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We aimed to explore predictors of sustained transitions (those that are maintained for an extra follow-up) between robustness and prefrailty in both directions.Longitudinal population-based cohort.Community-dwelling Spaniards 65 years or older from the Toledo Study of Healthy Ageing.The Fried's frailty phenotype was measured over 3 waves (2006-2009, 2011-2013, and 2014-2017). Multiple logistic regressions compared individuals following the pattern robust-prefrail-prefrail with those who remained robust across waves, and those following the pattern prefrail-robust-robust with those who remained prefrail, for sociodemographic, clinical, life-habits, dependency for activities of daily living, upper and lower extremities' strength variables. The Fried's items of those who remained prefrail and those who became robust were compared.Mean age was 72.3 years (95% CI: 71.8-72.8) and 57.9% (52.7%-63.0%) were women. After multivariate adjustment, predictors (apart from age) of the sustained transition robustness-prefrailty were as follows: number of drugs taken (odds ratio: 1.37; 95% CI: 1.14-1.65), not declaring the amount of alcohol consumed (8.32; 1.78-38.88), and grip strength (0.92 per kg; 0.86-0.99). Predictors of the sustained transition prefrailty-robustness were as follows: drinking alcohol (0.2; 0.05-0.83), uricemia (0.67; 0.49-0.93), number of chair stands in 30 seconds (1.14; 1.01-1.28), and grip strength (1.12; 1.05-1.2). Low grip strength was associated with a lower probability of regaining robustness.Prediction of sustained transitions between the first stages of frailty development can be achieved with a reduced number of variables and noting whether the Fried's item leading to a diagnosis of prefrailty is low grip strength. Our results suggest the need to intensify interventions on deprescription, quitting alcohol, and strengthening of upper and lower limbs.

The moderating effect of cognitive function on the association between social support and late-life depressive symptoms has not been thoroughly investigated. Identifying cognitive function as a possible moderator of this association might help plan community-based interventions for late-life depressive symptoms.Participants were community-dwelling older adults who visited a community-based mental health center. The ENRICHD Social Support Instrument and the Montgomery-Asberg Depression Rating Scale were used to evaluate social support and depressive symptoms, respectively. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination. Data from 1088 and 506 participants were included in the cross-sectional and longitudinal analyses, respectively. Multiple linear regression analysis was performed to assess the effects of social support on depressive symptoms and the possible moderating effect of cognition.After adjusting for possible confounders, greater social support at baseline was associated with fewer depressive symptoms in both cross-sectional (estimate = -0.25 standard error [SE] = 0.03, P 0.001) and longitudinal analyses (estimate = -0.11, SE = 0.05, P = 0.014). Moreover, the association between social support and depressive symptoms was significantly moderated by cognitive function (P for interaction0.001 for cross-sectional analysis, and P for interaction = 0.011 for longitudinal analysis).The tool for assessing social support was self-reported. There may have been a selection bias in the study sample.Greater social support was associated with fewer late-life depressive symptoms in both analyses. However, social support may have less benefits for alleviating depressive symptoms in older adults with cognitive decline.

Although individual sleep characteristics are related to frailty, these characteristics do not occur separately. A multidimensional measure of sleep might provide a better estimation of frailty compared to isolated sleep characteristics. This study investigated the association of a multidimensional measure of sleep health with frailty both across and within sex groups.Data were from the Taiwan Longitudinal Study on Aging (2011), a survey with a nationally representative sample of Taiwanese older adults (N = 2,015). Frailty was defined using the Fried criteria. Self-reported sleep during the past month was used to conceptualize the five sleep health dimensions in the SATED model. Their relationship was estimated using logistic regression analysis adjusting for sociodemographic characteristics (age, sex, education), health status (comorbidity, cognitive function, pain, depressive symptoms [excluding items overlapping with frailty and sleep]), and health risk behaviors (drinking, smoking, lack of exercise).Having a better sleep health composite score was significantly related to lower odds of being frail in both sexes adjusting for sociodemographic characteristics. This association remained significant among women but not among men after adding health and risk behaviors to the models. Satisfaction and alertness in both sexes and duration among women were significantly associated with frailty adjusting for sociodemographic characteristics. Only alertness among men was significantly related to frailty in the model with all covariates.Our findings show that having better sleep health across multiple dimensions is related to a lower risk of being frail, with differential risks for women and men.

To examine the feasibility, acceptability, and validity of multimodal ambulatory monitoring, which combines accelerometry with ecological momentary assessment (EMA), to assess daily activity and health-related symptoms among survivors of stroke.Prospective cohort study involving 7 days of ambulatory monitoring; participants completed 8 daily EMA surveys about daily activity and symptoms (mood, cognitive complaints, fatigue, pain) while wearing an accelerometer. Participants also completed retrospective assessments and an acceptability questionnaire.Community.Forty survivors of stroke (N=40).Not applicable.Feasibility was determined using attrition rate and compliance. Acceptability was reported using the acceptability questionnaire. Convergent and discriminant validity were determined by the correlations between ambulatory monitoring and retrospective self-reports. Criterion validity was determined by the concordance between accelerometer-measured and EMA-reported daily activity.All participants completed the study (attrition rate=0%). EMA and accelerometer compliance were 93.6 % and 99.7%, respectively. Participants rated their experience with multimodal ambulatory monitoring positively. They were highly satisfied (mean, 4.8/5) and confident (mean, 4.7/5) in using ambulatory monitoring and preferred it over traditional retrospective assessments (mean, 4.7/5). Multimodal ambulatory monitoring estimates correlated with retrospective self-reports of the same and opposing constructs in the predicted directions (r=-0.66 to 0.72, Plt;.05). More intense accelerometer-measured physical activity was observed when participants reported doing more physically demanding activities and vice versa.Findings support the feasibility, acceptability, and validity of multimodal ambulatory monitoring in survivors of mild stroke. Multimodal ambulatory monitoring has potential to provide a more complete understanding of survivors' daily activity in the context of everyday life.

To examine the effects of community-based resistance training (RT) on physical function for older adults with mobility disability.Four databases (PubM, PubMed, MEDLINE, Ovid, Cumulative Index to Nursing and Allied Health, Web of Science) were searched from inception to February 2, 2021.Randomized controlled trials that examined community-based RT for improving physical function in community-dwelling older adults were included.Two reviewers independently conducted title and abstract screening, full-text evaluation, data extraction, and risk of bias quality assessment.Twenty-four studies (3656 participants; age range, 63-83 years) were included. RT programs ranged from 10 weeks to 18 months in duration. RT was more effective than control in improving 6-minute walk test distance (n=638; mean difference [MD], 16.1m; 95% CI, 12.27-19.94; Plt;.0001), lower extremity strength (n=785; standardized MD, 2.01; 95% CI, 1.27-2.75; Plt;.0001), and usual gait speed (n= 2106; MD, 0.05 m/s, 95% CI, 0.03-0.07; Plt;.001). In sensitivity analyses, benefits were maintained when studies with a high risk of bias were excluded. There was no effect of RT on fast gait speed or Short Physical Performance Battery score compared with control.RT improves walking distance, lower extremity strength, and usual gait speed in older adults with mobility disability. Improvements in physical function could increase independence in activities of daily living for this at-risk population.

This study aimed to design a dynamic performance-exposure algorithm for falling risk assessment and prevention of falls in community-dwelling older adults. It involved a cross-sectional and follow-up survey assessing retrospective and prospective falls and respective performance-related, exposure and performance-exposure risk factors. In total, 500 Portuguese community-dwelling adults participated. Data modelling showed significant (p0.05) relationships between the above risk factors and selected nine key ordered outcomes explaining falls to include in the algorithm: previous falls; health conditions; balance; lower strength; perceiving action boundaries; fat mass; environmental hazards; rest periods; and physical activity. Respective high-, moderate- and low-risk cutoffs were established. The results demonstrated a dynamic relationship between older adults' performance capacity and the exposure to fall opportunity, counterbalanced by the action boundary perception, supporting the build algorithm's conceptual framework. Fall prevention measures should consider the factors contributing most to the individual risk of falling and their distance from low-risk safe values.

