BackgroundFrailty and pre-frailty are common geriatric conditions associated with reduced physiological reserve and a higher risk of falls. Mind–body exercises such as Tai Chi, Baduanjin, and Yoga are widely recommended as low-intensity interventions, while their specific effects on different aspects of balance remain unclear.ObjectiveThis systematic review and meta-analysis aimed to evaluate the effects of mind–body exercise on overall, dynamic, and static balance in pre-frail and frail older adults and to examine whether frailty stage and exercise characteristics influence outcomes.MethodsOur literature search was conducted in PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, and VIP Databases up to March 2026. Randomized controlled trials comparing mind–body exercise with usual care, health education, or no intervention in pre-frail or frail older adults were included. Pooled effect sizes were calculated as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random-effects models. Prespecified subgroup analyses were performed according to frailty stage, exercise frequency, session duration, and intervention length.ResultsTen RCTs with 12 comparisons were included. Mind–body exercise showed significant improvements in overall balance (SMD = 0.54, 95% CI 0.17–0.91), dynamic balance (SMD = −1.08, 95% CI −1.41 to −0.76), and static balance (SMD = 1.36, 95% CI 0.43–2.30). Exploratory subgroup analyses suggested that interventions delivered 2–4 times weekly, lasting 31–60 min per session, and continuing for at least 13 weeks were associated with relatively more consistent effects; however, these findings should be interpreted cautiously because they were derived from indirect subgroup comparisons rather than formal dose–response analyses.ConclusionMind–body exercise appears to be an effective and practical strategy for improving balance in pre-frail and frail older adults, particularly when implemented early in the frailty trajectory.
IntroductionBeing married is related to better health, but many studies reveal greater health benefits among men relative to women. Some research has indicated that married individuals exhibit decelerated epigenetic age relative to individuals who are not married, but questions remain regarding gender differences therein. The purpose was to investigate gender differences in associations of marital status to epigenetic age (ing) assessed on three clocks/algorithms (PhenoAge, GrimAge, and DunedinPACE).MethodsData from 762 participants in the national Midlife in the United States Study (MIDUS II; men N = 382, women N = 380) were used. Weighted linear regressions were conducted to test the hypotheses that 1) being married would be associated with decelerated epigenetic age (ing) and that 2) this association would be stronger among men than women.ResultsBeing married, relative to being separated or divorced, was associated with decelerated epigenetic aging on DunedinPACE, although not PhenoAge or GrimAge. Investigating gender differences revealed a divergence regarding never marrying, a marital status that accelerated GrimAge and DunedinPACE scores among men, but not women.DiscussionThese results contribute new knowledge about marital status and early risk for disease, as indicated by accelerated pace of aging among men and women whose relationships dissolved. More research is needed to identify factors explaining why men who never marry may be at risk for accelerated epigenetic aging while women are not.
BackgroundPreoperative cognitive impairment (PCI) is a recognized risk factor for postoperative cognitive dysfunction, but its association with the broader syndrome of perioperative neurocognitive disorders (PND) within 30 days after surgery requires further investigation. This study aimed to evaluate the association between preoperative cognitive performance, assessed by the Montreal Cognitive Assessment (MoCA), and the risk of PND in elderly patients.MethodsThis secondary exploratory retrospective analysis based on a completed prospective randomized controlled trial (RCT) cohort included 236 patients aged ≥65 years undergoing non-cardiac surgery under general anesthesia. Preoperative cognitive performance was evaluated using the MoCA, with a score <26 defining PCI. PND was defined as either postoperative delirium (assessed daily with CAM-ICU) or delayed neurocognitive recovery (assessed by MoCA at 7 and 30 days postoperatively). Logistic regression models were used to analyze the association between PCI (as a binary and continuous variable) and PND, adjusting for confounders including age, education, frailty, and surgical factors.ResultsThe overall incidence of PND was 40.7%. Patients with PCI (n = 81) had a significantly higher incidence of PND compared to those without PCI (74.1% vs. 23.2%, p < 0.001). In unadjusted analysis, PCI was associated with a 9.44-fold increased odds of PND (OR = 9.44, 95% CI: 5.07–17.58). After multivariable adjustment, PCI remained independently associated with PND (adjusted OR = 6.95, 95% CI: 2.71∼17.79). When analyzed as a continuous variable, each 1-point increase in the MoCA score was associated with a 32% reduction in the odds of PND (adjusted OR = 0.68, 95% CI: 0.58∼0.80). Subgroup analyses showed no statistically significant interaction was observed with age, education, or frailty.ConclusionPreoperative cognitive impairment, assessed by the MoCA, is an independent risk factor for PND within 30 days after surgery in elderly patients. Preoperative MoCA screening may help identify high-risk patients for targeted interventions.
