Background: Whether sleep quality and duration-combination assessed from multiple domains are strongly associated with mortality risk in older adults remains unelucidated. We aimed to clarify these ...relationships.Methods: We enrolled 7,668 older (age ≥65) Japanese adults in the Kyoto-Kameoka prospective cohort study who provided valid responses to the Pittsburgh Sleep Quality Index (PSQI) in a mail-in survey. Sleep quality and duration were classified into six groups using previously validated PSQI: short sleep duration (SSD: <360 min/day)/sleep disturbance (SD: ≥5.5 PSQI points), n=701; SSD/non-sleep disturbance (NSD: <5.5 PSQI points), n=100; optimal sleep duration (OSD: 360-480 min/day)/NSD, n=1863; OSD/SD, n=2113; long sleep duration (LSD: >480 min/day)/NSD, n=1972; LSD/SD, n=919. Mortality data were collected from February 15, 2012, to November 30, 2016. We evaluated the relationship between all-cause mortality risk and sleep quality and duration-combination using a multivariable Cox proportional hazards model that included baseline covariates.Results: The median follow-up period was 4.75 years (34,826 person-years), with a total of 616 deaths. After adjusting for confounders, compared with other groups, SSD/SD and LSD/SD had the highest hazard ratio (HR) of mortality SSD/SD: HR, 1.56 (95% confidence interval CI: 1.10-2.19); SSD/NSD: HR, 1.27 (95%CI: 0.47-3.48); OSD/NSD: reference; OSD/SD: HR, 1.20 (95%CI: 0.91-1.59); LSD/NSD: HR, 1.35 (95%CI: 1.03-1.77); LSD/SD: HR, 1.83 (95%CI: 1.37-2.45). However, mortality risk was not associated with the interaction between sleep quality and duration.Conclusions: Older adults with sleep disturbances involving SSD and LSD have a strong positive association with mortality risk, suggesting an additive effect between sleep quality and duration.
Osteoporosis can lead to an increased risk of fragility fractures, which are closely associated with substantial loss of function, morbidity, and mortality, particularly in older adults. While ...walkable neighborhoods are recognized as crucial features contributing to health aging, research exploring its specific association with fragility fractures remains limited, especially in the countries with high rates of aging populations. In this study, we examined the relationship between fracture outcomes and neighborhood built environment using a five-year period of fracture history data from 39,577 older adults (≥75 years old). Multivariate logistic regression models were performed to estimate the odds ratios of fracture outcome for each built environment attribute. Our findings offer new insights into urban planning strategies aimed at mitigating the risk of fragility fractures. Recommended strategies include: 1) prioritizing the creation of livable city with diverse destinations and facilitating easy access to public transportation; 2) the provision of cultural facilities, catering establishments, grocery stores, and drug stores, especially cultural facilities; 3) avoid establishing residences in high slope terrain areas.
•Fractured older adults are more likely to reside in less walkable neighborhoods with steeper slopes.•Higher Walk Score, mix of function, and accessibility of bus service are protective factors for fragility fracture health.•Cultural facilities, catering establishments, grocery, and drug stores are linked to reduced risk of fragility fractures.•Residing in high-slope terrain is a potential risk factor for fragility fracture.
Little is known about the extent to which the age-friendliness of streetscape built environments may influence older adults’ active travel (AT) patterns. Moreover, with the exception of street ...greenery, the non-linear and threshold effects of other characteristics of streetscape built environments have not been examined.
This study used data from the Third Guangzhou Official Household Travel Survey 2017 and Tencent Street View images. Using the Hurdle model and Generalized Additive Mixed Models (GAMMs), we examined the non-linear relationships between streetscape built environments and older adults’ AT patterns (i.e., frequency and duration). The models controlled for neighbourhood-level built environment attributes and individual-level characteristics.
Pavement ratio and street obstacles had negative impacts on older adults' AT duration within a certain range, but outside this range, the negative associations no longer held. Street safety, greenery, and vitality were positively associated with older adults’ AT duration within a certain range. Street design exerted positive effects on the likelihood of AT. Age-friendly streetscape built environment attributes showed stronger relationships with the likelihood of AT among older adults aged 70–79, and larger impacts on AT duration for older adults aged 60–69. Notably, street greenery had positive impacts on both AT frequency and duration among older adults aged 80 and above.
The results showed significant non-linear associations between six streetscape built environment characteristics and older adults’ AT patterns. This study provides implications for building age-friendly streetscape built environments.