The association of malnutrition with chronic kidney disease (CKD) is well established. However, there is a paucity of studies of the effect of malnutrition risk (MR) on kidney function decline among older persons who do not have end-stage or dialyzable CKD. This study aimed to examine the association between MR status and kidney function, and future risks of kidney function decline and CKD progression in community-dwelling older adults.Nutrition Screening Initiative's DETERMINE Your Nutritional Health Checklist and estimated glomerular filtration rate (eGFR) were assessed at baseline among 5,122 participants free of end-stage renal failure or dialyzed CKD in the Singapore Longitudinal Aging Studies (SLAS-1 and SLAS-2). Follow-up eGFR was assessed in a subcohort of SLAS-2 participants without CKD (eGFR60 mL/min/1.73 mIn baseline cross-sectional analyses adjusting for other risk factors, low, moderate, and high MR was significantly associated with decreasing eGFR coefficients of -1.5, -3.3, and -5.0 mL/min/1.73 mAmong older adults without advanced kidney disease, MR is associated with poor kidney function and increased risk of kidney function decline and CKD. Preventive interventions to modify MR may help to reduce the deterioration of renal function in older people.

Purpose: To examine the associations of accelerometer-derived steps volume and intensity with hospitalizations and all-cause mortality in older adults. Methods: This prospective cohort study involved 768 community-dwelling Spanish older adults (78.8 § 4.9 years, mean § SD; 53.9% females) from the Toledo Study for Healthy Aging (2012 2017). The number of steps per day and step cadence (steps/min) were derived from a hip-mounted accelerometer worn for at least 4 days at baseline. Participants were followed-up over a mean period of 3.1 years for hospitalization and 5.7 years for all-cause mortality. Cox proportional hazards regression models were used to estimate the individual and joint associations between daily steps and stepping intensity with hospitalizations and all-cause mortality. Results: Included participants walked 5835 § 3445 steps/day (mean § SD) with an intensity of 7.3 § 4.1 steps/min. After adjusting for age, sex, body mass index (BMI), education, income, marital status and comorbidities, higher step count (hazard ratio (HR) = 0.95, 95% confidence inter vals (95%CI: 0.90 1.00, and HR = 0.87, 95%CI: 0.81 0.95 per additional 1000 steps) and higher step intensity (HR = 0.95, 95%CI: 0.91 0.99, and HR = 0.89, 95%CI: 0.84 0.95 per each additional step/min) were associated with fewer hospitalizations and all-cause mortality risk, respectively. Compared to the group having low step volume and intensity, individuals in the group having high step volume and intensity had a lower risk of hospitalization (HR = 0.72, 95%CI: 0.52 0.98) and all-cause mortality (HR = 0.60, 95%CI: 0.37 0.98). Conclusion: Among older adults, both high step volume and step intensity were significantly associated with lower hospitalization and all-cause mortality risk. Increasing step volume and intensity may benefit older people.

To develop streamlined Risk Prediction Models (Manto RPMs) for late-life depression.Prospective study.The Survey of Health, Ageing and Retirement in Europe (SHARE) study.Participants were community residing adults aged 55 years or older.The outcome was presence of depression at a 2-year follow up evaluation. Risk factors were identified after a literature review of longitudinal studies. Separate RPMs were developed in the 29,116 participants who were not depressed at baseline and in the combined sample of 39,439 of non-depressed and depressed subjects. Models derived from the combined sample were used to develop a web-based risk calculator.The authors identified 129 predictors of late-life depression after reviewing 227 studies. In non-depressed participants at baseline, the RPMs based on regression and Least Absolute Shrinkage and Selection Operator (LASSO) penalty (34 and 58 predictors, respectively) and the RPM based on Artificial Neural Networks (124 predictors) had a similar performance (AUC: 0.730-0.743). In the combined depressed and non-depressed participants at baseline, the RPM based on neural networks (35 predictors; AUC: 0.807; 95% CI: 0.80-0.82) and the model based on linear regression and LASSO penalty (32 predictors; AUC: 0.81; 95% CI: 0.79-0.82) had satisfactory accuracy.The Manto RPMs can identify community-dwelling older individuals at risk for developing depression over 2 years. A web-based calculator based on the streamlined Manto model is freely available at https://manto.unife.it/ for use by individuals, clinicians, and policy makers and may be used to target prevention interventions at the individual and the population levels.

Sleep plays a vital role in older adults' health. The Community Aging in Place-Advancing Better Living for Elders (CAPABLE) trial, conducted in Maryland between 2012 and 2016, is a 5-month biobehavioral environmental intervention study to reduce functional disabilities in 300 low-income older adults. Individual and environmental factors impacting sleep were addressed in CAPABLE. This secondary data analysis was to test the preliminary effect of CAPABLE on actigraph-measured sleep, compared with a social engagement control in 73 CAPABLE participants with pretest-posttest actigraph data. Participants in this analysis were aged 75.8±7.5 years; 86.3% of them were females and 84.9% were Black/African Americans. Both CAPABLE intervention and social engagement control improved sleep efficiency and reduced sleep onset latency. The effect of CAPABLE on sleep was comparable to social engagement. These findings underline the importance of promoting physical function and maintaining social activity for sleep in low-income older adults with disabilities.

To systematically review qualitative studies about home-dwelling older adults' experiences of living with both frailty and multimorbidity.This study adopted a meta-ethnography; the databases included PubMed, Embase, CINAHL, Web of Science, PsycINFO, SCOPUS, and Google Scholar. Qualitative peer-reviewed articles in English were searched up to December 31, 2021. Themes and concepts were extracted through constant comparison across the included studies by three reviewers.Of the 147 articles screened, nine qualitative articles, encompassing a total sample of 173 participants, were included. The four final synthesised themes were 'Being isolated in a closed life,' 'Being dependent on help from others,' 'Rebuilding to maximise quality of life,' and 'Struggling to live a meaningful life.'Home-dwelling older adults with both frailty and multimorbidity are more likely to be socially isolated due to their physical limitations and lack of integration between hospital-based care and community healthcare services.

The aim of the current prospective study was to examine the relationship between adherence to the Mediterranean diet and incident frailty.1075 Greek community-dwelling older adults from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) were included in the present longitudinal analysis.Adherence to the Mediterranean diet was evaluated through the MedDietScore, calculated from the information participants provided on a validated food frequency questionnaire. Frailty was assessed using two multidomain tools: the Frailty Index (FI) and the Tilburg Frailty Indicator (TFI). Analysis of the incidence of frailty as a function of the baseline MedDietScore was performed using Cox proportional hazards models. Additionally, Generalized Estimating Equations (GEE) models were used to explore whether the baseline MedDietScore was associated with the change in the total number of frailty criteria met by participants over time. In testing for a dose-response association between Mediterranean diet and frailty, the MedDietScore was treated either as a continuous variable or as tertiles of low, medium and high adherence to MeDi.176 and 131 participants developed incident frailty, as measured with the FI and TFI respectively. Each unit of MedDietScore was associated with a 5% (ΗR 0.95, 95% CI 0.91-0.99, p = 0.012) and 10% (ΗR 0.90, 95% CI 0.86-0.95, p ≤ 0.001) decrease in the risk of incident frailty when measured with the FI and TFI respectively. Compared with participants reporting low adherence to the Mediterranean diet (lowest tertile), those with high adherence (highest tertile) had a 41% (ΗR 0.59, 95% CI 0.38-0.91, p = 0.017) and a 57% (ΗR 0.43, 95% CI 0.27-0.70, p ≤ 0.001) lower risk of incident frailty as measured with the FI and TFI respectively. After excluding from the analyses participants diagnosed with dementia at baseline or follow-up, the same results were obtained: each unit of MedDietScore was associated with a 5% (HR 0.95 CI 0.91-0.99, p = 0.023) and a 10% (HR 0.90 CI 0.86-0.94, p ≤ 0.001) decrease in the risk of incident frailty as measured with the FI and TFI respectively.The present longitudinal study showed that non-frail community-dwelling older adults with high adherence to the Mediterranean dietary pattern had a significantly lower incidence of frailty.