BackgroundDigital literacy refers to the ability to safely and effectively use digital technologies to access, manage, and apply information for daily living and social participation, and has been recognized as a key strategy for promoting healthy aging. However, limited research has simultaneously examined multiple psychosocial mechanisms underlying the relationship between digital literacy and cognitive function in older adults. This study aimed to examine the parallel mediating roles of self-efficacy, social participation, and psychological resilience in the relationship between digital literacy and cognitive function.MethodsA cross-sectional design was employed. We recruited older adults aged ≥60 years from a city in China to complete a questionnaire survey. The survey instruments included a general information questionnaire, the Digital Literacy Scale for Older Adults, the General Self-Efficacy Scale, the Social Participation Scale for Older Adults, the Brief Psychological Resilience Scale, and the Mini-Mental State Examination (MMSE). A multiple mediation model was constructed using structural equation modeling (SEM).ResultsAmong the 630 participants, the largest proportion of participants were aged 70–79 years (45.9%), and 52.1% were male. The mean MMSE score was 25.71 (SD = 3.38), indicating that the sample, on average, fell within the normal cognitive range (scores below 24 are typically considered indicative of mild cognitive impairment). Digital literacy was significantly correlated with cognitive function (r = 0.246, P < 0.01). The total effect of digital literacy on cognitive function was 0.347 (95% CI 0.258–0.417, P = 0.002). Mediation analysis revealed that digital literacy indirectly influenced cognitive function through three pathways: self-efficacy, social participation, and psychological resilience. The total indirect effect accounted for 39.5% of the total effect, and the direct effect accounted for 60.8%. Among the three mediating pathways, self-efficacy showed the strongest indirect effect (16.4%), followed by social participation (13.0%) and psychological resilience (10.1%).ConclusionDigital literacy not only shows a direct association with cognitive function in older adults but also shows indirect associations through self-efficacy, social participation, and psychological resilience. Therefore, multifaceted, synergistic interventions may be considered that integrate digital skills training with social engagement and psychological support are associated with cognitive health and the quality of life for older adults.
IntroductionThere are reports suggesting that reading newspapers is an accessible daily intellectual activity that may help prevent neurocognitive disorders, while no prospective studies have accurately investigated its effectiveness on cognitive function.MethodsThis study is a randomized controlled trial designed to explore the effects of reading newspapers on cognitive function and activity levels in community-dwelling older adults. The study included 163 non-subscribers aged 60 years or older; after screening, 64 participants were selected. Participants were randomly assigned to either the newspaper reading group (n = 31) or the non-reading group (n = 32), and a 26-week randomized controlled trial (RCT) was conducted. One person was disqualified because they could not be contacted. The newspaper reading group was instructed to read the newspaper at least four days a week, and compliance was verified by checking entries on activity log sheets. In addition, both groups were assessed before and after the trial. The primary outcome was cognitive function assessed using the Japanese Version of the MONTREAL COGNITIVE ASSESSMENT (MoCA-J). Secondary outcomes included the Mini Mental State Examination (MMSE-J), the Japanese version of the Geriatric Depression Scale-15 (GDS-15-J), the Life-Space Assessment (LSA), and the Vitality Index.ResultsWhen comparing the changes in these test items after 26 weeks, the newspaper reading group showed significantly better results than the non-reading group for the MoCA-J (difference: 1.47 [95% CI: 0.31–2.63], p = 0.013), GDS-15-J (difference: –1.85 [95% CI: –3.01 to –0.68], p = 0.002), and LSA (difference: 14.74 [95% CI: 7.13–22.35], p < 0.001). A significant trend was also observed in the newspaper reading group for the MMSE-J (difference: 2.46 [95% CI: 1.34–3.58], p = 0.065).DiscussionThese findings suggest that reading newspapers is a low-cost, self-directed intervention that can be easily incorporated into preventive care for community-dwelling older adults and may have beneficial effects on cognitive function and activity levels.
