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In the in-text description of Figure 5 on page 12, the "alpha" and "theta" labels have been mistakenly switched. To the following: "Consistent with the sensor level analysis, Figure 5 displays higher frontal theta and alpha source power in the Single-Task compared to Sequential-Task conditions in the younger group (Panels A-D, left column), lower posterior alpha power in the Single-Task compared to Immediate (non-significant) and Delayed Switch conditions in the older group (Panel C-D, middle column), and higher frontal theta power in the Single-Task compared to Immediate (non-significant) and Delayed Switch condition in the older group (Panel A-B, middle column)." The authors, therefore, wish to correct the description of Figure 5 in the first paragraph on page 12 from: "Consistent with the sensor level analysis, Figure 5 displays higher frontal theta and alpha source power in the Single-Task compared to Sequential-Task conditions in the younger group (Panels A-D, left column), lower posterior theta power in the Single-Task compared to Immediate Switch condition in the older group (Panel C, middle column), and higher frontal alpha power in the Single-Task compared to Delayed Switch condition in the older group (Panel D, middle column).". [Extracted from the article]

• The COM-FI is a valid and reliable tool, comparable to other frailty indices. • The COM-FI is comprised of physical, psychological, and medical components. • The COM-FI is a tool for use in integrated care settings. • The COM-FI prognostic capabilities include predicting need for care. • The COM-FI offers a platform to build towards a holistic frailty tool. Methods for measuring frailty over-emphasise physical health, and consensus for a more holistic approach is increasing. However, holistic tools have had mixed success in meeting the validation criteria required of a frailty index. We report on the further development and validation of a Frailty Tool designed for use in the community with a greater emphasis on psychological markers, Holland et al's Community-Oriented Frailty Index (COM-FI). A total of 351 participants aged 58–96 were recruited from Retirement Villages and local communities across the West Midlands of the UK. Participants completed a series of measures designed to assess frailty and outcomes associated with frailty over a 2-year period. All three candidate items ('polypharmacy', 'exercise frequency', and the Coronary Heart Disease and Diabetes 'joint effect') were incorporated into the tool, and one variable, 'falls' was removed from the index. The revised COM-FI was shown to be valid and met Rockwood's validation criteria (Rockwood et al., 2006), with the exception that in this specific sample there was no significant gender difference and the index did not predict mortality. Overall, the COM-FI is a valid and reliable tool, although the capacity for the COM-FI to predict mortality over a 2-year period remains inconclusive given the small numbers of people at the higher ends of the frailty range. Prediction of need for social care was good, showing the utility of this community based tool. [ABSTRACT FROM AUTHOR]

We recently reported that refocusing attention between temporal and spatial tasks becomes more difficult with increasing age, which could impair daily activities such as driving (Callaghan et al., 2017). Here, we investigated the extent to which difficulties in refocusing attention extend to naturalistic settings such as simulated driving. A total of 118 participants in five age groups (18–30; 40–49; 50–59; 60–69; 70–91 years) were compared during continuous simulated driving, where they repeatedly switched from braking due to traffic ahead (a spatially focal yet temporally complex task) to reading a motorway road sign (a spatially more distributed task). Sequential-Task (switching) performance was compared to Single-Task performance (road sign only) to calculate age-related switch-costs. Electroencephalography was recorded in 34 participants (17 in the 18–30 and 17 in the 60+ years groups) to explore age-related changes in the neural oscillatory signatures of refocusing attention while driving. We indeed observed age-related impairments in attentional refocusing, evidenced by increased switch-costs in response times and by deficient modulation of theta and alpha frequencies. Our findings highlight virtual reality (VR) and Neuro-VR as important methodologies for future psychological and gerontological research. [ABSTRACT FROM AUTHOR]

Background Frailty is associated with a prodromal stage called pre-frailty, a potentially reversible and highly prevalent condition before frailty becomes established. Despite this, there is no widely accepted definition of pre-frailty to support its early identification and management. This study applied an international consensus approach to define and better understand pre-frailty. Methods A modified electronic two-round Delphi Consensus study was conducted. In all, 23 experts from 12 countries with different backgrounds participated. The questionnaire was developed following a systematic literature review. An online consensus meeting was conducted with eight Delphi participants and two external experts. Qualitative and quantitative methods were employed for data analysis. An agreement level of 70% was applied for accepting statements. Results A total of 71 statements were circulated in Round 1. Of these, 52.8% were accepted. Fifty-one statements were re-circulated in Round 2, of which 92.1% were accepted. The online consensus meeting produced a consensus statement describing the concept, multi-factorial nature, and mechanism of pre-frailty as well as assessment, prevention and management approaches. All experts agreed that physical and non-physical factors such as psychological and social capacity are involved in the development of pre-frailty, potentially adversely affecting health and health-related quality of life outcomes. Practitioners should regard pre-frailty as a multi-factorial, multi-dimensional, and non-linear process that does not inevitably lead to frailty. It might be reversed or attenuated by targeted interventions. Brief, feasible and validated tools are recommended for opportunistic screening or case-finding followed by confirmation with multi-dimensional assessment. Conclusion It is difficult to establish consensus on one compact definition of pre-frailty, which is a multi-dimensional concept not only associated with physical impairment, but also with cognitive, nutritional, socioeconomic and other aspects of frailty. However, it may be too early to agree on an operational definition of pre-frailty since none yet exists for frailty. [ABSTRACT FROM AUTHOR]

Background: Health and social care interventions show promise as a way of managing the progression of frailty in older adults. Information technology could improve the availability of interventions and services for older adults. The views of stakeholders on the acceptability of technological solutions for frailty screening and management have not been explored.Methods: Focus groups were used to gather data from healthy and frail/pre-frail older adults, health and social care providers, and caregivers in three European countries - Italy, Poland and UK. Data were analysed using framework analysis in terms of facilitators or determinants of older adults' adoption of technology.Results: Our findings clustered around the perceived value; usability, affordability and accessibility; and emotional benefits of frailty screening and management technology to stakeholders. We also noted issues relating to social support, previous experience of technology and confidence of stakeholders.Conclusions: Professionals and caregivers understand the benefits of technology to facilitate frailty care pathways but these views are tempered by concerns around social isolation. Frail older adults raised legitimate concerns about the accessibility and usability of technology, specifically around the potential for their personal information to be compromised. Solutions must be developed within a framework that addresses social contexts and avoids stigma around frailty and ageing. [ABSTRACT FROM AUTHOR]

Interventions to minimise, reverse or prevent the progression of frailty in older adults represent a potentially viable route to improving quality of life and care needs in older adults. Intervention methods used across European Innovation Partnership on Active and Healthy Ageing collaborators were analysed, along with findings from literature reviews to determine ‘what works for whom in what circumstances’. A realist review of FOCUS study literature reviews, ‘real-world’ studies and grey literature was conducted according to RAMESES (Realist and Meta-narrative Evidence Synthesis: Evolving Standards), and used to populate a framework analysis of theories of why frailty interventions worked, and theories of why frailty interventions did not work. Factors were distilled into mechanisms deriving from theories of causes of frailty, management of frailty and those based on the intervention process. We found that studies based on resolution of a deficiency in an older adult were only successful when there was indeed a deficiency. Client-centred interventions worked well when they had a theoretical grounding in health psychology and offered choice over intervention elements. Healthcare organisational interventions were found to have an impact on success when they were sufficiently different from usual care. Compelling evidence for the reduction of frailty came from physical exercise, or multicomponent (exercise, cognitive, nutrition, social) interventions in group settings. The group context appears to improve participants’ commitment and adherence to the programme. Suggested mechanisms included commitment to co-participants, enjoyment and social interaction. In conclusion, initial frailty levels, presence or absence of specific deficits, and full person and organisational contexts should be included as components of intervention design. Strategies to enhance social and psychological aspects should be included even in physically focused interventions. [ABSTRACT FROM AUTHOR]

