INTRODUCTION:Dual-task testing, which combines a motor task with a simultaneous memory task, is commonly used to detect early cognitive decline because it challenges attention and executive function. However, most dual-task assessments emphasize motor performance while overlooking speech during the memory component. Speech reflects the integrity of multiple cognitive systems and has emerged as a promising digital biomarker of brain health. Yet, existing speech-based protocols typically rely on single-task, clinic-based recordings, limiting scalability and real-world applicability. Integrating speech analysis into brief, functional dual tasks may provide a practical solution for remote cognitive assessment. OBJECTIVE:To determine whether speech captured during a 20-second upper extremity frailty (UEF) dual-task test can distinguish individuals with mild cognitive impairment (MCI) from cognitively healthy adults in a fully remote environment. METHODS:In a multisite U.S. cohort, community-dwelling adults aged 50-79 years completed the Montreal Cognitive Assessment (MoCA) and a 20-second UEF dual task involving repeated elbow flexion-extension while counting backward aloud. Elbow motion and speech were recorded using the built-in webcam and microphone of a smartphone, tablet, or laptop during a Zoom session. Audio was extracted and transcribed into time-stamped text using an automated pipeline powered by OpenAI's Whisper large automatic speech recognition model. Custom-developed algorithms extracted nine speech-derived features reflecting timing, pausing behavior, and counting performance. Logistic regression models incorporating demographics, patient-reported outcomes, and speech features were constructed to classify cognitive status. RESULTS:Among 319 recordings meeting predefined audio-quality criteria (110 MCI; 209 controls), multiple speech features differed significantly between groups (p<0.05) and showed modest correlations with MoCA scores (Spearman's ρ=0.26-0.32, p<0.05). Models including speech features significantly improved discrimination of MCI compared to demographics alone. The combined model achieved an area under the receiver operating characteristic curve of 0.79, compared with 0.56 for demographics-only models. CONCLUSIONS:Speech captured during a brief, video-recorded dual-task test provides meaningful digital biomarkers of cognitive impairment. This device-agnostic protocol enables scalable, low-burden cognitive screening and supports longitudinal brain health monitoring outside traditional clinical settings.
PURPOSE:To define the frequency and annual rate of hypertensive crisis in older patients attending emergency department (ED), the sociodemographic and baseline patient profile, and clinical characteristics and long-term outcome of the hypertensive crisis episode. We also looked for differences between men and women. METHODS:This was a retrospective analysis of the multipurpose EDEN cohort, which recruited during 1-week period all patients aged 65 years who visited the ED of 52 Spanish public hospitals covering 19.3% of Spanish population. Demographic, social, baseline and clinical data of the episode of hypertensive crisis were recorded. Estimations of annual incidence were made, in general and through patient age. Outcome consisted of 1-year post-discharge combined adverse event (revisit to ED, hospitalization, or death). Comparison between men and women were performed in unadjusted and adjusted models. RESULTS:There were 186 cases of hypertensive crises among the 25,557 patients included in the EDEN cohort. The relative frequency of hypertensive crisis was 0.73% of ED visits (95%CI 0.63-0.84), with 0.56% (0.44-0.72) in men and 0.87% (0.73-1.04) in women (OR for men 0.64, 0.47-0.87), and annual rate of hypertensive crisis in Spanish older population was 429 cases per 100.000 inhabitants (95%CI 371-493), with 341 (267-436) in men and 493 (413-590) in women (OR for men 0.69, 0.51-0.94). Patients with hypertensive crisis had better baseline health status than the rest of the older patients attending the ED, with cardiovascular comorbidity being frequent (previously known hypertension in 88.2%) and with 22% having additional acute diagnoses on top of the hypertensive crisis. Hospitalization was needed in 7.5% of cases (0.5% in intensive care unit) and in-hospital mortality was observed in 2 cases (1.1%). Combined adverse events 1 year after discharge accounted for 57.9% of patients, with 65.6% in men and 52.5% in women (adjusted HR 1.61, 1.01-2.57). CONCLUSIONS:Hypertensive crises are more frequent in older women than men and they present a worse profile at baseline and higher severity than men. Nonetheless, men with hypertensive crisis may have a worse long-term prognosis compared to women, highlighting the need for targeted post-discharge monitoring strategies in this subgroup.
