Active Aging and Public Health: Evidence, Implications, and Opportunities

Group psychological counseling-based growth mindset intervention to promote active aging behaviors in older people: protocol for a randomized controlled trial

BACKGROUND

Although active aging is widely accepted and applied in various countries, research on active aging has predominantly focused on environmental interventions, often overlooking the autonomy of older people. This study addresses this gap by using group psychological counseling technique to implement growth mindset interventions, aiming to stimulate older people's autonomy and foster their active aging behaviors.

METHODS

This study employs a randomized controlled trial design with two groups: an autonomous intervention group and a usual control group. Each participant in the autonomous intervention group will be assigned to one fixed group of four to seven people and participate in four structured group psychological counseling-based growth mindset intervention sessions. The usual control group will engage in community activities of equivalent duration. The study will take place in the eastern and western provinces of China. Indicators of active aging and positive psychology orientation, including growth mindset, active learning behaviors, active health behavior, active social participation behaviors, and active self-security behaviors will be evaluated to verify intervention effects at four timepoints (baseline, after the intervention, one month and three months after the intervention). The study will employ the Theoretical Domains Framework (TDF) to conduct qualitative interviews among the participants and community workers who participate in the autonomous intervention group. The Generalized Estimating Equation (GEE) model will be utilized to examine the intervention effect.

DISCUSSION

The study will focus on the autonomy of older people and design a structured, scalable group psychological counseling-based growth mindset intervention program, offering a novel pathway to fostering active aging behaviors and tackling the critical challenges posed by population aging. This is the first study that will validate the effectiveness of the growth mindset theory in behavioral interventions tailored to the older people population. To improve the scalability and replicability of the intervention program, the study will utilize TDF to explore the factors that facilitate or hinder the effectiveness of the growth mindset intervention.

TRIAL REGISTRATION

Hypotheses were registered on Aspredicted.org (#138686) on July 18, 2023, prospectively registered. The trial was registered on the Chinese Clinical Trial Registry (ChiCTR2500095613) on January 9, 2025, retrospectively registered.

Global, regional and national burden and trends of larynx cancer among adults aged 55 and older from 1990 to 2021: results from the global burden of disease study 2021

BACKGROUND

Laryngeal cancer (LC), as a common head and neck tumor, significantly impacts the quality of life. Utilizing data from the 2021 Global Burden of Disease (GBD) study, we sought to delve deeply into the global LC burden experienced by individuals aged 55 and older from 1990 to 2021 at the global, regional, and national levels. This research encompassed three key indicators: incidence rate, mortality, and disability-adjusted life years (DALYs).

METHODS

Based on the GBD 2021 database, we selected data from 204 countries and regions covering the period from 1990 to 2021 for individuals aged 55 and above. We analyzed LC's performance in terms of incidence, mortality, and DALYs, calculating the age-standardized rates and the mean average annual percent change (AAPC) at global, regional, and national levels. In our analysis of global trends, we carefully considered multiple variables including age, sex, and the socio-demographic index (SDI). Furthermore, we assessed potential risk factors for LC-associated DALYs and made prospective predictions for the possible scenario by 2035.

RESULTS

Globally, the age-standardized DALY rate of LC among adults aged 55 years and older has undergone significant changes. Specifically, this rate dropped sharply from 245.89 cases per 100,000 people in 1990 to 153.76 cases per 100,000 people in 2021, with an AAPC showing a decreasing trend of -2.916. Simultaneously, the age-standardized incidence rate and mortality rate also exhibited a similar downward trend. From a regional perspective, South Asia ranked highest in relevant indicators in 2021, reporting a death toll of 29,258.96, confirmed cases of 34,234.23, and DALYs related to LC reaching 709,622.00. In contrast, the figures in Oceania were the lowest, with only 26.23 deaths, 29.53 incident cases, and 609.09 DALYs. When divided according to the quintiles of the SDI, in 2021, the medium-high SDI led in incidence rates, while the low SDI ranked last. However, in terms of mortality and DALY rates, medium-low SDI topped the list, with high SDI being the lowest. In terms of gender differences, in 2021, the age-standardized DALY rate of LC in males was approximately 7.13 times that of females, with the former reaching 282.12 cases per 100,000 people and the latter only 39.59 cases per 100,000 people. Among all age groups, a notable decrease was observed in the age-specific incidence rate and DALY for adults aged 60-64 years, with AAPC values of -0.123 (95% CI: -0.130 to -0.116) and - 3.553 (95% CI: -3.620 to -3.486), respectively. Similarly, the mortality rate for adults aged 65-69 years also showed a significant decline, with an AAPC of -0.123 (95% CI: -0.127 to -0.118). Additionally, tobacco has been revealed as the most important risk factor affecting the mortality and DALY of LC in adults aged 55 years and older. Looking ahead, it is predicted that by 2035, the incidence rate, mortality rate, and DALY rate of LC among people over 55 years old will continue to decline.

CONCLUSIONS

Despite the current data and future predictions indicating a decline in the global age-standardized incidence rate, the absolute number of estimates continues to increase. Therefore, we advocate that cancer prevention strategies should place greater emphasis on vigorously addressing modifiable risk factors, particularly for the male population, which requires special attention and scientific intervention.

Impact of living patterns and social participation on the health vulnerability of urban and rural older persons in Jiangsu Province, China

BACKGROUND

This study analyzes the influence of living patterns and social participation on the health vulnerability of older people in urban and rural areas and provides a reference for addressing this vulnerability.

METHODS

A total of 3500 participants aged 60 years and above from Jiangsu Province, China, were surveyed. The vulnerability index, which evaluates self-rated health, risk of falling, general pain or discomfort, chronic diseases, emotional characteristics, depression, anxiety, is used to measure health vulnerability. A multiple linear regression model is used to evaluate the effects of living patterns and social participation on health vulnerability.

RESULTS

A certain level of health vulnerability exists among Chinese urban and rural older people. Living with family members has a positive effect on their health. Individuals who live alone have worse health and lower subjective well-being. Social participation significantly reduces the comprehensive levels of general health vulnerability, physical health vulnerability, and mental health vulnerability of older people. For urban older people, living with families reduces the level of physical and mental health vulnerability, whereas living alone significantly increases health vulnerability. Living patterns significantly affect the psychological vulnerability of rural older people. Social participation has an important impact on the health of older people who live alone, especially on the mental health vulnerability of older people who live alone in urban areas.

CONCLUSION

Living patterns and social participation are important factors that affect the health vulnerability of older people in both urban and rural areas. Social participation has a significant effect on the health of older people who live alone. In particular, for older people who live alone in cities, being socially active can help change their "sedentary" lifestyle, thereby promoting physical and mental health and reducing vulnerability.

Arsenic exposure induces neural cells senescence and abnormal lipid droplet accumulation leading to social memory impairment in mice

The long-term harmful effects of arsenic exposure remain one of the important public health issues. The effects of arsenic exposure on the central nervous system, particularly concerning brain structure and function, have been garnering increasing attention. Hence, the aim of this study was to investigate the impact of chronic low-dose arsenic exposure on murine social memory and to elucidate the underlying molecular mechanisms. Male C57BL/6 mice at six months of age were randomly assigned to a control group and three treatment groups with different arsenic concentrations (50, 100, and 200 μg/L), with exposure durations of 30, 90, 180, and 360 days. The five-social memory test and three-chamber social memory test results indicated that chronic low-dose arsenic exposure disrupted social memory in mice. Further analysis revealed that arsenic exposure led to degeneration of neurons within the dorsal CA2 of the hippocampus (dCA2) and the lateral entorhinal cortex (LEC), which are pivotal for the modulation of social memory, and dCA2 neurons demonstrated structural disruptions and cytoplasmic fragmentation. In addition, arsenic exposure induced neurons and glial cells senescence in both dCA2 and LEC, with a particularly pronounced effect in microglia, and worse with dosage increasing of arsenic exposure, correlating with elevated expression levels of p16INK4A, ferritin light chain and the senescence-associated secretory factors TNF-α and IL-1β, and reduced expression of Lamin B1. Moreover, arsenic exposure triggered substantial cytoplasmic lipid droplets accumulation in neurons, astrocytes and microglia, with an upregulation of PLIN2 expression, a protein associated with lipid droplet formation in astrocytes. At the same time, the aberrant accumulation of lipid droplets further aggravated the astrocytes and microglia aging, especially microglia. Additionally, correlation analysis revealed that social memory impairment was negatively correlated with nerve cell senescence and lipid accumulation. Our findings suggest that arsenic exposure induced cellular functional abnormalities by triggering cellular senescence and the accumulation of lipid droplets, thereby exacerbated neuronal degeneration and result in impaired social memory in mice.

Clinical evidence of acupuncture for amnestic mild cognitive impairment: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

People with amnestic mild cognitive impairment (aMCI) carry a substantial risk of developing dementia compared to non-amnestic MCI (naMCI). Several previous studies proved the remarkable effectiveness of acupuncture for MCI, but they didn't distinguish between aMCI and naMCI. We conducted this meta-analysis to systematically assess the evidence of the efficacy of acupuncture in this unique population with aMCI.

METHODS

We comprehensively searched nine databases on January 09, 2024, to identify relevant articles estimating the effects of acupuncture for aMCI, and then assessed the risk of bias of the included trials utilizing the RoB 2.0 tool which included the domain of randomization process, deviation from intended interventions, missing outcome data, measurement of the outcome, selection of the reported outcome, and overall bias. The results of this meta-analysis were exhibited with forest plots. Sensitivity analyses were conducted to determine the robustness of the pooled results, and publication bias was estimated by Egger's and Begg's tests. Besides, we also performed subgroup analysis to determine whether there was a difference in therapeutic effects between four weeks and eight weeks of treatment duration. The certainty of the evidence was graded using GRADEpro GDT.

