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Highlights • This paper explores the effects of four dimensions of social exclusion on self-rated health and depression among older people in China. • Lower level of exclusion from social relationships was associated with less likely to report fair or poor SRH. • Lower level of subjective feelings of exclusion was associated with less likely to report fair or poor SRH. • Lower level of subjective feeling of exclusion was associated with less likely to report depression. • Lower level of exclusion from financial products was associated with less likely to report depression. Abstract Background It is well established that social exclusion is a key social determinant of health; however, such association between social exclusion and health outcomes among older people remain a relatively under-researched area. This paper explores the effects of four dimensions of social exclusion on self-rated health and depression among older people in China. Methods This paper includes 8038 individuals aged 60 and over from the first wave national multi-stage probability sample (2014) from the China Longitudinal Aging Social Survey (CLASS). Descriptive univariate information for individual variables and four dimensions of social exclusion are presented. Multinomial and binary logistic regression models are used to examine the associations between social exclusion and self-rated health and depression. Results Older people who were in the lower level of exclusion from social relationships or subjective feelings of exclusion were significantly less likely to report fair or poor self-rated health than people in the higher level of exclusion (lower level of exclusion from social activities was significantly associated with being less likely to report poor SRH only). Older people who were in the lower level of subjective feeling of exclusion or exclusion from financial products were significantly less likely to report depression. Conclusions Different dimensions of social exclusion have different effects on self-rated health and depression. Social policies need to reflect this and efforts of services could usefully be oriented to prevent multi-dimensions of social exclusion. Ultimately, such policies should have the potential to enhance the health of older people in China. [ABSTRACT FROM AUTHOR]

• Reducing modifiable risk factors could prevent the onset of cognitive decline. • Physical multimorbidity–cognitive function association was mediated by depression. • Routine screening for depression in multimorbidity patient may delay dementia onset. This paper explores the role of depressive symptoms (mediator/moderator) in the association between physical multimorbidity (exposure) and cognitive function (outcome) among older adults in the three most populous middle-income countries. This study used cross-sectional data from China (2015 China Health and Retirement Longitudinal Study), India (2017/2018 Longitudinal Ageing Study in India), and Indonesia (2014/2015 Indonesian Family Life Survey), with a total sample of 73,199 respondents aged ≥ 45 years. Three domains of cognitive tests were harmonised across surveys, including time orientation, word recall, and numeracy. The four-way decomposition analysis assessed the mediation and interaction effects between exposure, mediator/moderator, and outcome, adjusted for covariates. The mean age of the respondents (in years) was slightly younger in Indonesia (56.0, SD = 8.8) than in China (59.5, SD = 9.3) and India (60.0, SD = 10.5). The proportion of male respondents was 49.3 % in China, 47.3 % in India, and 47.5 % in Indonesia. Respondents in China had the highest mean cognitive function z scores (54.7, SD = 19.9), followed by India (51.1, SD = 20.0) and Indonesia (51.0, SD = 18.4). Physical multimorbidity was associated with lower cognitive function in China and India (p < 0.0001), with 48.4 % and 40.0 % of the association explained by the mediating effect of depressive symptoms ('overall proportion due to mediation'). The association was not found in Indonesia. Cognitive functions were lower among individuals with physical multimorbidity, and depressive symptoms mainly explained the association. Addressing depressive symptoms among persons with physical multimorbidity is likely to have not only an impact on their mental health but could prevent cognitive decline. [ABSTRACT FROM AUTHOR]

• It is a systematic review with a global perspective. • Social isolation of elder in the global community has multidimensional factors. • The factors that lead to elder's social isolation in the community vary by area. Older people's physical and mental health are now significantly impacted by social isolation, a major threat to public health. Our goal was to identify the connections between risk factors and social isolation among this population across various geographic areas. Seven databases were thoroughly searched, from their inception until April 2023. Inclusion and exclusion criteria were used to choose the studies. For the included cross-sectional studies, we used the Agency for Healthcare Research and Quality (AHRQ) to assess the probability of bias, and the Newcastle-Ottawa scale for the cohort studies. The statistical analysis was performed using STATA 15 to calculate pooled odds ratios (OR) and 95% CI. All 3043 papers were carefully examined, and 42 satisfied the criteria for inclusion. The results indicated that multi-domain risk factors and social isolation among older persons worldwide are significantly correlated. These multi-domain risk factors included biological factors, socioeconomic factors, and psychological and behavioral factors. It is also important to note that these factors may vary from region to region. Many domain factors were linked to social isolation in older individuals living in communities throughout the world. To develop effective strategies for controlling social isolation, it is crucial to conduct assessments of social isolation risk factors in local communities. [ABSTRACT FROM AUTHOR]

