Importance Poor cardiometabolic health is a risk factor associated with cognitive impairment in later life, but it remains unclear whether cardiometabolic trajectories can serve as early markers associated with dementia. Objective To compare cardiometabolic trajectories that precede dementia diagnosis with those among individuals without dementia. Design, Setting, and Participants This case-control study analyzed a sample drawn from community-dwelling participants in the Aspirin in Reducing Events in the Elderly (ASPREE) study. Recruitment through primary care physicians occurred between March 2010 and December 2014, with participants followed up for a maximum of 11 years. Dementia cases were matched on sociodemographic characteristics and time of diagnosis to dementia-free controls. Data analysis was performed between February and June 2024. Exposures Body mass index (BMI), waist circumference, systolic and diastolic blood pressure, glucose levels, high- and low-density lipoprotein (HDL and LDL) and total cholesterol levels, and triglyceride levels were measured repeatedly between 2010 and 2022. Main Outcomes and Measures Dementia ( Diagnostic and Statistical Manual of Mental Disorders [ Fourth Edition ] criteria) was adjudicated by an international expert panel. Results Among 5390 participants (mean [SD] age, 76.9 [4.8] years; 2915 women [54.1%]), there were 2655 individuals (49.3%) with less than 12 years of education. The study included 1078 dementia cases and 4312 controls. Up to a decade before diagnosis, dementia cases compared with controls had lower BMI for all years from −7 years (marginal estimate, 27.52 [95% CI, 27.24 to 27.79] vs 28.00 [95% CI, 27.86 to 28.14]; contrast P = 002) to 0 years (marginal estimate, 26.09 [95% CI, 25.81 to 26.36] vs 27.22 [95% CI, 27.09 to 27.36]; contrast P < .001) and lower waist circumference for all years from −10 years (marginal estimate, 95.45 cm [95% CI, 94.33 to 96.57 cm] vs 97.35 cm [95% CI, 96.79 to 97.92 cm]; contrast P = .003) to 0 years (marginal estimate, 93.90 [95% CI, 93.15 cm to 94.64 cm] vs 96.67 cm [95% CI, 96.30 to 97.05 cm]; contrast P < .001); cases also had a faster decline in BMI (linear change β, −0.13 [95% CI, −0.19 to −0.08]) and waist circumference (linear change β, −0.30 cm [95% CI, −0.51 to −0.08 cm]). Compared with controls, cases generally had higher HDL levels, in particular from 5 years (marginal estimate, 62.57 mg/dL [95% CI, 61.59 to 63.56 mg/dL] vs 60.84 mg/dL [95% CI, 60.35 to 61.34 mg/dL]; contrast P = .002) to 3 years (marginal estimate, 62.78 mg/dL [95% CI, 61.82 to 63.74 mg/dL] vs 61.08 mg/dL [95% CI, 60.60 to 61.56 mg/dL]; contrast P = .002) before dementia but with a decline in levels just before diagnosis (linear change β, −0.47 mg/dL [95% CI, −0.86 to −0.07 mg/dL]). Dementia cases had lower systolic blood pressure and triglyceride levels in the decade before diagnosis and higher LDL and total cholesterol levels, but these were not significantly different from controls. Conclusions and Relevance In this study of older individuals, decline in BMI, waist circumference, and HDL occurred up to a decade before dementia diagnosis. These findings provide insights into cardiometabolic changes preceding dementia and the potential for early monitoring and intervention.
INTRODUCTION:Hearing loss is common in ageing populations, but thorough investigation of factors associated with objective hearing loss in otherwise healthy, community-dwelling older individuals is rare. We examined prevalence of age-related hearing loss (ARHL) in healthy, community-dwelling older adults, and determined whether sociodemographic, lifestyle, or health factors associate with hearing thresholds. Audiometry assessment was investigated with self-reports of hearing loss and hearing handicap. METHODS:Australian participants (n = 1,260) of median age 73 years (IQR 71-76) joined ASPirin in Reducing Events in the Elderly (ASPREE)-Hearing, a sub-study of the ASPREE trial with exclusions including cognitive impairment, cardiovascular disease, independence-limiting physical disability, and uncontrolled hypertension. ASPREE collected demographics, anthropometrics, lifestyle, and health data. Audiometry measured better ear pure-tone average (PTA) across four frequencies (0.5-4 kHz) to establish hearing thresholds, categorised as normal or mild, moderate, and severe hearing loss. Questionnaires collected perceived hearing problems and noise exposure. RESULTS:ARHL prevalence by audiometry was 49.7%, affecting men (59%) more than women (41%). A majority (54.5%) self-reported some hearing problems which mostly aligned with objective assessments; 45.6% self-reported a "little trouble" with hearing, while 35% had objective mild hearing loss; 8.3% reported having a "lot of trouble" hearing, while 13% had moderate hearing loss; and 0.6% reported being "deaf," while 2% demonstrated severe hearing loss. There was a significant association (p < 0.001) between self-reported hearing handicap and audiometric measures of hearing loss. In multivariate analysis of health, demographics, and lifestyle risk factors, only age, gender (men), and education years (<12) remained associated (p < 0.05) with hearing loss. Hearing thresholds were not associated with smoking, living situation, alcohol use, hypertension, diabetes, or chronic kidney disease. CONCLUSION:ARHL robustly assessed by audiometry is common among healthy older Australians with men more likely to have abnormal hearing thresholds than women. Hearing loss was associated with fewer years of formal education, but not with a range of chronic conditions or alcohol use. Self-reported hearing loss correlates well with higher PTA hearing threshold levels in this healthy cohort where prevalence was lower than previously reported for the age group 70+ years. Hearing health education remains an important public health tool for this age. Targeting hearing in older patient health checks could be beneficial to mitigate the cognitive, social, and mental health consequences of ARHL, even if patients do not report a problem or handicap.