RESULTS

A total of 15 randomized controlled trials (RCTs) involving 908 people with aMCI were included in this study. According to the meta-analysis, acupuncture treatment provided a remarkable improvement in cognitive function as assessed by Mini-Mental State Examination (MD = 1.09, 95 %CI [0.86, 1.31], p < 0.00001), Montreal Cognitive Assessment (MD = 0.93, 95 %CI [0.80, 1.07], p < 0.00001), Alzheimer's Disease Assessment Scale-Cognitive (MD = 1.00, 95 %CI [-1.23, -0.77], p < 0.00001), and P300 latency (MD = -15.40, 95 %CI [-23.68, -7.12], p = 0.0003). Subgroup analysis showed evidence that the efficacy of four weeks of acupuncture treatment was consistent with that of eight weeks. Sensitivity analyses, Egger's and Begg's tests suggested the pooled results were robust and reliable. The overall quality of the evidence, as appraised by the GRADE criteria, was very low or low for all outcomes.

CONCLUSIONS

The evidence from 15 RCTs demonstrated that acupuncture interventions are effective in ameliorating cognitive function in people with aMCI. There is a need for larger-scale multicenter RCTs using standardised training protocols and more rigorous designs to confirm the conclusions further.

REGISTRATION

This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO). The registration number is CRD42023460470.

Acceptance Factors and Barriers to the Implementation of a Digital Intervention With Older Adults With Dementia or Caregivers: Protocol for an Umbrella Review

BACKGROUND

The increase in average life expectancy, aging, and the rise in the number of people living with dementia contribute to growing interest from the scientific community. As the disease progresses, people with dementia may need help with most daily activities and need to be supervised by their carer to ensure their safety. With the help of technology, health care provides new means of self-managing health that support active aging, allowing older people and people with dementia to live independently in their homes for a longer period of time. Although some systematic reviews have revealed some of the impacts of using digital interventions in this area, a broad systematic review that examines the overall results of the effect of this intervention type is mandatory.

OBJECTIVE

The aim of this review is to further investigate and understand the acceptability and barriers to using technology to monitor and manage health conditions of people living with dementia and their caregivers.

METHODS

A review of systematic reviews on acceptability factors and barriers for people with dementia and caregivers was carried out. Interventions that assessed acceptability factors and barriers to the use of technology by people with dementia or their carers were included. Each potentially relevant systematic review was assessed in full text by a member of a team of external experts.

RESULTS

The analysis of the results will be presented in the form of a detailed table of the characteristics of the reviews included. It will also describe the technologies used and factors of acceptability and barriers to their use. The search and preliminary analysis were carried out between May 5, 2023, and August 1, 2024.

CONCLUSIONS

This review will play an important role as a comprehensive, evidence-based summary of the barriers and facilitators to the use of digital interventions. This review may help to establish effective policy and clinical guideline recommendations.

Exploring the effect of social media use on loneliness among older adults: A meta-analysis

With the global aging population, more research is needed on older adults' mental health, particularly loneliness, a key psychological challenge resulting from life changes. While some researchers highlighted the potential of social media in reducing loneliness, the empirical findings remain unclear. This meta-analysis, including 19,134 observations, revealed no significant overall correlation between social media use and loneliness among older adults. To explore variability between studies, we conducted sensitivity analyses (excluding influential studies), subgroup analyses (based on age group, year of data collection, measure of social media use, and study region), and meta-regression with gender distribution as a moderator. Notably, a negative association was identified in the subgroup of studies conducted before COVID-19, indicating that social media may have helped reduce loneliness among older adults during that period. However, this benefit highlights that online networking cannot fully replace real-life social interaction.

Cultural adaptation and validation of the Arabic short version of the Iconographical Falls Efficacy Scale (Icon-FES): Assessing concern about falling among older adults

BACKGROUND

Concern about falling is a significant issue among older adults, affecting their quality of life and functional independence. Culturally adapted and validated assessment tools are essential for accurately evaluating concern about falling. This study aimed to translate, cross-culturally adapt, and validate the Arabic short version of the Iconographical Falls Efficacy Scale (Icon-FES).

METHODS

The translation and cultural adaptation process followed established guidelines. Structural validity was assessed using exploratory factor analysis (EFA). Internal consistency reliability, test-retest reliability, convergent validity, and known-groups validity of the scale were evaluated.

RESULTS

A total of 123 community-dwelling older adults (mean age 69.54 ± 3.48 years; 53.7% male) participated. The Arabic short version of Icon-FES demonstrated strong structural validity, with EFA supporting a unidimensional structure accounting for 73.47% of the variance. It exhibited high internal consistency (Cronbach's α = 0.95) and excellent test-retest reliability (ICC = 0.97). Convergent validity was confirmed through significant correlations with the Arabic Falls Efficacy Scale-International (FES-I; rs = 0.73, p < 0.001), Single Leg Stance (SLS; rs =  - 0.34, p < 0.001), and Five Times Sit-to-Stand Test (5TSTS; rs = 0.44, p < 0.001). Known-groups validity showed higher scores in females, those with lower education, and a history of falls.

CONCLUSIONS

The Arabic short version of Icon-FES is a reliable and valid tool for assessing concern about falling among community-dwelling older adults. It offers an innovative approach through culturally adapted visual elements that could enhance applicability, enabling accurate assessment and supporting targeted interventions among Arabic-speaking older adults.

Association between olfactory dysfunction and gustatory dysfunction: evidence from the National Health and Nutrition Examination Survey

Background

Olfactory dysfunction (OD) and gustatory dysfunction (GD) are common among adults, with prevalence increasing significantly in older age groups. Both dysfunctions have negative effects on appetite, nutrition, social functioning and even environmental safety. OD and GD frequently coexist, indicating a possible close association between these conditions. At present, there is a lack of large-sample epidemiological studies on the relationship between OD and GD. Our study aims to investigate the relationship between OD and GD using both measurement and questionnaire data from the 2013-2014 NHANES for US adults aged 40 years and older.

Methods

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES). OD and GD were both assessed by measurements and questionnaires. The association between OD and GD was investigated with logistic regression models by adjusting for demographic characteristics, systemic diseases, and diseases of the nose and pharynx. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) are presented.

Results

Participants with complete olfactory and gustatory measurements and questionnaires (n = 2,582) were included. Using whole-mouth measurements, anosmia OD significantly increased the odds of hypogeusia and ageusia GD after adjusting for confounding factors. Similarly, the questionnaire data revealed that OD significantly increased the odds of GD. However, hyposmia OD decreased the odds of hypogeusia GD using the tongue-tip taste measurement.

Conclusion

Our findings highlighted that OD was closely associated with GD in a nationally representative sample of US adults.

Association of workforce participation with depression among US older adults: results from NHANES 2005-2018

BACKGROUND

The challenges of global aging would boost more workforce participation of older adults, and depression rate was increasing among older adults. This study aimed to explore the associations of workforce participation with depression among US older adults.

METHODS

This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Depression was measured with Patient Health Questionnaire-9 items (PHQ-9). Workforce participation was measured with work status, work types, shift work, and hours worked per week. Multivariate generalised linear and logistic regression models, also with restricted cubic spline (RCS) were performed to examine linear or non-linear associations between workforce participation and depression. Analyses of subgroup and sensitivity were conducted: using data from non-multiple imputation, participants aged over 65, and all non-excluded participants aged 60 or above to execute repeated analysis; recruiting propensity score matching (PSM) method that focused on selected SDoH, lifestyle, and health status-related factors to strengthen essential comaparability between workers and non-workers; employing two-stage least squares (2SLS) model and setting retirement age (over 65 years or not) as an instrumental variable (IV) to solve the potential reverse causation between work status and depression.

RESULTS

A total of 10,312 participants aged 60 or above were enrolled with a prevalence of depression of 6.4%. There was a significantly negative association of PHQ-9 score with working (Exp [β] = 0.68; 95%CI: 0.53-0.87), working as private employee (Exp [β] = 0.67; 95%CI: 0.50-0.89), or working on regular daytime (Exp [β] = 0.65; 95%CI: 0.52-0.82). Especially, regular daytime working reduced depression risk by 52% compared with those who not working (OR = 0.48; 95%CI: 0.27-0.87). A significant decreased PHQ-9 score and depression risk as hours worked per week increased until reaching 34.86 and 25.35 in the RCS for generalised linear and logistic regression models, respectively. These effects were consistent across the analyses of subgroup and sensitivity.

CONCLUSIONS

Regular daytime working was positively related to decreased depression risk among US older adults, and the suggested optimal working hours were 25 to 35 per week. Policymakers should appreciate the potential value of moderate workforce participation to mental health among older adults.

Global, regional, and national burden of low back pain for adults aged 55 and older 1990-2021: an analysis for the global burden of disease study 2021

BACKGROUND

Low back pain (LBP) is a widespread condition that increasingly affects the older adults, highlighting the need for a detailed examination of its global impact. Our research aimed to evaluate the LBP's burden and trends in individuals over 55 years of age across 204 countries and territories from 1990 to 2021.

METHODS

We analyzed the data from the Global Burden of Disease 2021, focusing on LBP prevalence, incidence, and years lived with disability (YLDs), along with associated risk factors.

RESULTS

In 2021, a total of 271,680,057 individuals aged 55 and older globally suffered from LBP. The age-standardized prevalence rate was 18,282.8 per 100,000 population, marking a 10.4% decrease since 1990. The age-standardized incidence and YLD rates had decreased by 9.4% and 11.0%, respectively. Central and Eastern Europe and Australasia had the highest burden, while Andean Latin America, Caribbean, and East Asia had the lowest. Notably, there were significant gender differences, with males experiencing lower rates than females. Occupational ergonomic factors, smoking, and high body mass index were identified as major contributors to the LBP burden.