: Background: Mitochondrial dysfunction serves as a fundamental driver of the aging process, precipitating progressive functional decline through complex molecular cascades. Summary: This review elucidates the core mechanisms underpinning this dysfunction, including reactive oxygen species (ROS)-induced redox imbalance, mitochondrial DNA (mtDNA) damage accumulation, impaired mitophagy, and metabolic reprogramming. Crucially, we examine how mitochondria act as signaling hubs for inter-organ crosstalk. Through the secretion of mitokines (e.g., FGF21, GDF15) and the release of damage-associated molecular patterns (DAMPs), dysfunctional mitochondria trigger chronic inflammation via the cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) and NLRP3 inflammasome (NLRP3) pathways, actively driving systemic aging within the skeletal muscle-brain and adipose/liver-cardiovascular axes. Additionally, this paper synthesizes current therapeutic interventions, ranging from lifestyle modifications and nicotinamide adenine dinucleotide (NAD+) precursors to frontier technologies like mitochondrial transplantation and gene editing. Key Messages: While promising in animal models, clinical translation of these interventions is currently hindered by limited long-term safety data and evidence gaps. Therefore, mitochondria-targeted studies incorporating integrated multi-organ phenotyping are urgently required to establish robust strategies for extending human healthspan.
INTRODUCTION:Delirium is common in hospitalized older adults and is associated with higher morbidity and mortality in this population. Our geriatric trauma co-management (GTC) program integrates a geriatrician in the trauma team, with a focus on team-based, interdisciplinary care coordination to mitigate geriatric syndromes, including delirium. METHODS:We analyzed 12,631 patients aged 65 and older admitted to the trauma surgery team at a level-1 trauma center from 2017 to 2024. We perform a 1:1 ratio matching of propensity scores. The primary outcome was delirium incidence, defined by acute encephalopathy, positive Confusion Assessment Method (CAM) score, or new use of antipsychotic medicine between GTC and usual standard care (UC). The secondary outcomes included discharge disposition, in-hospital falls, intensive care unit (ICU) length of stay (LOS), mortality, and 30-day readmission. Chi-square and Students's t tests were used for bivariate analyses. Multivariate linear or logistic regression analyses were used for outcomes. When applicable, the analyses were adjusted. RESULTS:The propensity score-matched cohort included 1,318 patients (659 GTC; 659 UC). Mean age was 82.1 ± 8.1 years, 45% were male. GTC patients had a 37% higher likelihood of being discharged to SNF (1.37 [1.04-1.79]). The mean ICU LOS was higher in the GTC group (3.9 ± 5.7 days vs. 2.3 ± 3.7 days, adjusted p = 0.002), but there were no significant differences in mean LOS, in-hospital falls, in-hospital mortality, discharge to hospice or death during hospitalization, death within 30 days after discharge, or 30-day readmissions. For the prespecified composite delirium outcome, GTC patients had higher documented delirium (51.9%) compared with 28.1% for UC patients (2.50 [1.88-3.34]). Secondary exploratory analyses of individual delirium definitions showed higher rates of acute encephalopathy occurred in 7.6% of GTC patients versus 1.2% of UC patients (OR 14.80, 95% CI [4.82-45.45]; p < 0.0001). Positive CAM score was documented in 42.6% of GTC patients compared with 11.1% of UC patients (4.68 [3.23-6.78]; p < 0.0001). Positive CAM score and/or new use of antipsychotic medicine occurred in 27.2% of GTC patients versus 22.2% of UC patients (1.38 [1.02-1.87]; p = 0.038). In contrast, new antipsychotic alone was more common in UC (15.8% vs. 7.9%, p < 0.05). Among patients with a positive CAM score, GTC patients had lower in-hospital mortality compared with UC (8.2% vs. 18.4%; OR 0.40, 95% CI: 0.17-0.95; p < 0.05). CONCLUSION:GTC in older trauma patients helps identify delirium and potentially reduces the need for antipsychotics and improves mortality. A randomized controlled trial is needed to verify these findings.