Adipose tissue infiltration into skeletal muscle (i.e., myosteatosis) has emerged as an independent contributor to metabolic disorders and declines in skeletal muscle function with age. It remains unclear whether myosteatosis is a marker of aging or simply a consequence of disease or disuse. This review summarizes evidence from population-based epidemiologic studies that utilized non-invasive imaging to measure myosteatosis and to evaluate age-related changes among community-dwelling middle aged and older adults. Myosteatosis consistently increased with age, independent of weight change, and the burden of myosteatosis was greater among women, and non-White racial and Hispanic ethnic groups after accounting for physical activity levels, chronic disease burden, and overall body size. Myosteatosis accumulation is not uniform throughout the body and is differentially associated with clinically meaningful age-related outcomes, including changes to gait, balance, muscle strength, and physical function. Hormonal, cellular, genetic, and lifestyle differences comprise the biological pathways that may lead to age-related increases in myosteatosis. Future work in diverse populations using standardized imaging methodologies could include longitudinal measures of biological markers to better understand the biological precursors that accompany the phenotypic change. In conclusion, evidence from several well-characterized epidemiologic studies is consistent with myosteatosis an independent marker of aging.
ObjectiveTo investigate the association between severe hearing loss and systemic immune aging in older adults using participant-level clinical immunophenotyping, and to explore potential inflammatory pathways and cellular contexts using public mouse cochlear transcriptomic data.MethodsWe analyzed a single-center cohort of 76 older adults, classified into normal hearing (NH), mild-to-moderate hearing loss (MMHL), or severe-to-profound hearing loss (SPHL) groups. Age- and sex-adjusted models were used to assess immune profiles. Prespecified sensitivity and diagnostic analyses evaluated age specification, overlap weighting, influential observations, and the stability of the inversion model. Additionally, public mouse cochlear bulk transcriptomics and single-nucleus RNA sequencing (snRNA-seq) data were examined to identify relevant inflammatory pathways and cell-type-specific immune-stress modules.ResultsSPHL was significantly associated with a higher T-cell/CD8 skew, increased CD4 differentiation, an elevated EM/naive CD4 balance, a lower CD8 activation/checkpoint score, and increased odds of CD4/CD8 inversion. These associations remained consistent across sensitivity analyses. Mouse bulk transcriptomics highlighted inflammatory response and IL6/JAK/STAT3 signaling pathways, while snRNA-seq localized immune-stress modules primarily to broad macrophage and perivascular macrophage-like cell populations.ConclusionSevere hearing loss in older adults is associated with distinct peripheral immune remodeling features indicative of systemic immune aging. These findings support an association-focused framework linking hearing loss severity with immune dysregulation, though validation in larger, clinically annotated cohorts is required.
The capacity for tissue repair and regeneration undergoes a profound and progressive decline across the human lifespan, representing a fundamental driver of aging and chronic disease. This review establishes a comprehensive ontogenetic framework by mapping the continuous biological transition from the flawless, scarless regenerative plasticity of embryonic development to the irreversible fibrotic scarring and organ failure characteristic of senescence. We synthesize the hierarchical collapse of reparative networks across multiple biological scales. Importantly, this ontogenetic decline should not be interpreted as a purely degenerative trajectory but rather as a dynamic systems-level reprogramming in which evolutionary trade-offs prioritize tumor suppression, immune surveillance, and reproductive fitness over long-term regenerative fidelity. Recognizing this adaptive reallocation of biological resources reframes aging not simply as failure but as a predictable recalibration of repair hierarchies. At the molecular and cellular levels, the accumulation of genomic instability, unresolvable DNA damage, and mitochondrial dysfunction gradually overwhelms intracellular quality-control mechanisms. Concurrently, epigenetic drift and chronic, low-grade systemic inflammation (“inflammaging”) dismantle the stem cell niche, driving adult stem cell exhaustion and shifting wound healing away from functional tissue replacement toward maladaptive fibrosis. Furthermore, we examine divergent, organ-specific repair trajectories. By contrasting the severe regenerative restrictions of the adult central nervous system and myocardium with the persistent, yet exhaustible, resilience of the liver, we elucidate the unique intrinsic and microenvironmental barriers that impede structural and functional recovery. Finally, we evaluate the clinical paradigm shift from passive management of age-related degeneration to active restoration of tissue integrity. By integrating systemic geroscience—which addresses the global hallmarks of aging—with targeted bioengineering and in vivo epigenetic modulation, contemporary regenerative medicine seeks to recreate permissive, youthful microenvironments. Ultimately, mastering these ontogenetic principles holds unprecedented potential to reactivate endogenous repair pathways, mitigate multi-organ collapse, and significantly extend human functional healthspan.