Thailand is experiencing a rapid increase in the number of older people with dementia (PWD). We examined the frequency, severity, and correlates of dementia neuropsychiatric symptoms (NPS) among community-dwelling Thai older adults.This study was based on analysis of baseline data from a larger clinical trial comparing two different implementation approaches of an evidence-based exercise intervention for people with dementia. To be eligible, participants needed to be age 60 and above, have probable dementia, have one or more NPS, be ambulatory, and have an adult (age 18+) family caregiver. In the 353 eligible participants, we examined the correlation between NPS severity and caregiver distress (assessed by the Neuropsychiatric Inventory Questionnaire or NPI-Q) and used ordinary least squares (OLS) regression to examine associations between PWD and caregiver characteristics and NPS severity.NPS frequency varied from 18% for appetite and/or eating changes to 42% for delusions. NPS severity was significantly (p0.05) associated with caregiver stress for all individual NPS. Among PWD characteristics, higher ADL score (less functional impairment) was inversely associated with NPS total severity (b = -0.16, p0.05). More physical role limitation was significantly associated with higher NPS total severity (b = 0.77, p0.001). Among caregivers' characteristics, higher burden was significantly associated with higher NPS total severity (b = 0.19, p0.001).Our study found NPS to be common among community-dwelling PWD in Thailand and have adverse impacts on both PWD and family caregivers. These findings highlight the clinical importance of NPS symptoms among Thai older adults.

BACKGROUND: No evidence-based recommendations regarding optimal breakfast frequency and timing and type 2 diabetes mellitus (T2DM) exist for older adults because of limited studies. OBJECTIVES: We sought to prospectively assess relations between breakfast frequency and timing and T2DM risk among older adults and determine whether these depended on sex or cardiometabolic risk factors. METHODS: Weekly breakfast frequency and usual daily breakfast time were assessed by questionnaire at baseline in 3747 older adults (aged ≥ 65 y) from the Cardiovascular Health Study (CHS) who were free of cancer and T2DM and followed for 17.6 y. Multivariable-adjusted hazard ratios (aHRs) with 95% CIs estimated from Cox proportional hazards models were used to quantify associations with T2DM. RESULTS: Most CHS participants (median age: 74 y; IQR: 71–78 y) consumed breakfast daily (85.5%), and 73% had their first daily eating occasion between 07:00 and 09:00, both of which were associated with higher socioeconomic status, factors that are indicative of a healthier lifestyle, and lower levels of cardiometabolic risk indicators at baseline. During follow-up, 547 T2DM cases were documented. No strong evidence was observed linking breakfast frequency and risk of T2DM. Compared with participants whose breakfast timing (first eating occasion of the day) was 07:00–09:00, those who broke fast after 09:00 had an aHR for T2DM of 0.71 (95% CI: 0.51, 0.99). This association was present in participants with impaired fasting glucose at baseline (aHR: 0.61; 95% CI: 0.39, 0.95) but not in those without (aHR: 0.83; 95% CI: 0.50, 1.38). No associations between eating frequency or timing and T2DM were observed within other prespecified subgroups. CONCLUSIONS: Eating breakfast daily was not associated with either higher or lower risk of T2DM in this cohort of older adults, whereas a later (after 09:00) daily first eating occasion time was associated with lower T2DM risk in participants with impaired fasting glucose at baseline. This trial was registered at clinicaltrials.gov as NCT00005133.

Gait variability is associated with brain abnormalities, falls, and disability in older adults. The Enhanced Gait Variability Index (EGVI), a composite measure of gait variability, offers advantages over traditional measures of variability for individual spatiotemporal parameters (STPs). Gait assessment under complex conditions may reveal additional information about performance and provide insight into potential abnormalities. The EGVI has not been investigated in older adults while performing a concurrent motor task.To examine dual-task cost of the EGVI and STPs in a sample of community-dwelling older adults.Thirty-eight community-dwelling older adults (mean age = 72.5 years) walked at self-selected speeds on an instrumented walkway under a single-task (ST) and a motor dual-task (DT) condition. Descriptive statistics were calculated for the EGVI, STPs included in the EGVI, and several other common STPs (cadence, stride width, percent double-support). Wilcoxon signed-rank tests assessed differences in each gait variable between conditions. Dual-task cost (DTC) was calculated for each gait variable.Going from ST to DT walking, EGVI scores increased significantly (104.5 ± 8.4 to 125.1 ± 10.8, p .001). Participants also increased double-support (p .001) and stance time (p .01), while decreasing stride velocity (p .001), step length (p .001), and single-support time (p .05). Significant changes were not observed for cadence, stride width, or step time. Stride velocity and EGVI showed the greatest DTC.When confronted with a concurrent motor dual-task, older adults responded by increasing their EGVI and altering several STPs. The EGVI is a single composite measure that may have utility under ST and DT conditions to enhance understanding of gait variability in older adults. Further research should examine if DTC of EGVI scores predict meaningful constructs such as falls, participation, and self-rated health in older adults.

Anemia is associated with increased risk of all-cause mortality in older populations. However, the relationship between hemoglobin and major adverse cardiovascular events (MACE), and whether this is modulated by frailty, is unclear.CHAMP (Concord Health and Ageing in Men Project) is a prospective study of community-dwelling men aged ≥ 70 years. The relationship between hemoglobin and 7-year MACE was analysed by means of Cox regression. The Youden index was used to determine the optimal hemoglobin cutoff point in predicting MACE. Frailty was assessed with the use of the Fried criteria.The cohort comprised 1604 men (mean ± SD age 76.9 ± 5.5 years). Decreasing hemoglobin was associated with increased comorbidity, frailty, and MACE (P0.001), with 140 g/L the optimal cutoff point for predicting MACE. Hemoglobin, age, and frailty independently predicted MACE (all P0.001). Each 10 g/L decrement in hemoglobin level was associated with increased risk of MACE (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.06-1.20; P0.001), all-cause mortality (HR 1.20, 95% CI 1.12-1.29; P0.001), cardiovascular mortality (HR 1.07, 95% CI 1.01-1.14; P = 0.025), myocardial infarction (HR 1.17, 95% CI 1.09-1.25; P0.001), and heart failure (HR 1.17, 95% CI 1.09-1.25; P0.001). When stratified into hemoglobin quintiles, men in the lowest 2 quintiles (Hb 133-140 g/L and132g/L, respectively) were at increased risk of MACE, cardiovascular mortality, myocardial infarction, and heart failure (all P0.05). This relationship for MACE was independent from frailty status, with the test for interaction between frailty and hemoglobin not reaching significance (P = 0.24).Low hemoglobin was associated with increased MACE in community-dwelling older men independently from frailty. A hemoglobin cutoff point of 140 g/L, a level that is above contemporary definitions of anemia, predicted long-term MACE.