Given the social burden and significant cost of dementia care in Australia, finding evidence-based approaches that improve outcomes, maintain independence, and reduce the impact on patients and families is essential. Finding effective ways to train and assist the healthcare staff who support these individuals is also critical, as they are considered to be at risk of workplace stress, burnout, and other psychological disturbances which negatively affects standards of care. The current paper describes a protocol for evaluating the effects of a Montessori-based approach to dementia care, in non-residential respite centres. An 18 month prospective observational, cohort controlled design is suggested that will compare participants from a community respite service that has undergone a Montessori-based workplace culture change and those from a service that provides a person-centred ‘care as usual’ approach. To achieve this, the protocol includes the assessment of participants across multiple variables on a monthly basis including the cognitive, behavioural, and emotional functioning of clients with dementia, levels of caregiver burden experienced by informal carers, and burnout, compassion satisfaction and workplace engagement among respite staff. The protocol also employs a qualitative evaluation of program fidelity. This approach will provide further insight into the potential benefits of early intervention with Montessori approaches for persons living with dementia in the community, their caregivers, and the staff and volunteers who assist them. [ABSTRACT FROM AUTHOR]

Background Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL ( Cri teria for S creening and T riaging to A ppropriate a L ternative care) checklist in emergency departments. Methods Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale. Patients or their informal caregivers will be contacted by telephone around three months after initial assessment to ascertain survival, self-reported health, post-discharge frailty and health service utilisation since discharge. Logistic regression and bootstrapping techniques and AUROC curves will be used to test the predictive accuracy of CriSTAL for death within 90 days of admission and in-hospital death. Discussion The CriSTAL checklist is an objective and practical tool for use in emergency departments among older patients to determine individual probability of death in the short-term. Its validation in this cohort is expected to reduce clinicians’ prognostic uncertainty on the time to patients’ death and encourage timely end-of-life conversations to support clinical decisions with older frail patients and their families about their imminent or future care choices. [ABSTRACT FROM AUTHOR]

Hospitalized older people are at risk of poor functioning after hospital discharge. We aimed to relate formal and informal care costs to level of risk for low functioning of hospitalized older people up to one year after admission. We studied 460 patients 65 years or older who were admitted to a 450-bed hospital in the Netherlands between June 2010 and October 2010. Participants were classified into five risk groups at hospital admission using the Identification Seniors At Risk-Hospitalized Patients (ISAR-HP). Patients were interviewed at hospital admission and at three and twelve months after admission using validated questionnaires to measure health care utilization. Informal caregivers were interviewed by mailed paper questionnaires at the same time as patients. We estimated costs per unit from hospital information systems and nationally representative research. Mean healthcare costs were €30k euro per person per year, with one third for initial hospital stay (€9,8k), one third for formal healthcare costs between hospital discharge and twelve month follow up (€10,3k), and one third for informal healthcare costs between hospital discharge and twelve month follow up (€9,5k). Informal and formal healthcare costs were almost double for people with the highest risk score compared to people not at risk (p < 0.001). Older patients with high risk scores at hospital admission have substantially higher formal and informal care costs in the year after initial hospital admission than people with low risk scores. This implies that substantial investments may be made in preventive interventions for at-risk hospitalized older people. [ABSTRACT FROM AUTHOR]