Older adults have difficulty recalling specific autobiographical events. This over-general memory style is a vulnerability factor for depression. Two groups receiving interventions that have previously been successful at reducing over-general memory in depressed populations were compared to a control group. Participants were healthy older adults aged ≥70 years: memory specificity training (MEST; n = 22), life review (n = 22), and control group (n = 22). There were significant improvements in autobiographical memory specificity in the MEST and life review groups at post-training, relative to the control group, suggesting that over-general memory can be reduced in older adults. Change in social problem solving ability and functional limitations were related to change in autobiographical memory specificity, supporting the suggested role of specific retrieval in generating solutions to social problems and maintaining independence. Qualitative analysis of participants' feedback revealed that life review may be more appropriate for older adults, possibly because it involves integrating specific memories into a positive narrative. [ABSTRACT FROM AUTHOR]

Over the last several decades, the growing number of patients with geriatric problems has become a serious challenge for primary care physicians. Frailty is an often encountered condition in older age. This is a state of increased vulnerability and loss of total physiological reserves, needed to maintain physiological and psychosocial homeostasis. Definition of physical frailty is based on the following criteria: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity, where 3 out of 5 these criteria confirms frailty. It is a dynamic, transitional process which constantly progresses, although it is potentially reversible. Frailty often co-exists with other severe diseases, affecting general well-being of the patient. Therefore, it is important for the family doctor to understand diagnosis and treatment to protect from an invasive procedure or potentially harmful medication, and prevent decline of functional independence. The aim of this review is to present current available treatment options and their effectiveness for frailty. Data from many observational studies were collected. The most beneficial seems to be combined multidisciplinary treatment including physical exercises, nutritional supplementation and cognitive training. Additionally, the further positive results of physical activity training on mobility, balance, coordination, muscle strength and reducing falls in frail elderly were also confirmed by many scientific reports. Pharmacological, nutritional, psychological and other interventions solely can also be helpful but the evidence is low. Preventive actions at many stages in the process leading to frailty can be applied. [ABSTRACT FROM AUTHOR]

Extra-care housing has been an important and growing element of housing and care for older people in the United Kingdom since the 1990s. Previous studies have examined specific features and programmes within extra-care locations, but few have studied how residents negotiate social life and identity. Those that have, have noted that while extra care brings many health-related and social benefits, extra-care communities can also be difficult affective terrain. Given that many residents are now ‘ageing in place’ in extra care, it is timely to revisit these questions of identity and affect. Here we draw on the qualitative element of a three-year, mixed-method study of 14 extra-care villages and schemes run by the ExtraCare Charitable Trust. We follow Alemàn in regarding residents' ambivalent accounts of life in ExtraCare as important windows on the way in which liminal residents negotiate the dialectics of dependence and independence. However, we suggest that the dialectic of interest here is that of the third and fourth age, as described by Gilleard and Higgs. We set that dialectic within a post-structuralist/Lacanian framework in order to examine the different modes of enjoyment that liminal residents procure in ExtraCare's third age public spaces and ideals, and suggest that their complaints can be read in three ways: as statements about altered material conditions; as inter-subjective bolstering of group identity; and as fantasmatic support for liminal identities. Finally, we examine the implications that this latter psycho-social reading of residents' complaints has for enhancing and supporting residents' wellbeing. [ABSTRACT FROM PUBLISHER]

Frailty is a common condition in older age and is a public health concern which requires integrated care and involves different stakeholders. This meta-synthesis focuses on experiences, understanding, and attitudes towards screening, care, intervention and prevention for frailty across frail and healthy older persons, caregivers, health and social care practitioners. Studies published since 2001 were identified through search of electronic databases; 81 eligible papers were identified and read in full, and 45 papers were finally included and synthesized. The synthesis was conducted with a meta-ethnographic approach. We identified four key themes: Uncertainty about malleability of frailty; Strategies to prevent or to respond to frailty; Capacity to care and person and family-centred service provision; Power and choice. A bottom-up approach which emphasises and works in synchrony with frail older people's and their families' values, goals, resources and optimisation strategies is necessary. A greater employment of psychological skills, enhancing communication abilities and tools to overcome disempowering attitudes should inform care organisation, resulting in more efficient and satisfactory use of services. Public health communication about prevention and management of frailty should be founded on a paradigm of resilience, balanced acceptance, and coping. Addressing stakeholders’ views about the preventability of frailty was seen as a salient need. [ABSTRACT FROM AUTHOR]

• Given the growing importance of the early identification of frailty to prevent subsequent functional decline and disability at both individual and population-level, we have conducted an international delphi study to identify defining characteristics of pre-frailty. • The final consensus statement produced by this international collaboration of experts in the field describes pre-frailty as an aged-associated, multi-factorial, multi-dimensional, and non-linear prodromal risk-state associated with one or more of physical impairment, cognitive decline, nutritional deficiencies, and socioeconomic inequalities, predisposing to the development of frailty. • Further study is required to fully operationalise this definition of pre-frailty for use in clinical practice including the development of improved screening and assessment tools. : Frailty is associated with a prodromal stage called pre-frailty, a potentially reversible and highly prevalent intermediate state before frailty becomes established. Despite being widely-used in the literature and increasingly in clinical practice, it is poorly understood. : To establish consensus on the construct and approaches to diagnose and manage pre-frailty. : We conducted a modified (electronic, two-round) Delphi consensus study. The questionnaire included statements concerning the concept, aspects and causes, types, mechanism, assessment, consequences, prevention and management of pre-frailty. Qualitative and quantitative analysis methods were employed. An agreement level of 70% was applied. : Twenty-three experts with different backgrounds from 12 countries participated. In total, 70 statements were circulated in Round 1. Of these, 52.8% were accepted. Following comments, 51 statements were re-circulated in Round 2 and 92.1% were accepted. It was agreed that physical and non-physical factors including psychological and social capacity are involved in the development of pre-frailty, potentially adversely affecting health and health-related quality of life. Experts considered pre-frailty to be an age-associated multi-factorial, multi-dimensional, and non-linear process that does not inevitably lead to frailty. It can be reversed or attenuated by targeted interventions. Brief, feasible, and validated tools and multidimensional assessment are recommended to identify pre-frailty. : Consensus suggests that pre-frailty lies along the frailty continuum. It is a multidimensional risk-state associated with one or more of physical impairment, cognitive decline, nutritional deficiencies and socioeconomic disadvantages, predisposing to the development of frailty. More research is needed to agree an operational definition and optimal management strategies. [ABSTRACT FROM AUTHOR]