Physical frailty may compromise physical function and reduce self-reliance in community-dwelling older adults. We investigated if nutritional risk factors and protein intake were associated with physical frailty in community-dwelling adults.This cross-sectional study combined data from two studies in community-dwelling adults ≥65 years. Variables included physical frailty (SHARE-FI75+), nutritional risk factors (dysphagia, poor dental status, illness, unintentional weight loss, low and high BMI), chronic diseases, physical function, and protein intake (4-day food records). Logistic regression analyses were performed to investigate the association between physical frailty, number of nutritional risk factors and specific nutritional risk factors, and between physical frailty and protein intake.A total of 1430 participants were included in the study of these n = 860 were ≥80 years. Having one, two or more nutritional risk factors increased odds of physical pre-frail/frail condition (adjusted OR 1.39 95% CI 1.07-1.80; OR 2.67 1.76-4.04, respectively). Unintentional weight loss, poor dental status, dysphagia, and high BMI independently increased odds of physical pre-frail/frail condition. In participants ≥80 years two or more nutritional risk factors were associated with physical pre-frail/frail condition (adjusted OR 2.56 95%CI 1.45-4.52) and high BMI increased odds of physical pre-frail/frail condition independently. Higher intakes of protein did not significantly reduce odds of physical pre-frail/frail condition (adjusted OR 0.23 95% CI 0.05-1.09) in this sample of community-dwelling adults ≥80 years.Nutritional risk factors were independently associated with physical pre-frail/frail condition in community-dwelling older adults. Tackling nutritional risk factors offers an opportunity in primary prevention of malnutrition and physical frailty.

Some patients with stage I-III colorectal cancer (CRC) do not undergo tumor resection. Little is known about survival of these non-curatively managed patients. The aim of this study is to report all-cause mortality and to identify which factors are associated with survival in these patients.A retrospective review of electronic medical records was performed in two hospitals in the Netherlands. Patients diagnosed with CRC without distant metastases (radiologically determined stage I-III) and managed without tumor resection between 2011 and 2017 were included. The primary outcome was all-cause mortality. The effect of several variables on survival was evaluated with a multivariate logistic regression.Of the 107 patients with stage I-III CRC that did not undergo resection of the primary tumor, 80% died within two years; median survival time was 8.5 months (IQR 2.5-22 months). Malnutrition risk (OR 6.36 (CI 1.21-33.25); p = 0.03) and comorbidity burden (OR 1.51 (CI 1.05-2.18 p = 0.03) were significantly associated with decreased survival after two years in a multivariate model. Age and disease stage were not. When treatment decision was mainly patient driven instead of based on the multi-disciplinary tumor board's decision, survival was longer (mean overall survival 16 months vs 10 months, respectively) p0.05.Survival of patients with radiologically determined stage I-III CRC who did not undergo surgical resection was approximately 20% at two years and associated with the number of comorbidities, malnutrition risk status and dependent living, but not with age or disease stage.

Background People who take medications often experience challenges including making decisions about risks versus benefits and integrating medication management with all aspects of life (e.g., social and work responsibilities). Existing medication self-management frameworks are primarily adherence-focused and lack integrating holistic perspectives. Objective To explore the priorities of people with chronic medication experience (i.e., take at least 1 medication daily for at least 3 months) and what they can contribute to the understanding of medication self-management. Methods Concept mapping is a participatory, mixed-methods approach with 3 stages: brainstorming, sorting/rating, and mapping. Group brainstorming discussions were held with participants who generated statements about what mattered to them regarding medications in their everyday lives. In sorting/rating, individual participants grouped statements into thematic piles and rated their importance and feasibility. During mapping, a subset of participants discussed and agreed on a visual map and named the statement clusters. Following mapping, the researchers analyzed rating results, stratified by participant characteristics (gender, age, duration of medication use, number of medications, and chronic conditions). Results Sixty-three participants generated 1044 statements during 8 brainstorming sessions, which the researchers synthesized into 94 statements. Fifty-four participants individually sorted and rated the statements. Most statements were rated highly on both importance and feasibility, regardless of participant characteristics. Eight participants attended the mapping session. The final map had 9 thematic clusters, which were named by participants as: 1) researching and becoming educated about medications; 2) social support; 3) effectiveness of medication; 4) self-ownership of medication; 5) ease of use; 6) convenience and accessibility; 7) information provided by healthcare provider; 8) personal interactions with healthcare provider; and 9) patient involvement and trust. Conclusions Results enhance existing medication management frameworks by providing a more comprehensive perspective. Understanding medication self-management requires more research that incorporates and prioritizes the perspectives of individuals who manage their medications.

OBJECTIVES To determine the accuracy of the 5-time stand-to-sit (5TSTS) test for the identification of older adults with reduced gait speed. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 559 community-dwelling older adults were included in the study, divided into groups of women (n=465) and men (n=94). METHODS 5TSTS and gait speed were assessed. Multiple linear regression analysis with adjustment was performed in order to determine the association between 5TSTS and gait speed, followed by the receiver operating characteristic (ROC) curve for the identification of the usefulness of 5TSTS to discriminate older adults with reduced gait speed. Based on the ROC curve, we identified the area under the curve, the sensitivity, specificity, and cutoff points of the 5TSST. Statistical analyses were made using the SPSS software (version 25.0), and a significance level of 5% (P ≤ .05) was adopted. RESULTS The 5TSTS showed correlation with gait speed. Additionally, 5TSTS was able to discriminate reduced gait speed with moderate accuracy (P < .05; AUC between 0.7 and 0.8). For women, the cutoff scores for 5TSTS to identify gait speed

Sarcopenia, the lowered skeletal muscle mass, weakened skeletal muscle strength, and reduced physical performance with aging, is a component of frailty and high-risk factor for falls, resulting in an increase in mortality. In cardiovascular disease (CVD) patients, systemic inflammation, oxidative stress, overactivation of ubiquitin-proteasome system, endothelial dysfunction, lowering muscle blood flow, impaired glucose tolerance, hormonal changes, and physical inactivity possibly contribute to CVD-related sarcopenia. Prevalence of sarcopenia and osteosarcopenia, which is osteopenia and sarcopenia coexisting together, seems to be higher in CVD patients than in community-dwelling adults, suggesting the necessity of early diagnosis and prevention of CVD-related sarcopenia. Atrial stiffness, coronary artery calcification score, and serum vitamin D levels may be of help as the biomarkers to suspect sarcopenia, and renin-angiotensin-aldosterone system inhibitors may play a role in the medical prevention and treatment of CVD-related sarcopenia. There are few reports to convince the efficacies of dietary and antioxidant supplementation on sarcopenia at present, whereas aerobic and resistance training exercises have been recognized as an effective strategy to prevent and treat sarcopenia.

Background Considering the prevalence of mental health problems in older adults, this study aims to investigate the effect of inhalation aromatherapy using lavender and chamomile essential oils on depression, anxiety, and stress of community-dwelling older people. Methods A three-armed, parallel, randomized, and controlled trial design was used in this study. 183 participants were enrolled and randomly assigned to three groups (n = 61): the lavender, chamomile, and control groups. The participants in the experimental groups inhaled three drops of 1.5% lavender and chamomile essential oils for 30 nights. The participants in the control group inhaled only distilled water in a similar fashion. Data were collected using the Depression, Anxiety, and Stress-Scale (DASS) at baseline, immediately after the intervention, and one month after the intervention. Chi-square, Fisher's exact, one-way ANOVA, and repeated measures ANOVA were used for data analysis. Results Statistically significant improvement occurred in depression, anxiety, and stress levels immediately and one month after the intervention in lavender and chamomile groups compared to the control group (p Conclusion Inhalation aromatherapy with both lavender and chamomile essential oils helped decrease depression, anxiety, and stress levels in community-dwelling older adults.

To investigate whether and how social support influenced frailty progression through depressive symptoms and physical activity.Of 1235 community-dwelling older adults enrolled at baseline, 778 (63.0%) undergoing at least one yearly follow-up were included in the final analysis. Data were collected on frailty, social support, depressive symptoms, physical activity and covariates.Two frailty trajectory classes were identified and labeled as alleviated frailty and deteriorated frailty. Subjective support prevented the deterioration of frailty through decreased depressive symptoms, while objective support and support utilization prevented the deterioration of frailty through increased physical activity.The pathways through which social support ameliorates frailty vary by support types. Subjective support interventions should be included in the multifactorial interdisciplinary management of frailty to address social and psychological vulnerabilities, along with objective support and support utilization interventions addressing physical inactivity.