CONCLUSION

This study analyzed the global burden of LBP in adults aged 55 and older, noting a decrease in age-standardized rates but an increase in total cases and regional disparities. It stressed the need to tackle modifiable risk factors like occupational ergonomics, smoking, and obesity to lessen LBP's impact. The study also called for region-specific, gender-sensitive healthcare policies to ensure fair health outcomes for all adults aged 55 and older.

Motives of Peer Volunteers Aged Over 50 in Physical Activity Programs: A Scoping Review

Peer-volunteering schemes can facilitate health improvement via increasing physical activity levels. Understanding what motivates peer volunteers is valuable for the feasibility of volunteering schemes. This scoping review aims to explore the motivations of peer volunteers aged over 50 who participate in programs that promote physical activity. Four databases were searched in March 2023 with no date restrictions. The inclusion criteria were adults over 50 years of age, experience in physical activity peer-volunteering schemes, assessed volunteer motivation, and uses English language. Nine studies were included (252 participants, aged 54-85) Peer-volunteer and volunteering characteristics were extracted from the papers. An inductive thematic analysis approach was taken to analyze the motivation data. The themes were then mapped onto theoretical constructs of motivation. Three themes of motivation emerged that could enable us to better design peer-volunteer recruitment strategies: altruistic (giving back), personal improvement (meeting goals), and past experience (helping others overcome experienced barriers). The review suggested that peer-volunteer motivations fall in line with the mechanisms of motivation suggested by psychological theories such as social cognitive and self-determination theories. To improve peer-volunteer uptake and retention, appropriate theoretical frameworks should be employed to inform the content of future interventions to ensure that volunteers will have their motivations met.

Socioeconomic status moderate the relationship between mental health literacy, social participation, and active aging among Chinese older adults: evidence from a moderated network analysis

OBJECTIVE

The aging population represents a formidable global challenge, with China experiencing an accelerated demographic shift. While previous research has established a directional link between mental health literacy, social participation, and active aging, the moderating effect of socioeconomic status (SES) on these associations remains underexplored. This study sought to address this gap by employing moderated network analysis, in contrast to the total score approaches commonly used in prior literature.

METHODS

A cross-sectional design was implemented, involving 1,032 Chinese individuals aged 60 and above, who completed the Mental Health Literacy Questionnaire, Active Aging Scale, Social Participation Questionnaire, and Socioeconomic Status Index Scale. The moderated network method was applied to explore the bidirectional relationships between mental health literacy, social participation, and active aging, while examining the moderating role of SES.

RESULTS

The analysis identified the strongest bidirectional relationships between attitudes toward mental illness and the development of spiritual wisdom. Seven interaction terms emerged involving mental health literacy, social participation, and active aging, moderated by SES. Notably, the most significant interaction terms were found between attitudes toward mental illness and engagement in active learning.

CONCLUSIONS

These results contribute novel insights into the bidirectional relationships among mental health literacy, social participation, and active aging, as well as the role of SES in moderating these relationships. The findings highlight the need for targeted policy interventions to address socioeconomic inequalities in later life, thereby fostering active aging.

Identifying Community-Built Environment's Effect on Physical Activity and Depressive Symptoms Trajectories Among Middle-aged and Older Adults: Chinese National Longitudinal Study

BACKGROUND

The effects of physical activity (PA) across different domains and intensities on depressive symptoms remain inconclusive. Incorporating the community-built environment (CBE) into longitudinal analyses of PA's impact on depressive symptoms is crucial.

OBJECTIVE

This study aims to examine the effects of PA at different intensities-low-intensity PA (eg, walking activities) and moderate-to-vigorous-intensity PA (eg, activities requiring substantial effort and causing faster breathing or shortness of breath)-across leisure-time and occupational domains on depressive symptom trajectories among middle-aged and older adults. Additionally, it investigated how CBEs influence depressive symptoms and PA trajectories.

METHODS

This longitudinal study included 6865 middle-aged and older adults from the China Health and Retirement Longitudinal Survey. A CBE variable system was developed using a community questionnaire to assess attributes of the physical built environment. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Latent growth curve modeling was applied to analyze 3 waves of the cohort data (2015, 2018, and 2020) to explore the differential effects of PA on depressive symptoms and the role of the CBE.

RESULTS

In the 2015 and 2018 waves, higher low-intensity leisure-time physical activity (LTPA) was associated with lower depressive symptoms (β=-.025, P=.01 and β=-.027, P=.005, respectively). Across all waves, moderate-to-vigorous-intensity LTPA showed no significant predictive effects (P=.21 in 2015, P=.57 in 2018, and P=.85 in 2020, respectively). However, higher occupational physical activity (OPA), particularly at moderate-to-vigorous intensities, was consistently associated with higher depressive symptoms. Parallel process latent growth curve modeling revealed that the initial level of total LTPA negatively predicted the initial level of depressive symptoms (β=-.076, P=.01). OPA exhibited dual effects, positively predicting the initial level of depressive symptoms (β=.108, P<.001) but negatively predicting their upward trajectory (β=-.136, P=.009). Among CBE variables, better infrastructure conditions (β=-.082, P<.001) and greater accessibility to public facilities (β=-.036, P=.045) negatively predicted the initial level of depressive symptoms. However, greater accessibility to public facilities positively predicted the upward trajectory of depressive symptoms (β=.083, P=.04). Better infrastructure conditions (β=.100, P=.002) and greater accessibility to public transport (β=.060, P=.01) positively predicted the initial level of total LTPA. Meanwhile, better infrastructure conditions (β=-.281, P<.001) and greater accessibility to public facilities (β=-.073, P<.001) negatively predicted the initial level of total OPA. Better infrastructure conditions positively predicted the declining trajectory of total OPA (β=.100, P=.004).

CONCLUSIONS

This study underscores the importance of considering the differential effects of PA across domains and intensities on depressive symptoms in public policies and guidelines. Given the influence of the environment on PA and depressive symptoms, targeted community measures should be implemented.

Impact of gut microbiota on cardiac aging

Recent research has suggested imbalances in gut microbiota composition as contributors to cardiac aging. An individual's physical condition, along with lifestyle-associated factors, including diet and medication, are significant determinants of gut microbiota composition. This review discusses evidence of bidirectional associations between aging and gut microbiota, identifying gut microbiota-derived metabolites as potential regulators of cardiac aging. It summarizes the effects of gut microbiota on cardiac aging diseases, including cardiac hypertrophy and fibrosis, heart failure, and atrial fibrillation. Furthermore, this review discusses the potential anti-aging effects of modifying gut microbiota composition through dietary and pharmacological interventions. Lastly, it underscores critical knowledge gaps and outlines future research directions. Given the current limited understanding of the direct relationship between gut microbiota and cardiac aging, there is an urgent need for preclinical and clinical investigations into the mechanistic interactions between gut microbiota and cardiac aging. Such endeavors hold promise for shedding light on the pathophysiology of cardiac aging and uncovering new therapeutic targets for cardiac aging diseases.

Using nudges to promote health among older adults: A scoping review

BACKGROUND

Nudge is an attempt to easily and cheaply influence an individual's health judgments, decisions, or behaviors in nuanced and predictable ways. To date, there are no published reviews of the evidence for or against nudges as health promotion strategies in older adults.

OBJECTIVE

This review aims to summarize what is known about the impact of various nudges that target different kinds of health behavior in older adults.

DESIGN

A scoping review.

REVIEW METHODS

We conducted a comprehensive search across the PubMed, Web of Science, Embase, EBSCOhost, and the Cochrane Library databases from the earliest available date to March 2024. To gain a broad understanding of this field, we used relevant search terms related to 'nudge' and 'older adult'. All articles selected and data extracted were double-checked. Nudges were summarized and analyzed according to Thaler's dual-systems theory taxonomy.

RESULTS

Overall, 18 articles were selected. Nudges have been applied to reduce overuse in healthcare (n = 7), enhance vaccination uptake (n = 4), raise dietary intake (n = 3), increase physical activity (n = 1), improve lifestyle management (n = 1), improve hand hygiene (n = 1), and improve terminal treatment (n = 1). Twelve nudges were used to promote health for older adults. Type I nudges included environmental cues, reminders, default options, and feedback. Type II nudges were framing, social norms, social comparison, highlighted suggested choices, pre-commitment, accountability justification, expert authority, and gamification. Most, but not all, nudges have proven to be feasible and effective for health promotion among older adults.

CONCLUSIONS

This encouraging evidence suggests there is potential for nudges to promote health among older adults. Future research should tailor nudges to individual and cultural characteristics, explore the most effective nudges and long-term effects, expand nudges to more health domains, implement age-friendly digital nudges, and analyze the nursing economics of nudges.

REGISTRATION

Open Science Framework websites (OSF.IO/PGY25).

Evaluation instruments for public health policies for elderly care: a scoping review protocol

INTRODUCTION

The global phenomenon of population ageing is expanding rapidly, with WHO projecting that the number of individuals aged 60 and over will reach 2.1 billion by 2050, a significant rise from 900 million in 2015. This pronounced growth poses substantial challenges to healthcare systems globally, necessitating the development of effective public policies to ensure adequate access to healthcare services for the elderly demographic. In this context, this scoping review aims to identify and analyse theoretical and logical models, as well as evaluation instruments, of public policies directed at elderly healthcare.

METHODS AND ANALYSIS

This scoping review protocol is developed in accordance with the Joanna Briggs Institute manual and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Article searches will be conducted in the following databases: Embase, Medline/PubMed, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Literature in Health Sciences and Science Direct. Additionally, searches will be performed on Google Scholar and in the grey literature (www.opengrey.eu). The search strategy will be conducted in January 2025, without language restriction for identifying texts. A descriptive analysis of the mapped studies will be conducted, categorising them by analysis categories. The results will be presented through a narrative summary of the findings to examine how they correlate with the review's objective and research question.

ETHICS AND DISSEMINATION

This study does not require ethical review due to its nature. The results will be submitted for publication in a peer-reviewed journal and presented at a scientific conference.