•Streetscape attributes may not necessarily affect the odds of AT and the number of AT trips.•Street design was positively associated with the odds of AT.•Street greenery was positively associated with older adults' AT duration.•Pavement ratio, street obstacle, street safety, and street vitality had non-linear relationships with AT duration.•Streetscape attributes held diverse associations with the odds of AT and duration of AT for different age groups.
The hippocampus shrinks in late adulthood, leading to impaired memory and increased risk for dementia. Hippocampal and medial temporal lobe volumes are larger in higher-fit adults, and physical ...activity training increases hippocampal perfusion, but the extent to which aerobic exercise training can modify hippocampal volume in late adulthood remains unknown. Here we show, in a randomized controlled trial with 120 older adults, that aerobic exercise training increases the size of the anterior hippocampus, leading to improvements in spatial memory. Exercise training increased hippocampal volume by 2%, effectively reversing age-related loss in volume by 1 to 2 y. We also demonstrate that increased hippocampal volume is associated with greater serum levels of BDNF, a mediator of neurogenesis in the dentate gyrus. Hippocampal volume declined in the control group, but higher preintervention fitness partially attenuated the decline, suggesting that fitness protects against volume loss. Caudate nucleus and thalamus volumes were unaffected by the intervention. These theoretically important findings indicate that aerobic exercise training is effective at reversing hippocampal volume loss in late adulthood, which is accompanied by improved memory function.
Individuals with mild cognitive impairment (MCI), the preclinical stage of Alzheimer disease (AD), suffer decline in their visual working memory (WM) functions. Using large-scale network analysis of ...electroencephalography (EEG), the current study intended to investigate if there are differences in functional connectivity properties extracted during visual WM coding stages between MCI patients and normal controls (NC). A total of 21 MCI patients and 20 NC performed visual memory tasks of load four, while 32-channel EEG recordings were acquired. The functional connectivity properties were extracted from the acquired EEGs by the directed transform function (DTF) via spectral Granger causal analysis. Brain network analyses revealed distinctive brain network patterns between the two groups during the WM coding stage. Compared with the NC, MCI patients exhibited a reduced visual network connectivity of the frontal-temporal in θ (4-7Hz) band. A likely compensation mechanism was observed in MCI patients, with a strong brain functional connectivity of the frontal-occipital and parietal-occipital in both θ and α (8-13Hz) band. Further analyses of the network core node properties based on the differential brain network showed that, in θ band, there was a significant difference in the out-degree of the frontal lobe and parietal lobe between the two groups, while in α band, such difference was located only in the parietal lobe. The current study found that, in MCI patients, dysconnectivity is found from the prefrontal lobe to bilateral temporal lobes, leading to increased recruitment of functional connectivity in the frontal-occipital and parietal-occipital direction. The dysconnectivity pattern of MCI is more complex and primarily driven by core nodes Pz and Fz. These results significantly expanded previous knowledge of MCI patients' EEG dynamics during WM tasks and provide new insights into the underpinning neural mechanism MCI. It further provided a potential therapeutic target for clinical interventions of the condition.
Background
Older adults are underrepresented in most clinical trials. As the United States observes growth in the number of older adults over time, it will be critical to include them in clinical ...trials to improve the generalizability of results across age groups. Although clinical trial participation requires clinical trial knowledge, no study has assessed clinical trial knowledge among older adults. Using a national survey, this study aims to identify the prevalence and determinants of clinical trial knowledge among older adults.
Methods
We used the 2020 Health Information National Trends Survey for secondary data analysis. We restricted the sample to older adults (aged 65 years and up). Our outcome variable was whether respondents reported having any clinical trial knowledge. We controlled for demographics, social determinants of health, healthcare utilization, and comorbidities through multivariable logistic regression models.
Results
Using a weighted sample of 27,574,958 adults, we estimated that 61.1% of older adults reported having at least some knowledge of clinical trials. After controlling for other factors, those with one to two (OR = 1.80, 95% CI:1.14–2.84) or three to five (OR = 2.93, 95% CI:1.74–4.95) portal visits compared with no portal visits, those with cancer (OR = 1.92, 95% CI:1.22–3.02), and those with depression (OR = 2.27, 95% CI:1.23–4.20) had greater odds of having clinical trial knowledge. Inversely, those with hypertension (OR = 0.62, 95% CI:0.42–0.92) had lower odds of clinical trial knowledge.
Conclusions
Patient portal recruitment may be a supplemental intervention to improve clinical trial knowledge among older adults. Further research on additional interventions for identifying eligible participants is needed to minimize the burden among clinicians amidst other competing demands during clinic visits.