Background The loco-check has been widely used to raise awareness of locomotive syndrome (LS) not only in the general population but also among medical practitioners. However, a screening tool of the loco-check for LS-1, LS-2, and LS-3 has not yet been established. The present study developed a screening tool for use with the loco-check to detect LS-1, LS-2, and LS-3. Methods A cross-sectional study of 1659 community-dwelling older adults (730 males, 929 females) with a mean age of 73.8 ± 6.0 years old (range, 65–96 years old) was conducted, based on the Standards for Reporting Diagnostic Accuracy (STARD). All subjects underwent the loco-check as an index test and the 25-question Geriatric Locomotive Function Scale (GLFS-25) as a reference standard at the same time. Subjects with a GLFS-25 total score of ≤6 points, 7–15 points, 16–23 points, and ≥24 points were diagnosed with non-LS, LS-1, LS-2, and LS-3, respectively. A conventional receiver-operating characteristic curve analysis was used to confirm the optimal cut-off values of the loco-check score and their sensitivity and specificity to identify LS-1, LS-2, and LS-3, with a preference for a slightly higher sensitivity as the tool is intended primarily for screening purposes. Results The optimal cut-off values of the loco-check score to discriminate LS-1, LS-2, and LS-3 as a screening tool were 1 point (sensitivity 85.4% and specificity 64.9%), 2 points (sensitivity 88.8% and specificity 75.1%), and 3 points (sensitivity 87.6% and specificity 84.6%), respectively. Conclusions Our findings may help both the general population and medical practitioners become roughly aware of and estimate the severity of LS, which will contribute to its use in community health activities and the dissemination of the concept of LS.

The Mediterranean diet has been recommended to delay cognitive decline, but adherence to the diet among older adults remain poor, and research on interventions that effectively promote the diet has been inconclusive. This study examined the effects of a mini-flipped, game-based Mediterranean diet learning program in improving dietary behavior and cognitive function in community-dwelling older adults in Taiwan. A cluster randomized controlled trial was conducted. The experimental group completed an 8-week, mini-flipped, game-based learning program. Data were collected at baseline and 8 weeks after intervention. Outcome measures included dietary behavior, global cognitive function, and subjective cognitive dysfunction. Compared with the control group, the experimental group exhibited significantly improved Mediterranean diet behavior and global cognitive function after the intervention, although there was no significant difference in subjective cognitive function. Future research should be conducted with larger populations and longer-term follow-up to evaluate the effect of this learning program.

To identify patterns of intrinsic capacity (IC) and determine the association between these patterns with incident one-year outcomes.A total of 756 older adults aged ≥ 60 years were followed up after 1 year. IC was assessed using the revised integrated care for older people screening tool, and its patterns were examined by the latent class analysis. Logistic regression models were conducted to compare the risk of adverse outcomes.Three IC patterns were identified. Both "sharp declines in sensory domain" (Class 2) and "sharp declines in locomotion, psychological, cognition and vitality domains" (Class 3) were at greater risk of disabilities and poor physical quality of life than "relatively healthy" (Class 1). The Class 3 was twice as likely to be hospitalized as Class 1.Assessment of IC could provide valuable information on stratifying older adults into heterogeneous groups, promoting targeted interventions to delay the adverse outcomes.

Objectives We surveyed older adults about their perceived mental health and their comfort discussing and engaging in mental health treatment. Methods A nationally representative survey of community-dwelling older adults aged 50–80 (N = 2,021), with respondents asked to rate their current mental health as compared to 20 years ago, comfort discussing their mental health, and potential hesitations to seeking treatment in the future. Results About 79.6% reported their mental health as the same or better than 20 years ago; 18.6% reported their mental health to be worse. Most respondents reported that they were comfortable (87.3%) discussing their mental health, preferring to discuss such concerns with their primary care provider (30.6%). About 28.5% of respondents did endorse some hesitation seeking mental health care in the future. Conclusions Most older adults reported that their mental health was as good if not better than it was 20 years ago and felt comfortable discussing mental health concerns.

To investigate the mediating roles of community integration and positive thinking on the relationship between depression and mental health recovery among community dwelling people with mental disorders in South Korea. A cross-sectional, descriptive study was utilized. Data were collected from 167 community-dwelling people with mental disorders who did not use the day program at community mental health centers. Data were collected from November 20, 2018, to February 15, 2019. Both community integration and positive thinking were found to mediate the effects of depression on mental health recovery. The mediating effect of positive thinking was significantly greater than that of community integration. This study added evidence for a significant multiple mediating effect of community integration and positive thinking on the relationship between depression and mental health recovery in community-dwelling people with mental disorders. Although the consumer-centered recovery paradigm of people with mental health difficulties is of global importance, little research has been conducted on mental health recovery among community-dwelling people with mental disorders who do not use the day program at community mental health centers. It was found that community integration and positive thinking mediated the effects of depression on mental health recovery, with positive thinking mediating this relationship the most. Thus, these results suggest a specific direction of community mental health services to promote mental health recovery for people with mental disorders who do not have access to community mental health services.

BACKGROUND: Some older people stop visiting the dentist when they get older. This study aims to identify the characteristics and oral health status of older people who do visit community dental practices.METHODS: In this exploratory cross-sectional study, the oral health of Dutch community-dwelling older people was assessed. A random sample of general dental practitioners and older people who visit the dental practice was drawn. The dentists were asked to prospectively select one older patient and describe this patient using a specially developed registration form; the patient was requested to complete a questionnaire. Data were described for 3 distinct groups of older people. Statistical measures for distribution and dispersion were used to describe the oral health of community-dwelling older patients in relation to the age.RESULTS: A total of 373 (40.4%) dentist registration forms and 372 (40.3%) patient questionnaires were returned. Data were available for 364 (39.4%) dentist-patient couples. Amongst the patients, 52.8% were female and most had a high socioeconomic status. About 65.7% had one or more problems related to general health, and 75.2% used medication. Regarding the overall oral health status, the average number of teeth was 20, 3.5% were edentulous. Oral health problems were more common in the older patient group (aged 75+), in whom frailty was also most common.CONCLUSIONS: Older people who visit community dental practices are still relatively healthy, non-frail, and highly educated. Even in this group, there is a turning point in both general and oral health from the age of 75.

Objective To identify the self-reported frequency of emergency department (ED) visits, ED-related hospitalizations, and reasons for ED visits among people with traumatic spinal cord injury (SCI) and compare them with general population data from the same geographic area. Design Cross-sectional. Setting A specialty hospital in the Southeastern United States. Participants The participants (N=648) were community-dwelling adults (18 years and older) with a traumatic SCI, who were at least 1 year postinjury. A comparison group of 9728 individuals from the general population was retrieved from the 2017 National Health Interview Survey (NHIS). Interventions Not applicable. Main Outcome Measures Participants completed self-report assessments on ED visits, ED hospitalizations, and reasons for ED visits in the past 12 months using items from the NHIS. Results A total of 37% of participants with SCI reported at least 1 ED visit, and 18% reported at least 1 ED hospitalization in the past 12 months. Among those having at least 1 ED visit, 49% were admitted to hospitals. After controlling for sex, age, and race/ethnicity, participants with SCI were 151% more likely to visit the ED (odds ratio [OR], 2.51) and 249% more likely to have at least 1 ED hospitalization than the NHIS sample (OR, 3.49). Persons with SCI had a higher percentage of ED visits because of severe health conditions, reported an ED was the closest provider, and were more likely to arrive by ambulance. NHIS participants were more likely to visit the ED because no other option was available. Conclusions Compared with those in the general population, individuals with SCI have substantially higher rates of ED visits, yet ED visits are not regularly assessed within the SCI Model Systems. ED visits may indicate the need for intervention beyond the acute condition leading directly to the ED visits and an opportunity to link individuals with resources needed to maintain function in the community.