TRIAL REGISTRATION NUMBER

Open Science Framework: https://doi.org/10.17605/OSF.IO/AV4WH.

The Impact of Different Types of Exercise on Executive Functions in Overweight/Obese Individuals: A Systematic Review and Network Meta-Analysis

To compare the effects of different exercise training on executive function (EF) in obese or overweight individuals. PubMed, Web of Science, SPORTDiscus, MEDLINE, and CINAHL. The included articles, in English, should have been published from January 2000 to February 2024. All included studies were randomized controlled trials (RCTs) of exercise intervention in overweight or obese populations. The primary outcomes are EFs, which encompass core functions (e.g., inhibitory control, working memory (WM), and cognitive flexibility (CF)) and higher-level functions (e.g., responding, planning, and problem-solving). Therefore, the primary outcomes should include at least one of the above indicators. Additionally, given the focus of many exercise intervention studies on academic performance (AP) in obese adolescents, a secondary outcome includes AP. This meta-analysis synthesizes findings from 20 RCTs published between 2010 and 2023, encompassing a total of 1183 overweight or obese participants. Interventions were categorized into seven types: control training (CT), aerobic exercise (AE), resistance training (RT), coordinated physical activity (CPA), prolonged time of exercise (PTE), high-intensity interval training (HIIT), and AE combined with RT (mix mode, MIX). The surface under the cumulative ranking curve (SUCRA) results demonstrated the preferable effects of various interventions on EF improvement. SUCRA values indicate that CPA performs best in improving the accuracy and reaction speed of CF, as well as the reaction speed of inhibitory control in children and adolescents. AE shows significant effects in enhancing AP in this population. Additionally, PTE excels in improving CF and inhibitory control in middle-aged and older adults. Through subgroup analysis based on age and intervention duration, we found AE exhibited a significant effect on interventions for the 0-17 age group (SMD = 0.84, 95%CI = 0.31~1.38, p = 0.002) and interventions lasting 8-16 weeks showed significant improvement in EFs (SMD = 0.53, 95%CI = 0.00~1.05, p = 0.048). There was also a significant difference between CPA intervention and CT (SMD = 1.12, 95%CI = 0.45~1.80, p = 0.001) in children and adolescents. Additionally, PTE showed significant effects for middle-aged adults aged 17-59 (SMD = 0.93, 95%CI = 0.11~1.96, p < 0.027). Conclusions: This NMA found that CPA and AE have significant benefits for CF, inhibitory control, and AP in children and adolescents. Furthermore, PTE improves EFs in adults and older adults. Combining the findings of this study with previous related research, we recommend that OW/OB begin by interrupting prolonged sedentary behavior and increasing fragmented physical activity, gradually incorporating AE, RT, and CPA (such as jump rope).

Impact of Chinese visceral adiposity index on all-cause mortality risk in community-dwelling older adults: a prospective cohort study

BACKGROUNDS

Whether excess visceral fat tissue increases the risk of death in older individuals remains controversial.

AIMS

To investigate the association between the Chinese Visceral Adiposity Index (CVAI) and all-cause mortality risk in older Chinese individuals.

METHODS

This cohort study utilized data of individuals aged ≥ 65 years in 2014 to 2018 wave from the Chinese Longitudinal Healthy Longevity Survey database. Older individuals in the 2014 wave were included and followed up in 2018. CVAI was calculated based on age, body size, and blood lipid parameters, with higher values indicating increased visceral fat. Survival status was determined from official death certificates, local primary healthcare providers, or the family members of participants. Kaplan-Meier survival curve and log-rank test were employed to analyze cumulative mortality risk through CVAI tertiles (tertile 1: CVAI index < 97.34; tertile 2: 97.43 ≤ CVAI index < 132.21; and tertile 3: CVAI index ≥ 132.21). A Cox proportional hazards regression model was used to assess the relationship between the CVAI groups and all-cause mortality risk. Additionally, a sensitivity analysis was performed by excluding participants who died within the first year of follow-up. A subgroup analysis was performed based on age and sex, and a restricted cubic spline plot was created to analyze the dose-response relationship between CVAI and mortality risk.

RESULTS

A total of 1414 individuals were included, and the mean age of the participants was 84.6 (standard deviation: 10.9) years, of which 46.4% were women and 32.8% were died during a median follow-up time of 36.4 months. In the multivariable adjusted Cox regression model, we observed a significantly lower risk of mortality in the CVAI tertile 2 and 3 groups than in the tertile 1 group. The hazard ratios (HR) of the tertile 2 and 3 groups were 0.68 (95% CI, approximately 0.52-0.89) and 0.63 (95% CI, approximately 0.48-0.82), respectively. Subgroup analysis revealed that the protective effect of higher CVAI levels on mortality was more pronounced in participants aged 65-79 years and in women.

CONCLUSION

Our study established a linear relationship between CVAI and mortality risk among community-dwelling older adults, with higher CVAI levels associated with a lower risk of all-cause mortality. These findings highlight the potential importance of visceral adiposity in predicting mortality risk in community-dwelling older adults.

Marine peptides as potential anti-aging agents: Preparation, characterization, mechanisms of action, and future perspectives

Aging is a universal biological process characterized by a decline in physiological functions, leading to increased susceptibility to diseases. With global aging trends, understanding and mitigating the aging process is paramount. Recent studies highlight marine peptides as promising bioactive substances with potential anti-aging properties. This review critically examines the potential of marine peptides as novel food ingredients in anti-aging, exploring their sources, preparation methods, physicochemical properties, and the underlying mechanisms through which they impact the aging process. Marine peptides exhibit significant potential in targeting aging, extending lifespan, and enhancing healthspan. They act through mechanisms such as reducing oxidative stress and inflammation, modulating mitochondrial dysfunction, inducing autophagy, maintaining extracellular matrix homeostasis, and regulating longevity-related pathways. Despite challenges in stability, bioavailability, and scalability, marine peptides offer significant potential in health, nutraceuticals, and pharmaceuticals, warranting further research and development in anti-aging.

Efficacy of extracting and preventively intervening late-stage older adults who are at high risk for spending high medical costs by using the health check-up system in Japan: a pilot study

Objectives

In Japan, the seven diseases (femur fracture, cerebral infarction, chronic renal failure, heart failure, dementia, pneumonia, and chronic obstructive pulmonary disease) are the top causes of inpatient medical costs among the late-stage older adults aged 75 years and over. This pilot study was conducted with the following two objectives; (1) to examine the proportion of risks of onset and severity of seven diseases among the late-stage older adults, and (2) to examine the efficacy of interventions focusing on the prevention of unplanned hospitalization.

Methods

Participants were 45,233 older adults aged 75 and over living in Kure City, Japan. In addition to the government-mandated health checkup items, the Intervention group underwent additional risk screening tests included questionnaires, physical examinations, blood tests, and educational guidance by nurses. The efficacy of the intervention was examined whether there were differences in the number of hospitalizations, the use of emergency and critical care, and the incidence of hemodialysis induction between the Intervention and control groups (Usual Health Checkup group and No Health Checkup group) for the 2 years.

Results

There were 485 participants in the Intervention group, 1,067 in the Usual Health Checkup group, and 43,712 in the No Health Checkup group. As the risks of seven diseases in the Intervention group, the largest proportion of deviations occurred for systolic blood pressure (63.3%), estimated salt intake (60.3%), and low-density lipoprotein cholesterol (51.5%). Estimated glomerular filtration rate deviated in 41.0%, N-terminal pro b-type natriuretic peptide in 37.9%. 7.5% scored <2 points on the Mini-Cog©, and 9.1% performed the Timed Up and Go test in >12 s. The incidence of hospitalization due to any of the seven diseases was significantly higher in the No Health Checkup group (p < 0.001). There were no differences among the three groups in the use of emergency and critical care or the introduction of hemodialysis.

Conclusion

This study revealed that additional health checkup tests and intervention methods could be prevented hospitalization among the adults of 75 years and older. It is necessary to make health checkups and follow-ups more accessible those are already available within the existing health system in Japan.

Neighbourhood Walkability and Greenness Exhibit Different Associations with Social Participation in Older Males and Females: An Analysis of the CLSA

We explored the relationship between neighbourhood and social participation among older adults using a Living Environments and Active Aging Framework. This prospective cohort study used baseline data from the Canadian Longitudinal Study on Aging (CLSA) with a 3-year follow-up. Three aspects of social participation were the outcomes; walkability and greenness at baseline were exposure variables. The sample consisted of 50.0% females (n=16,735, age 72.9± 5.6 years). In males, higher greenness was associated with lower loneliness and less variety in social activities. No significant associations between greenness and social participation were found in females. High walkability was related to a higher variety of social activity and higher loneliness in males but not females, and less desire for more social activity in both sexes. Greenness and walkability impact social participation among older adults. Future research should include sex and gender-based analyses.

Gender disparities in physical, psychological, and cognitive multimorbidity among elderly hypertensive populations in rural regions

BACKGROUND

The prevalence of gender disparities in physical, mental, and cognitive disorders among elderly hypertensive individuals in rural areas remains unclear. This study evaluates these disparities and the factors contributing to multimorbidity in this demographic.

METHODS

A face-to-face survey was conducted from July 1 to August 31, 2023, involving the hypertensive population registered with the National Basic Public Health Service Program in Jia County. Physical disorder was defined as having one or more self-reported chronic conditions other than hypertension. Participants experiencing anxiety or depression were as having a psychological disorder. The 9-item Patient Health Questionnaire (PHQ-9) was used to assess depression symptomatology, and anxiety symptoms were evaluated using the 7-item Generalized Anxiety Disorder questionnaire (GAD-7). Cognitive disorders were assessed using the Brief Mental Status Examination Scale (MMSE). Multifactorial logistic regression models were used to analyze factors affecting different disorder combinations in both genders. The net difference in multimorbidity prevalence between genders was determined using the propensity score matching (PSM).