INTRODUCTION:Frailty is a multifactorial geriatric syndrome, and sleep disturbances have emerged as a potential contributing factor. However, conventional statistical approaches may not adequately capture the complex and nonlinear patterns inherent in wearable-derived sleep data. This study evaluated the feasibility of machine learning models for classifying frailty using objectively measured sleep features in older adults under free-living conditions. METHODS:This cross-sectional study included 90 community-dwelling adults aged ≥65 years. Participants were classified as robust or pre-frail/frail using the Fried frailty phenotype. Sleep data were collected via a wrist-worn device, and sleep stage, duration, and interaction features were extracted. Five ML models (random forest, gradient boosting, categorical boosting, extreme gradient boosting, and logistic regression) were developed and model performance on an independent test dataset was evaluated using accuracy, F1 score, receiver operating characteristic area under the curve (ROC AUC), precision-recall area under the curve (PR AUC), sensitivity, specificity, and Matthews correlation coefficient. Shapley additive explanations (SHAP) analysis was applied to enhance model interpretability. RESULTS:Among the evaluated models, random forest showed the best overall performance, achieving the highest ROC AUC of 0.892 and PR AUC of 0.894. SHAP analysis identified age, cognitive function, rapid eye movement sleep, sleep duration, and interaction features reflecting sleep characteristics as important contributors to frailty classification. CONCLUSION:Wearable derived sleep monitoring combined with interpretable ML may provide a feasible and non-invasive approach for early frailty risk identification in older adults. Sleep features, together with age and cognitive function, may serve as meaningful indicators of frailty risk in older adults.
INTRODUCTION:Falls are a major public health concern among older adults, leading to injuries, loss of independence, and increased mortality. A body shape index (ABSI), which integrates waist circumference with height and weight, may better characterize abdominal adiposity than body mass index (BMI). To our knowledge, this is the first study to examine the association between ABSI and fall risk in older adults using data from the National Health and Aging Trends Study (NHATS). METHODS:We analyzed data from NHATS, a nationally representative cohort of US Medicare beneficiaries aged ≥65 years. Baseline anthropometric data (height, weight, waist circumference) from round 1 were linked to 12-month fall outcomes in round 2. Exposures were BMI and ABSI. Survey-weighted logistic regression models estimated associations between each measure and fall outcomes, adjusting for sociodemographic and health-related covariates. RESULTS:In adjusted models, ABSI was significantly associated with both any fall (odds ratio [OR] = 1.15, 95% confidence interval [CI]: 1.04-1.27; p = 0.009) and multiple falls (OR = 1.20, 95% CI: 1.03-1.39; p = 0.018). BMI showed weaker and less consistent associations (any fall: OR = 1.02, 95% CI: 1.00-1.03; p = 0.030; multiple falls: OR = 1.01, 95% CI: 0.995-1.03; p = 0.158). Associations were stronger among adults aged ≥80 years and those with multimorbidity or conditions such as arthritis, hypertension, or diabetes. CONCLUSION:ABSI may be a more sensitive anthropometric measure than BMI for identifying older adults at risk for falls, underscoring its potential to improve geriatric fall-risk assessment and prevention strategies.
INTRODUCTION:Alzheimer's disease (AD) is the most common form of dementia. Depression is common in AD, with limited evidence for efficacy of pharmacotherapy. Limited in-home non-pharmacological treatments for depression in AD underscore a need for novel in-home treatments. Virtual reality (VR) is an immersive audiovisual technology, which has been used in different clinical contexts. Exposure to nature can improve mental health, including the behavioural and psychological symptoms of dementia (BPSD). To our knowledge, in-home VR use has not been assessed in AD with depression (AD-D). This study aims to assess the feasibility of an in-home nature VR (N-VR) exposure versus an active non-immersive control intervention for individuals with AD-D. METHODS:This is a pilot, parallel group, assessor-blinded, randomized controlled trial, assessing a N-VR for AD-D. Participants (n=50) with AD-D are randomized (1:1) to N-VR vs. an active control intervention of nature-based videos. All participants receive the intervention as 15-min sessions delivered twice a week, for 4 weeks. Assessments are conducted remotely by assessors (via WebEx) blinded to randomized assignment at baseline, after each session, and within 7 days of completing the 4-week course to assess tolerability, feasibility, and acceptability. Participants also have the option to participate in a focus group at the end of the study. DATA ANALYSIS:Measures of feasibility, tolerability and acceptability, and preliminary clinical outcomes will be compared between the VR and control groups in intention-to-treat analyses. Qualitative data from the focus group is thematically analyzed. Relevant participant characteristics (e.g., age, sex, baseline clinical characteristics) will be described across groups and may be considered in exploratory or sensitivity analyses, recognizing the limited statistical power of this pilot study. DISCUSSION:If successful, this study has the potential to establish feasibility of remote VR for individuals with AD-D. CLINICAL TRIALS:NCT06732128 For the reporting of the RCT, the Consolidated Standards of Reporting Trials (CONSORT) has been used.