Despite the reported 'male-female health-survival paradox', no components of the comprehensive geriatric assessment (CGA) routinely used in the field of geriatrics focus on female-specific symptoms. To investigate the impact of gynecological factors among elderly women, we noted the gynecological history and examined the association between self-rated symptoms of pelvic organ prolapse (POP) and CGA.This community-based, cross-sectional study in Japan included 164 community-dwelling women aged ≥75 years.The main outcome measures were the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), activities of daily living (ADL), and Timed Up and Go (TUG) test. Self-rated symptoms of POP were assessed using POPDI-6, and the participants were dichotomized into POPDI-60 (symptom group) and POPDI-6 = 0 (no-symptom group). Several components of the CGA were compared between the groups with and without symptoms of POP and the association with POPDI-6 score was analyzed by multiple logistic regression analysis.Compared with the no-symptom group, the symptom group had significantly longer TUG test time (≥13.5 s) (P = 0.024) and difficulty in basic ADL (score21) (P = 0.02). In multiple logistic regression analysis, basic ADL21 and TUG time ≥13.5 s were significantly associated with POPDI-60 (odds ratio [OR] = 2.78; 95% confidence interval [CI] = 1.10-7.06 and OR = 3.45; 95% CI = 1.01-1.24).Self-rated POP symptoms were associated with CGA components among community-dwelling elderly women. Evaluating POP symptoms as part of the CGA could be meaningful for improving physical and psychological health in elderly women.

Tai Chi could alleviate depression, while the biological mechanisms underlying this effect remains unelucidated. This study recruited 18 community-dwelling older persons with a pre-post testing design, aiming to unveil the potential epigenetic effect by which Tai Chi in the alleviation of depression, using methylation of BDNF promoter as the biomarker. The methylation levels (determined by pyrosequencing using saliva samples) of the targeted BDNF sequence were positively associated with the existence and severity of depressive symptoms (measured with the 9-item Patient Health Questionnaire). Both methylation levels and depression decreased significantly after the Tai Chi intervention. Demethylation of BDNF promoter might be one of the potential mechanisms underlying the holistic depression alleviating effect of Tai Chi. BDNF methylation may potentially serve as a screening, diagnostic as well as disease activity biomarker to determine treatment effects for depression. Further adequately powered studies are needed to verify and strengthen our findings.

To assess how well community-dwelling older adults in Singapore were coping with their diabetes, and the sociodemographic characteristics that were associated with their level of coping.This was a cross-sectional study involving 257 older adults. Multiple regression was used to assess the associations between various sociodemographic characteristics and coping measures of present quality of life and level of self-care.Older adults mainly sought care in the primary care setting. They were not coping well given their mean scores for diabetes-dependent quality of life and the self-care index were -3.57 and 3.55 respectively. Compared to those with post-secondary education, individuals who had no formal (adjusted B -0.92, p 0.003), primary level (adjusted B -0.76, p0.001) and secondary level (adjusted B -0.50, p0.02) education reported lower present quality of life. Those with prior lowest skill level occupations were less likely to consume a healthy diet per week than those with prior highest skill level occupations (adjusted B -1.48, p 0.004).There should be provision of diabetes self-care interventions targeting older adults in Singapore especially for those with lower education and work skill levels. As the first line of contacts, primary care providers should advocate for diabetes self-care and develop community-based interventions for these priority groups.

Frailty is a clinically discernible state in which decreased physiological reserve and function result in a reduced ability to cope with stressors. Information and communication technology (ICT) has been proposed as an aid to help with frailty, yet the use of ICT by older people, particularly women, is an understudied area.To analyze the association between use of ICT (specifically internet functions and social media) and frailty status in postmenopausal midlife and elderly women.A cross-sectional study was designed to investigate whether frailty status is related to ICT use in postmenopausal midlife and older women. Community-dwelling women attending primary health care centers for health checks were invited to participate in the study. Postmenopausal status was the only inclusion criterion, whereas limitations that could interfere with use of ICT were exclusion criteria. The Fried phenotype was used to assess frailty. Four types of ICT use were examined: the internet for e-mail, the internet for other functions, and social media (WhatsApp or Facebook). Chi-square test and multivariate multinomial regression analysis were used to examine the association between frailty status and ICT use.We included 409 women (age = 67.45 ± 7.81 years, mean ± SD), who were frail (n = 135, 33.01%), pre-frail (n = 159, 38.87%), or robust (n = 115, 28.11%). Frailty status was significantly and inversely associated with any ICT use, showing a strong association with use of WhatsApp (P 0.001) and internet searches (P 0.001). ICT non-use was a predictor of frailty, while ICT users were more likely to be robust (OR 10.62; 95% [CI], 5.34-21.10) or pre-frail (OR 9.03; [CI], 95% 5.18-15.74).Postmenopausal midlife and older women not using ICT were more likely to be frail.

Human gait is a complex task resulting from the interaction of sensory perception, muscle force output, and sensory-motor integration, which declines with the aging process and impacts gait speed in older women.What are the separate and combined impacts of sensory-motor factors on gait speed of older women?Sixty healthy older women (69.3 ± 5.9 years) volunteered for this study. A previous screening using Pearson's correlation selected variables significantly correlated with gait speed: age, plantar tactile perception, lower limb explosive force, and mean velocity (MV) of the center of pressure (CoP). Simple and multivariate regression models were performed with selected variables. The magnitude of evidence was obtained using Bayesian inference, determining posterior probabilities based on our data.Gait speed was negatively correlated with age and positively correlated with plantar tactile perception, MV (Romberg index), and lower limb explosive force. The coefficient of determination (RAge, plantar tactile perception, MV (Romberg index), and lower limb explosive force impact gait speed, whereas the combination of the first three factors has an excellent posterior probability of predicting or affecting gait speed.

Background This study investigated the role of a large range psychological, attitudinal and health related variables as predictors of depression trajectories amongst older adults over a 4-year time period. Methods Data from three consecutive waves of the TILDA survey of older community dwelling adults aged 50+ in Ireland were combined for analysis. Depression symptom scores were assessed using the Center for Epidemiological Studies– Depression scale (CES-D). Changes in depression scores over three time points were modelled as distinct trajectory classes using group-based trajectory modelling, whilst simultaneously controlling for demographic, attitudinal and health related predictors of these trajectory classes using multinomial regression. Results Four distinct depression trajectories were identified as (1) a stable low symptom level group (79%), (2) a moderate but deteriorating symptoms group (7.6%), (3) a moderate but improving group (10.1%) and (4) a vulnerable group with consistently high symptoms (3.1%). Multinomial logistic regression indicated that limiting pain, mobility impairments, perceived stress and loneliness predicted membership of the moderate and higher depressive symptom classes. Retirement status and higher reported levels of worry were associated with a greater likelihood of membership of the moderate symptom classes only. Limitations Use of the CES-D is open to bias due to subjective nature of respondent reporting. Conclusions Results concur with previous studies on the development of depression among older people and highlight the key health related and psychological variables that may inform interventions aimed at mitigating risks of developing depression among older adults.

Appetite loss (AL) in older adults can reduce energy and nutrient intake, increasing the risk of weight loss, sarcopenia, frailty, and ultimately, mortality. The identification of associated factors to AL is important to plan different interventions.To identify the association between appetite loss, frailty, and psychosocial factors in community-dwelling older adults.Cross-sectional analysis of the cohort study MiMiCS-FRAIL based in Jundiai City, São Paulo, Brazil. Patients 60+ years old were evaluated from January 2019 to August 2020. The AL (dependent variable) was evaluated through the SNAQ questionnaire; the independent variables were: frailty (identified by frailty index-36; FI-36) which is based on the accumulation of deficits; depressive symptoms (GDS scale); ethnicity, and years of formal schooling, both used as proxies of socioeconomic status. The associations were investigated using logistic regression models (crude and multiple).The final sample included 122 older adults, 58.2% of women, mean age of 71.7 years, 80.3% White, and low educational level (5.8 ± 4.3 years of formal schooling). We found 19.6% of the sample presenting AL. The final regression models showed independent and significant association between AL and age (OR = 1.11; 95%IC = 1.03-1.20; p 0.01), being non-White (OR = 6.47; 95%IC = 1.63-25.58; p 0.01), and presence of depressive symptoms (OR = 8.38; 95%IC = 2.31-30.47; p 0.01). However, years of formal schooling, gender, and FI-36 remained statistically non-significant in the model.Our data pointed to the presence of depressive symptoms and social variables as significant factors associated with AL. Further studies with more robust samples or longitudinal design will clarify some unanswered questions of our study.