BackgroundThe global ageing population is growing rapidly, with Sub-Saharan Africa undergoing a significant demographic transition. Although research on general ageing-related health outcomes in the region, such as frailty, multimorbidity, and socioeconomic deprivation, has expanded in recent years, the sexual health needs of ageing women remain comparatively understudied and inadequately addressed. This systematic review synthesizes evidence regarding the sexual health needs, challenges, and reproductive health concerns of ageing women in Sub-Saharan Africa.MethodsScopus and PubMed databases were used to search, select, and review the publication records between 1 January 2000 and 26 May 2026. Sexual or reproductive health of women framed as ageing, older, elderly, menopausal, or postmenopausal in Sub-Saharan Africa studies were included. The PRISMA 2020 guidelines were followed for study selection and reporting. Data extraction and quality assessment were performed systematically.ResultsA total of 358 records identified across Scopus and PubMed, 34 studies met the eligibility criteria and were included in the review. Six themes were identified: patterns and predictors of sexual activity in later life; menopausal symptom burden and sexual dysfunction; the intersection of HIV status and reproductive ageing; socio-cultural norms and the culture of silence; contraceptive needs and fertility ambivalence; and health-seeking behaviour and systemic barriers. Ageing women encounter multiple intersecting challenges, including age-related physiological changes, socio-cultural marginalisation, and inadequate responses from health systems.ConclusionSexual health needs of ageing women in Sub-Saharan Africa remain largely overlooked in research, policy, and healthcare delivery. There is an urgent need for age-sensitive sexual and reproductive health services, training for healthcare providers, and policy frameworks that acknowledge and address the unique needs of this population. Future research should prioritise empirical studies that highlight the lived experiences of ageing women and evaluate interventions aimed at enhancing their sexual health and wellbeing.
IntroductionFalls are a leading cause of injury and hospitalization in older adults, with pharmacotherapy identified as a modifiable risk factor. Tools for identifying potentially inappropriate medications (PIMs), such as the EU(7)PIM, PRISCUS, and FORTA lists, differ in methodology. However, their comparative performance in predicting fall risk has not been systematically evaluated. The aim of our work was to investigate the association between PIM use and fall risk among older adults and to analyze the correlations between PIM utilization based on three PIM lists (EU(7)PIM, PRISCUS, and FORTA C/D) and fall risk.MethodsIn a retrospective case -control study based on real-world data from Hungarian emergency and primary care settings, we analyzed fall-related emergency department visits (n=886) in individuals aged ≥65 years and matched them with a control group from general practices (n = 1364).ResultsUse of PIMs identified by all three lists was significantly associated with increased fall risk. (Use of 1 FORTA C/D active substance: AOR: 1.434; CI95%:1.120–1.838; p = 0.004; Use of 1 EU(7)PIM active substance: AOR: 1.201; CI95%: 0.907–1.591; p = 0.200; Use of 1 PRISCUS active substance: AOR: 1.390; CI95%:1.069–1.808; p = 0.014) Of the three lists, use of drugs on the PRISCUS list was most significantly associated with increased fall risk. (Use of 2 PRISCUS active substance: AOR: 1.557; CI95%:1.148–2.114; p = 0.004; Use of 3 PRISCUS active substance: AOR: 2.045; CI95%: 1.408–2.982; p = 0.000; Use of 4 PRISCUS active substance: AOR: 1.869; CI95%: 1.149–3.065; p = 0.012; Use of 5 PRISCUS active substance: AOR: 2.638; CI95%: 1.464–4.895; p = 0.002).DiscussionWe introduce the concept of “polyPIMuse” –the use of ≥5 PIM-listed drugs –which further elevated fall risk, particularly for PRISCUS and FORTA C/D lists. Despite methodological differences, all three PIM tools proved useful in predicting fall risk. Incorporating these tools into routine medication reviews may aid fall prevention strategies in geriatric care.
