a 15-year horizon, being then dominated by ERS alone.

CONCLUSION

This research provides new evidence that SMS is a cost-effective add-on to ERS strategies. This economic evaluation informs the case for further, cost-effective, refinement of lifestyle change programmes targeted to older adults, with the aim of ultimately reducing the impact of non-communicable diseases in this population.

Resilience and Mental Health Among Regularly and Intermittently Active Older Adults: Results From a Four-Year Longitudinal Study

BACKGROUND

This study aims to investigate whether regularly active individuals have different levels of mental health and resilience compared to intermittently active individuals.

METHODS

In this 4-year longitudinal study, 180 older people were included. General linear models were used to assess the level of physical activity, psychological resilience, and mental health among regularly and intermittently active older adults.

RESULTS

Those who maintained regular physical activity were more resilient than those who did not. However, no differences were observed for mental health outcomes. Although those with higher levels of resilience had fewer mental health problems, there were no significant differences between the groups based on their level of physical activity.

CONCLUSION

Differences in resilience levels favoring regularly active individuals were found. In both groups, resilience was inversely associated with mental health problems. These findings may help elucidate the underlying mechanisms in the relationship between physical activity and health outcomes.

A retrospective audit of the timescales involved in the diagnosis and management of suspected Achilles tendon ruptures at a single National Health Service trust: A quality service improvement and redesign project

Introduction

The Achilles tendon is the most frequently ruptured tendon. Prompt diagnosis of this injury ensures optimal management decisions are instituted early ensuring the best outcome and patient experience, at minimal cost to the United Kingdom National Health Service. Despite this, regional and national variations to diagnosis and management exist, with anecdotal evidence of inefficiencies in the local patient pathway. To explore this further, a retrospective departmental audit of timescales from presentation to ultrasound diagnosis and definitive treatment decision was undertaken.

Methods

All suspected Achilles tendon ruptures in 2018 were identified through electronic and written patient records, and information on timescales involved in the diagnosis and management of each compiled. Descriptive statistics were used to map each step of the pathway and timescales involved, with performance assessed against local departmental standards and the Swansea Morriston Achilles Rupture Treatment (SMART) protocol.

Results

In total, 119 patients were identified, of which 113 received an ultrasound examination. Local departmental standards were met in the majority of cases, with 78% (n = 88) diagnosed by ultrasound within one week of the request and 83% (n = 91) given a treatment decision within two weeks of presentation. However, this was suboptimal when compared with timeframes utilised for developing the SMART protocol, with only 7% (n = 8) scanned within 48 hours of presentation.

Conclusions

Key areas of the patient pathway were identified for quality service improvement and redesign, with multidisciplinary discussion resulting in the development of a revised patient pathway which expedites diagnosis and treatment for these injuries.

The impact pathways of environmental, social, and behavioural factors on healthy ageing for urban dwellers aged 85+: Longitudinal study of the Tokyo Oldest Old Survey on Total Health (TOOTH)

In the context of global population ageing and concentration in cities, the population aged 80 and over (80+) is growing rapidly. Japan has the fastest ageing population and longest healthy average life expectancy, while health decline becomes pronounced and care needs increase in the 85+ age group post the ‘average life expectancy’. The healthy ageing of older urban community dwellers is a pressing issue in world initiatives for sustainable urbanisation. However, for the 85+ age group, less is known about how promoting/inhibiting factors and their pathways influence healthy ageing, and related longitudinal studies remain insufficient. Using data from a longitudinal cohort study conducted from 2008–2009 to 2014–2015 among independent dwellers aged 85+ in central Tokyo (men = 203, women = 232), this study analysed the impact pathways of environmental, social, and behavioural factors on health and survival to explore promoters and potential risks on healthy ageing by gender, with multi-group structural equation modelling (SEM) and Bayesian SEM. For both genders, there was a positive chained pathway starting from friends as facilitators through positive interactions between 'social participation’ and 'active behaviour' to 'ageing-related health'. Additionally, their personal networks were small, suggesting that men with family-centred networks and women with non-family-centred networks require different approaches and supports. Implications of the results are discussed, and an organised social watch and support system, which becomes more important in the ‘new normal’ for urban dwellers aged 85+, is recommended.