Naturalistic Driving Studies (NDSs) offer a promising approach for assessing driving safety in older adults living with mild dementia. Traditional tools, such as on-road tests and driving simulators, often fall short in capturing everyday driving behaviour, as they are conducted in structured, time-limited, and sometimes stressful settings. In contrast, NDS can monitor real-world driving over extended periods and in natural contexts. This commentary reviews the current landscape of NDS involving individuals with mild dementia, outlining key limitations in study design, including heterogeneous sensor configurations, inconsistent driving metrics, and a lack of standard outcome definitions. To address these issues, we propose a next-generation framework for NDS design that emphasizes core sensor technologies such as inertial measurement unit, global positioning system, and cameras, and highlights the importance of integrated, resource-efficient systems. We offer recommendations to enhance the validity, comparability, and clinical utility of naturalistic driving methods in clinical research. Although the framework focuses on mild dementia, its principles may also be applied to other populations experiencing cognitive impairment.
INTRODUCTION:Hospital-induced immobility contributes to functional decline and delirium in older adults. This pilot study evaluated the preliminary efficacy of a multicomponent intervention - Help, Optimise and Mobilise Elders (H.O.M.E) in improving functional mobility among older adults in acute care. METHODS:A quasi-experimental study evaluated the H.O.M.E intervention in older inpatients. The intervention group (n = 42) received pre-mobilisation assessments, regular mobilisation, and weekly group physiotherapy and art activities, while the control group (n = 39) received usual care. Functional mobility and independence were assessed at baseline and discharge (maximum walking distance, gait speed, and the Modified Barthel Index). Secondary outcomes included delirium incidence and hospital length of stay. RESULTS:Linear regression showed the intervention group had significantly greater improvement in Modified Barthel Index scores than controls (B = 4.19, 95% CI: 0.60-7.79, p = 0.02), with no significant differences in gait speed, maximum walking distance, hospital stay or costs. Unadjusted logistic regression indicated that the intervention group had 65% lower odds of self-reported functional decline at 30 days post-discharge (odds ratio = 0.35, 95% CI: 0.12-0.99, p = 0.047). CONCLUSION:The H.O.M.E intervention improved functional independence during hospitalisation and may reduce medium-term functional decline, although limited post-discharge benefits highlight the need for continued care beyond hospitalisation.
Introduction: Routine physical symptoms can impact our everyday emotional experiences in adulthood and old age, with evidence of elevated emotional reactivity on days with more symptoms. Social support is known to profoundly influence emotional regulation in the face of challenge. Although different types and sources of support are known to differ in how helpful they are, this has not been tested for emotional reactivity to routine physical symptoms. We therefore examined (1) emotional support received in daily life, (2) perceptions of support from friends, and (3) from family, as moderators of emotional reactivity to routine physical symptoms. We also aimed to extend limited and inconsistent evidence on the moderating role of functional limitations and age. Methods: Multi-level models were applied to the MIDUS 3: Daily Diary Project (2017-2019), wherein 1,021 participants (Mage= 62.7; range= 43-90; 56% female) reported routine physical symptoms, emotional support received, positive and negative affect on eight consecutive days. Results: Evidence for the differential role of social support emerged: perceived support from family (but not friends) attenuated emotional reactivity while emotional reactivity was exacerbated on days when emotional support was received (but only for negative affect). No “spillover” effect indicated that the potentially negative role of received support is short-lived and context dependent. We found exacerbated emotional reactivity for those with more limitations, but age was unrelated. Conclusion: Findings add to the literature on the complex role of social support and functional health for handling the emotional ups and downs of everyday symptom as we age.