Background Although socio-economic and demographic disadvantage plays a huge part in poor outcomes for Aboriginal women and their babies, culturally inappropriate health services can also have adverse outcomes. When Aboriginal women can access services that meet their needs, they are likely to attend more frequently and thus have the opportunity for any complications to be addressed. Research Required Ngaanyatjarra women have expressed discontent at their lack of meaningful input to current maternity services. This study provided an opportunity for them to have their concerns documented and solutions developed. Methodology We used a participatory research methodology of group meetings and individual interviews followed by thematic analysis of content. The study population was Ngaanyatjarra women in a remote desert community in central Australia. Findings Older Ngaanyatjarra women hold traditional knowledge and skill of pregnancy and birth. Middle-aged and younger women lack traditional knowledge. Women of all age groups revealed a lack of knowledge about contemporary birth practices. All participants wanted to improve their knowledge related to pregnancy and birth. They recommended a 'two ways' approach to antenatal education. The Western maternity services model was acknowledged for its advantages, but women wanted to have more input into this model and they believed that traditional knowledge and practices could be incorporated without compromising the health and wellbeing of young women during pregnancy and birth. Conclusion Aboriginal women need to have opportunities for true participation in the development of local maternity services. A 'two ways' approach to antenatal education enables both traditional and contemporary knowledge to benefit all Aboriginal women while improving the acceptability of modern maternity services. [ABSTRACT FROM AUTHOR]

Cognitive frailty (CF) is the conjunction of cognitive impairment without dementia and physical frailty. While predictors of each element are well-researched, mechanisms of their co-occurrence have not been integrated, particularly in terms of relationships between social, psychological, and biological factors. This interdisciplinary scoping review set out to categorise a heterogenous multidisciplinary literature to identify potential pathways and mechanisms of CF, and research gaps. Studies were included if they used the definition of CF OR focused on conjunction of cognitive impairment and frailty (by any measure), AND excluded studies on specific disease populations, interventions, epidemiology or prediction of mortality. Searches used Web of Science, PubMed and Science Direct. Search terms included "cognitive frailty" OR (("cognitive decline" OR "cognitive impairment") AND (frail*)), with terms to elicit mechanisms, predictors, causes, pathways and risk factors. To ensure inclusion of animal and cell models, keywords such as "behavioural" or "cognitive decline" or "senescence", were added. 206 papers were included. Descriptive analysis provided high-level categorisation of determinants from social and environmental through psychological to biological. Patterns distinguishing CF from Alzheimer's disease were identified and social and psychological moderators and mediators of underlying biological and physiological changes and of trajectories of CF development were suggested as foci for further research., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Carol Holland reports financial support was provided by UKRI BBSRC & MRC BB/W018322/1, which support was relevant for all authors. Carol Holland reports a relationship with Brocher Foundation that includes: travel reimbursement. Carol Holland reports a relationship with CONGRESO INTERNACIONAL DE PSICOLOGIA Y EDUCACIÓN, Spain that includes: speaking and lecture fees and. travel reimbursement. Alexandre Benedetto reports further financial support from the UKRI BBSRC BB/S017127/1. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background and Aims: Music-based interventions have been found to benefit people living with dementia and have positive impacts on cognition and well-being. Most people with dementia live in the community and compared to people with dementia in residential care often have less access to music-based interventions. There are many forms of music interventions and singing has shown particular promise; in the realm of music interventions. It is important to determine what aspects of music interventions yield the most benefits for people with dementia. This review aimed to synthesise evidence on the impacts of singing interventions on quality of life, mood and neuropsychiatric symptoms for community-dwelling people with dementia. Methods: We systematically searched three electronic databases (PsycINFO, MEDLINE and Web of Science) for studies reporting on singing interventions with community-dwelling people with dementia. Studies were eligible for inclusion if they reported on a singing intervention with people living with dementia that included an outcome measure of quality of life, mood or agitation. Fourteen publications were identified and included in this review, with a total of n = 361 people with dementia. Results: Despite some inconsistencies across the literature, evidence suggests that singing interventions led to an improvement in mood and a reduction in agitation levels in people living with dementia. There was no strong evidence to suggest that singing interventions led to significant improvements in quality of life. Conclusions: This review highlights the potential of singing interventions as an effective psychosocial intervention for community-dwelling people with dementia. For key developments in this area, we urge that future studies include a control group where possible which will allow for more robust examinations of singing interventions and allow intervention effects to be distinguished from general deterioration in dementia symptoms over time., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To investigate: (i) whether mood states associated with bipolar disorder are associated with poorer quality of life in older adults, and (ii) what are some of the predictors of quality of life in older adults with mood states associated with bipolar disorder., Methods: The authors completed a cross-sectional multilevel analysis of panel data from seven waves of The English Longitudinal Study of Ageing dataset. The main analysis included 567 participants who reported experiencing mood states associated with bipolar disorder. Some participants reported this in more than one wave, resulting in 835 observations of mood states associated with bipolar disorder across the seven waves. Quality of life was assessed using the Control, Autonomy, Self-realization, and Pleasure-19 (CASP-19) measure., Results: The presence of mood states associated with bipolar disorder was significantly associated with poorer quality of life, even after controlling for multiple covariates (age, sex, social isolation, loneliness, alcohol use, education level, and economic status). Loneliness significantly predicted poorer quality of life in older adults with mood states associated with bipolar disorder. In contrast, higher educational attainment and being female predicted better quality of life in this group., Conclusions: Older adults with mood states associated with bipolar disorder have potentially worse quality of life compared to the general population, which may be partly driven by loneliness. This has ramifications for the support offered to this population and suggests that treatments should focus on reducing loneliness to improve outcomes., (© 2024 The Author(s). British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Cognitive frailty (CF) is defined as the clinical syndrome of the combination of physical frailty and cognitive impairment, without dementia. Numerous risk factors for CF have been previously identified but this scoping review focusses on the critical need for social engagement and the association with cognition. The focus of this scoping review on the opportunity for social engagement rather than on perception or experience of loneliness. Based on the results of 55 studies were synthesised into four social engagement categories, namely participation, household, network, and habitat. Social engagement is associated with maintaining or improving cognition, particularly through active participation in social roles. Habitat (i.e., rural or urban settings) also influences cognition and the challenge is to enable social participation., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Fowler Davis, Benkowitz, Holland, Gow and Clarke.)

Background: Telecare is claimed to support people to live in their own homes for longer by providing monitoring services that enable responses to emergencies at home. Although most telecare technologies commissioned in the United Kingdom predominantly supply reactive services, there has been recent interest among policy makers to develop proactive telecare services to provide additional understanding of older adults' health and well-being needs to provide a means for more preventive interventions. Proactive telecare refers to providing regular well-being calls or encouraging users to regularly confirm their well-being to anticipate and prevent crises through an increased understanding of individuals' needs and by building social relationships with older adults. Such technologies have already begun to be introduced, yet little research has explored the potential value of proactive telecare., Objective: This study explores the perceptions of different interest groups to understand the extent to which using a proactive telecare service can support older adults to live independently, what potential health and well-being benefits may be elicited from its use, and what the limitations are., Methods: Semistructured interviews were conducted with older people (those with experience in using proactive telecare and those without), family members of proactive telecare users, and proactive telecare staff regarding their perceptions and opinions about the value of a proactive telecare service. Data were analyzed using inductive thematic analysis., Results: A total of 30 individuals participated in this study. Older adults described the value of proactive telecare in feeling safe and in control and appreciated feeling connected. Family members and staff valued the potential to detect early health deterioration in older adults, and all participants highlighted the benefit of strengthening access to social networks, particularly for socially isolated older people. However, telecare is often viewed as a last resort, and therefore, anticipatory care may not suit all populations, as demonstrated by the mixed acceptance of the technology among older adults who did not have experience using it. Participants also reported limitations, including the requirement for family, friends, or neighbors to assist older adults during an emergency and the need for financial resources to fund the service., Conclusions: This study presents the first known qualitative inquiry about a proactive telecare system, which provides rich and detailed insights from different perspectives into the potential benefits of this intervention. Proactive telecare may promote and facilitate the accumulation of social and technological resources as individuals prepare to cope with age-related challenges, thus helping to avoid negative outcomes prematurely. However, similar to reactive telecare, proactive telecare must be matched to individual preferences and existing financial and social resources., (©Lauren Fothergill, Carol Holland, Yvonne Latham, Niall Hayes. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 14.12.2023.)