Purpose To examine the “age-related positivity effect” and its sex differences in the pain-depression relationship among Chinese community-dwelling older adults. Design Cross-sectional design. Methods The study was conducted with a sample of 1,913 older adults in Jinan, China. Data were collected on pain intensity, age, sex, depressive symptoms, and potential covariates. Results The hierarchical linear regression analyses revealed that pain intensity was significantly related to depressive symptoms, there was a significant two-way interaction between age and pain intensity, and there was a significant three-way interaction between sex, age, and pain intensity. The Johnson-Neyman plot revealed that the relationship between pain and depressive symptoms decreased with advancing age, indicating an “age-related positivity effect.” And the age-related positivity effect in the pain-depression relationship was significant only in men, but not in women. Conclusions The study suggests that all older women and “young-old” men (younger senior citizens aged 60-79) in China are more likely to experience depressive symptoms from pain. Interventions on cognitive psychology should particularly target all older women and young-old men to reduce the detrimental effect of pain on emotional well-being.

We examined the influence of lifestyle on brain aging after nearly 30 years, and tested the hypothesis that young adult general cognitive ability (GCA) would moderate these effects. In the community-dwelling Vietnam Era Twin Study of Aging (VETSA), 431 largely non-Hispanic white men completed a test of GCA at mean age 20. We created a modifiable lifestyle behavior composite from data collected at mean age 40. During VETSA, MRI-based measures at mean age 68 included predicted brain age difference (PBAD), Alzheimer's disease (AD) brain signature, and abnormal white matter scores. There were significant main effects of young adult GCA and lifestyle on PBAD and the AD signature (ps ≤ 0.012), and a GCA-by-lifestyle interaction on both (ps ≤ 0.006). Regardless of GCA level, having more favorable lifestyle behaviors predicted less advanced brain age and less AD-like brain aging. Unfavorable lifestyles predicted advanced brain aging in those with lower age 20 GCA, but did not affect brain aging in those with higher age 20 GCA. Targeting early lifestyle modification may promote dementia risk reduction, especially among lower reserve individuals.

CONTEXT: Cognitively impaired older adults frequently need surrogate decision-making near the end-of-life. It is unknown whether differences in the surrogate’s relationship to the decedent are associated with different end-of-life treatment choices. OBJECTIVES: To describe differences in end-of-life care for community dwelling, cognitively impaired older adults when children and spouses are involved in decision-making. METHODS: Retrospective observational study. RESULTS: Among 742 community-dwelling adults with cognitive impairment (mild cognitive impairment or dementia) prior to death, children participated in end-of-life decisions for 615 patients (83%) and spouses participated in decisions for 258 patients (35%), with both children and spouses participating for 131 patients (18%). When controlling for demographic characteristics, decedents with only a spouse decision-maker were less likely to undergo a life-sustaining treatment than decedents with only children decision-makers (p < 0.05). There was no difference in the probability of in-hospital death or burdensome transfers across facilities across decedent-decision-maker relationships. Differences in rates of life-sustaining treatment were greater when we restricted to decedents with dementia. CONCLUSION: Decedents with cognitive impairment or dementia were less likely to receive life-sustaining treatments when spouses versus children were involved with end-of-life treatment decisions but were no less likely to experience other measures of potentially burdensome end-of-life care.

Background Language and communication have an impact on how a clinical condition is treated and experienced, from both the health care professional (HCP) and patient perspective. Malnutrition is prevalent among community-dwelling older adults, yet perceptions of patient understanding of the term malnutrition to date remain underexplored. Objective This qualitative study explored the use and perceptions of the term malnutrition among HCPs and older adults at risk of malnutrition. Design Semi-structured interviews and focus groups were conducted with HCPs and older adults with a prescription for oral nutritional supplements (ONS) in the community, to explore perspectives. Participants and setting HCPs with experience of working with older adults were recruited in primary care centers, general practitioner practices, community health organizations, and community pharmacies in County Dublin, Ireland, between 2018 and 2019. Older adults, aged ≥60 years, with a current or previous prescription for ONS were recruited from daycare centers. One-to-one interviews were conducted with general practitioners (n = 16) and patients (n = 13), and focus groups were conducted with other HCPs, including dietitians (n = 22), nurses (n = 22), pharmacists (n = 9), physiotherapists (n = 12), occupational therapists (n = 6), and speech and language therapists (n = 4). Data analysis Data from interviews and focus groups were transcribed verbatim and analyzed using thematic analysis. Results There was mutual agreement between HCPs and patients on the main theme, “malnutrition is a term to be avoided.” There were three subthemes with varying input from the different HCP groups and patients: “Malnutrition is a term a patient doesn’t want to hear”—malnutrition has negative connotations that imply neglect and stigma; “malnutrition is a clinical term which patients don’t understand”—with perceptions that it is better to substitute the term with simpler motivating messages; and “lack of confidence identifying malnutrition”—expressed by non-dietetics HCPs who believed they had insufficient expertise on malnutrition to communicate effectively with patients. Conclusions HCPs and patients perceived negative connotations with the term malnutrition, and HCPs used alternatives in practice. Additional consultation with HCPs and patients is recommended to explore appropriate language for conveying health risks associated with malnutrition. Future research should also address how current communication challenges can be addressed as part of strategic management programs or interventions to prevent and treat malnutrition.

Introduction Programs and services available through the aging services network can help community-dwelling older adults to age in place but are often not discussed in routine primary care. The primary care liaison was developed as a novel integration intervention to address this disconnect. Methods Employed by an Area Agency on Aging, primary care liaisons performed outreach to primary care with the goal of raising awareness of community-based programs, resources, and services available to older adults and their caregivers and facilitating referrals. The evaluation of the primary care liaison model, conducted from December 2015 to February 2019, used the Reach, Effectiveness, Adoption, Implementation, Maintenance framework and assessed reach (number of clinics contacted), adoption (number of referrals to the Area Agency on Aging), implementation (number of follow-up contacts with a practice), and effectiveness (proportion of referrals reached and provided relevant resources). Results The primary care liaisons contacted a median of 18.5 clinics per month (IQR=15−31). Primary care referrals averaged >100 per month, and referrals increased over time. Successful follow-up outreach visits had a median of 3 (IQR=2−10), and follow-up contacts had a median of 3 (IQR=1−7) per practice. Three quarters of caregivers for people with dementia reached by Area Agency on Aging staff were provided with information about relevant resources. Conclusions The primary care liaison model is feasible, fosters ongoing interactions between primary care and Area Agencies on Aging, and connects older adults and their caregivers to relevant programs and services. Adoption of the primary care liaison model by other Area Agencies on Aging across the U.S. may help further the vision of optimized health and well-being of older adults.

We assessed the predictors of becoming frail between non-frail and vulnerable community-dwelling older adults in a retrospective cohort study with adults (n=346) aged 60 years or older recruited from primary healthcare centers. Edmonton Frailty Scale assessed frailty status, and Kaplan-Meier estimated the frailty-free probability and compared it between groups. Cox regression models explored predictors of becoming frail. At baseline, there were 32.3% individuals classified as Frail according to the EFS, whereas 32.4% were vulnerable and 35.3% non-frail. We observed 82 incident cases of frailty, 65.8% among those classified as vulnerable and 37.8% in the non-frail group (p0.05). Female sex, years of education, and an overall score of45 on the Berg Balance Scale were the only independent predictors of becoming frail. Although frailty is not only correlated with mobility, static and dynamic balancing abilities appear to have the same impact as a vulnerable state to becoming frail.