•

A 6-year longitudinal cohort study for independent urban dwellers aged 85+.

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SEM analysis among environmental, social, and behavioural factors on health.

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Friends can facilitate positive chained path through activities to health.

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Gender-differences in nature of personal networks affect healthy ageing.

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Social watching, support are necessary for this group in sustainable urbanisation.

Associations between starting and stopping volunteering and physical activity among older adults - longitudinal evidence from the German Ageing Survey

Background

Physical activity (PA) contributes to healthy aging. Several studies have investigated factors influencing PA. However, population-based studies evaluating associations between volunteering and changes in PA are lacking. Our aim was to clarify whether starting and stopping to volunteer is associated with changes in physical activity in older adults.

Method

We used data from the German Ageing Survey (wave 5 and 6 in the years 2014 and 2017), which is a representative survey of community-dwelling middle-aged and older adults. We included individuals ≥ 65 years (analytical sample: n = 5,682). PA was investigated using questions from the international physical activity questionnaire (IPAQ) and converted into metabolic equivalent of tasks (METs) per week. Changes in volunteering status in groups or organizations (yes/no) and their association with changes in PA were investigated in adjusted asymmetric fixed effects models stratified by sex.

Results

We found an association, between starting to volunteer and increased physical activity in older adults in the total sample (ß = 1,078.93, p = 0.052). This change reached significance for men (ß = 1,751.54, p = 0.016), but not for women (ß = 187.25, p = 0.832) in the stratified analyses. In the total sample, there was no association between stopping volunteering and decreases in PA (ß = -285.61, p = 0.543). This also held true in the stratified analyses for men (ß = -320.76, p = 0.583) and women (ß = -158.96, p = 0.845).

Conclusion

Our study identified an association between beginning to volunteer and increased physical activity among older men. Thus, beginning to volunteer may assist older men in increasing their physical activity levels.

Impact of Activity Tracker Usage in Combination with a Physical Activity Intervention on Physical and Cognitive Parameters in Healthy Adults Aged 60+: A Randomized Controlled Trial

Regular physical activity (PA) is of central importance for healthy aging and has a well-known impact on helping older adults maintain their cognitive and physical health. Thus, we aimed to compare the effectiveness of two physical activity interventions primarily conducted at home (print-based or web-based vs. web-based plus the use of an activity tracker) on cognitive and physical health parameters in older adults. Data of participants (n = 551, 60–80 years) were analyzed after being randomly allocated to a waitlist control group (CG), a web-based or print-based intervention group (IG) or a web-based intervention group that also included the use of an activity tracker (AG). Measured parameters were grip strength, endurance (two-minute step test), gait speed (four-meter walk test), cognition (Simon task; balanced integration score (BIS), reaction time and accuracy) and physical self-concept (Physical Self-Description Questionnaire (PSDQ)). We found the highest effect sizes in all measured dimensions for AG (grip strength, endurance, gait speed, reaction time, physical self-concept), followed by IG (endurance, gait speed, reaction time, physical self-concept) and CG (endurance, gait speed, BIS). Findings suggest that a combined web-based and activity tracker intervention may improve physical functions, physical self-concept, and cognition in community-dwelling older adults.

Prevalence and potential risk factors of chronic pruritus among community middle-aged and older population in Beijing, China

BACKGROUND

Chronic pruritus is a common problem among older adults, with a significant impact on their quality of life. However, it is under-studied epidemiologically, especially among Chinese older adults.

OBJECTIVE

To identify the prevalence and explore the risk factors of chronic pruritus among the middle-aged and older adults in Beijing, China.