RESULTS

Out of 18,447 hypertensive individuals aged 65 years and above (42.28% men), the prevalence of multimorbidity was 30.64% in men and 38.67% in women. Outcomes included seven categories: physical disorders, psychological disorders, cognitive disorders, and four different combinations of these disorders. The primary outcome was the presence of two or more disorders. The prevalence of physical, psychological, and cognitive disorders and their four combinations were higher in women than in men; Key factors influencing multimorbidity risk included subjective health status, illness duration, medication history, blood pressure control, and lifestyle behaviors in both men and women. Post-PSM analysis revealed that women had a 6.74% higher multimorbidity prevalence than men.

CONCLUSIONS

Physical, psychological, and cognitive disorders, along with their various multimorbid combinations, significantly impact the elderly hypertensive population. Prioritizing a healthy lifestyle is essential to mitigate multimorbidity risks. Considering that the prevalence of multimorbidity is higher in women than in men with hypertension, sufficient sleep, maintaining a healthy waist circumference, and medication adherence are vital for managing blood pressure and reducing multimorbidity risks.

The Functional Profile, Depressive Symptomatology, and Quality of Life of Older People in the Central Alentejo Region: A Cross-Sectional Study

Background: Europe's aging population presents challenges such as a shrinking labor force, pressure on health services, and increased demand for long-term care. This study assesses the functional profile, depressive symptoms, and quality of life of older adults in the Central Alentejo region of Portugal. Methods: A cross-sectional, descriptive study was conducted with a convenience sample of 868 older adults in Portuguese long-term care facilities across the Évora district. A structured questionnaire collected sociodemographic data, elderly nursing core set patient information, a health questionnaire with nine responses, and WHO Quality of Life Assessment (short version) scores. Results: Nearly half of the participants needed assistance with care. Women (OR = 1.46) and those with cognitive impairment (OR = 10.83) had higher impaired functionality, while education (OR = 0.52) and being overweight (OR = 0.52) were inversely related to functional dependence. Quality of life scores ranged from 56.4 (physical) to 66.6 (environmental). Moderate depressive symptoms were found in 17.1% of participants, with 9% having moderately severe to severe symptoms. Higher dependence doubled the likelihood of depressive symptoms (OR = 2.18). Discussion and Conclusions: High rates of depression and functional dependence correlate with a low perception of quality of life, highlighting the need for research to promote and protect the health of older adults.

Association of Shift Work, Sociodemographic Variables and Healthy Habits with Obesity Scales

BACKGROUND

Shift work has been associated with unhealthy lifestyle habits and a higher prevalence of obesity, which negatively impacts the health of shift workers. The objective of our study was to examine the influence of shift work on obesity, as well as on sociodemographic variables, anthropometric measurements, and lifestyle habits in individuals working this type of schedule.

METHODS

An observational, cross-sectional, descriptive study involving 53,053 workers from various labour sectors across several Spanish autonomous communities was conducted. It included 31,753 men (17,527 of them working shifts) and 21,300 women (11,281 of them working shifts). The relationship between shift work and obesity was examined, as well as its association with sex, age, social class, education level, smoking, alcohol consumption, sedentary behaviour, and unhealthy diet.

RESULTS

Obesity showed higher prevalence and mean values among shift workers across all four formulas used (BMI obesity, WtHR high, CUN BAE obesity, METS-VF high). All variables related to unhealthy lifestyle habits revealed a significantly greater prevalence among shift workers, with high statistical significance (p < 0.001). Age, sex, and social class affected the risk of obesity, with a greater prevalence observed in shift workers compared to non-shift workers (p < 0.001). Men had a higher risk than women, with an OR ranging from 1.17 (1.12-1.21) for BMI obesity to 7.45 (6.71-8.20) for METS-VF high.

CONCLUSIONS

Shift workers exhibit a higher prevalence of obesity and unhealthy lifestyle habits, with men at greater risk. The variables that most significantly increase the risk of obesity include age, physical inactivity, low adherence to the Mediterranean diet, and alcohol consumption.

Short Physical Performance Battery (SPPB) and Its Relationship with the Predisposition to Muscle and Joint Injuries Associated with the COL1A1 and IL-6 Gene in Older Adults

Background/Objectives: Aging leads to physiological changes influenced by lifestyle, environment, and genetics, increasing the risk of morbidity and mortality in older adults. COL1A1 gene encodes an essential protein in connective tissues, which is associated with musculoskeletal lesions. The interleukin-6 (IL-6) gene is a proinflammatory and anti-inflammatory regulator and has a greater predisposition to fractures and osteoporosis reported. In turn, these alterations are associated with a decrease in physical capacity, leading to a progressive loss of functionality and quality of life in older adults. Methods: A cross-sectional study was designed to identify the relationship between physical condition as determined using the Short Physical Performance Battery (SPPB) and the predisposition parameters for muscle and joint injuries in a population of 422 older adults, active and of ≥60 years. The variables evaluated were sociodemographic data, SPPB evaluation, and COL1A1 and IL-6 gene DNA extracted by buccal scraping. Results: SPPB total score was significantly correlated with age -0.07, weight -0.02, waist circumference -0.02, and body mass index -0.05 (p < 0.005). Conclusions: Regarding genetic variables, there were no significant differences. However, lower SPPB values were observed in the GG genotype and GT of COL1A1 when compared to the CC genotype and GC of IL-6.

The association between depressive trajectories and disability-free survival among middle-aged and older adults in China: a prospective cohort study

BACKGROUND

This study aims to examine the association of depressive trajectories with disability-free-survival (DFS).

METHODS

This prospective cohort study used data from the China Health and Retirement Longitudinal Study, 2011-2015. Depressive symptoms were assessed using the Centre for Epidemiology Studies Depression Scale-10. Disability was assessed using activities of daily living (ADLs) and instrumental ADLs. Trajectories of depressive symptoms were identified and classified by latent mixture modelling. Logistic regression models were used to examine the association between depressive trajectories and DFS.

RESULTS

A total of 8373 participants aged 45 years and older were included. We identified four distinct trajectories of depressive symptoms: 'no depressive symptoms', 'decreasing depressive symptoms', 'increasing depressive symptoms', and 'persistent depressive symptoms'. Compared to participants in the no depressive symptom trajectory, those in the decreasing depressive symptoms, increasing depressive symptoms and persistent depressive symptoms trajectories had an increased risk of disability or mortality, with multiple-adjusted hazard ratios (95% confidence intervals) of 1.75 (1.45-2.12), 2.05 (1.77-2.38) and 3.50 (2.77-4.42).

CONCLUSION

Our study shows that among middle-aged and older Chinese adults, individuals with a trajectory of depressive symptoms are at increased risk of disability or mortality. Our findings underscore the importance of early prevention, identification and intervention of depression in clinical care to promote healthy ageing.

Disparities in the Quality of Working Life Among Older Workers: Housing Conditions and Life Satisfaction With Latent Class Analysis

Little empirical research informs understanding of the disparate active aging experiences among working older adults, especially in terms of the association with living circumstances and life satisfaction. To address this knowledge gap, this study used latent class analysis on data from the 2020 Health and Retirement Study (HRS) core interview and focused on 1,194 employed adults aged 50 and above. The results revealed four subtypes of the quality of working life in older workers. Notably, in contrast to the other identified classes, higher levels of housing satisfaction and feelings of neighborhood safety were significantly associated with an increased likelihood of being a member of the group of older adults with the highest work capacities and the healthy work-life balance. Furthermore, participation in the class characterized by the highest work capacity and a healthy work-life balance was related to the highest levels of overall life satisfaction.

Sarcobesity: New paradigms for healthy aging related to taurine supplementation, gut microbiota and exercise

Enigmatic sarcopenic obesity is still a challenge for science and adds to the global public health burden. The progressive accumulation of body fat combined with a dysfunctional skeletal muscle structure and composition, oxidative stress, mitochondrial dysfunction, and anabolic resistance, among other aggravating factors, together represent the seriousness and complexity of treating the metabolic disorder of sarcobesity in aging. For this reason, further studies are needed that encourage the support of therapeutic management. It is along these lines that we direct the reader to therapeutic approaches that demonstrate important, but still obscure, outcomes in the physiological conditions of sarcobesity, such as the role of taurine in modulating inflammatory and antioxidant mechanisms in muscle and adipose tissue, as well as the management of gut microbiota, able to systemically re-establish the structure and function of the gut-muscle axis, in addition to the merits of physical exercise as an instrument to improve muscular health and lifestyle quality.

Relationship between big five personality and health literacy in elderly patients with chronic diseases: the mediating roles of family communication and self-efficacy

The significance of health literacy for elderly individuals with chronic illnesses lies in managing and delaying disease development, which is affected by personal and environmental factors. Family communication can provide an emotional support environment; self-efficacy is an important factor of subjective initiative and personality. A relatively persistent thinking and behavior pattern can affect the environment, subjective initiative, and individual health outcomes. This study aims to explore the effects of the Big Five personality traits on the health literacy of elderly individuals with chronic illnesses and to hypothesize that family communication and self-efficacy mediate the Big Five personalities and health literacy. A cross-sectional study of 2251 elderly individuals with chronic diseases was conducted through nationwide random quota sampling. The structural equation model was used to explore the mediating role of family communication and self-efficacy between the Big Five personality and health literacy. Family communication played a simple mediating role in the influence of extraversion, agreeableness, conscientiousness, and neuroticism on health literacy. Self-efficacy played a simple mediating role in the influence of the Big Five personalities on health literacy. Self-efficacy and family communication played a chain mediating role between extraversion, agreeableness, conscientiousness, neuroticism, and health literacy. Nurses can enhance the health literacy of elderly individuals with chronic illnesses with extraversion, agreeableness, conscientiousness, and neuroticism through family communication and self-efficacy while promoting the health literacy of those with openness through self-efficacy.