With the advancement of medical care and technology, human life expectancy is increasing, many advanced countries have aging societies, and the elderly have increasing needs for society to address; ...these have become some of the main problems to be solved in modern society (Chang et al., 2021). To solve these problems, long-term care institutions have become one of the solutions. In addition, dementia is the most important social problem among elderly individuals (Tsang et al., 2020). In most Asian countries, the solution to the problem of dementia in the elderly is to establish long-term care institutions, such as villages for elderly individuals and nursing homes. However, there is still the problem of companionship in an aging society. The needs of the elderly lie in companionship. Through family companionship, the elderly can share the joys of daily life with their families.
Abstract
Introduction
The present study represents the first systematic review summarizing existing publications on older sexual and gender minority (LGBT+) people's engagement with physical activity ...(PA) aged 65 and over.
Methods
Relevant articles were systematically searched in four scientific databases (i.e., PsychArticles, PsychInfo, Pubmed, and Web of Science) in March 2023. We included original articles published after 1968 with relevant keywords associated with “PA”, “older adults”, and “LGBT+ identity”. Of the 887 records identified, 53 articles were included in the systematic review.
Results
Studies were critically reviewed according to participants’ subjectivity considered in the publications: (a) sexual minority (LGB+) identities; (b) sexual and gender minority (LGBT+) identities; (c) transgender and gender-diverse identities; (d) gay and bisexual male identities; and (e) lesbian and bisexual female identities. The most frequent research areas, taking together all the five identity categories considered in the present review, were the differences between LGBT+ people and cis-heterosexual people, the discrimination and homophobia/transphobia in sport-related contexts, and the competent interventions and aging well in LGBT+ older adults.
Conclusions
Findings suggest a lack of information regarding PA in older LGBT+ aged 65 and over. Future research should investigate the barriers and enablers of PA in older LGBT+ people.
Policy Implications
It is mandatory to promote regular exercise to reduce health disparities between older LGBT+ individuals and their cis-heterosexual counterparts. The policy and environmental implications of the findings for older LGBT+ people are discussed.
We examined the associations between retinal microvascular density, cognition, and physical fitness in healthy older adults with no reported cognitive decline.
Twenty cognitively normal older adults ...(age: 70.3 ± 4.6 years) were recruited. Both eyes of each subject were imaged using optical coherence tomography angiography. The vessel densities of the retinal vascular network (RVN), superficial vascular plexus (SVP), and deep vascular plexus (DVP) were measured. Cognitive function was assessed using the Mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA), while physical performance was evaluated using the total work during the YMCA cycle ergometer test (TW-YMCA). Spearman correlations (rs) were computed between measures of retinal microvascular density, cognitive function, and physical performance.
The MoCA was significantly correlated to vessel density of SVD (rs = 0.53, P = 0.02) but not RVN (rs = 0.39, P = 0.09) and DVP (rs = 0.02, P = 0.93). MoCA was not correlated with TW-YMCA (rs = 0.05, P = 0.83). Retinal microvascular densities were not related to TW-YMCA (rs = −0.05–0.18, P > 0.05). Additionally, MMSE was not related the retinal vessel densities (rs = −0.10–0.21, P > 0.05) and TW-YMCA (rs = −0.19, P = 0.41).
This is the first study to reveal the association between retinal vessel density and cognition as measured with MoCA in healthy older adults with no reported cognitive decline.
•The densities of retinal vessels were measured in older people.•Cognitive function was also measured.•The vessel density was correlated with the cognitive function measured with MoCA.
Older adults are at high risk of developing chronic wounds due to numerous changes that occur with aging. It is reasonable to consider chronic wounds as a geriatric syndrome—highly prevalent, ...multifactorial, and associated with substantial morbidity and mortality. Due to the morbidity and cost associated with chronic wounds, prevention, early diagnosis, and treatment are important. The most common chronic wounds presenting in older adults are pressure and vascular wounds, including those associated with diabetes. Atypical wounds are also common and should raise the suspicion for skin malignancy. Diagnosis is primarily clinical and assessment should include documentation of wound characteristics, such as location, size and depth, presence of slough, drainage, odor, and infection. The mainstay of treatment is based on the TIME principle: Tissue debridement, Infection control, Moisture balance, and optimal wound Edges. The use of protein supplements has been shown to improve wound healing in subsets of older adults. In addition to wound care and optimizing nutrition, disease‐specific wound therapy forms an integral part of wound management. Pressure reduction for pressure injury, compression therapy for venous wounds, evaluation of arterial circulation with ABI or arterial Doppler and iCC for diabetic ulcers form the mainstays of therapy. Atypical wounds may present as chronic ulcers and should be biopsied. The goals of treatment should be realistic and for some older adults, palliative wound management may be more appropriate.
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