BACKGROUND:Continence impairment and depressive symptoms frequently coexist in older adults, but whether their co-occurrence identifies a subgroup at elevated mortality risk across populations remains uncertain. METHODS:We conducted parallel analyses among adults aged ≥ 60 years in the 2005-2010 National Health and Nutrition Examination Survey (NHANES) linked mortality files and the 2011-2018 China Health and Retirement Longitudinal Study (CHARLS). Continence impairment was defined as urinary or fecal incontinence in NHANES and by a combined functional item on difficulty controlling urination and defecation in CHARLS; these measures were harmonized at the conceptual rather than item level. Participants were classified as having neither exposure, depressive symptoms only, continence impairment only, or both. NHANES used survey-weighted Cox models, whereas CHARLS used ordinary unweighted Cox models in a unified fixed 7-year cohort. Missing covariates were addressed by multiple imputation with 20 datasets. Additive interaction measures were estimated from fixed-horizon risk ratios, not hazard ratios. RESULTS:The analyses included 4851 NHANES participants (1052 deaths) and 4690 CHARLS participants (1044 deaths). Compared with neither exposure, the co-occurring group had higher mortality in NHANES (HR 1.60, 95% CI 1.20-2.13; p = 0.001) and CHARLS (HR 1.50, 95% CI 1.19-1.87; p < 0.001). Fixed-horizon risk-ratio analyses provided no statistical evidence of additive interaction. The CHARLS midpoint death-time analysis produced a similar co-occurring-group estimate (HR 1.54, 95% CI 1.23-1.93). CONCLUSIONS:Co-occurring continence impairment and depressive symptoms identified a higher-risk subgroup relative to participants with neither exposure in both cohorts, highlighting the value of considering these conditions together in mortality risk assessment.
OBJECTIVE:This study assessed the current status and quality of long-term care (LTC) services in five Southeast Asian countries, including Cambodia, Thailand, the Philippines, Malaysia, and Myanmar, amid rising demand due to population aging. METHODS:A mixed-methods approach was used. First, the relationship between population aging and Universal Health Coverage (UHC) was analyzed using demographic and health system data. Semi-structured interviews were then conducted with key stakeholders involved in care provision for older adults, guided by seven evaluation domains identified through a comprehensive literature review. RESULTS:Findings revealed a positive association between UHC progress and population aging. LTC organization and delivery varied across countries, reflecting disparities in healthcare infrastructure. Home-based care predominated; however, public service availability and care integration were inconsistent. Dementia care was largely unrecognized and typically managed within households or communities. Use of information and communication technology (ICT) in LTC was minimal or absent. Thailand showed notable progress in linking rehabilitation services to UHC, though workforce shortages and limited access persisted. Preventive care, including frailty prevention, remained underdeveloped. CONCLUSIONS:Substantial variation exists in LTC definitions and delivery across Southeast Asia. While efforts are underway to strengthen home-based care, enhance dementia recognition, integrate ICT, and expand rehabilitation, significant challenges remain. Addressing these is vital to ensure equitable access to quality LTC for older populations in the region.
Chronic gabapentinoid use in older adults may accelerate cognitive decline, while abrupt discontinuation can trigger a "glutamate storm." This case of a 94-year-old female demonstrates that withdrawal-induced neurotoxicity manifests as severe hyperactive delirium, highlighting the need for cautious prescribing and ultra-slow tapering to protect vulnerable geriatric brains.
AIMS:To systematically evaluate frailty risk prediction models for older patients with diabetes in China, providing a reference for healthcare professionals in selecting or developing appropriate frailty risk prediction models for older patients with diabetes and offering evidence for the formulation of intervention strategies. METHODS:A systematic search was conducted in PubMed, the Cochrane Library, Medline, Embase, Web of Science, China Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), VIP Database, and Wanfang Database for studies related to frailty risk prediction models for older patients with diabetes. The search period covered from database inception to November 15, 2025. Data extraction and quality assessment were independently performed by two researchers using the Prediction Model Risk of Bias Assessment Tool (PROBAST) and a data extraction form. RESULTS:A total of 14 studies involving 25 models were included, with outcome event incidence rates ranging from 10.1% to 51.2%. The area under the receiver operating characteristic curve (AUC) of the models ranged from 0.703 to 0.975. All 14 studies showed good overall applicability but exhibited a high risk of bias. High-frequency predictors included age, polypharmacy, nutritional status, glycated hemoglobin, and ADL score. CONCLUSIONS:Frailty risk prediction models for older patients with diabetes in China demonstrate good discriminative ability and applicability, but have significant methodological flaws and a high risk of bias. Future studies should strictly follow reporting guidelines for risk prediction models to develop and evaluate frailty risk prediction models for older patients with diabetes in China, and validate their feasibility in clinical practice to provide high-quality evidence for clinical decision-making.
