Background: With increasing life expectancy, Sub-Saharan Africa is undergoing a demographic transition toward an aging population. Consequently, the burden of dementia, including Alzheimer's disease, is expected to rise, placing increasing pressure on healthcare systems with limited capacity for specialized long-term care. Amid this growing challenge, apathy has emerged as one of the most prevalent and clinically consequential neuropsychiatric symptoms of dementia. Despite its association with functional decline, poorer quality of life, and increased caregiver burden, apathy remains underrecognized and underinvestigated in both clinical practice and research across Sub Saharan Africa. Perspective: The recognition of apathy in dementia may be further complicated by the reliance on diagnostic frameworks developed primarily in Western populations. In many African settings, culturally embedded expectations regarding aging, social participation, and family support may influence how behavioral changes are interpreted, potentially obscuring early manifestations of apathy. For example, in communal, interdependent societies such as Ethiopia, where family structures and community networks shape the experience of aging, an older adult’s quiet withdrawal may be interpreted as a normal feature of aging or retirement rather than a distinct and clinically significant neurobehavioral syndrome. In the absence of localized empirical data and culturally validated assessment tools, regional prevalence estimates remain uncertain, caregiver burden cannot be accurately characterized, and progressive functional decline may go unnoticed. Conclusion: Improving dementia care beyond a narrow focus on memory requires a practical agenda that establishes regional baselines, validates culturally appropriate assessment tools, and strengthens neuropsychiatric training. Prioritizing apathy offers an achievable pathway toward dementia care models that are culturally responsive, clinically comprehensive, and grounded in the realities of African families.
Background Optimal blood pressure targets in the oldest-old remain uncertain. Ogimi Village, Okinawa, an internationally recognised exceptional longevity community, offers a distinctive setting in which to examine determinants of functional decline. Methods We analysed annual municipal health examinations in Ogimi (2015–2024): 225 assessments from 154 community-dwelling residents aged ≥65 years. Outcomes were loss of independence (LOI, long-term care insurance database) and all-cause mortality. Handgrip strength, chair-stand time, body mass index, muscle mass ratio, and the blood-pressure-adjusted left pulse wave velocity coefficient (lPWVC) were summarised by principal component analysis; Cox models used cluster-robust variance and multiple imputation (M = 20). Results Mean age was 83.6 years; 33 LOI events and 37 deaths occurred. Antihypertensive use was 52.9%, similar below and above age 90 (51.8% vs 55.9%, p = 0.694). Age ≥90 years was the strongest predictor of LOI (hazard ratio 5.06–5.52) and mortality (3.07, 95% CI 1.54–6.11), whereas systolic blood pressure predicted neither. Handgrip strength and chair-stand time were not independently predictive, although the lowest functional reserve tertile showed poorer LOI-free survival (log-rank p = 0.036). Among those aged ≥85 years, lPWVC was positively but non-significantly associated with LOI (odds ratio 1.53, 95% CI 0.65–3.61), and adding functional reserve scores and lPWVC to age improved discrimination (AUC 0.604 to 0.722). Conclusions Chronological age dominated functional decline in this longevity population, whereas higher systolic blood pressure conferred no excess risk, consistent with reverse epidemiology in the oldest-old. These observational findings are hypothesis-generating and are not evidence against antihypertensive treatment.
Alzheimer’s disease is the leading cause of dementia worldwide, and in Nigeria its burden is rising with population ageing while healthcare systems remain poorly equipped for long-term neurocognitive care. Pharmacological therapies offer only modest benefit, creating a need for accessible non-pharmacological approaches. Music-based interventions leverage preserved musical memory and emotional processing pathways, and evidence suggests they improve cognitive engagement, reduce agitation, enhance mood, and ease caregiver burden. However, implementation in Nigeria is constrained by a shortage of trained personnel, absence of structured dementia care programs, and minimal integration into neurology services. This letter argues for culturally adapted, low-cost music-based interventions within Nigeria’s dementia care framework, supported by local research and clinical integration.