IntroductionThe brain exhibits high plasticity and responds to many forms of external stimuli, such as trauma, seizures, drugs, and biomaterials. Collagen is a non-toxic biocompatible protein that participates in the plastic reformation of the brain. In this study, we explored whether collagen can reconstruct astrocytes and brain vessels by using microcontact printing on organotypic mouse brain slices.MethodsOrganotypic brain slices from postnatal days 8–10 were prepared and connected to collagen microcontact prints. After 2–6 weeks, glial fibrillary acidic protein–positive (GFAP+) astrocytes and laminin+ vessels were immunohistochemically stained.ResultsOur data show that (1) collagen restructures laminin+ vessels in the whole brain slice along 50-µm-wide collagen lanes. (2) This restructuring is linked to the reformation of GFAP+ astrocytes in the collagen–laminin lanes. (3) In contrast to 50 µm lanes, larger 400-µm collagen spots caused a marked depletion forming large holes in the brain slice accompanied with the cell death of GFAP+ astroglia. (4) Preliminary/exploratory data using live cell imaging may indicate that astroglia restructure before the vessels.DiscussionCollagen has the distinctive potential to induce plasticity and the restructuring of vessels and astrocytes, however, collagen may also lead to cell death under certain conditions.
A large genome-wide association study of parental lifespan was reported in 2019. A later transcriptome-wide association study (TWAS) based on those summary statistics identified a set of transcriptional programs associated with longer genetically predicted survival, including increased brain NAD + salvage, especially NMNAT2, reduced glucose-stimulated insulin secretion, a shift toward synaptic pruning with less broad plasticity, and a glial pattern characterized by relatively greater microglial and lower astrocytic signatures, with only weak pan-tissue senescence signals. Building on those directional findings, this short communication proposes a minimal three-arm oral regimen with unequal evidentiary weight: first, the Cheung Glutamatergic Regimen, consisting of low-dose dextromethorphan potentiated by a CYP2D6 inhibitor together with piracetam and L-glutamine, as an exploratory adjunct aimed at preserving residual functional connectivity; second, daily nicotinamide mononucleotide and N-acetylcysteine with pulsed senolytics for NAD + salvage and senescence modulation; and third, GLP-1 receptor agonism for metabolic reprogramming. The NAD+/senescence arm is the primary mechanistic anchor, GLP-1 receptor agonism provides secondary metabolic support, and the glutamatergic arm is exploratory. Each arm targets a separate node within the pruning-plasticity-metabolic triad. The regimen is fully oral, uses conservative dosing, and draws on prior therapeutic or human-exposure data, although the proposed combination has no established safety profile. Although direct combination data are lacking and the foundational TWAS remains a preprint, the components show plausible but uneven mechanistic alignment with the TWAS signals and may justify carefully designed, safety-focused pilot evaluation.
Mesenchymal stem cells (MSCs) are widely investigated for regenerative medicine, tissue repair, immunomodulation, and selected cancer-related applications because of their multilineage differentiation potential, paracrine activity, immunoregulatory properties, and capacity to home to sites of injury. However, the therapeutic potential of MSCs depends not only on their tissue source or surface-marker expression but also on their functional state. MSC senescence is not a single phenotypic alteration; rather, it reflects the combined effects of persistent DNA damage response activation, disruption of mitochondrial and metabolic homeostasis, remodeling of epigenetic and secretory networks, and loss of proteostasis. Collectively, these changes drive MSCs toward reduced proliferative capacity, dysregulated paracrine signaling, impaired immunomodulatory activity, and diminished tissue-repair potential, thereby compromising cell-product potency and batch-to-batch consistency. This review summarizes the molecular mechanisms underlying MSC senescence, its source-specific functional consequences, and emerging rejuvenation strategies, with an emphasis on MSC quality control, potency assessment, and clinical translation.
IntroductionGiven cognitive benefits observed in lifelong bilinguals, a key question is whether L2 learning can boost cognition in later life.MethodsIn a pre–post intervention study, we assessed cognitive effects of learning a new language in older adults as measured by global cognition and domain-specific cognitive tests.Results and DiscussionWhile the MMSE, MoCA, and domain-specific measures (Stroop, Simon, nonword repetition, phonemic fluency, and semantic fluency) did not show significant whole-group pre-post change, a number of individual participants improved on all or some of these measures. Further, both linear regression and machine learning models indicated that participants with lower baseline scores on the MMSE, MoCA, phonemic fluency, and semantic fluency showed greater improvement in post-intervention measurements, reflecting greater cognitive gains, with phonemic fluency emerging as the best predictor of intervention outcome. A post hoc, adherence-sensitive analysis further indicated a +1.225-point MoCA advantage in completers relative to non-completers, consistent with an adherence-associated pattern. Machine learning analyses confirmed that cognitive gains were heterogeneous across participants and that the most responsive outcomes were reaction-time-based executive measures, particularly the Stroop task and Symbol Digit Substitution Test (SDST). Cluster analysis showed that the top improver profile combined lower baseline executive performance with markedly higher engagement and lesson completion.ConclusionThese results provide preliminary evidence that engagement in a structured and sustained L2-learning program may be associated with measurable pre–post cognitive changes in some older adults, especially when baseline performance leaves room for improvement. Further, high intervention adherence and engagement are critical to the extent of cognitive benefits derived from L2 learning interventions. Clinically, structured language learning programs that emphasize adherence, dose, and fidelity appear promising for older adults, especially those with emerging decline. These results are noteworthy, given the scarcity of effective options to improve cognitive health in aging, and the fact that L2 learning is low-cost and broadly accessible.