INTRODUCTION:The demand for total joint arthroplasty (TJA) continues to rise in an aging population, and evaluating the safety and outcomes of these procedures in octogenarians has become increasingly important. While advanced age is associated with increased medical complexity, including frailty, polypharmacy, and higher perioperative risk, growing evidence supports favorable outcomes of TJA in octogenarians, when patient selection and perioperative care are appropriately tailored. This study aimed to evaluate short-term perioperative outcomes among octogenarians undergoing planned same-day discharge after elective primary hip or knee arthroplasty and to contextualize these findings within optimization strategies for older surgical patients. METHODS:We conducted a retrospective case series of octogenarian patients who underwent elective primary total hip, total knee, or unicompartmental knee arthroplasty at a single orthopedic institution (2020-2023). Demographics, perioperative metrics, and 90-day outcomes were collected from the electronic health records and institutional surgical database. In parallel, a narrative review of the literature was performed to contextualize these findings within current optimization strategies for elderly arthroplasty patients. RESULTS:Fifteen patients met the inclusion criteria, with a mean age of 81.6 years, and 5 patients were female. The mean body mass index was 25.7 ± 2.3 kg/m2. Most patients were categorized as American Society of Anesthesiologists (ASA) II (n = 12), with ASA III (n = 2) and ASA I (n = 1). The median Charlson comorbidity index was 4. The most frequent comorbidities were hypertension (n = 10), diabetes mellitus (n = 3), and coronary/cardiovascular disease (n = 1). Procedures included either hip or knee arthroplasties with 8 total knee arthroplasties, 6 total hip arthroplasties, and 1 unicompartmental knee arthroplasty. The mean estimated blood loss was 100 ± 58 mL, and the mean operative time was 72 ± 19 min. All patients were discharged on the day of surgery, with a mean discharge time from the facility of approximately 4 h. There were no intraoperative complications and no readmissions within 30 or 90 days, and no perioperative adverse events were observed. Literature review highlights the value of geriatric comanagement, individualized anesthetic planning, early mobilization, and standardized discharge processes in reducing complications such as delirium, infection, and prolonged hospitalization. CONCLUSION:Primary same-day TJA can be safely and effectively performed in selected octogenarian patients when guided by comprehensive preoperative assessment and multidisciplinary perioperative care. This case series reinforces growing evidence that age alone should not preclude surgical intervention. Our findings contribute to an evolving understanding of evidence-based, age-inclusive arthroplasty practices.
INTRODUCTION:Physical and cognitive impairment constitute significant threats to healthy aging and the maintenance of independence but may be preventable through reduction of modifiable risk factors. While chronic stress has been linked to cognitive and physical function separately, few studies have accounted for combined decline. This study assessed associations between exposure to stressful life events (SLEs) and cognitive decline, physical decline, and combined physical and cognitive decline. METHODS:Data were taken from the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) cohort study of community-dwelling older adults in Finland (n = 701). SLE exposure was assessed retrospectively at baseline using a 32-item questionnaire. Cognitive function (mean z score) was based on 5 cognitive tests, while physical function was based on self-reported mobility and ability to perform activities of daily living. Both were assessed at baseline and follow-up (mean 8.3 years). A combined physical-cognitive function score was created by multiplying the cognitive and physical function scores. Multivariate multiple linear regression was conducted to assess associations between SLE exposure and decline in physical/cognitive function over time. RESULTS:Greater lifetime SLE exposure was associated with cognitive decline only in the presence of simultaneous physical decline. Recent SLEs were associated with cognitive decline alone, while non-recent SLEs were associated with physical decline. Acute SLEs (sudden onset, short duration), especially those related to bereavement, were associated with cognitive and physical decline individually and combined, while chronic SLEs (extended duration) were not. CONCLUSION:Both physical and cognitive function should be accounted for to understand the role of chronic stress in aging. Associations appear to depend on stress type and timing, providing insight into the temporal dynamics linking stressor exposure, cognitive decline, and physical decline.