Background: During the COVID-19 pandemic, government-mandated social distancing prevented the spread of the disease but potentially exacerbated social isolation and loneliness for older people, especially those already vulnerable to isolation. Older adults may have been able to draw from their personal resources such as psychological resilience (PR) and technology use (TU) to combat such effects. Educational attainment (EA) or early-life EA may potentially shape later-life personal resources and their impact on the effects of the pandemic lockdown on outcomes such as loneliness. The developmental adaptation model allows for the supposition that social isolation, TU, and PR may be affected by early EA in older adults., Objective: This study examined the indirect impact of EA on pandemic-linked loneliness in a sample of older adults. The developmental adaptation model was used as the conceptual framework to view EA as a distal influence on loneliness, social isolation, PR, and TU. We hypothesized that EA would predict TU and PR and have a moderating impact on social isolation and loneliness. We also hypothesized that PR and TU would mediate the effect of EA on loneliness., Methods: This was a cross-sectional observational study, in which data were gathered from 92 older adults aged ≥65 years in the United Kingdom from March 2020 to June 2021, when the country was under various pandemic-linked social mobility restrictions. The data captured demographic information including age, gender, ethnicity, and the highest degree of education achieved. The University of California Los Angeles Loneliness Scale, Connor-Davidson Resilience Scale, Lubben Social Network Index, and Technology Experience Questionnaire were used as standardized measures. Pearson correlation, moderation, and mediation regression analyses were conducted to investigate the hypotheses., Results: We found a higher prevalence of loneliness in older adults than in prepandemic norms. EA was correlated with greater TU and PR and moderated the impact of social isolation on loneliness. PR mediated and TU partially mediated the relationship between EA and loneliness., Conclusions: Early-life EA was confirmed as a distal resource for older adults and played an indirect role in affecting loneliness levels during the pandemic. It has an impact on present-day personal resources, such as PR and TU, which affect loneliness and also moderate the impact of social isolation on loneliness. Policymakers should be aware that older adults with low levels of EA may be more vulnerable to the harmful impacts of loneliness when isolated by choice., (©Eric Balki, Niall Hayes, Carol Holland. Originally published in JMIR Aging (https://aging.jmir.org), 24.11.2023.)

Introduction: Psychosocial interventions have been shown to improve mood, relieve stress and improve quality of life for people living with dementia (PwD). To date, most evaluations of singing interventions have focused on the benefits for PwD and not their carers. This research aims to evaluate the benefits of dementia singing groups for both PwD and their carers., Methods and Analysis: This 2-year project will observe the impact of two different singing intervention services, one combining singing alongside dance and another that includes a sociable lunch. This project will aim to recruit a total of n=150 PwD and n=150 carers across the two singing interventions. Using a mixed-methods approach, the influence of both services will be analysed via the following outcome measures: quality of life, neuropsychiatric symptoms, social isolation, loneliness, cognition, carer burden and depressive symptoms in PwD and their carers using a prestudy/poststudy design. Regression models will be used to analyse the data with time (pre/post) as the exposure variable. Semistructured interviews will be conducted with a subset of people (n=40) to further investigate the impact of singing services with a specific focus on the acceptability of the interventions, barriers to access and prolonged engagement and potential for remote delivery. Interview data will be analysed using Braun and Clarke's reflexive thematic analysis, and public advisers will assist with coding the transcripts. A social return on investment analysis will be conducted to determine the social impact of the services., Ethics and Dissemination: This project has received ethical approval from the University of Liverpool's Ethics Committee (App ref: 12374) and Lancaster University's Ethics Committee (App ref: 3442). All participants will provide informed consent to participate. Results will be presented at national and international conferences, published in scientific journals and publicly disseminated to key stakeholders., Competing Interests: Competing interests: Carol Holland, Jeanette Main and Steve Pendrill are trustees of the Lyrics and Lunch charity. All other authors declare no conflict of interest., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background: Older adults are at higher risk for health issues, including mental health problems. This was especially apparent during the COVID-19 pandemic, where older adults were simultaneously more vulnerable to the disease and the mental health concerns created by social distancing. Subsequently, the use of digital communication technology (DCT) became a critical option for maintaining social connectedness in older adults. Prior to the pandemic, the low uptake and use of technology by older adults was an established problem, known as the digital divide. However, not much is known about how this may have changed as a result of the pandemic., Objective: This study aims to explore how older adults maintained social connectedness through DCT during the pandemic and to understand factors influencing the use and acceptance of DCT., Methods: A mixed methods explorative field study was set up, involving surveys and interviews of 25 community-dwelling older adults (65-88 years old) living in the United Kingdom. The surveys included the internet acceptance questionnaire (based on the Technology Acceptance Model [TAM]); COVID-19 dysfunctional anxiety was captured using the COVID-19 Anxiety Scale (CAS). Background information (demographics, use of technology) was gathered before conducting semistructured interviews. We hypothesized that CAS would affect constructs of TAM and that predictive constructs of TAM would have remained valid during the pandemic. We also posited that there would be unidentified themes outside TAM that impacted the acceptance and use of DCT. We used the quantitative data to guide the semistructured interviews, which were then analyzed through thematic analysis to identify additional themes., Results: Correlational analysis showed that CAS influences all constructs of TAM. We also saw that the predictive constructs of TAM, especially the perceived ease of use (PEU) and perceived usefulness (PU), remained valid during the pandemic. Common acceptance-influencing themes were encountered in both quantitative and qualitative analyses, with 3 matching the known constructs of TAM (PU, PEU, and behavioral intention). We identified 2 additional themes affecting acceptance, namely influence of the pandemic (situational context) and privacy and security concerns. DCT use (especially email and videoconferencing use) increased during the pandemic, but the results related to social networking sites were mixed., Conclusions: The COVID-19 pandemic impacted technology acceptance and use by older adults, encouraging their use of certain DCT apps (email and videoconferencing apps, such as WhatsApp). These apps helped insulate them from adverse effects (social isolation and loneliness). Other social networking apps, however, exerted a negative influence, increasing anxiety and a general feeling of negativity. Future studies should maximize older adult agency related to design, privacy, security, and user requirements for development. We also recommend that when studying DCT acceptance for older adults, our additional identified themes should be considered alongside the existing TAM constructs., (©Eric Balki, Carol Holland, Niall Hayes. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 02.08.2023.)