Relationship between physical activities and mental health in older people: a bibliometric analysis

Objective

To summarize the general situation and focal points of research on the physical activity and mental health of older people over the past 15 years and provide references for future research.

Methods

Literature published between January 1, 2009, and December 31, 2023, was retrieved from the Web of Science core database. A bibliometric visualization analysis of countries/regions, institutions, authors, keywords, and references was conducted using CiteSpace6.1.R6.

Results

A total of 4,329 articles were included, and the annual number of articles published over the past 15 years showed an upward trend. The articles were primarily from 65 countries/regions and 626 institutions. The most represented country and institution were the USA and the University of Pittsburgh, respectively. Among the authors identified, Schuch and Callow were the most influential. The research focuses on four areas: the psychological effects of physical activity in older people; physical activity intervention approaches to the mental health of older people; physical activity and mental health assessment questionnaires; and the impact of physical activity on multidimensional aging. Research frontiers involve emerging topics such as the assessment and intervention of mental health in older people and the relationship between their physical activity and cognitive function.

Conclusion

This study conducted a comprehensive, objective, and visual analysis of publications and revealed the status of relevant studies, trending topics, and trends concerning the physical activity and mental health of older people from 2009 to 2023. We hope that this work will help researchers identify new perspectives on potential collaborators, important topics, and research frontiers.

Mediterranean Diet-Based Sustainable Healthy Diet and Multicomponent Training Combined Intervention Effect on Body Composition, Anthropometry, and Physical Fitness in Healthy Aging

BACKGROUND

Diet and exercise interventions have been associated with improved body composition and physical fitness. However, evidence regarding their combined effects in older adults is scarce. This study aimed to investigate the impact of a combined 12-week Mediterranean diet-based sustainable healthy diet (SHD) and multicomponent training (MT) intervention on body composition, anthropometry, and physical fitness in older adults.

METHODS

Diet intervention groups received a weekly SHD food supply and four sessions, including a SHD culinary practical workshop. The exercise program included MT 50 min group session, three times a week, on non-consecutive days. Body composition and physical fitness variables were assessed through dual X-ray absorptiometry, anthropometric measurements, and senior fitness tests. Repeated measures ANOVA, with terms for group, time, and interaction, was performed.

RESULTS

Our results showed that a combined intervention significantly lowered BMI and total fat. Also, significant differences between assessments in all physical fitness tests, except for aerobic endurance, were observed. Adjusted models show significant differences in BMI (p = 0.049) and WHR (p = 0.037) between groups and in total fat (p = 0.030) for the interaction term. Body strength (p < 0.001), balance tests (p < 0.001), and aerobic endurance (p = 0.005) had significant differences amongst groups. Considering the interaction term, differences were observed for upper body strength (p = 0.046) and flexibility tests (p = 0.004 sit and reach, p = 0.048 back scratch).

CONCLUSIONS

Our intervention study demonstrates the potential of implementing healthy lifestyle and sustainable models to promote healthy and active aging.

From Reactive to Proactive - The Future Life Design to Promote Health and Extend the Human Lifespan

Disease treatment and prevention have improved the human lifespan. Current studies on aging, such as the biological clock and senolytic drugs have focused on the medical treatments of various disorders and health maintenance. However, to efficiently extend the human lifespan to its theoretical maximum, medicine can take a further proactive approach and identify the inapparent disorders that affect the gestation, body growth, and reproductive stages of the so-called "healthy" population. The goal is to upgrade the standard health status to a new level by targeting the inapparent disorders. Thus, future research can shift from reaction, response, and prevention to proactive, quality promotion and vigor prolonging; from single disease-oriented to multiple dimension protocol for a healthy body; from treatment of symptom onset to keep away from disorders; and from the healthy aging management to a healthy promotion design beginning at the birth.

Melatonin alleviates aging-related heart failure through melatonin receptor 1A/B knockout in mice

Age-related cardiovascular diseases continue to be important issues that contribute to the societal burden. Unveiling the molecular mechanisms underlying age-related cardiovascular diseases provides novel opportunities to delay aging and facilitate early disease diagnosis and treatment. This study utilized knockout mice lacking melatonin receptors type 1A (MT1) and 1B (MT2). Ultrasonography, pathological staining, and transcriptomics were used to investigate the role of MT1/2 in the hearts of aging mice. Knockout of both receptors decreased ejection fraction and exacerbated fibrosis, inflammation, oxidative stress, and apoptosis levels in aging mice. Our findings indicated that the cardiac function of MT1 knockout mice was more severely affected than that of MT2 knockout mice. Additionally, we observed that intraperitoneal administration of melatonin (20 mg/kg/day for 90 days) ameliorated abnormal cardiac function in aging mice. However, the absence of MT1/2 resulted in the inability of melatonin to improve cardiac function. Our study, utilizing an aging polymerase chain reaction assay and cell experiments, revealed that melatonin receptors potentially influence cardiac function in aging mice through their effects on leukocyte differentiation antigen 14 (CD14) expression. Consequently, melatonin receptors, particularly MT1, are key contributors to cardiac aging, and therapeutic interventions targeting this receptor are promising for delaying the progression of cardiac aging.

Quantitative assessment of rotator cuff injuries using synthetic MRI and IDEAL-IQ imaging techniques

Purpose

To evaluate synthetic magnetic resonance imaging (SyMRI) and iterative decomposition of water and fat with echo asymmetry and least squares estimation (IDEAL-IQ) imaging for a comprehensive evaluation of rotator cuff injuries (RCI).

Methods

Ninety-seven patients with RCI were classified into four groups based on the arthroscopic results: (grade II), partial tear (grade III), complete tear (grade IV), and controls (grade I). T1 (Transverse Relaxation Time 1), T2 (Transverse Relaxation Time 2), proton density (PD), and fat fraction (FF) were evaluated using SyMRI and IDEAL-IQ. Measurement reliability was assessed using intraclass correlation coefficients (ICC). The diagnostic potential for grading RCI was evaluated using ordinal regression and ROC analyses.

Results

A high measurement reliability (ICC > 0.7) was observed across subregions. T1 and T2 significantly varied across grades, particularly T2 in the lateral subregion between grades III and IV (P < 0.001) and the central subregion between grades II and III (P < 0.001). ROC analyses yielded valuable diagnostic accuracy, including T2 in the lateral subregion with an AUC of 0.891, distinguishing grade I from grade IV. Positive correlations were found between T2 values in specific shoulder subregions and injury grade (r = 0.615 for lateral, r = 0.542 for medial, both P < 0.001). In grade IV, FF was notably increased in the supraspinatus, infraspinatus, and subscapularis muscles compared with grades I-III. There were no significant FF variations in the teres minor muscle among grades.

Conclusions

Quantitative MRI parameters from SyMRI and IDEAL-IQ, especially T2 and FF, may classify and assess RCI severity. The results could help improve the accuracy of diagnosing different grades of RCI, offering clinicians additional tools for improving patient outcomes through personalized medicine.

Insights from neighbourhood walking interviews using the Living Environments and Active Aging Framework (LEAAF) in community-dwelling older adults

We aimed to understand whether neighbourhood characteristics are associated with movement and social behaviors using walking interviews with 28 community-dwelling older adults (aged 65+). Results indicated support for each component and each relationship in our proposed "Living Environments and Active Aging Framework". Additional themes such as neighbourhoods with children, moving to neighbourhoods with opportunities for social activity and movement, and lingering effects of pandemic closures provided novel insights into the relationship between the living environment (neighbourhood) and active aging. Future work exploring sex and gender effects on these relationships, and work with equity-deserving groups is needed.

Unveiling the multi-dimensional frailty network among older cancer survivors in China: A network analysis study

INTRODUCTION

Frailty has a significant impact on the overall quality of life of older cancer survivors, but the relationships among frailty symptoms are not well understood. This study aims to explore the specific associations among multidimensional symptoms of frailty among older cancer survivors by employing network analysis to provide supportive evidence for targeted interventions in the future.

MATERIALS AND METHODS

Data were obtained by cluster sampling from three large Grade-A tertiary hospitals in Shandong Province, China, and collected through face-to-face interviews by trained investigators. We included patients who were diagnosed with a solid malignant tumor at the age of 60 years or older. Frailty indicators were measured by the Groningen Frailty Indicator (GFI) and analyzed primarily through network analysis, including network estimation, centrality, and stability analysis. The relative importance of a node in a network was tested by centrality analyses, and Spearman correlations were applied to estimate the relationships between symptom pairs (symptom score) and symptom clusters (standardized symptom score) in the symptom network. In terms of centrality, the indexes of strength, closeness, and betweenness were adopted to measure the importance of nodes.

RESULTS

Five hundred and eight older cancer survivors were included, with an average age of 68.4 years (standard deviation [SD] = 5.4), and a higher proportion were male (n = 307[60.4%]). The prevalence of frailty among older cancer survivors was 58.9% (n = 299), with a mean GFI score of 4.46 (SD = 2.87). The strongest edge was between "dressing and undressing" and "going to the toilet" (r = 0.58). The nodes with the higher strength centrality were "going to the toilet" (rS=1.09), "walking around outside" (rS=0.97), and "part of social network" (rS=0.96); and the nodes with the higher closeness centrality were "mark physical fitness" (rC=0.005), "calm and relaxed" (rC=0.005), and "nervous or downhearted" (rC=0.005).

DISCUSSION

This study demonstrated that older cancer survivors in China have a high prevalence of frailty, with self-care and social participation-related symptoms playing a key role in the multidimensional network of frailty symptoms. Psychological symptoms can rapidly influence other symptoms within this network. Therefore, prioritizing psychological symptoms in the assessment of older adults with cancer is essential for effective frailty management.