Background Population aging and declining family caregiving capacity have increased unmet care needs among disabled older adults in China. In response, home- and community-based services have expanded to complement traditional family care. However, how unmet need and local service availability shape perceived need for social services remains unclear. Methods Using data from 6672 older adults with activities of daily living (ADL) limitations from four waves of the Chinese Longitudinal Healthy Longevity Survey (2005–2014), we applied multilevel logistic regression models to examine perceived need for eight types of social service programs. Key predictors included unmet need for care and the self-reported availability of neighborhood social services. Results Among Chinese older adults with ADL disability, 58% reported unmet need for care and more than half of respondents reported perceived need for social connection and basic care services. At the same time, 20% or less of respondents reported that social services were available in their neighborhoods. We found that both unmet need for care and available social services were positively associated with perceived need for social services. Furthermore, the availability of social services was associated with disabled older adults’ perceived need for a broader range of services, extending beyond those intended to address their specific unmet needs. Availability of basic care services was associated with decreased need for other services. These patterns did not substantially differ by unmet need for care or rural/urban residency. Conclusion Efforts to develop home- and community-based services for older adults should be driven by the gap between perceived need for services and availability of services. Services are needed in both rural and urban areas, for older adults whose needs are fully met by family and among those who have unmet need for care. Diverse service programs require financing, transportation, and outreach efforts to ensure equitable access.
Background Cardiometabolic diseases (CMDs) significantly contribute to U.S. morbidity. Physical activity (PA) is associated with lower CMD prevalence, yet trends in CMD prevalence by PA level and associated disparities remain underexplored. Methods We analyzed 2007–2018 NHANES data from 26,380 adults aged ≥20 years. CMDs included diabetes, cardiovascular disease (CVD), and chronic kidney disease (CKD; eGFR <60 mL/min/1.73 m² or ACR ≥30 mg/g). PA was categorized as no activity, some/irregular activity, or regular activity. Age-standardized prevalence and survey-weighted logistic regression estimated trends (reference: 2007–2008) and adjusted odds ratios (aORs). Results Diabetes prevalence increased, with higher odds in 2013–2014 (OR = 1.27; 95% CI: 1.01–1.60), 2015–2016 (OR = 1.41; 1.08–1.84), and 2017–2018 (OR = 1.45; 1.16–1.80) and an absolute increase of 2.49% (0.85 to 4.13). No significant trends were observed for CKD (absolute change: 0.11%; -1.57 to 1.80) or CVD (0.10%; -1.40 to 1.59). CMD prevalence was highest among those with no activity and lowest among regular activity. Regular PA was associated with lower odds of diabetes (aOR = 0.70; 0.62–0.79), CKD (aOR = 0.74; 0.65–0.83), and CVD (aOR = 0.75; 0.64–0.87); some/irregular activity was associated with lower odds of CVD only (aOR = 0.72; 0.62–0.85). Non-Hispanic Blacks had the highest CKD and CVD prevalence across PA levels; diabetes prevalence was highest among Mexican Americans with regular activity. Conclusion Diabetes prevalence increased significantly, while CKD and CVD prevalence remained stable. Guideline-adherent PA is associated with lower CMD odds, yet disparities underscore the need for equity-driven, culturally tailored PA promotion.
Background With the rapid growth of the aging population, an increasing number of individuals with cognitive impairment are being admitted to Class A tertiary hospitals in China, the country’s highest-level medical institutions. Despite the availability of multiple guidelines, their effective implementation in clinical practice within these settings remains insufficient. Methods This study examined barriers and facilitators to implementing evidence-based cognitive impairment care, particularly patient safety and functional preservation, in a Class A tertiary hospital in China. A descriptive qualitative design was adopted, guided by the Theoretical Domains Framework (TDF) to identify themes. Purposive sampling was used to recruit patients, caregivers, nurses, physicians, therapists, and social workers from the hospital for semi-structured interviews. Data were analyzed using an initial inductive coding approach, followed by deductive coding aligned with the TDF. Results A total of 39 participants were interviewed, and ten TDF domains were identified. The domains classified as barriers included knowledge, physical skills, environmental context and resources, social/professional role and identity, and beliefs about consequences. Domains identified as facilitators included cognitive and interpersonal skills, behavioral regulation, memory attention and decision processes, social influences, and intentions. Conclusions Caring for patients with cognitive impairment is complex and influenced by multilevel factors. This study provides valuable evidence to inform the development of evidence-based strategies aimed at improving care for these patients, promoting their safety and preserving functional abilities.