Introduction: This study investigated how psychological resilience influenced greater technology use among older adults, and whether they moderated the impact of social isolation on loneliness during the COVID-19 pandemic. We also explored whether technology mediates the impact of psychological resilience on loneliness. To explain the relationship between variables, the research drew upon the socio-emotional selective theory, which posits the notion that older adults are more focused on current and emotionally important relationships and goals concerning emotional regulation goals such as psychological well-being. Methods: Using a cross-sectional observational design, data were collected from 92 residents aged 65 to 89 in England from March 2020 to June 2021. Participants completed the Connor-Davidson Resilience Scale, Technology Experience Questionnaire, UCLA Loneliness Scale, and Lubben Social Network Index. Pearson correlation, mediation and moderation analyses were conducted to investigate the hypotheses. Results: Most participants experienced moderate to severe levels of loneliness, displaying higher levels than pre-pandemic. Psychological resilience predicted greater technology use, and lower levels of loneliness. Technology was found to mediate the relationship between psychological resilience and loneliness. Neither technology use, nor psychological resilience was found to moderate the impact of social isolation on loneliness. Discussion: Findings suggested that strategies directed towards screening older adults for psychological resilience levels and low technology experience may help identify those most at risk for adapting poorly when exposed to stressors in situations like the Covid-19 pandemic. Early interventions can be initiated to increase psychological resilience and technology use, including empirical interventions, that may help decrease loneliness, especially in times of elevated risks for loneliness., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Balki, Hayes and Holland.)

As people age, losses accumulate (ie, the death of family and friends, the loss of agility, and the loss of independence). Such losses have an impact on one's Sense of Coherence, that is, one's ability to see the world as comprehensible, manageable, and meaningful. Antonovsky deemed Sense of Coherence as a mostly stable state by the age of 30 years. Until now, there has not been an investigation into how serial loss of resources affects older people as they near the end of life. Sense of Coherence was used as the theoretical framework for this study to answer the question of how older people maintain or regain a Sense of Coherence in the presence of serious illness as they near death. Data were gathered using semistructured interviews and guided by interpretive description. This investigation found new concepts that contribute to Antonovsky's midlevel theory of salutogenesis and the construct of Sense of Coherence. Those are Incomprehensibility and Serial Loss of General Resistance Resources. The results indicate that the crux of a strong Sense of Coherence for this population is excellent communication and a coherent "big-picture" conversation., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 by The Hospice and Palliative Nurses Association. All rights reserved.)

Objective: To ascertain the prevalence and predictors of physical health comorbidities in older adults with bipolar disorder., Methods: The authors conducted a systematic review and narrative synthesis of peer-reviewed journal articles reporting on physical health comorbidities in older adults (aged ≥50) with a diagnosis of bipolar disorder. The Mixed Methods Appraisal Tool (MMAT) assessed study quality., Results: 23 papers reporting on 19 studies met the inclusion criteria. The literature on diabetes, obesity and renal disease was inconclusive. There was some tentative evidence to higher rates of cardiovascular disease and some forms of cancer in older adults with bipolar disorder in comparison to the general population, but this requires further investigation. We identified no studies looking at oral health., Limitations: The quality ratings of the identified research were generally low. Very few studies included a comparison sample from the general population or controlled for key covariates in their analysis., Conclusion: Existing literature provides tentative evidence that some physical health comorbidities are elevated in older adults with bipolar disorder. Clinicians should consider interventions that improve the physical health of this group, alongside the chronic mental health difficulties they experience., Competing Interests: Conflict of interest None., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: The purpose of this study was to explore the experiences of individuals with Parkinson's through the theoretical lens of illness uncertainty during the first UK full lockdown period (March-June 2020) put in place due outbreak of the COVID-19 pandemic., Methods: Individual semi-structured interviews were carried out via telephone in May 2020 with 10 individuals with Parkinson's (six men and four women) recruited from Parkinson's UK. Interviews were recorded and transcribed verbatim, and thematic analysis was adopted to analyse the resulting data., Results: Four overarching themes emerged from the interview data: (1) COVID-19 amplifying existing fears and difficulties around the uncertainty of Parkinson's; (2) practical and psychological efforts to manage uncertainty; (3) benefit-finding as a way of acknowledging the positives of lockdown; (4) risk and future management in the context of uncertainty., Discussion: Participants reported a range of implicit and explicit strategies to cope with the 'double whammy' of uncertainty caused by having Parkinson's during a global pandemic. While these were generally successful in maintaining well-being, it is important that such successful accounts are used to help inform novel strategies and interventions targeting individuals who might need additional support.

Atrial fibrillation (AF) and diabetes are increasingly prevalent worldwide, both increasing stroke risk. AF can be detected by patient-led electrocardiogram (ECG) screening applications. Understanding patients' views around AF screening is important when considering recommendations, and this study explores these views where there is an existing diagnosis of diabetes. Nine semi-structured qualitative interviews were conducted with participants from a previous screening study (using a mobile ECG device), who were identified with AF. Thematic analysis was completed using NVivo 12 Plus software and themes were identified within each research question for clarity. Themes were identified in four groups: 1. patients' understanding of AF - the 'concept of irregularity' and 'consideration of consequence'; 2. views on screening - 'screening as a resource-intensive initiative', 'fear of outcomes from screening' and 'expectations of screening reliability'; 3. views on incorporating screening into routine care - 'importance of screening convenience'; and 4. views on the screening tool - 'technology as a barrier' and 'feasibility of the mobile ECG recording device for screening'. In conclusion, eliciting patients' views has demonstrated the need for clear and concise information around the delivery of an AF diagnosis. Screening initiatives should factor in location, convenience, personnel, and cost, all of which were important for promoting screening inclusion., Competing Interests: Conflicts of interest None declared., (Copyright © 2022 Medinews (Cardiology) Limited.)

Background: The global population of older adults (aged >60 years) is expected to triple to 2 billion by 2050. Proportionate rises in older adults affected by loneliness and social isolation (or social connectedness) are expected. Rapid deployability and social changes have increased the availability of technological devices, creating new opportunities for older adults., Objective: This study aimed to identify, synthesize, and critically appraise the effectiveness of technology interventions improving social connectedness in older adults by assessing the quality of reviews, common observations, and derivable themes., Methods: Following the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), 4 databases (PsycINFO, PubMed, Embase, and MEDLINE) were searched between February 2020 and March 2022. We identified reviews with adults aged ≥50 years in community and residential settings, reporting outcomes related to the impact of technologies on social disconnectedness with inclusion criteria based on the population, intervention, context, outcomes, and study schema-review-type articles (systematic, meta-analyses, integrative, and scoping)-and with digital interventions included. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to measure the strength of outcome recommendations including the risk of bias. The reviews covered 326 primary studies with 79,538 participants. Findings were extracted, synthesized, and organized according to emerging themes., Results: Overall, 972 publications met the initial search criteria, and 24 met our inclusion criteria. Revised Assessment of Multiple Systematic Reviews was used to assess the quality of the analysis. Eligible reviews (3/24, 12%) were excluded because of their low Revised Assessment of Multiple Systematic Reviews scores (<22). The included reviews were dedicated to information and communications technology (ICT; 11/24, 46%), videoconferencing (4/24, 17%), computer or internet training (3/24, 12%), telecare (2/24, 8%), social networking sites (2/24, 8%), and robotics (2/27, 8%). Although technology was found to improve social connectedness, its effectiveness depended on study design and is improved by shorter durations, longer training times, and the facilitation of existing relationships. ICT and videoconferencing showed the best results, followed by computer training. Social networking sites achieved mixed results. Robotics and augmented reality showed promising results but lacked sufficient data for informed conclusions. The overall quality of the studies based on GRADE was medium low to very low., Conclusions: Technology interventions can improve social connectedness in older adults. The specific effectiveness rates favor ICT and videoconferencing, but with limited evidence, as indicated by low GRADE ratings. Future intervention and study design guidelines should carefully assess the methodological quality of studies and the overall certainty of specific outcome measures. The lack of randomized controlled trials in underlying primary studies (<28%) and suboptimal methodologies limited our findings. Robotics and augmented or virtual reality warrant further research. Low GRADE scores highlight the need for high-quality research in these areas., Trial Registration: PROSPERO CRD42022363475; https://tinyurl.com/mdd6zds., (©Eric Balki, Niall Hayes, Carol Holland. Originally published in JMIR Aging (https://aging.jmir.org), 24.10.2022.)