AIM:Loneliness is common in later life and may be shaped by aging stereotypes. Drawing on Stereotype Embodiment Theory, this study examined whether the components of aging-stereotype internalization predict loneliness independently of sociodemographic factors and whether effects differ by dimension. METHODS:In this cross-sectional study, 485 community-dwelling adults aged 65 or older in Turkey completed the Elderly Internalized Stigma Scale (EISS), indexing awareness, agreement, and self-application, and the Social and Emotional Loneliness Scale for Adults (SELSA-S). Spearman's correlations and multiple linear regression were used, with separate models for total, emotional, and social loneliness. RESULTS:Self-application showed the strongest bivariate association with loneliness (ρ = 0.25, p < 0.001), whereas agreement was unrelated. It was independently associated with total loneliness (β = 0.23) and both dimensions (β = 0.18 emotional, β = 0.21 social; all p < 0.001), whereas awareness was not. Agreement showed a negative coefficient consistent with suppression. Being unmarried was the strongest correlate of emotional loneliness (β = 0.55) but was unrelated to social loneliness (β = 0.04), for which self-application had the largest standardized coefficient among the included predictors. Separating the components explained more variance than the composite score. CONCLUSION:Loneliness was associated with applying aging stereotypes to oneself rather than with awareness or general agreement, and this held for both dimensions. Being married was associated with lower emotional loneliness but not with social loneliness. Findings for social loneliness should be interpreted cautiously given the low internal consistency of that subscale. Interventions targeting self-directed stereotypes merit evaluation.
AIM:To examine the longitudinal association between possible sarcopenia and subsequent cognitive function in older Chinese adults and whether a 27-item frailty index accounted for this association. METHODS:We analyzed China Health and Retirement Longitudinal Study data using a primary three-stage sequence: possible sarcopenia, physical activity and covariates in 2011; frailty in 2013; and cognition in 2015. Multiple imputation (m = 20), bootstrap estimation with Rubin pooling and independent R 4.5.0 replication were used. Sensitivity analyses included a 16-item non-disability score, exploratory physical activity effect modification, inverse probability of censoring weighting, five additional temporal sequences and reverse-path models. RESULTS:The primary sequence included 2036 participants. Possible sarcopenia had a negative but imprecise adjusted total association with later cognition (TE = -0.112, 95% CI -0.242 to 0.019; p = 0.094). The direct association was similar (NDE = -0.107, 95% CI -0.238 to 0.024), while the indirect association through frailty was small and included zero (NIE = -0.0047, 95% CI -0.0141 to 0.0046). The non-disability score and all additional sequences showed no precise indirect association. The physical-activity interaction was unsupported (p = 0.192). IPCW strengthened the total, but not the indirect, association. CONCLUSIONS:The primary sequence did not provide precise evidence of an association between possible sarcopenia and later cognition, and the analysis did not provide statistically precise evidence that frailty mediated the association. Findings were time-window-dependent and compatible with bidirectional or shared aging processes rather than a validated early marker or a single frailty-mediated pathway.