Switching indoor fuels and the incidence of physical-psychological-cognitive multimorbidity: A prospective cohort study

BACKGROUND

In developing countries, including China, solid-fuel-based heating and cooking is common. For older people, the multimorbidity prevalence is exceptionally high. Nevertheless, studies on the associations of indoor solid fuels use, especially switching fuels types, on multimorbidity in middle-aged and older people is scarce.

METHODS

Data from five waves of the China Health and Retirement Longitudinal Study were used in this study. Indoor fuels were classified as solid or clean fuels. Physical-psychological-cognitive multimorbidity (PPC-multimorbidity) was defined as the simultaneous presence of three disease types (physical illness, psychological disorders, cognitive impairment). Using Cox proportional risk models, hazard ratios (HRs) and 95 % confidence intervals (95 % CI) were calculated to investigate the associations of heating- and cooking-related baseline indoor fuels and switching indoor fuels with PPC-multimorbidity incidence.

RESULTS

In the heating (n=3121, mean age=56.55 years, male proportion=54.25 %) and cooking (n=3574, mean age=56.67 years, male proportion=52.94 %) analyses, 75.07 % and 45.64 % of the participants used solid fuels at baseline, and 564 (18.07 %) and 613 (17.15 %) PPC-multimorbidity cases were diagnosed during follow-up, respectively. Participants with baseline heating- and cooking-based solid fuels use had greater PPC-multimorbidity incidences [HRs (95 % CIs): 1.23 (0.98, 1.55) and 1.44 (1.21, 1.73)], respectively. Additionally, combined baseline heating- and cooking-based solid fuels use was associated with even greater PPC-multimorbidity incidence [HR (95 % CI): 1.55 (1.18, 2.04)]. Persistent solid fuels use obviously increased the PPC-multimorbidity incidence [HRs (95 % CIs): 2.43 (1.67, 3.55) for heating and 2.63 (2.03, 3.40) for cooking]. Moreover, switching from solid to clean fuels was associated with a significantly decreased PPC-multimorbidity incidence [HRs (95 % CIs): 0.27 (0.20, 0.35) for heating and 0.36 (0.28, 0.46) for cooking].

CONCLUSIONS

Long-term solid-fuels use is associated with an increased PPC-multimorbidity incidence, and switching to cleaner fuels is associated with a decreased PPC-multimorbidity incidence in adults aged ≥45 years.

Associations and attributable burdens in late-life exposure to PM2.5 and its major components and depressive symptoms in middle-aged and older adults: A nationwide cohort study

BACKGROUND

Depression in late life has been associated with reduced quality of life and increased mortality. Whether the chronic fine particular matter (PM2.5) and its components exposure are contributed to the older depression symptoms remains unclear.

METHOD

Middle-aged and older adults (>45 years) were selected from the China Health and Retirement Longitudinal Study during the four waves of interviews. The concentrations of PM2.5 and its major constituents were calculated using near real-time data at a spatial resolution of 10 km during the study period. The depressive symptom was evaluated by the Depression Center for Epidemiologic Studies Depression (CES-D)-10 score. The fix-effect model was applied to evaluate the association between PM2.5 and its major constituents with depressive symptoms. Three three-step methods were used to explore the modification role of sleep duration against the depressive symptoms caused by PM2.5 exposure.

RESULTS

In our study, a total of 52,683 observations of 16,681 middle-aged and older adults were assessed. Each interquartile range (IQR) level of PM2.5 concentration exposure was longitudinally associated with a 2.6 % (95 % confidence interval [CI]: 1.3 %, 4.0 %) increase in the depression CES-D-10 score. Regarding the major components of PM2.5, OM, NO3-, and NH4+ showed the leading toxicity effects, which could increase the depression CES-D-10 score by 2.2 % (95 %CI: 1.0 %, 3.4 %), 2.2 % (0.6 %, 3.9 %), and 2.0 % (95 %CI: 0.6 %, 3.4 %) correspondingly. Besides, males were more susceptible to the worse depressive symptoms caused by PM2.5 and its major components exposure than female subpopulations. Shortened sleep duration might be the mediator of PM2.5-associated depressive symptoms.

CONCLUSION

Our results suggest that long-term exposure to PM2.5 and its major components were associated with an increased risk for depressive symptoms in middle-aged and older adults. Reducing the leading components of PM2.5 may cost-effectively alleviate the disease burden of depression and promote healthy longevity in heavy pollutant countries.

The Role of Depression and Anxiety in the Relationship Between Arthritis and Cognitive Impairment in Chinese Older Adults

BACKGROUND

Mental disorders and cognitive impairment are common in older patients with arthritis. While it is recognized that mental conditions may play a role in the connection between arthritis and cognitive impairment, the precise underlying relationship remains uncertain.

METHODS

The data was derived from the baseline survey of the Guangdong Mental Health Survey in South China, involving a sample of 3,764 citizens aged 65 and older. An array of aspects were explored, including socio-demographics, lifestyle behaviors, self-reported chronic conditions, depression, anxiety, and cognitive impairment. Logistic regression analyses examined the association between arthritis and cognitive impairment after adjustment for potential confounders. Serial mediation models were used to examine whether depression or anxiety played a mediating role in the arthritis-cognitive impairment linkage.

RESULTS

The prevalence rates of cognitive impairment and arthritis of the older adults were 28.9% and 12.1%, respectively. Compared to those without arthritis, participants with arthritis were at a higher risk of cognitive impairment (OR = 1.322, 95%CI: 1.022-1.709) after adjustment for socio-demographics, lifestyle behaviors, and mental health conditions. Serial mediation analyses indicated that depressive and anxiety symptoms co-played a serial mediating role in the association between arthritis and cognitive impairment (B1 = 0.025, 95%CI: 0.005-0.052; B2 = 0.050, 95%CI: 0.021-0.086).

CONCLUSIONS

Arthritis may heighten cognitive impairment risk in Chinese older adults, and the relationship was potentially mediated by depressive and anxiety symptoms. Future interventions should be considered, integrating mental health assessments into arthritis care frameworks and being alert to possible cognitive impairment.

Novel insights into the activating transcription factor 4 in Alzheimer's disease and associated aging-related diseases: Mechanisms and therapeutic implications

Ageing is inherent to all human beings, most mechanistic explanations of ageing results from the combined effects of various physiological and pathological processes. Additionally, aging pivotally contributes to several chronic diseases. Activating transcription factor 4 (ATF4), a member of the ATF/cAMP response element-binding protein family, has recently emerged as a pivotal player owing to its indispensable role in the pathophysiological processes of Alzheimer's disease and aging-related diseases. Moreover, ATF4 is integral to numerous biological processes. Therefore, this article aims to comprehensively review relevant research on the role of ATF4 in the onset and progression of aging-related diseases, elucidating its potential mechanisms and therapeutic approaches. Our objective is to furnish scientific evidence for the early identification of risk factors in aging-related diseases and pave the way for new research directions for their treatment. By elucidating the signaling pathway network of ATF4 in aging-related diseases, we aspire to gain a profound understanding of the molecular and cellular mechanisms, offering novel strategies for addressing aging and developing related therapeutics.

Delaying Renal Aging: Metformin Holds Promise as a Potential Treatment

Given the rapid aging of the population, age-related diseases have become an excessive burden on global health care. The kidney, a crucial metabolic organ, ages relatively quickly. While the aging process itself does not directly cause kidney damage, the physiological changes that accompany it can impair the kidney's capacity for self-repair. This makes aging kidneys more susceptible to diseases, including increased risks of chronic kidney disease and end-stage renal disease. Therefore, delaying the progression of renal aging and preserving the youthful vitality of the kidney are crucial for preventing kidney diseases. However, effective strategies against renal aging are still lacking due to the underlying mechanisms of renal aging, which have not been fully elucidated. Accumulating evidence suggests that metformin has beneficial effects in mitigating renal aging. Metformin has shown promising anti-aging results in animal models but has not been tested for this purpose yet in clinical trials. These findings indicate the potential of metformin as an anti-renal aging drug. In this review, we primarily discuss the characteristics and mechanisms of kidney aging and the potential effects of metformin against renal aging.

Sedentary patterns and health outcomes in the oldest-old: a latent profile analysis

Background

Sedentary behavior is most prevalent among those aged 80 years and above, referred to as the oldest-old. Current literature emphasizes the significance of sedentary behavior patterns, but further evidence is required to understand how these patterns relate to specific health outcomes and to identify at-risk profiles for tailored interventions in the oldest-old. Therefore, the aim of this study was to identify profiles of adults aged 80+ years based on their sedentary patterns and health outcomes, and to examine associations between profiles and socio-demographics.

Methods

A cross-sectional study was conducted in Flanders (Belgium) from February 2021 to December 2022 recruiting 90 older adults (80+) through convenience sampling, employing word of mouth, social media and local service centers. Latent profile analysis identified device-based sedentary patterns and assessed their associations with physical and cognitive functioning, mental health-related quality of life (QoL), and social isolation. Associations of these profiles with socio-demographic factors were analyzed.

Results

Three distinct profiles were identified: (1) the 'cognitively and physically frail' profile, (2) the 'healthy' profile and (3) the 'lower mental health-related QoL' profile. Those in the 'cognitively and physically frail' profile exhibited the least favorable sedentary pattern, and had a higher likelihood of residing in a nursing home. No significant differences were found for the other socio-demographic variables, being age, sex, educational degree and family situation.

Conclusions

Three distinct profiles in the oldest-old population, based on cognitive and physical functioning, mental health-related QoL, and sedentary behavior patterns, were identified. Lower physical and cognitive functioning was associated with unhealthy sedentary patterns. Further research with larger samples is crucial to uncover potential links between socio-demographics and at-risk subgroups, enhancing our understanding of sedentary behavior and geriatric health outcomes in this population.