METHODS

A total of 929 participants aged ≥35 years from six communities in Beijing, China, were interviewed. The survey collected the demographic characteristics, the experience of chronic pruritus (>6 weeks), chronic disease history, the level of physical activities, and sleep quality. A population-based case-control study was conducted, including 178 chronic pruritus cases and 697 controls. A multivariate logistic regression model was performed to explore the risk factors of chronic pruritus. Additionally, a random forest algorithm was used to rank the importance of potential risk factors and analyze the overall interpretation of risk factors.

RESULTS

The prevalence of chronic pruritus was 19.48% (181/929) among the Beijing middle-aged and elderly population. The findings indicated that older adults aged 65 years old or above, male, with college or higher degree, alcohol drinking, hypertension, hyperlipidemia, chronic lung disease, cardiovascular disease, digestive system disease and osteoarthritis/rheumatism, middle or low sleep quality were associated with the increased risk of chronic pruritus, respectively. Physical activity level (≥3000 Met) was associated with a decreased risk of chronic pruritus. The rank according to the most contribution of chronic pruritus risk was sleep quality, education, physical activity level, osteoarthritis/rheumatism, age, and gender.

CONCLUSION

Prevalence of chronic pruritus was high among the Chinese middle-aged and elderly population. Age, gender, high education, alcohol drinking, hypertension, hyperlipidemia, chronic lung disease, cardiovascular disease, digestive system disease, osteoarthritis /rheumatism, poor sleep quality may serve as risk factors of chronic pruritus. Moderate and high physical activity levels may serve as protective factors of chronic pruritus risk.

Effects of changes in depressive symptoms on handgrip strength in later life: A four-year longitudinal study in England

BACKGROUND

Few studies have examined the associations between changes in depressive symptoms and handgrip strength in older people. This study aimed to examine the magnitude of the association between depressive symptoms over 2 years and weak handgrip strength on the 4 years of follow-up.

METHODS

We conducted a longitudinal study using data from the English Longitudinal Study of Aging, a nationally representative panel survey of older adults in England. Data were derived from waves 4 (2008-2009), 5 (2010-2011), and 6 (2012-2013). A total of 5,080 participants were included in the analysis. Depressive symptoms were dichotomized using the eight-item Center for Epidemiological Studies Depression Scale in waves 4 and 5 and were regarded as the exposure. Handgrip strength measurements objectively measured in wave 6 were dichotomized according to the 25th percentile of the British norm and used as the outcome. The targeted maximum likelihood estimation model was utilized to assess time-variant depressive symptoms on handgrip strength, adjusted for time-variant and time-invariant covariates.

RESULTS

The maintenance of non-depressive symptoms (relative risk [RR], 0.72; 95% confidence interval [CI], 0.59-0.87) or improvement of depressive symptoms (RR, 0.71; 95% CI, 0.55-0.91) had a protective effect on weak handgrip strength compared with the persistence of depressive symptoms.

LIMITATION

This study is not a randomized control trial but a longitudinal observational study, indicating that our study finding may still have been affected by unknown confounders.

CONCLUSION

Our findings suggest the importance of managing depressive symptoms to prevent poor physical function.

Effects of Changes in Physical Activity with Cognitive Decline in Korean Home-Dwelling Older Adults

Purpose

Patients and Methods

Results

Conclusion

Physical activity and social support mediate the relationship between chronic diseases and positive mental health in a national sample of community-dwelling Canadians 65+: A structural equation analysis

BACKGROUND

Mental health is a critical component of healthy aging. Aging increases the likelihood of developing chronic diseases. The negative effects of chronic diseases on mental health have been extensively documented. Physical activity and social support have been reported to influence mental health positively.

METHODS

Data analyzed are drawn from the national Canadian Community Health Survey - Mental Health in 2012. Structural equation modeling (SEM) techniques were used to estimate and test the mediating role of physical activities and social support in the relationship between chronic disease, positive mental health, and psychological distress in a national adult population sample aged 65+.