INTRODUCTION:How people perceive their own aging may delay (or motivate) engagement in health behaviors in response to age-related decline. Hearing loss is a common, age-related condition but many adults delay help-seeking and underutilize hearing aids. We examined whether gain- and loss-focused awareness of age-related change (AARC) predict interindividual differences in hearing-related health behaviors. METHODS:Data were drawn from 503 adults (mean age = 64.06 years, 69.4% female) from Resilient Minds, an app-based research study. All participants reported at least some hearing difficulties (80.5% mild, 13.5% moderate, 6% severe). AARC gains and AARC losses were assessed using the 10-item Awareness of Age-Related Change questionnaire. Informal help-seeking, formal help-seeking, and hearing aid use were assessed using dichotomous items (yes/no). We conducted logistic regressions, adjusting for objective hearing (pure tone average), age, sex, socioeconomic status, social engagement, and comorbidities. Interaction terms assessed whether age moderated these associations. RESULTS:Higher AARC losses were associated with greater likelihood of formal help-seeking (odds ratio [OR] = 1.06, p = 0.04) and using hearing aids (OR = 1.13, p = 0.01). While AARC gains did not directly predict these behaviors, an age interaction showed that higher AARC gains were linked to informal help-seeking only among older adults. CONCLUSION:Awareness of age-related losses may be adaptive when it reflects realistic recognition of age-related challenges, like hearing difficulties. Promoting positive, gain-focused views of aging could support earlier informal help-seeking among older adults by encouraging open conversations about hearing concerns within their close social networks.
INTRODUCTION:Ischemic stroke (IS) remains a leading cause of global morbidity and mortality, necessitating novel therapeutic targets. MicroRNAs show promise in modulating post-stroke pathology, yet the role of miR-28-5p in IS remains unexplored. This study aimed to investigate miR-28-5p expression in IS and its clinical and mechanistic significance. METHODS:Serum miR-28-5p levels were quantified via qRT-PCR in 129 IS patients and 97 healthy controls. Kaplan-Meier (K-M) analysis and multivariate COX regression analysis evaluated the prognostic value of miR-28-5p in IS. In vitro, dual-luciferase assays validated the interaction between miR-28-5p and WNK3. Oxygen-glucose deprivation/reoxygenation (OGD/R)-treated HMC3 microglia were used to assess miR-28-5p/WNK3 axis in microglial polarization, oxidative stress, and inflammation. RESULTS:Serum miR-28-5p was significantly downregulated in IS patients, associated with elevated triglycerides, low-density lipoprotein cholesterol, reduced high-density lipoprotein cholesterol levels, and higher NIHSS scores. K-M analysis revealed a lower progression-free survival rate in IS patients with low miR-28-5p expression, and COX regression analysis confirmed miR-28-5p as an independent prognostic factor. In mechanism miR-28-5p directly targeted WNK3. Overexpression of miR-28-5p suppressed OGD/R-induced M1 polarization, oxidative stress (reduced malondialdehyde, elevated superoxide dismutase), and inflammatory cytokines (decreased TNF-α, IL-6, IL-1β, and increased IL-10), whereas WNK3 overexpression reversed these effects. CONCLUSION:MiR-28-5p served as a diagnostic biomarker and independent prognostic factor in IS. Its neuroprotection involved suppressing WNK3-mediated microglial M1 polarization, oxidative stress, and inflammation, highlighting its potential as a therapeutic target for IS.