Implementation of a Comprehensive and Personalised Approach for Older People with Psychosocial Frailty in Valencia (Spain): Study Protocol for a Pre-Post Controlled Trial

With ageing, the risk of frailty increases, becoming a common condition that exposes older people to an increased risk of multiple adverse health outcomes. In Valencia (Spain), the ValueCare project develops and applies a value-based care approach that addresses the multidimensional nature of frailty by implementing integrated and personalized care to tackle psychosocial frailty. A pre-post controlled design with a baseline measurement at inclusion, at the end of implementation and a follow-up measurement after 6 months of intervention. In Valencia (Spain), 120 participants over 65 years of age are recruited from primary care centres to receive the ValueCare comprehensive and personalised care plan according to the results and are compared with 120 participants receiving "usual care". An assessment questionnaire is designed using validated instruments, and a personalised care plan is developed specifically for each participant based on the results obtained. The study protocol has been registered under the ISRCTN registration number ISRCTN25089186. Addressing frailty as a multidimensional and multifactorial risk condition requires the development and implementation of comprehensive assessments and care. In this context, this study will provide new insights into the feasibility and effectiveness of a value-based methodology for integrated care supported by ICT for older people experiencing frailty.

Relationships between oral function, dietary intake and nutritional status in older adults aged 75 years and above: a cross-sectional study

BACKGROUND

Malnutrition is related to impaired oral health and function that causes poor dietary intake, declining the general health of older adults. The role of dietary intake in the association between oral function and nutritional status of Chinese older adults (aged 75 and above) was examined in this cross-sectional study.

METHODS

Through the randomized cluster sampling method, 267 older adults living in rural areas of Qingdao, Shandong (aged 81.4 ± 4.3, 75-94 years) were chosen as the primary research participants. A Mini Nutritional Assessment - Short Form was used to determine nutritional status, and Food Frequency Questionnaire and 24-hour Food Intake Recall were used to assess dietary intake. The oral function was evaluated by analyzing the teeth, oral problems, bite force, tongue pressure, lip sealing pressure, chewing function questionnaire, whole saliva flow rate, 10-Item Eating Assessment Tool, and water swallow test.

RESULTS

Based on the MNA-SF score, it was divided into a well-nourished group and a malnutrition group, with the malnutrition group comprising 40.6% of participants. The participants in the malnutrition group showed a higher rate of xerostomia, lower bite force, tongue pressure, and lip sealing pressure, and higher Chewing Function Questionnaire and 10-Item Eating Assessment Tool scores. Furthermore, their plant fat, iron, cereals and potatoes, vegetables, fruits, and seafood intake were relatively low. The regression model indicated that exercise frequency, stroke, chewing and swallowing function, intake of vegetables and fruits were risk factors for nutritional status of older adults.

CONCLUSION

Malnutrition was relatively common among the Chinese older adults aged 75 and above, and it was significantly correlated with exercise frequency, stroke, chewing and swallowing function, and intake of vegetables and fruits. Therefore, nutrition management should be carried out under the understanding and guidance of the oral function and dietary intake of the older adults.

Mediterranean Dietary Pattern for Healthy and Active Aging: A Narrative Review of an Integrative and Sustainable Approach

The global population is on a trajectory of continuous growth, with estimates projecting an increase from 7.7 billion in 2019 to approximately 9.7 billion by 2050. Longevity is also expected to rise rapidly, with advancements in healthcare contributing to increased life expectancies and an increase in the maximum lifespan. The aging process is accompanied by different changes, often leading to a decline in daily life activities and an increased susceptibility to disease. Age-related changes can cause cellular damage and subsequent cellular death. Oxidative stress and inflammation play significant roles in this process contributing to molecular damage and mitochondrial dysfunction. Active aging has been associated with improved quality of life and a reduced risk of morbidity and premature mortality. In this context, the Mediterranean diet has emerged as a promising approach to promoting healthy aging and sustainability. The phytochemical compounds within the Mediterranean diet have been linked to a lower risk of developing cardiovascular disease, type 2 diabetes, obesity, cancer and neurodegenerative diseases. The findings of peer-reviewed articles regarding the use of the Mediterranean diet as a healthy and sustainable dietary pattern written in Portuguese, Spanish or English were included in this narrative literature review. This dietary pattern's emphasis on the consumption of fresh and local food aligns with both health and environmental sustainability goals. This work provides a comprehensive review of the benefits of the Mediterranean diet and its components in a healthy aging process and highlights the importance of this dietary pattern as a sustainable approach.

Effects of a similar amount of regular non-structured or competitive physical activity across late adulthood: a cross-sectional study

Introduction

Master athletes are examples of successful aging. It is not clear whether it is the competitive-oriented training or just the amount of total regular exercise that reduces the age-related decline in physiological functions. We aimed to compare health-related parameters in competitive (C) and physically active older adults (A) that performed the same weekly physical activity (PA) amount.

Methods

Seventeen C and 17 A were matched for age (8 and 9 male participants under and over 70 years old respectively, for both groups) and weekly PA amount (GPAQ). Body composition, leg and arm maximal strength, balance and reaction time were measured; moreover, leg and arm exercise efficiency, estimated VO2max, and VO2/HR relationships were evaluated. Perception of life and sleep quality was also assessed through specific questionnaires (SF-36 and PSQI). The effect of group (C vs. A), age (U70 vs. O70) and their interaction was examined through a Two-Way ANOVA test.

Results

C dedicated more time to vigorous PA compared to A (p = 0.03), while less to moderate daily work (p < 0.01) and active commuting (p = 0.06). C exhibited better body composition (all p < 0.05), higher leg maximal strength (p < 0.05) and a trend for elevated arm strength (p = 0.06). Reaction time, leg and arm cycling efficiency were similar in the two groups (all p > 0.05), while balance reduced in A O70. Estimated VO2max was higher for C in leg cycling (p = 0.05) and remained constant across ages (all p > 0.05). VO2/HR relationship, life and sleep quality did not differ for groups and ages.

Conclusions

Regular physical exercise of about 6,000 METs/week seems to have a beneficial effect on health-related parameters, both in non-structured and competitive PA, when compared to sedentary behaviour. However, the older adults engaged in competitive training exhibit further advantages: better body composition, higher arm and leg muscle strength, and higher leg VO2max. This study highlights the importance of encouraging active lifestyles for maintaining long-term health, high levels of life quality perception and reducing age-related decline. However, vigorous training suitability needs to be verified by a team of PA specialists.

Programmes Addressed to Informal Caregivers' Needs: A Systematic Literature Review

BACKGROUND

Addressing informal caregivers' needs is essential for ensuring quality healthcare and promoting citizen-centred care. This systematic review assessed current knowledge about programmes aimed at meeting the needs of informal caregivers of adults who are dependent on others for daily life activities.

METHODS

Following the PRISMA guidelines, the electronic databases EBSCOhost Research Platform, MEDLINE, CINAHL, Scopus, Web of Science and The Virtual Health Library were searched for randomized experimental studies published between 2012 and 2022 that implemented programmes addressing informal caregivers' needs to improve their experiences, health, and well-being. Quality was assessed using the standardized critical evaluation tools from the Joanna Briggs Institute. Two independent investigators performed the eligibility assessment and data extraction. Quantitative data on the effectiveness of interventions were collected, and the content of each intervention was synthesized and aggregated into categories, through narrative synthesis.

RESULTS

The majority of the included studies (n = 16) were conducted in European countries and implemented a structured intervention programme compared to the provision of usual care. The studies were of fair to high methodological quality, with a higher risk of bias related to blinding. The results supported the achievement of favourable health outcomes among informal caregivers, namely improvements in mental health (n = 3) and quality of life (n = 3) and a decrease in psychological symptomatology (n = 5) and burden (n = 3). None of the interventions reported adverse outcomes; however, five studies did not describe significant differences in the outcomes assessed after the implementation of the programmes. Interventions focusing on training and educating caregivers (n = 14) and cognitive-behavioural strategies (n = 7) were the most common, while programmes focusing on emotional and psychological support as a resource to improve caregivers' psychological outcomes were scarce.

CONCLUSIONS

This systematic review adds to the growing body of evidence and insight showing that programmes that address informal caregivers' needs seem to contribute to better physical and psychological health outcomes through the promotion of caregivers' educational support and the implementation of cognitive-behavioural strategies. Future research should implement methodologically robust cross-country programmes tailored to informal caregivers' physical, emotional, psychosocial, societal, and educational needs throughout the care trajectory.

"You get out of the house, you talk to each other, you laugh…And that's fantastic" - a qualitative study about older people's perceptions of social prescribing in mainland Portugal

BACKGROUND

Social prescribing (SP) is a non-clinical approach, most commonly based in healthcare units, that aims to address non-medical health-related social needs by connecting individuals with community-based services. This qualitative study explores the perception of Portuguese older adults regarding the benefits of SP and their willingness to participate in SP initiatives.

METHODS

Three face-to-face focus group sessions were conducted with 23 participants in different cities in Portugal. Open and semi-open questions were used to guide the discussions and thematic analysis was used to analyze the data.

RESULTS

The participants recognized the potential benefits of SP for older adults, including diversifying leisure activities, improving mental health, and complementing existing support systems. They highlighted the need for external support, usually in the form of link workers, to facilitate personalized referrals and consider individual characteristics and preferences. While some participants expressed reluctance to engage in SP due to their existing busy schedules and a perceived sense of imposition, others showed openness to having new experiences and recognized the potential value of SP in promoting activity. Barriers to participation, including resistance to change, mobility issues, and family responsibilities, were identified.

CONCLUSIONS

The study emphasizes the importance of a person-centered and co-designed approach to SP, involving older adults in the planning and implementation of interventions. The findings provide valuable insights for the development of SP programs tailored to the unique needs and aspirations of older adults in Portugal, ultimately promoting active and healthy aging. Future research should consider the perspectives of family doctors and include a broader representation of older adults from diverse geographic areas.