Background Japanese policymakers seek to develop a national system for monitoring nursing home quality, yet limited evidence is available about current quality of care and its relationship with strains on the direct-care workforce from Japan’s declining working-age population and growing cohorts of frail older adults. Methods We analyzed survey data from >1000 Japanese nursing homes collected in 2020, 2022, and 2024. We linked these data with administrative data and conducted multivariable regressions assessing the relationship between direct-care staffing and two measures of quality of care: pressure ulcers and restraint use. We adjusted for facility characteristics and resident care need severity. Results More full-time equivalent direct-care staff per resident is associated with fewer pressure ulcers among residents. An increase of one direct care worker full-time equivalent is associated with 2.74 (95% CI: [1.59, 3.89]) fewer patient ulcers in our baseline analysis and 3.17 (95% CI: [1.41, 4.93]) fewer patient ulcers when additionally controlling for staff turnover. Increases in the full-time equivalent numbers of care workers or nurses are also separately associated with fewer patient ulcers. Staffing is not statistically significantly associated with use of restraints. Conclusions Higher levels of full-time-equivalent direct-care staff per resident are associated with lower prevalence of pressure ulcers. These findings contribute to the limited evidence base on staffing and care quality in Japan as the country develops more systematic quality monitoring in long-term care.
Background With the increasing aging population, the number of older adults with epilepsy (OAE) is growing, a trend that warrants greater attention. The aim of this systematic review is to summarize the cognitive comorbidities in OAE and to identify the factors associated with cognitive impairment in this population. Methods We searched original research articles in three databases (PubMed, Web of Science, and EMBASE) between November 12th, 2019, and November 12th, 2025, on the cognitive performance of OAE and its related conditions. A total of 62 articles were included for the final analysis, strictly following the PRISMA guideline. Results Cross-sectional studies indicated that the median percentage of cognitive impairment in OAE was 51.6% (25.9∼87%). Memory (31.5% [29.3∼44.0%]), language (38% [15.0∼39.8%]), and executive (35.0% [25.0∼41.0%]) functions were also impaired. 14.0% (5.9∼49.9%) of OAE presented with dementia at the first diagnosis, and they were 2.5 times more likely to develop dementia than controls, which could contribute to premature death and other clinical outcomes. Factors including demographic features, seizure-related conditions, clinical comorbidities, antiseizure medications (ASMs), and surgery contributed to cognitive decline in OAE. Conclusions Cognitive impairment is common among OAE. Clinicians should pay more attention to this cognitive comorbidity in OAE and manage the related factors that may worsen the situation. Early identifications and targeted interventions may help delay cognitive deterioration, improve quality of life, and reduce healthcare burden.
Background: Mobility is fundamental to healthy aging. Forward gait velocity (GV) is a well-established measure of fall risk, but fewer studies assess backward GV with respect to fall history and fear of falling in community-dwelling adults. Methods: Independently ambulatory, community-dwelling adults (n=39) completed forward and backward gait assessments and surveys on fall history and fear of falling. Younger adults (n=20) were aged 18-30 years, and older adults (n=19) were ≥60 years. Forward and backward gait were compared by age group and relationships among gait and fall variables were quantified with correlation coefficients. Results: One-quarter of adults reported a fall in the previous year. Compared to older adults, younger adults exhibited faster forward GV (138.3 cm/sec ±16.5 vs. 119.3 cm/sec ±23.4; p<0.01) and backward GV (82.6 cm/sec ±18.2 vs. 63.8 cm/sec ±20.7; p<0.01). Among older adults, backward GV was negatively correlated with fear of falling (r=-0.58; p<0.01) and explained a greater proportion of variance in fear of falling compared to forward GV (33.9% vs. 24.8%). Conclusions: Backward walking is an important yet underappreciated measure of mobility and fear of falling in community-dwelling adults.