Prevalence of atrial fibrillation (AF) and diabetes is increasing worldwide. Diabetes is a risk factor for AF and both increase stroke risk. Previous AF screening studies have recruited highrisk patient groups, but not with diabetes as the target group. This study aims to determine whether people with diabetes have a higher prevalence of AF than the general population and investigate whether determinants, such as diabetes duration or diabetes control, add to AF risk. In a cross-sectional screening study, patients with diabetes were recruited via their GP surgeries or a diabetes centre. A 30-second single-lead electrocardiogram (ECG) was recorded using the Kardia ® device, along with physiological measurements and details relating to risk factor variables. There were 300 participants recruited and 16 patients identified with AF (5.3% prevalence). This demonstrated a significantly greater likelihood of AF than the background population (p=0.043). People with diabetes and AF were significantly older than those who only had diabetes. More people with type 2 diabetes had AF than people with type 1. Prediction of AF diagnosis by age, sex, diabetes type, diabetes duration and level of control revealed only age as a significant predictor. In conclusion, these findings add to existing data around the association of these chronic conditions, supporting AF screening in this high-risk group, particularly in those of older age. This can contribute to appropriate management of both conditions in combination, not least with regards to stroke prevention., Competing Interests: Conflicts of interest None declared., (Copyright © 2022 Medinews (Cardiology) Limited.)

Quality of life (QoL) is an essential consideration when managing the wellbeing of patients and assists in interpretation of symptoms, functional status and perceptions. Atrial fibrillation (AF) and diabetes demand significant healthcare resources. Existing data demonstrate a negative impact on QoL as individual conditions, but there is less evidence relating to the impact of these disease groups in combination. This study therefore explores QoL in patients with AF and diabetes. This cross-sectional, observational study required participants to complete the short form (SF)-36 survey via an online platform and was offered to people affected by AF alone and people with AF and diabetes in combination. The SF-36 provides a prevalidated tool with eight domains relating to physical and psychological health. A total of 306 surveys were completed (231 AF group, 75 AF and diabetes group).The mean and standard deviation (SD)were calculated for each QoL domain,after re-coding in accordance with SF-36 guidance. Multi-variate analysis of variance (MANOVA) demonstrated an overall significant difference between the groups when considered jointly across all domains.There were significant differences between AF and AF with diabetes QoL responses in physical functioning, energy fatigue,emotional wellbeing, social functioning and pain. In these domains, the mean was highest in the AF group. There were no significant differences in the role physical,role emotional and general health domains. In conclusion, this study demonstrates that diabetes and AF has a more detrimental effect on QoL than AF alone, in the majority of domains. Further research into the general AF population and where chronic conditions co-exist is important to comprehend the true impact this disease combination has on QoL., Competing Interests: Conflicts of interest None declared., (Copyright © 2021 Medinews (Cardiology) Limited.)

Introduction: This article describes the views of European rural general practitioners regarding the strengths, weaknesses, opportunities and threats (SWOT) of the implementation of a chronic care model (CCM) in European rural primary care., Methods: This was a mixed-methods online survey. Data were collected from 227 general practitioners between May and December 2017. Categorical data were analysed using descriptive methods while free-text responses were analysed using qualitative methods. The setting was rural primary care in nine European countries (including Central and Eastern Europe). Main outcomes measures were respondents' evaluations of a chronic care model in their rural healthcare settings in terms of SWOT., Results: The SWOT analysis showed that the expertise of healthcare professionals and the strength of relationships and communications between professionals, caregivers and patients are positive components of the CCM system. However, ensuring adequate staffing levels and staff competency are issues that would need to be addressed. Opportunities included the need to enable patients to participate in decision making by ensuring adequate health literacy., Conclusion: The CCM could certainly have benefits for health care in rural settings but staffing levels and staff competency would need to be addressed before implementation of CCM in such settings. Improving health literacy among patients and their carers will be essential to ensure their full participation in the implementation of a successful CCM.

Background: Recent behavioural research has reported age-related changes in the costs of refocusing attention from a temporal (rapid serial visual presentation) to a spatial (visual search) task. Using magnetoencephalography, we have now compared the neural signatures of attention refocusing between three age groups (19-30, 40-49 and 60+ years) and found differences in task-related modulation and cortical localisation of alpha and theta oscillations. Efficient, faster refocusing in the youngest group compared to both middle age and older groups was reflected in parietal theta effects that were significantly reduced in the older groups. Residual parietal theta activity in older individuals was beneficial to attentional refocusing and could reflect preserved attention mechanisms. Slowed refocusing of attention, especially when a target required consolidation, in the older and middle-aged adults was accompanied by a posterior theta deficit and increased recruitment of frontal (middle-aged and older groups) and temporal (older group only) areas, demonstrating a posterior to anterior processing shift. Theta but not alpha modulation correlated with task performance, suggesting that older adults' stronger and more widely distributed alpha power modulation could reflect decreased neural precision or dedifferentiation but requires further investigation. Our results demonstrate that older adults present with different alpha and theta oscillatory signatures during attentional control, reflecting cognitive decline and, potentially, also different cognitive strategies in an attempt to compensate for decline., (© 2021 The Authors. European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Autobiographical memory specificity has been associated with cognitive function, depression, and independence in older adults. This longitudinal study of 162 older adults moving to active supported living environments tracks changes in the role of the ability to recall specific autobiographical memory as a mediator between underlying cognitive function, or depression, and outcome perceived health or independence (e.g., Instrumental Activities of Daily Living, IADLs), across 18 months, as compared with controls not moving home. Clear improvements across time in autobiographical specificity were seen for residents but not controls, supporting the role of a socially active environment, and confirmed by correlation with number of activities reported in diaries, although the impact of diary activities on the effect of time on autobiographical specificity was not found. The role of autobiographical specificity in mediating general cognition and outcome functional limitations was clear for social limitations at 12 and 18 months, but its role in mediating effects of executive function and perceived health persisted throughout. The role of specificity in mediating between depression and perceived health, IADLs, and Functional Limitations persisted throughout. Analysis examining autobiographical specificity and depression as joint mediators between cognition and independence showed a forward effect such that higher specificity scores reduced the negative mediation effect of depression on independence. Finally, data showed the reduction of many of these mediations over time, supporting the role of autobiographical memory in times of change in a person's social situation. Data support potential autobiographical memory intervention development., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Holland, Boukouvalas, Clarkesmith and Cooke.)