RESULTS

Approximately 83% of the older adults sample reported having at least one chronic disease, and the mean score of psychological distress and positive mental health was 14.15 ± 4.73 and 55.28 ± 10.67, respectively. Initial analysis found that chronic illness was negatively related to positive mental health (β= -0.72, P < 0.001) and positively related to psychological distress (β=0.98, P < 0.001). The final structural model found that physical activity and social support partially mediated the negative consequences of chronic disease on psychological distress and strengthened seniors' positive mental health.

LIMITATIONS

Limiting causal attribution, potential reporting bias and limited in recognizing negative and positive social support are the major limitations.

CONCLUSIONS

Older adults with chronic diseases should be encouraged to increase physical activity and social support levels. The study outcomes have clinical implications for the delivery of mental health services to improve mental health and resilience to coping with stress among older adults.

Specific Types of Physical Exercises, Dietary Preferences, and Obesity Patterns With the Incidence of Hypertension: A 26-years Cohort Study

Objectives: To examine the associations of specific types of physical exercises, dietary preferences, and obesity patterns with incident hypertension.

Methods: In this cohort study, obesity patterns were defined using general and abdominal obesity as G-/A-, G+/A- or G-/A+, and G+/A+. The type of physical exercises and dietary preferences were collected using a validated questionnaire. Participants with systemic blood pressure/diastolic blood pressure ≥140 mmHg/90 mmHg, use of antihypertensive medications, or a self-reported diagnosis were identified as hypertension.

Results: There were 10,713 participants in this study. Martial arts, gymnastics, and ping pong could decrease the risk of hypertension (HR: 0.792, 0.884, and 0.855; and 95% CI: 0.743–0.845, 0.825–0.948, and 0.767–0.953, respectively). However, TV or computer usage, and consumption of fast food, soft/sugared drinks, and salty snack food could increase incident hypertension (HR: 1.418, 1.381, 1.233, and 1.225; and 95% CI: 1.315–1.529, 1.269–1.504, 1.157–1.314, and 1.139–1.316, respectively). Obese subjects had an increased risk of hypertension.

Conclusion: The type of physical exercises, dietary preferences, and obesity patterns were associated with incident hypertension. More attention should be paid to these lifestyles to benefit health outcomes.

Distinct physical activity and sedentary behavior trajectories in older adults during participation in a physical activity intervention: a latent class growth analysis

BACKGROUND

This study aimed to identify latent moderate-to-vigorous intensity physical activity (MVPA) and sedentary behavior (SB) trajectories in older adults participating in a randomized intervention trial and to explore associations with baseline social-cognitive predictors.

METHODS

Data were assessed at baseline (T0, participants were inactive or had recently become active), after a ten-week physical activity intervention (T1), and a second 24-week intervention phase (T2). Latent class growth analysis was used on accelerometer-assessed weekly MVPA and daily SB, respectively (n = 215 eligible participants). Activity changes within trajectory classes and baseline social-cognitive predictor differences between trajectory classes were analyzed.

RESULTS

A "stable insufficient MVPA" (n = 197, p for difference in MVPA level at T0 and T2 (pT0-T2) = .789, effect size (Cohen's d) = .03) and a "stable high MVPA" trajectory (n = 18, pT0-T2 = .137, d = .39), as well as a "slightly decreasing high SB" (n = 63, p for difference in SB (pT0-T2) = .022, d = .36) and a "slightly increasing moderate SB" trajectory (n = 152, pT0-T2 = .019, d = .27) emerged. Belonging to the "stable high MVPA" trajectory was associated with higher action planning levels compared to the "stable insufficient MVPA" trajectory (M = 5.46 versus 4.40, d = .50). Belonging to the "decreasing high SB" trajectory was associated with higher action self-efficacy levels compared to the "increasing moderate SB" trajectory (M = 5.27 versus 4.72, d = .33).