INTRODUCTION:This study examined whether the waist circumference-body mass index ratio (WBR), lean body mass (LBM), and fat body mass (FBM) were associated with dementia or cognitive change. METHODS:We analyzed data from >17,000 individuals aged 65 to 98 years at enrollment. LBM and FBM were estimated using the Hume equation. Dementia was determined according to DSM-IV. Global cognition, verbal fluency, episodic memory, and psychomotor speed were assessed across 11 years. Cox and mixed-effects models were used to examine the associations with dementia and cognitive change. RESULTS:WBR was positively associated with dementia (Q4 versus Q1, hazard ratio [HR]: 1.29, p = 0.004) and cognitive decline (coefficients:-0.122 to -0.025, p < 0.05). Dementia risk was 15% to 38% lower for individuals in higher quartiles of LBM and FBM (Q2 to Q4), compared to Q1 (p < 0.05). Higher LBM and FBM were associated with slower cognitive decline (coefficients: 0.035 to 0.203, p < 0.05), except for verbal fluency. DISCUSSION:Higher LBM and FBM in later life may be associated with better cognition, while abdominal fat could be a risk factor. Highligths:Higher WBR is associated with greater dementia risk, only in men.Higher WBR is associated with faster cognitive decline.Greater LBM and FBM are associated with lower dementia risk.Greater LBM and FBM are associated with slower cognitive decline.Central adiposity may be a risk factor for cognitive impairment in older adults.
BACKGROUND:Hospitalizations involving opioid use disorder (OUD) are increasing. Medications for opioid use disorder (MOUD) reduce mortality and acute care utilization. Hospitalization is a reachable moment for initiating MOUD and arranging for ongoing MOUD engagement following hospital discharge. Despite existing quality metrics for MOUD initiation and engagement, few hospitals provide hospital based opioid treatment (HBOT). This protocol describes a cluster-randomized hybrid type-2 implementation study comparing low-intensity and high-intensity implementation support strategies to help community hospitals implement HBOT. METHODS:Four state implementation hubs with expertise in initiating HBOT programs will provide implementation support to 24 community hospitals (6 hospitals/hub) interested in starting HBOT. Community hospitals will be randomized to 24-months of either a low-intensity intervention (distribution of an HBOT best-practice manual, a lecture series based on the manual, referral to publicly available resources, and on-demand technical assistance) or a high-intensity intervention (the low-intensity intervention plus funding for a hospital HBOT champion and regular practice facilitation sessions with an expert hub). The primary efficacy outcome, adapted from the National Committee on Quality Assurance, is the proportion of patients engaged in MOUD 34-days following hospital discharge. Secondary and exploratory outcomes include acute care utilization, non-fatal overdose, death, MOUD engagement at various time points, hospital length of stay, and discharges against medical advice. Primary, secondary, and exploratory outcomes will be derived from state Medicaid data. Implementation outcomes, barriers, and facilitators are assessed via longitudinal surveys, qualitative interviews, practice facilitation contact logs, and HBOT sustainability metrics. We hypothesize that the proportion of patients receiving care at hospitals randomized to the high-intensity arm will have greater MOUD engagement following hospital discharge. DISCUSSION:Initiation of MOUD during hospitalization improves MOUD engagement post hospitalization. Few studies, however, have tested different implementation strategies on HBOT uptake, outcome, and sustainability and only one to date has tested implementation of a specific type of HBOT (addiction consultation services). This cluster-randomized study comparing different intensities of HBOT implementation support will inform hospitals and policymakers in identifying effective strategies for promoting HBOT dissemination and adoption in community hospitals. TRIAL REGISTRATION:NCT04921787.