AIM:Despite accumulating evidence regarding dementia prevention strategies, disseminating research findings to the public is often challenging. Therefore, this study examined potential strategies to support sustained engagement in dementia prevention activities. METHODS:The participants were members of senior citizens' clubs in Tottori Prefecture, Japan. We used a questionnaire survey to collect data on basic demographics, frailty, and subjective cognitive decline (SCD), which also included questions on awareness of the Tottori Method Dementia Prevention Program, interest in experiencing the program if an instructor was dispatched, and the feasibility of engaging in the program through internet-based delivery or printed materials. RESULTS:A total of 9506 respondents were included in the analysis. Awareness of the dementia prevention program was 11.9%. Overall, 50.4% of the respondents registered a desire to try the program if an instructor was dispatched. The highest proportion of respondents (50.5%) reported willingness to engage in the program if materials summarizing activities that could be completed in approximately 10 min were provided. However, frailty and SCD were associated with lower interest in these dementia prevention activities (adjusted odds ratios [95% confidence interval] = 0.77 [0.67-0.89] and 0.86 [0.79-0.95], respectively). CONCLUSIONS:Opportunities to experience the program and activities that can be completed in a short time should be availed to promote sustained engagement in dementia prevention activities. Additionally, proactive outreach strategies targeting individuals at a higher risk of health problems may be necessary to effectively disseminate the information as they may be less interested in dementia prevention.
AIM:To examine whether repeated gastrointestinal disease reporting was associated with subsequent multidomain health deterioration and whether the direction of association was consistent across two national aging cohorts. METHODS:CHARLS was the primary longitudinal cohort. Participants with at least two gastrointestinal exposure assessments across waves 1-3 were classified as never, intermittent/low, or persistent/high reporting. The primary composite comprised cognitive, ADL, IADL, or depressive-symptom deterioration. Logistic and robust Poisson models were fitted. ELSA provided a cross-cohort consistency analysis using a pre-Wave-1 gastrointestinal disease/medication proxy. RESULTS:CHARLS included 12 144 participants/5607 events; fully adjusted models included 9555/4523. Adjusted relative risks were 1.10 (95% CI 1.03-1.18) for intermittent/low and 1.06 (1.01-1.11) for persistent/high reporting. In ELSA, the fully adjusted three-level education model included 3286/1752 and yielded an odds ratio of 1.24 (0.97-1.59); the longitudinal-weighted estimate was 1.21 (0.90-1.63). Gastrointestinal exposure produced negligible incremental discrimination in either cohort. CONCLUSIONS:Repeated gastrointestinal reporting was associated with a small increase in subsequent deterioration in CHARLS, while ELSA estimates were directionally similar but less precise. Gastrointestinal history may prompt broader geriatric assessment but is not a stand-alone predictor or evidence of causality.
OBJECTIVE:We examined whether the association between adherence to the Japanese dietary pattern and all-cause and cardiovascular disease (CVD) mortality is consistent across diverse residential topographical settings in Japan. METHODS:This prospective cohort study included 48 479 adults aged 40-79 years from the Japan Collaborative Cohort Study, with baseline dietary assessment in 1988-1990. Adherence was quantified by the Japanese Diet Index 8 (JDI-8), with components dichotomized at sex-specific medians. Residential municipalities were classified as coastal, urban inland, flat/intermediate inland, or mountainous inland. Shared frailty Cox proportional hazards models with a municipality-level random intercept (33 municipalities) estimated hazard ratios (HRs) and 95% confidence intervals (CIs). We tested effect modification by residential area using interaction tests and stratified analyses. RESULTS:During a median follow-up of 19.2 years, 9304 all-cause deaths and 2685 CVD deaths occurred. Comparing the highest with the lowest JDI-8 quartile, HRs were 0.929 (95% CI, 0.872-0.990; p for trend = 0.034) for all-cause mortality and 0.862 (95% CI, 0.766-0.970; p for trend = 0.023) for CVD mortality. Interactions by residential area were not statistically significant (p for interaction = 0.246 for all-cause and 0.185 for CVD mortality). Component-level distributions varied by area, with urban inland residents having lower proportions of miso soup, rice, and fish intake. CONCLUSIONS:Higher adherence to the Japanese dietary pattern was associated with lower all-cause and CVD mortality, with directionally consistent associations across diverse residential settings. The absence of significant heterogeneity supports generalizability within Japan, although stratified estimates are exploratory.
Nationwide claim-recorded lecanemab drug amount for outpatient administration within medical institutions increased from 1.05 million mg in April 2024 to 7.73 million mg in March 2025. Under a 60-kg scenario, these amounts corresponded to 807 and 5924 standardized monthly treatment-volume equivalents; these aggregate measures are not patient counts.