CONCLUSIONS

Change occurred heterogeneously in latent (not directly observed) subgroups, with significant positive trajectories only observed in the highly sedentary.

TRIAL REGISTRATION

German Registry of Clinical Trials, DRKS00016073 , Registered 10 January 2019.

Differing determinants of disability trends among men and women aged 50 years and older

Background

Researchers have emphasized the importance of examining how different factors affect men’s and women’s functional status over time. To date, the literature is unclear about whether sex affects the rate of change in disability in middle to older age. Researchers have further emphasized the importance of examining how different factors affect men’s and women’s functional status over time. We examined (a) sex differences in disability trends and (b) the determinants of the rate of change in disability for men and women 50 years and older.

Methods

This study utilized the Taiwan Longitudinal Study on Aging Survey, a nationally representative database (four waves of survey data 1996–2007, N = 3429). We modeled and compared the differences in disability trends and the influences of determinants on trends among men and women using multiple-indicator and multiple-group latent growth curves modeling (LGCM). Equality constraints were imposed on 10 determinants across groups.

Results

Once disability began, women progressed toward greater disability 18% faster than men. Greater age added about 1.2 times the burden to the rate of change in disability for women than men (p < 0.001). More comorbidities also added significantly more burden to baseline disability and rate of change in disability among women than men (p < 0.001), but women benefited more from higher education levels in lower baseline disability and slower rate of change. Having a better social network was associated with lower baseline disability among women only (p < 0.05). For both men and women, physically active leisure-time activities were beneficial in lower baseline disability (p_{men and women} < 0.001) and rate of change in disability (p_men < 0.01; p_women < 0.05), with no significant differences between groups.

Conclusions

Age may widen the sex gap in the rate of change in disability. However, both sexes benefit from participating in leisure-time activities. Promoting health literacy improves health outcomes and physical function among women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02574-3.

Ageing rate of older adults affects the factors associated with, and the determinants of malnutrition in the community: a systematic review and narrative synthesis

BACKGROUND

Malnutrition negatively impacts on health, quality of life and disease outcomes in older adults. The reported factors associated with, and determinants of malnutrition, are inconsistent between studies. These factors may vary according to differences in rate of ageing. This review critically examines the evidence for the most frequently reported sociodemographic factors and determinants of malnutrition and identifies differences according to rates of ageing.

METHODS

A systematic search of the PubMed Central and Embase databases was conducted in April 2019 to identify papers on ageing and poor nutritional status. Numerous factors were identified, including factors from demographic, food intake, lifestyle, social, physical functioning, psychological and disease-related domains. Where possible, community-dwelling populations assessed within the included studies (N = 68) were categorised according to their ageing rate: 'successful', 'usual' or 'accelerated'.

RESULTS

Low education level and unmarried status appear to be more frequently associated with malnutrition within the successful ageing category. Indicators of declining mobility and function are associated with malnutrition and increase in severity across the ageing categories. Falls and hospitalisation are associated with malnutrition irrespective of rate of ageing. Factors associated with malnutrition from the food intake, social and disease-related domains increase in severity in the accelerated ageing category. Having a cognitive impairment appears to be a determinant of malnutrition in successfully ageing populations whilst dementia is reported to be associated with malnutrition within usual and accelerated ageing populations.

CONCLUSIONS

This review summarises the factors associated with malnutrition and malnutrition risk reported in community-dwelling older adults focusing on differences identified according to rate of ageing. As the rate of ageing speeds up, an increasing number of factors are reported within the food intake, social and disease-related domains; these factors increase in severity in the accelerated ageing category. Knowledge of the specific factors and determinants associated with malnutrition according to older adults' ageing rate could contribute to the identification and prevention of malnutrition. As most studies included in this review were cross-sectional, longitudinal studies and meta-analyses comprehensively assessing potential contributory factors are required to establish the true determinants of malnutrition.