• Important changes in cognitive structure reported after a cognitive training. • Lower level of cohesion among cognitive variables after a cognitive training. • No long-term impact of a training on the cognitive performance was observed. • Short-term impact of a training on the cognitive performance was observed. This paper reports the results from a 3-year follow-up study to measure the long-term efficacy of a cognitive training for healthy older adults and investigates the effects of booster sessions using an entropy-based metric. Design: semi-randomized quasi-experimental controlled design. Participants: 50 older adults, (M = 73.3, SD = 7.77) assigned into experimental (N = 25; Mean age = 73.9; SD = 8.62) and control groups (N = 25; mean age = 72.9; SD = 6.97). Instruments: six subtests of WAIS and two episodic memory tasks. Procedures: the participants were assessed on four occasions: after the end of the original intervention, pre-booster sessions (three years after the original intervention), immediately after the booster sessions and three months after the booster sessions. Results: the repeated measures ANOVA showed that two of the cognitive gains reported in the original intervention were also identified in the follow-up: Coding (F(1, 44) = 11.79, MSE = 0.77, p =.001, eta squared = 0.084) and Picture Completion (F(1, 47) = 10.01, MSE = 0.73, p =.003, eta squared = 0.060). After the booster sessions, all variables presented a significant interaction between group and time favorable to the experimental group (moderate to high effect sizes). To compare the level of cohesion of the cognitive variables between the groups, an entropy-based metric was used. The experimental group presented a lower level of cohesion on three of the four measurement occasions, suggesting a differential impact of the intervention with immediate and short-term effects, but without long-term effects. [ABSTRACT FROM AUTHOR]

• Hyperparathyroidism patients reported poorer cognition compared with controls. • Limited data presented the association between elevated PTH levels and cognition. • Identified studies show mixed results to support an association between PTH and cognition. • High-quality studies are needed to improve the evidence base. To systematically estimate the association between elevated parathyroid hormone (PTH) levels and cognitive function. This review was conducted on ten papers identified through database searches from inception to 31 October 2018. The quality of studies was assessed using the Downs and Black checklist. There is a low volume of data reporting on the impact of elevated PTH levels on cognitive impairment. The quality of the identified studies ranged from poor (37 %) to good (76 %). Although the results from studies were mixed, one cross-sectional study and one prospective study suggested a link between elevated PTH levels and a decrease in the Mini-Mental State Examination (MMSE) score. Three cross-sectional studies that assessed other cognitive domain in specific domains, such as language, memory and executive function provided mixed results for an association between elevated PTH levels and cognitive function. Two studies showed mixed evidence for a link between elevated PTH levels and poor executive function. One prospective study, one cross-sectional study and three case-control studies provide mixed evidence for an association between higher PTH levels and Alzheimer´s disease (AD). Two studies showed limited evidence for an association between elevated PTH levels and vascular dementia. This review presented that the level of evidence available to support an association between elevated PTH levels and cognitive function was generally weak and inconsistent. Future studies with more better methodological quality are needed. [ABSTRACT FROM AUTHOR]

• Frailty prevalence by Frailty index was 13.5%, 1.5% by Frailty Phenotype and 4% by Kihon Checklist. • Frailty index showed moderate correlation and modest agreement with Frailty phenotype and Kihon Checklist. • Age, polypharmacy and physical activity are associated with being pre-frail and frail. • Higher waist circumference was associated with being pre-frail by frailty index. • Lower handgrip and lower walking speed were associated with being frail by frailty index. Frailty prevalence defined by the deficit accumulation model (Frailty Index) has limited exploration in a Japanese population. The objective of this paper is to investigate the prevalence of frailty by Frailty Index among a cohort of healthy Japanese older adults, define risk factors associated with pre-frailty and frailty status and evaluate Frailty Index's agreement with Frailty Phenotype and Kihon checklist. Data from 673 participants of the 2014 wave of the Nagoya Longitudinal Study - Healthy Elderly were used. Annual assessments include investigation of mood, memory, health status, nutrition, physical performance and oral health. The Frailty Index was compared to Frailty Phenotype and Kihon Checklist, and factors associated to Frailty Index were investigated through univariate and multivariate logistic regression. Frailty prevalence was 13.5% (n = 91) by Frailty Index, 1.5% (n = 10) by Frailty Phenotype and 4% (n = 27) by Kihon Checklist. Although the correlations between the three scales were moderate to high, the agreement between the scales was poor. In terms of risk factors, age, polypharmacy and physical activity level were associated with being pre-frail and frail. Having a higher waist circumference was associated with being pre-frail, and lower handgrip strength and lower walking speed were associated with being frail. The Frailty Index showed similar metrics and agreement comparable to findings of previous studies, and was able to identify a higher number of individuals who were pre-frail and frail. Age, polypharmacy, physical activity, waking speed and waist circumference were associated with pre-frailty and frailty by frailty index. [ABSTRACT FROM AUTHOR]