INTRODUCTION:This study tests the moderating role of essentialist beliefs about aging (i.e., perceptions of aging as a fixed versus malleable process) in the relationship between physical functioning and subjective well-being distinguishing between (a) overall quality of life and (b) health satisfaction among older adults in clinical care. We propose that essentialist beliefs serve as adaptive, palliative cognitions that help maintain high subjective well-being despite health challenges. METHODS:Hospitalized multimorbid older adults in Germany (N = 102; 67-96 years) completed measures of essentialist beliefs about aging, quality of life and health satisfaction. Physical functioning was assessed using the Barthel-Index. Hierarchical multiple regression analyses tested whether essentialist beliefs moderated the association between physical functioning and subjective well-being. RESULTS:Essentialist beliefs significantly moderated the association between physical functioning and both indicators of subjective well-being. For quality of life, stronger essentialist beliefs were linked to more positive evaluations under poor physical functioning, whereas more flexible beliefs were associated with lower quality of life. In contrast, for health satisfaction, more flexible beliefs were associated with a stronger link between physical functioning and health satisfaction, while essentialist beliefs weakened this association. These effects were particularly evident at lower levels of physical functioning. CONCLUSION:These findings highlight the domain-specific role of aging beliefs and suggest that essentialist beliefs may serve as a psychological buffer under conditions of physical decline, while more malleable beliefs promote condition-congruent evaluations of health.
INTRODUCTION:Diabetes mellitus contributes to motor control impairments that can compromise balance and increase fall risk, particularly in older adults. Given that both the prevalence of aging and diabetes are increasing globally, understanding this relationship is vital for targeted fall prevention. This study examined the association between diabetes status and balance performance in older adults and assessed potential causal relationships using Mendelian randomization. METHODS:We analyzed 1,218 adults aged ≥60 years from the 2021-2023 National Health and Nutrition Examination Survey (NHANES). Participants were classified as nondiabetic (n = 248), prediabetic (n = 690), or diabetic (n = 280) on the basis of fasting glucose and HbA1c. Balance was evaluated via the modified Romberg test. Associations were examined via ordinal logistic regression, and causality was assessed via Mendelian randomization with diabetes-related genetic instruments. RESULTS:In fully adjusted models, diabetes was strongly associated with impaired balance (β = -0.88; 95% CI: -1.33 to -0.44; p < 0.001). Prediabetes also demonstrated a significant association with balance impairment (β = -0.53; 95% CI: -0.85 to -0.22; p < 0.001). Mendelian randomization provided evidence that genetically predicted diabetes was associated with increased fall risk (OR = 4.75; 95% CI: 1.48-15.24; p = 0.009). CONCLUSIONS:Observational analyses link diabetes and prediabetes to poorer balance performance, and genetic evidence supports an association between diabetes liability and increased fall risk.
INTRODUCTION:Sarcopenia and osteosarcopenia are increasingly prevalent among older adults. Exercise and nutritional support are key non-pharmacological treatments; however, their benefits may diminish after discontinuation. This study investigated the effects of a 6-month detraining period following a 6-month exercise program in postmenopausal Korean women with osteosarcopenia. METHODS:This study is a 6-month follow-up of an assessor-blinded randomized controlled trial (ERTO-K study). A total of 33 postmenopausal women with osteosarcopenia (mean age, 75.9 ± 5.2 years) who had completed a 6-month intervention were included. Osteosarcopenia was defined as osteopenia or osteoporosis based on WHO criteria and sarcopenia according to the AWGS 2019 guidelines. Participants were originally assigned to either progressive resistance exercise (RE group, n = 17) or home exercise (HE group, n = 16). Outcomes were assessed at the end of the intervention and after 6 months of detraining, including skeletal muscle index (SMI), handgrip strength (HGS), Short Physical Performance Battery (SPPB), Berg Balance Test (BBT), 4-meter gait speed, 5 times chair stand test, Muscle Quality Index (MQI), and bone mineral density (BMD). RESULTS:During the 6-month detraining period, no significant changes in SMI were observed. In contrast, lumbar spine BMD significantly decreased in both groups (RE: -0.014 g/cm2; HE: -0.017 g/cm2), and femoral neck BMD decreased in the RE group. HGS significantly decreased (RE: -2.28 kg; HE: -3.45 kg; both p < 0.001), as did 4-meter gait speed (RE: -0.27 m/s; HE: -0.20 m/s; both p < 0.001). The BBT score showed a small but significant decrease in the RE group, while no significant change was observed in the HE group. No significant changes were observed in SPPB score, 5 times chair stand time, or MQI. CONCLUSION:After 6 months of detraining, declines in muscle strength and gait speed were observed, while SMI remained unchanged and BMD decreased at specific sites. These findings suggest that functional measures and muscle strength may be more practical indicators for monitoring early changes during detraining than muscle mass.