Aging is a progressive, multisystem process characterized by declining physiological resilience and increased susceptibility to chronic diseases. Recent advances in high-throughput proteomics have enabled comprehensive mapping of age-related changes across circulating proteins, revealing dynamic and non-linear trajectories that reflect biological rather than chronological aging. This review synthesizes current evidence on proteomic biomarkers across major physiological systems, including the immune, metabolic/endocrine, cardiovascular, musculoskeletal, and nervous systems, and highlights shared molecular signatures that underpin multisystem decline. Robust biomarkers such as IL-6, CRP, CXCL9/10, GDF15, IGF-1, VCAM-1, NT-proBNP, NfL, and GFAP consistently track inflammatory activation, mitochondrial and metabolic stress, extracellular matrix remodeling, and neuro-glial injury. Large population cohorts demonstrate that proteomic aging clocks, leveraging dozens to hundreds of circulating proteins, can predict frailty, multimorbidity, organ-specific biological age, and mortality with high accuracy. Emerging evidence suggests that a limited set of cross-system “protein aging modules”—including inflammatory cytokines, chemokines, complement proteins, and ECM-modifying enzymes—may serve as integrative readouts and potential regulators of aging biology. We discuss methodological advances, system-specific mechanisms, and translational applications of proteomic aging models. Together, these findings position proteomics as a powerful tool for quantifying biological age, identifying early disease risk, and guiding precision interventions to promote healthier aging.
BackgroundObesity is a chronic, progressive, relapsing disease characterized by excess or dysfunctional adiposity that impairs health and contributes to multimorbidity, disability, and reduced life expectancy. Contemporary international frameworks recommend moving beyond BMI-only definitions toward disease-based diagnostic models that integrate adiposity, complications, and functional status. Croatia faces a high prevalence of obesity alongside constrained healthcare resources and limited reimbursement for modern pharmacotherapy, highlighting the need for nationally adapted clinical guidance.MethodsThis position statement was developed using a modified Delphi consensus process involving 23 multidisciplinary experts from academic and clinical institutions across Croatia. Consensus statements were derived from contemporary international guidelines, randomized controlled trials, and meta-analyses. Evidence quality and recommendation strength were graded using an adapted GRADE-based framework.ResultsThe document establishes a Croatia-specific framework for the diagnosis, staging, and management of obesity. Diagnosis requires confirmation of excess adiposity with evidence of clinical risk or dysfunction and integrates anthropometric measures with metabolic, mechanical, psychological, and functional domains. A staging system aligned with EASO and Lancet frameworks guides treatment intensity according to disease severity. Management is based on four pillars: lifestyle therapy, psychological support, pharmacotherapy, and metabolic/bariatric surgery. Pharmacological treatment is stage-based and comorbidity-driven, prioritizing agents with proven organ-protective effects. Special considerations are provided for older adults, emphasizing preservation of muscle mass, functional capacity, independence, and quality of life. Long-term structured follow-up is recommended for all patients, reflecting the chronic disease model of obesity.ConclusionThis position statement provides an evidence-based, nationally adapted clinical framework that aligns obesity management with modern chronic disease standards. By integrating disease staging, individualized therapy, and long-term care, it supports precision treatment across the lifespan and emphasizes obesity management as a key strategy for preventing complications, reducing disability, and promoting healthy longevity.