Background: Increasing prevalence of atrial fibrillation has a significant impact on health, society, and healthcare resource utilization, due to increased morbidity, mortality, risk of stroke, and reduction in quality of life. Early diagnosis allows for treatment initiation, a reduction in complications and associated costs, and so innovation to improve screening and enable easy access are needed Developments in digital technology have significantly contributed to the availability of screening tools. The single-lead electrocardiogram AliveCor (Mountainview, CA) device offers the opportunity to provide heart rhythm screening and has been used extensively in clinical practice and research studies., Methods: This review investigates the feasibility, validity, and utility of the AliveCor device as a tool for atrial fibrillation detection in clinical practice and in wider research. Databases searched included PUBMED, CINAHL, MEDLINE, and World of Science, plus grey literature search. Search terms related to atrial fibrillation, screening, and AliveCor with adults >18 years. Feasibility metrics were applied including process, resource, management, and scientific outcomes. Studies not written in the English language were excluded. Validity of AliveCor was explored by extracting sensitivity and specificity data from eligible studies and overall effectiveness analyzed by incorporating the above, with wider issues surrounding screening approaches, cost effectiveness and appropriateness of AliveCor as a screening tool., Results: The AliveCor device screening was reviewed in 11 studies matching inclusion criteria. Atrial fibrillation detection rates ranged from 0.8% to 36% and this largely correlated to the study population, where wider age inclusion and mass/population screening represented lower atrial fibrillation detection. Recruitment from higher-risk groups (older age, targeted localities, chronic disease) identified higher numbers with atrial fibrillation. Feasibility metrics demonstrated AliveCor as an effective tool of choice in terms of process, resources, and management. Duration of screening time had an impact on rates of atrial fibrillation detection. There was however significant heterogeneity between studies reviewed., Conclusion: The AliveCor device offers a convenient, valid, and feasible means of monitoring for atrial fibrillation. Further analysis of electrocardiograms produced by AliveCor may be necessary in some circumstances. The AliveCor electrocardiogram device can be successfully implemented into both opportunistic and systematic screening strategies for atrial fibrillation.

Background: according to the World Health Organisation, the role of the environment for older adults is to maintain and facilitate independence and promote quality of life. However, measures that examine the environment in terms of its potential impact on older people are either oriented towards specific aspects of the environment, specifically designed for community-level assessment rather than individually oriented, or are unwieldy for everyday use., Objectives: this article describes the development and validation of the Age-Friendly Environment Assessment Tool (AFEAT), assessing whether individual function and frailty impact on perceptions of environmental age-friendliness. The extent to which such perceptions may have moderate impacts of frailty on outcomes such as need for care support, quality of life and loneliness is examined., Methods: a total of 132 participants aged 58-96 were recruited from retirement villages and local communities in the Midlands of the UK. Participants completed the AFEAT, and a series of measures designed to assess frailty and assessments of quality of life, loneliness and perceptions of functional limitations., Results: internal reliability assessment indicated that the AFEAT possesses a Cronbach's Alpha score of 0.745. The AFEAT significantly predicted quality of life and loneliness, accounting for 17.1% and 5.8% of variance respectively, indicating high concurrent and predictive validity. Furthermore, the AFEAT moderated the predictive strength of frailty in predicting the amount of formal care an individual receives, but not quality of life or loneliness., Discussion: the AFEAT is a valid and reliable tool, and analyses highlight the need for an individual-oriented Age-Friendly environment tool., (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Frailty is a multidimensional clinical state that is common in older age and can be managed through intervention. Strategies to manage frailty have not been previously explored with stakeholders in Poland. This may stem from misperceptions about the nature and malleability of frailty, which has resulted in it being viewed as a lower priority healthcare concern. Objectives: To explore stakeholders' views to determine whether there are effective everyday strategies that they can adopt to reduce, reverse or prevent frailty. Methods: Semi-structured focus groups were conducted with five stakeholder groups (frail/pre-frail and robust older adults, health and social care professionals and family caregivers) in Poland ( n  = 44). Data was analysed using a reflexive thematic analysis approach. Results: Two themes were developed. The first emphasized both the positive everyday and more effortful strategies used by individuals to counter frailty; these included the adoption of healthy lifestyle behaviours, social engagement and shared experiences. Stakeholders perceived that older adults, even frail ones, might benefit from engaging in meaningful activities to build resilience against frailty. The second examined formal interventions delivered by health and social care professionals. Stakeholders noted the need to increase awareness of the malleability of frailty among professionals. Conclusion: Raising awareness of the malleability of frailty amongst health and social care professionals is critical. Further, information provision and personal support should be essential elements of health interventions aimed at older adults and family caregivers. Interventions to support resilience building in older adults should also be framed within a model of fostering self-efficacy.[Box: see text].

Background: The prevalence of frailty at population-level is expected to increase in Europe, changing the focus of Public Health. Here, we report on the activities of the A3 Action Group, focusing on managing frailty and supporting healthy ageing at community level. Methods: A three-phased search strategy was used to select papers published between January 2016 and May 2018. In the third phase, the first manuscript draft was sent to all A3-Action Group members who were invited to suggest additional contributions to be included in the narrative review process. Results: A total of 56 papers were included in this report. The A3 Action Group developed three multidimensional tools predicting short⁻medium term adverse outcomes. Multiple factors were highlighted by the group as useful for healthcare planning: malnutrition, polypharmacy, impairment of physical function and social isolation were targeted to mitigate frailty and its consequences. Studies focused on the management of frailty highlighted that tailored interventions can improve physical performance and reduce adverse outcomes. Conclusions: This review shows the importance of taking a multifaceted approach when addressing frailty at community level. From a Public Health perspective, it is vital to identify factors that contribute to successful health and social care interventions and to the health systems sustainability.

Dispersion is a measure of intra-individual variability reflecting how much performance across distinct cognitive functions varies within an individual. In cognitive aging studies, results are inconsistent: some studies report an increase in dispersion with increasing age and decline in performance, while others report an increasingly homogenous cognitive profile in older adults. We propose that inconsistencies may reflect qualitative differences in the cognitive functioning of the aging brain: age-groups may differ in how efficiently they engage resources, depending on both executive processing and resources available. This in turn would result in either greater or less dispersion. 21 young (mean 25.14 years, SD ± 2.85), 21 middle-old (65.05 ± 4.19), and 20 old-old (80.65 ± 4.38) healthy adults completed a series of neuropsychological tasks engaging executive processing, including switching, planning, updating, working memory and short-term memory. Individual dispersion profiles were obtained using a regression method which computes individual standard deviation across tasks from standardized test scores. Results revealed associations between performance, dispersion and cognitive reserve (measured as education level). Although differences across groups did not approach significance, there was a general pattern consistent with existing literature showing greater dispersion in the old-old group, and this was negatively associated with performance. In contrast, the middle-old group showed young-equivalent dispersion index, while performance was similar to the young group on some tasks and to the old-old group on others, possibly reflecting differences in cognitive demand. Educational level positively correlated with performance in the middle-old group only. Overall, a distinct pattern emerged for the middle-old adults: they showed young-equivalent performance on a number of measures and similar dispersion index, while uniquely benefitting from cognitive reserve. This may possibly reflect engagement in compensatory mechanisms. This study contributes to clarifying inconsistencies in previous studies and calls for more thoughtful selection of sample cohorts in aging research. The study of dispersion may provide a behavioral index of age-related changes in how cognition functions and recruits resources. Future work could examine whether this also reflects age-related changes in neural recruitment and aim at identifying factors contributing to cognitive reserve, in order to prolong good performance and improve cognition in aging.