INTRODUCTION:Unadopted intrinsic capacity (U-IC) may be an early indicator of loss of independence, reflecting the gap between intrinsic abilities and actual engagement in daily activities. Impairments in instrumental activities of daily living (IADLs) are central to this construct but are usually assessed subjectively. We developed and evaluated a remote patient monitoring solution that operationalizes U-IC by combining objective measures of mobility, IADL engagement, frailty, and patient-reported outcomes, and tested its ability to identify older adults with cognitive impairment and fallers, two key risk factors for loss of independence. METHODS:Community-dwelling adults aged 50-95 years were recruited from a convenience sample for this feasibility study. We examined U-IC-related risk factors including physical frailty, depression, self-reported IADL ability (Lawton Scale), remotely derived IADL inability (medication noncompliance, leisure disengagement, food-preparation inactivity), and mobility deficits (inactivity, postural transition, walking, and standing deficits). Cognitive status was classified using the Montreal Cognitive Assessment (MoCA; cutoff 25). All variables were normalized to a 1 to 10 scale (1 best, 10 worst) to support holistic visualization. Group-level comparisons by cognitive status and fall history were used to evaluate the discriminative ability of U-IC models. RESULTS:Sixty-four participants completed the assessment (cognitively healthy n = 22; cognitively impaired n = 42). U-IC metrics collected over 7 days (24/7) related to food-preparation inactivity (odds ratio (OR) = 3.76, p = 0.026) and leisure disengagement (OR = 3.42, p = 0.033) significantly differentiated cognitively impaired participants. Seventeen (27%) participants reported a fall in the past year and, versus non-fallers, showed greater slowness (OR = 3.70, p = 0.018), lower self-reported IADL ability (OR = 3.50, p = 0.034), and more postural transition deficits (OR = 3.00, p = 0.042). U-IC models incorporating key variables showed good discrimination for cognitive impairment (AUC = 0.80) and fair discrimination for fall status (AUC = 0.78). CONCLUSION:Remote, objective assessment of U-IC is a promising approach to identify older adults at high risk for loss of independence, including those with cognitive impairment and a history of falls. The remote monitoring platform and holistic visualization may serve as an efficient pre-screening tool to flag at-risk individuals and guide timely, multidimensional interventions. Longitudinal studies are needed to determine how changes in U-IC predict future loss of independence and response to targeted interventions.
INTRODUCTION:Previous studies have provided evidence for an association between hearing loss and cognitive decline. Patients with hearing loss may vary from the general population on several parameters that could influence their cognitive functions, including severity of hearing loss, age, and educational level. But to what extent cognitive impairments, as measured by clinical cognitive tests, are present in patients with hearing loss as compared with community samples have rarely been examined. Such studies would help determine whether specific attention to cognitive dysfunction should be provided as part of comprehensive hearing healthcare. This study sought to examine cognitive impairments in patients with hearing loss as compared with community-dwelling older adults across a range of cognitive domains. METHODS:Participants included a sample of patients from an audiological clinic (N = 83) and a community sample of older adults (N = 39). Performance on clinical cognitive tests were compared between groups using standard t tests or Mann-Whitney's U test. On each cognitive test, the proportion of individuals with impaired performance was classified. Impaired performance corresponded to a score at or below the 5th and 10th percentile cut-offs of Danish normative data. Among individuals in the clinical sample who showed cognitive impairment on at least one cognitive test, the proportion of individuals without subjective memory complaints was identified. RESULTS:Patients in the clinical sample performed significantly worse than the community sample on cognitive tests measuring processing speed, working memory, executive functions, verbal memory, and visuo-constructive abilities. In the clinical sample, 10%-15% of the patients were classified with impaired performance when applying the 5th percentile cut-off, and more than 15% were classified as impaired when applying the 10th percentile cut-off. Among patients in the clinical sample with impaired cognitive performance, 43.5% reported no memory problems. CONCLUSION:Patients from an audiological clinic had significantly worse performance across a range of cognitive tests when compared to a community sample, and 10%-15% had performance in the impaired range. These results emphasize that cognitive deficits are common in patients from an audiological clinic and that self-reports might not be reliable for identifying memory problems.