Beliefs and motivation regarding physical activity among older adults in Germany: results of a qualitative study

Purpose: As the proportion of older adults in Germany continues to grow, so does the need for physical activity as a strategy for health promotion. The purpose of this study is to gain insights into the belief system underlying older adults' physical activity and its interplay with motivation by integrating Theory of Planned Behaviour and Self-Determination Theory.Methods: We conducted 20 semi-structured interviews with residents of Germany who were 65 years of age or older. Transcripts of interviews were analysed with a coding frame of deductive main categories and inductive subcategories.Results: Part of our results is a typology that divides our sample into four groups based on the intensity and perceived sufficiency of their physical activity. These groups mainly differ in their intrinsic vs. extrinsic motivation and how they deal with barriers to physical activity, i.e., control beliefs.Conclusion: Messages to promote physical activity should be tailored regarding older adults' varying beliefs and motivation. To overcome barriers, intrinsic motivation plays a crucial role. Intrinsic motivation is closely linked to activities that are joyful and satisfy basic psychological needs. Moreover, it is important for older adults to be able to adjust their activities to age-related physical limitations and chronic diseases.

Statistical analysis plan for the coaching for healthy AGEing trial - a cluster-randomised controlled trial to enhance physical activity and prevent falls in community-dwelling older people

BACKGROUND

This statistical analysis plan details the Coaching for Healthy AGEing (CHAnGE) trial analysis methodology.

OBJECTIVE

To investigate the effect of a combined physical activity and fall prevention program on physical activity and falls compared to a healthy eating among people aged 60 years and over.

METHODS

The CHAnGE trial is a pragmatic parallel-group cluster-randomised controlled trial with allocation concealment and blinded assessors. Clusters are allocated to either (1) a physical activity and fall prevention intervention or (2) to a healthy eating intervention. The primary outcomes are: objectively measured physical activity at 12 months post-randomisation, and self-reported falls throughout the 12-month trial period. Secondary outcomes include the proportion of participants reporting a fall, the proportion of participants meeting the Australian physical activity guidelines, body mass index, eating habits, mobility goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being, self-reported physical activity, disability, and use of health and community services.

ANALYSIS

We will follow the intention-to-treat principle. All analysis will allow for cluster randomisation using a generalised estimating equation approach. The between-group difference in the number of falls per person-year will be analysed using negative binomial regression models. For the continuously scored primary and secondary outcome measures, linear regression models adjusted for corresponding baseline scores will assess the effect of group allocation. Analyses will take into account cluster randomisation and will be adjusted for baseline scores. A subgroup analysis will assess differential effects of the intervention by baseline physical activity levels and history of falls.

Managing a positive impression: Self-presentation among octogenarians

This paper addresses self-presentation among home-dwelling octogenarians living in the Faroe Islands. The purpose was to examine how older adults make meaning of ageing in interaction and examine the possible impact of social and cultural norms on this meaning making practice. The study is based on social constructionism. Interviews were conducted with both married couples and individual men and women during the spring of 2019. The interviewees projected a positive impression of life as older adults. They used humour to cover up health problems, and downward social comparison with others to enhance their own active lifestyle. They included third-party compliments to enhance the impression of appearing 'younger' than their chronological age, thus reconciling the misalignment between age norms and lived experience.

Methodological aspects for accelerometer-based assessment of physical activity in heart failure and health

Background

For valid accelerometer-assessed physical activity (PA) data, several methodological aspects should be considered. We aimed to 1) visualize the applicability of absolute accelerometer cut-offs to classify PA intensity, 2) verify recommendations to measure PA over 7 days by examining inter-day variability and reactivity, 3) examine seasonal differences in PA, and 4) recommend during which 10 h day period accelerometers should be worn to capture the most PA in patients with heart failure (HEART) and healthy individuals (HEALTH).