Objective: This invited paper offers an innovative framework for mixed methods research design. Method: We propose the adoption of the Model of Disciplined Inquiry, a five-component model that focuses on the research question(s) rather than the type(s) of data collected. This pluralist model firmly anchors the research design and paradigm assumptions in the research question(s). Decisions about an appropriate research strategy are made in line with those assumptions. We propose three logics of inquiry to help articulate the processes involved in making sense of findings and their relationship to theory. Results: The Model of Disciplined Inquiry is demonstrated by applying it to the framework to a longitudinal study and describe our decision-making processes at each component stage. The results support the arguement in favour of shifting the focus away from the types of data generated (i.e. qualitative or quantitative) and relatedly a move away from mixed methods research to mixed design research. Conclusion: We conclude the paper with some challenges experienced in the example study and some challenges yet to be resolved., Competing Interests: No potential conflict of interest was reported by the authors. , (© 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Ageing populations represent a challenge to the sustainability of current healthcare systems. The need to balance these demographic changes with gains in healthy life years and quality of life (QoL) constitutes an additional challenge. Aware of this, the European Commission (EC) launched the European Innovation Partnership on Active and Healthy Ageing (EIPonAHA) in 2012. The EIPonAHA is an interdisciplinary and cross-sector initiative involving more than 3000 partners with two specific objectives: to increase the healthy life expectancy of Europeans by two years by 2020, while increasing their QoL. The initiatives of the EIPonAHA have been organized according to six thematic action groups (AGs), with the A3 group targeting areas relating to the prevention of functional decline and frailty. In addition to the good practices of partners, there are several on-going collaborative works. The involvement of the EC includes support through an elaborated research programme in which the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) and the Directorate-General for Communications Networks, Content and Technology (DG CONNECT) are the main funding bodies. Screening approaches and preventive interventions constitute most of the initiatives within the A3 AG. Partners are distributed across five sub-groups according to good practices: i) cognitive decline, ii) food and nutrition, iii) physical activity, iv) caregivers, and v) frailty and functional decline. Regular updates of the progression of both good practices and collaborative works are presented in A3 AG meetings. The 2017 meeting in Valencia, Spain, showcased in this paper, provides an up-to-date overview of the current status of A3 activities., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Fragile X syndrome (FXS) is the most common inherited cause of intellectual disability and is caused by an expansion of cytosine-guanine-guanine (CGG) repeats in the FMR1 gene. Female premutation allele carriers (55-200 CGG repeats) are at risk to have an affected child. Currently, specific population-based carrier screening for FXS is not recommended. Previous studies exploring female premutation carrier frequency have been limited by size or ethnicity. This retrospective study provides a pan-ethnic estimate of the Fragile X premutation carrier frequency in a large, ethnically diverse population of women referred for routine carrier screening during a specified time period at Progenity, Inc. Patient ethnicity was self-reported and categorized as: African American, Ashkenazi Jewish, Asian, Caucasian, Hispanic, Native American, Other/Mixed/Unknown, or Sephardic Jewish. FXS test results were stratified by ethnicity and repeat allele category. Total premutation carrier frequency was calculated and compared against each ethnic group. A total of 134,933 samples were included. The pan-ethnic premutation carrier frequency was 1 in 201. Only the Asian group differed significantly from this frequency. Using the carrier frequency of 1 in 201, a conservative pan-ethnic risk estimate for a male fetus to have FXS can be calculated as 1 in 2,412. This risk is similar to the highest ethnic-based fetal risks for cystic fibrosis and spinal muscular atrophy, for which population-wide screening is currently recommended. This study adds to the literature and supports further evaluation into specific population-wide screening recommendations for FXS., (© 2018 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc.)

Objectives: Expanded carrier testing is acknowledged as an acceptable strategy for carrier testing by the American College of Obstetrics and Gynecology. Limited studies have investigated positivity rates of expanded carrier panels. We describe our experience with 3 commercial laboratory panels varying in size from 3 to 218 disorders., Methods: We reviewed outcomes for 3 multigene carrier screening panels: trio (3 diseases), standard (23 diseases), and global (218 diseases). All panels used targeted genotype analysis of preselected mutations via next-generation sequencing. We calculated positivity rates for each panel., Results: Positivity rates were 7.2% for Preparent Trio, 13.2% for Preparent Standard, and 35.8% for Preparent Global. The most frequent positive results in the global panel were (in descending order): abnormal hemoglobin electrophoresis, familial Mediterranean fever, cystic fibrosis, fragile X, glucose-6-phosphate dehydrogenase deficiency, alpha-thalassemia, and nonsyndromic hearing loss., Conclusions: While genetic diseases are individually rare, they are cumulatively common. Our experience illustrates that, with a panel of 218 diseases, the likelihood of identifying a carrier can be as high as 36%. Understanding panel positivity rates is one important factor for providers when choosing the right test for their practice, setting appropriate expectations for patients, and planning for follow-up counseling., (© 2018 John Wiley & Sons, Ltd.)

[This corrects the article DOI: 10.1371/journal.pone.0180127.].

Objective: To elicit European healthcare policy-makers' views, understanding and attitudes about the implementation of frailty screening and management strategies and responses to stakeholders' views., Design: Thematic analysis of semistructured qualitative interviews., Setting: European healthcare policy departments., Participants: Seven European healthcare policy-makers representing the European Union (n=2), UK (n=2), Italy (n=1), Spain (n=1) and Poland (n=1). Participants were sourced through professional networks and the European Commission Authentication Service website and were required to be in an active healthcare policy or decision-making role., Results: Seven themes were identified. Our findings reveal a 'knowledge gap', around frailty and awareness of the malleability of frailty, which has resulted in restricted ownership of frailty by specialists. Policy-makers emphasised the need to recognise frailty as a clinical syndrome but stressed that it should be managed via an integrated and interdisciplinary response to chronicity and ageing. That is, through social co-production. This would require a culture shift in care with redeployment of existing resources to deliver frailty management and intervention services. Policy-makers proposed barriers to a culture shift, indicating a need to be innovative with solutions to empower older adults to optimise their health and well-being, while still fully engaging in the social environment. The cultural acceptance of an integrated care system theme described the complexities of institutional change management, as well as cultural issues relating to working democratically, while in signposting adult care , the need for a personal navigator to help older adults to access appropriate services was proposed. Policy-makers also believed that screening for frailty could be an effective tool for frailty management., Conclusions: There is potential for frailty to be managed in a more integrated and person-centred manner, overcoming the challenges associated with niche ownership within the healthcare system. There is also a need to raise its profile and develop a common understanding of its malleability among stakeholders, as well as consistency in how and when it is measured., Competing Interests: Competing interests: CH has received research grants from ExtraCare Charitable Trust, and DK received a research grant from the Ministry of Science and Higher Education in Poland., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)