Background:Multi-component interventions may be critical for reducing Alzheimer's disease (AD) risk since AD pathogenesis is multi-factorial. Combined Aerobic exercise and Cognitive Training (ACT) may have synergistic effects, but studies are limited with mixed findings. Methods:A 3-site, single-blinded Stage II 2 × 2 factorial trial aimed to test the effects of 6-month ACT on cognition in older adults with amnestic mild cognitive impairment in academic research facilities and gyms. Among 325 participants consented, 146 were enrolled and randomized equally to 6-month ACT, cycling only, speed of processing (SOP) cognitive training only, or control. Primary outcomes, executive function and episodic memory, were measured with alternating EXAMINER and Brief Visuospatial Memory Test-Revised (BVMT-R) forms at baseline, 3, 6, 12, and 18 months, and global cognition with the Montreal Cognitive Assessment (MoCA) and EXAMINER/BVMT-R composite. Results:Executive function improved significantly from baseline to 6 months (ds = 0.58-1.18, adjusted Ps < 0.001-0.026) in all groups except SOP. Global cognition composite increased in cycling only (d = 0.73; adjusted P = 0.012). MoCA decreased over 18 months (adjusted P = 0.030) in the control group only. Between-group comparison was significant between ACT and SOP groups at 6 months (adjusted P = 0.029), but sensitivity analyses showed ACT being superior to both cycling- and SOP-only groups (Ps = 0.030 and 0.002, respectively) among in-person interventions (48.6% of all sessions were delivered in person as designed due to COVID-19). Conclusions:ACT's synergistic effects remain to be determined. All interventions are feasible for clinical practice. Trial Registration:www.clinicaltrials.gov (NCT03313895; date of registration: 10/18/2017).
Background Type 2 diabetes is linked to a high prevalence of oral health problems, but whether poor oral health contributes to diabetes risk remains unclear. This study examined the association between various oral health markers and the incidence of type 2 diabetes. Methods Data were derived from the British Regional Heart Study cohort of men aged 71–92 years (n=2147) across 24 UK towns. Oral health markers included tooth count, periodontal disease, dry mouth, self-rated oral health, denture use, and associated difficulties. Participants were followed for 8 years (2010–2018) for diabetes incidence using General Practice records. Cox regression models adjusted for age, BMI, social class, smoking, alcohol use, physical activity, and medical history. Results Among 1908 men without diabetes at baseline, 78 developed diabetes during follow-up. Significant associations with diabetes risk were observed for complete tooth loss (Hazard ratio (HR)=4.03, 95% Confidence Interval (CI) =1.83–8.86), poor/fair self-rated oral health (HR=2.63, 95% CI=1.50–4.62), denture use or no dentures among those with no natural teeth (HR=2.91, 95% CI=1.36–6.22), and having ≥2 oral health problems causing difficulty in daily tasks (HR=3.10, 95% CI=1.27–7.55). Conclusion Poor oral health, including tooth loss, poor self-rated oral health, and difficulties associated with oral health problems, was significantly linked to an increased risk of developing type 2 diabetes in older adults. Further research is needed to clarify the underlying mechanisms and explore whether improving oral health can reduce the risk of diabetes in older men.