Methods

Fifty-six HEART (23% female; mean age 66 ± 13 years) and 299 HEALTH (51% female; mean age 54 ± 19 years) of the COmPLETE study wore accelerometers for 14 days. Aim 1 was analyzed descriptively. Key analyses were performed using linear mixed models.

Results

The results yielded poor applicability of absolute cut-offs. The day of the week significantly affected PA in both groups. PA-reactivity was not present in either group. A seasonal influence on PA was only found in HEALTH. Large inter-individual variability in PA timing was present.

Conclusions

Our data indicated that absolute cut-offs foster inaccuracies in both populations. In HEART, Sunday and four other days included in the analyses seem sufficient to estimate PA and the consideration of seasonal differences and reactivity seems not necessary. For healthy individuals, both weekend days plus four other days should be integrated into the analyses and seasonal differences should be considered. Due to substantial inter-individual variability in PA timing, accelerometers should be worn throughout waking time. These findings may improve future PA assessment.

Trial registration

The COmPLETE study was registered at clinicaltrials.gov (NCT03986892).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01350-6.

Relationship between physical activity and functional capacity change in aged cohort in São Paulo, Brazil

OBJECTIVES

to evaluate the relationship between leisure-time physical activity and functional capacity change among aged people.

METHODS

we analyzed data of an aged cohort looking for determinants of functional capacity at follow-up. Baseline data were collected between 2007 and 2008 - average follow-up of 3,5 years. A full multivariate linear regression model was built to evaluate functional capacity at the end of the follow-up, controlling for functional capacity at baseline, sociodemographic, health and behavioral characteristics and amount of leisure-time physical activity in the period.

RESULTS

final model showed functional capacity independently correlated with age (p<0.001), body mass (p=0.013) and the number of activities of daily living compromised at baseline (p<0.001). Functional capacity improved with increased physical activity but loss statistical significance after adjustments (p=0.384).

CONCLUSIONS

functional capacity decreases with increased age, increased loss of functional capacity at baseline and increased body mass. Albeit a non-significant association, leisure-time physical activity appears as an important modifiable factor.

Effect of 5 years of exercise training on the cardiovascular risk profile of older adults: the Generation 100 randomized trial

AIMS

The aim of this study was to compare the effects of 5 years of supervised exercise training (ExComb), and the differential effects of subgroups of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), with control on the cardiovascular risk profile in older adults.

METHODS AND RESULTS

Older adults aged 70-77 years from Trondheim, Norway (n = 1567, 50% women), able to safely perform exercise training were randomized to 5 years of two weekly sessions of HIIT [∼90% of peak heart rate (HR), n = 400] or MICT (∼70% of peak HR, n = 387), together forming ExComb (n = 787), or control (instructed to follow physical activity recommendations, n = 780). The main outcome was a continuous cardiovascular risk score (CCR), individual cardiovascular risk factors, and peak oxygen uptake (VO2peak). CCR was not significantly lower [-0.19, 99% confidence interval (CI) -0.46 to 0.07] and VO2peak was not significantly higher (0.39 mL/kg/min, 99% CI -0.22 to 1.00) for ExComb vs. control. HIIT showed higher VO2peak (0.76 mL/kg/min, 99% CI 0.02-1.51), but not lower CCR (-0.32, 99% CI -0.64 to 0.01) vs. control. MICT did not show significant differences compared to control or HIIT. Individual risk factors mostly did not show significant between-group differences, with some exceptions for HIIT being better than control. There was no significant effect modification by sex. The number of cardiovascular events was similar across groups. The healthy and fit study sample, and contamination and cross-over between intervention groups, challenged the possibility of detecting between-group differences.

CONCLUSIONS

Five years of supervised exercise training in older adults had little effect on cardiovascular risk profile and did not reduce cardiovascular events.

REGISTRATION

ClinicalTrials.gov: NCT01666340.