BackgroundFrailty in the elderly population is increasing, and the development of high-quality clinical practice guidelines or consensuses can guide medical staff to better provide health services for frail elderly individuals. In recent years, scholars at home and abroad have actively explored exercise intervention management in elderly individuals with frailty or prefrailty. How to rapidly generalize interventions with “known and definite effects” for the community-dwelling frail elderly population is the core issue of the research on frailty. There is a lack of study regarding whether digital interventions can improve exercise adherence for older adults with frailty and prefrailty.ObjectiveIn accordance with the Comprehensive Framework for Implementation Research (CFIR), this study implemented scientific strategies for exercise interventions for elderly people with community frailty and prefrailty. Empirical research was conducted via the cloud platform of the home‒community integration system to provide a theoretical basis for improving the physical, psychological and social frailty of frail elderly people and reducing the incidence of adverse outcomes caused by frailty in the community.MethodsQualitative and quantitative research methods were fully integrated. Semistructured interviews were conducted with 64 older adults who designated family doctors and 44 community workers in the community to identify the regular exercise adherence of frail or prefrail older adults as well as the promoting and hindering factors of community workers in the implementation of scientific exercise interventions. Following the guidance of the Comprehensive Framework for Implementation Research (CFIR), scientific exercise intervention strategies for frail elderly people in the community were implemented. The control group received routine nursing, and the intervention group received a scientific nursing intervention. After 3 months of intervention, the effects of the strategy on implementation outcomes (feasibility, acceptability, fidelity, etc.), intervention outcomes (physical function, emotional state, social support, self-efficacy), process outcomes (skills or cognition), and resource utilization in older adults with frailty or prefrailty were evaluated.ResultsIn the qualitative interviews conducted with CFIR as the theoretical guiding framework, a total of 22 influencing factors, 12 promoting factors and 10 hindering factors in 4 areas were identified to construct scientific strategies for implementation。The implementation results revealed that the feasibility (P = 0.003), acceptability (P = 0.002) and fidelity (P = 0.001) of the intervention group were significantly better than those of the control group. The intervention results revealed that, compared with those in the control group, physical fitness (gait: P = 0.016; balance: P < 0.001; grip strength: P < 0.001; body fat percentage: P < 0.001), depression (P < 0.001), social support (P < 0.001), and self-efficacy (P < 0.001) significantly improved.ConclusionGuided by the implementation of the scientific theoretical framework, this study used a whole-process, systematic, diversified and scientific online and offline joint exercise implementation strategy, proving that the strategy can be used to create a safe, effective and sustainable exercise intervention for frail or prefrail elderly individuals in the community that effectively improves their physical fitness, depression, social support and self-efficacy, delays the progression of frailty, and reduces the incidence of adverse outcomes such as disability, falls, hospitalizations and even death.
BackgroundAlthough multimodal exercise interventions are recognized for their potential to attenuate age-related cognitive decline, the current literature lacks longitudinal depth. Specifically, robust randomized evidence addressing the long-term efficacy of structured training protocols remains limited. This single-blind RCT involved 882 community-dwelling older adults categorized as healthy, having subjective memory complaints (SMCs), or having mild cognitive impairment (MCI).MethodsParticipants were randomized to an experimental group (EG), performing 48 months of supervised moderate-to-high-intensity multimodal training (aerobic, resistance, and stretching), or to a control group (CG), maintaining usual habits. The primary outcome was the 48-month change in Mini-Mental State Examination (MMSE) scores. Secondary outcomes were scores on eight neuropsychological tests assessed at 12, 24, 36, and 48 months. A linear mixed-effects model analysis with repeated measures (LMM) was used to evaluate significant differences between the CG and EG.ResultsIn the final analysis of 674 participants, healthy participants (between-group effect: p = 0.008; η2p = 0.007; time*group interaction: p < 0.001; η2p = 0.025) in the EG showed significantly higher MMSE scores than those in the CG. SMC participants in the EG also showed higher MMSE scores than those in the CG (between-group effect: p = 0.052; η2p = 0.004; time*group interaction: p < 0.001; η2p = 0.031), although the between-group difference only approached statistical significance. Similarly, healthy and SMC participants in the EG demonstrated significantly better performance in the secondary outcomes of memory, attention, and reasoning than those in the CG. The sample size of the MCI group was insufficient to allow for conclusive statistical analyses.ConclusionA 48-month multicomponent exercise program significantly improved cognitive performance in healthy and SMC older adults. Structured physical activity may effectively slow cognitive decline.Clinical Trial Registrationhttps://clinicaltrials.gov/study/NCT02236416. Identifier number: NCT02236416.