This study aimed to examine the validity and reliability of the Persian Version of the Comprehensive Frailty Assessment Instrument Plus (CFAI-Plus) among community-dwelling older adults. It was completed by 340 older adults ≥60 years. The content and face validity were confirmed based on the opinion of the target group and experts. In the exploratory factor analysis, seven factors were extracted, explaining 62.8% of the total variance. Confirmatory factor analysis showed acceptable fit indices (Root Mean Square Error of Approximation = 0.045; Comparative Fit Index = 0.93; Tucker-Lewis Index = 0.92). Internal consistency was adequate for factors (Cronbach's alpha: range 0.47 to 0.88), and the test-retest reliability was acceptable (intra-class correlation coefficient: range 0.76 to 0.92). A higher CFAI-Plus score were found in those who were older, female, less-educated, single, lived alone, and had inadequate income. This study supports the reliability and validity of the Persian CFAI-Plus in community-dwelling older adults.

The aim of this systematic review (SR) and meta-analysis was to assess what type of exercise is associated with fall risk reduction among apparently healthy adults aged 50 and older. We conducted a SR by searching for randomized controlled trials (RCTs) included in Cochrane SRs published until October 2019. Five SRs that compared exercise versus any type of control included 32 RCTs. The outcomes examined were falls, fallers, fractures, and fear of falling. A random effects-based meta-analysis by type of exercise was performed. Almost all the interventions were effective for fall rate reduction, with a major effect for three-dimensional exercise, strength/resistance exercises, and mixed exercises. The number of fallers was reduced by three-dimensional exercise and mixed exercises. Fall-related fractures were generally reduced by all types of exercises considered all together, but none singly resulted in statistically effective fracture prevention. Fear of falling was slightly decreased with endurance exercises.

Background Foot deformities are highly prevalent in older adults and negatively impact their mobility and quality of life. However, the association between foot problems and physical function is still unclear. Objective To investigate whether structural foot deformities and plantar tactile sensitivity are associated with lower extremity physical function impairment in community-dwelling older adults. Methods We included 200 men and women aged 60 years and older from a community-based program. The foot assessment included toe deformities and calluses inspection and evaluation of plantar tactile sensitivity using monofilaments. The Short Physical Performance Battery (SPPB) was used to assess lower extremity physical function. We conducted a multivariate logistic regression analysis to investigate the association between foot problems and lower extremity physical function. Results Hallux valgus was the most prevalent deformity among older adults. Those participants with reduced plantar tactile sensitivity (OR= 2.77; 95% CI: 1.38, 5.55) and a hallux valgus (OR= 2.23; 95% CI: 1.10, 4.52) were more likely to present poor lower extremity physical function. Conclusion Hallux valgus and impaired plantar sensitivity were associated with reduced lower extremity physical function in older adults. Further studies are necessary to identify this causality and to what extent management of these foot problems can improve general mobility and quality of life of older adults.

Objectives Inadequate financial and health literacy presents a formidable public health and economic challenge in old age. This study investigated declining financial and health literacy in relation to decision making performance, scam susceptibility and psychological wellbeing. Design Longitudinal study. Setting A community-based cohort in Northeastern Illinois, USA. Participants One thousand fourty-six older adults who were free of dementia at baseline and underwent annual clinical and literacy assessments. Measurements Financial and health literacy, decision making, scam susceptibility, and psychological wellbeing were assessed using validated instruments. Linear mixed effects models estimated person-specific rates of change in financial and health literacy, and multivariable regression analyses examined the associations of declining literacy with subsequent levels of decision making, scam susceptibility, and psychological wellbeing. Results The mean age was 81 years and 76% were female. Over up to 10 years of annual follow-ups, the average financial and health literacy score dropped 1 percentage point a year. Substantial variability in decline was observed between participants. Faster decline in financial and health literacy was associated with poorer decision making, higher scam susceptibility, and lower psychological wellbeing. Notably, these associations were above and beyond the baseline literacy level and persisted even after controlling for cognition. Conclusions Most community-dwelling older adults experience decline in financial and health literacy over time, but decline is not inevitable. Declining literacy is related to poorer decision making, greater scam susceptibility and lower wellbeing. These findings suggest that efforts to mitigate declining financial and health literacy may promote independence and wellbeing in old age.

This study was a 24-week non-randomized controlled trial aimed at investigating the effects of lifestyle education by sex in patients with schizophrenia. The data was collected and analyzed for 75 subjects at five facilities in Aomori, Japan. Mean weight and BMI decreased in both biologically male and female subjects over a 24-Week study period in the Intervention group, but were maintenance or increase in the control Group. Although, when compared with the control group by ANCOVA (Analysis of Covariance), there were significant differences in body weight, BMI, and body fat percentage in the biologically male participants in the Intervention group, but not in the females. For the biologically males in the Intervention group, sex differences were speculated to affect weight loss strategies, such as using a pedometer to incorporate walking into their daily routine. Thus, when implementing lifestyle improvement education program, it is recommended to implement a program that considers sex differences.

Swallowing function decreases with age and impacts nutritional state and frailty. The aim of the study was to test the relationship between swallowing function, dysphagia, frailty, malnutrition and depression in community dwelling older participants.Community dwelling older participants (n = 180), were enrolled (74 men aged 75.9 ± 7.8, 65-91 years, and 107 women aged 75.9 ± 8.0, 65-95 years). Swallowing function was assessed by the Test of Mastication and Swallowing Solids (TOMASS) and the Timed Water Swallow Test (TWST). Dysphagia was identified using Hebrew 10-Item Eating Assessment Tool (H-EAT-10). Frailty was assessed by grip strength and the FRAIL Questionnaire. The Mini Nutritional Assessment - Short Form (MNA-SF) was used to identify nutritional status. Depression was screened with the Geriatric Depression Scale - Short Form (GDS-SF).18.3% of the participants had a score of 3 or above in H-EAT-10, indicating suspected dysphagia. 17.8% of the participants were malnourished or at risk of malnutrition, and 48.3% were defined as frail or pre-frail. The odds of being malnourished/at risk of malnutrition were 3 times greater in those with suspected dysphagia. The odds of being frail/pre-frail were also 3 times greater in those with suspected dysphagia. Moreover, suspected dysphagia and frail/pre-frail health status coincided in 69.7% of participants. Participants that were malnourished/at risk of malnutrition required more masticatory cycles (p .05) and more time (p .05) to eat a cracker and drink 150 mL of water (p .05), and had reduced swallowing capacity (volume/sec) in the TWST (p .05) than those who were at normal nutritional statues. Similar results were found for frail/pre-frail participants versus robust health status. A decrease in grip strength was associated with increased (worse) frailty score, decreased nutritional score, decreased chewing function in TOMASS and decreased water drinking function in TWST (p .05). MNA-SF score, age, GDS-SF score and EAT-10 were the best predictors of FRAIL score.A simple multi-dimensional screen should be employed by trained allied health professionals, nurses and their assistants to improve early identification and early referral to relevant health providers in order to provide preventive intervention for dysphagia, nutrition, frailty and depression.

This study aimed to examine the factors associated with willingness to complete advance directives (ADs) in community-dwelling older adults. In total, 121 community-dwelling older adults in Korea completed the questionnaires inquiring about their willingness and perceptions in completing ADs (susceptibility, severity, benefits, barriers, and cues to action), which were based on the Health Belief Model. The mean score for willingness to complete ADs was 6.2 (SD = 3.6). A multiple linear regression analysis showed that higher scores of perceived severity (β = 0.199, p = 0.021), perceived benefits (β = 0.221, p = 0.016), and cues to action (β = 0.159, p = 0.030) were associated with a greater willingness to complete ADs. However, higher scores of perceived barriers (β = -0.409, p 0.001) were likely to lower the willingness to complete ADs. This study highlights that future interventions aimed at increasing AD completion rates in older adults should consider improving perceived severity, benefits, and cues to action and minimizing perceived barriers.