Background Structured exercises and interdisciplinary approaches may uncover insights regarding longstanding and intractable concerns, including barriers to and opportunities for achieving oral health for impoverished older adults. This study integrates qualitative social and systems science approaches to identify leverage points at individual, interpersonal, community, and societal levels with which to develop interventions that promote oral health equity for racial/ethnic minority older adults living in disadvantaged northern Manhattan neighborhoods of New York, NY, USA. Methods Twenty-four focus group sessions were conducted at community sites with African American, Dominican, and Puerto Rican older adults, and 16 key informant interviews were conducted at senior centers with staff. Group model-building workshops were held annually in person with the research team to articulate feedback mechanisms across various levels that reflected insights from qualitative data analysis. Results Among the feedback mechanisms identified was a reinforcing loop that explicates the relationship between oral health and social engagement, and consequences of communication by word of mouth for patient oral health awareness. An intervention affecting this feedback loop is caregiver support for oral hygiene at the interpersonal level that has a positive impact on oral health at the individual level, enabling this reinforcing loop to operate as a virtuous cycle. Conversely, lack of caregiver support could induce a vicious cycle of deteriorating oral health. These insights contributed to conceptual and computational simulation models. Conclusions Multilevel insights on promoting oral health equity for older adults arose from community-based research involving qualitative data analysis, group model-building activities, and dynamic simulation modeling.
Background Cognitive impairment refers to difficulties in concentration, memory, learning new skills, or decision-making those affect daily functioning. This study aimed to determine the prevalence of cognitive impairment among older adults in Bahir Dar, Northwest Ethiopia, and to identify associated factors. Methods A community-based cross-sectional study was conducted from January to May 2023. A total of 591 participants were selected using a multistage cluster sampling technique. Variables with an adjusted odds ratio (AOR) and 95% confidence interval (CI), with a p-value < 0.05, were considered significantly associated with cognitive impairment Results The overall prevalence of cognitive impairment among older adults was 56.3% (95% CI: 52.34–60.36). Factors significantly associated with cognitive impairment included age >75 years (AOR = 2.09, 95% CI: 1.29–3.39), inability to read and write (AOR = 5.54, 95% CI: 2.51–12.23), primary education (AOR = 3.02, 95% CI: 1.85–4.95), depressive symptoms (AOR = 2.56, 95% CI: 1.23–5.31), anxiety (AOR = 2.12, 95% CI: 1.44–3.13), diabetes mellitus (AOR = 2.08, 95% CI: 1.05–4.11), hypertension (AOR = 2.13, 95% CI: 1.20–3.78), and functional limitation (AOR = 2.13, 95% CI: 1.09–4.19). Conclusions The high prevalence of cognitive impairment among older adults in Bahir Dar highlights the urgent need to prioritize it as a public health concern.
Background: Multiple long-term conditions (MLTCs), defined as two or more long-term conditions (LTCs), represent a growing public health challenge. However, the rate and timing at which additional conditions are acquired after MLTC onset remain poorly understood. It is unclear when individuals are at greatest risk of further accumulation or which sociodemographic groups experience faster progression. We aimed to quantify the rate and timing of MLTC accumulation in England and assess sociodemographic influences following MLTC onset. Methods: We conducted a retrospective cohort study using Clinical Practice Research Datalink (CPRD) Gold and Aurum data from 1987 to 2020. Adults aged >= 18 years with at least two LTCs were followed longitudinally through successive diagnoses up to their tenth condition. Median transition times between diagnoses were estimated to characterise accumulation patterns. To assess sociodemographic influences on MLTC accumulation, we applied random forest regression with one-hot encoded sociodemographic and clinical features to predict the number of LTCs acquired within 10 years after the second diagnosis. Feature importance metrics and R2 were used to evaluate predictors. Results: Among 7286,481 adults, the median time between diagnoses declined from 32.6 months between the second and third condition to 5.1 months between the ninth and tenth. Most additional conditions were diagnosed within three years following the second LTC. In the random forest model, older age was the strongest predictor of faster accumulation, followed by cardiovascular and mental health conditions at baseline, female sex, greater deprivation, and Asian ethnicity. The model explained 32.4% of the variance in 10-year LTC accumulation (R2 = 0.324). Conclusions: MLTC accumulation accelerated after the second diagnosis, identifying an early period of increased risk. Random forest analyses showed that sociodemographic and clinical factors were associated with faster accumulation, although predictive performance was moderate. These findings highlight a potential window for targeted intervention following MLTC onset.
Background: Continuous EEG has been proposed to improve detection of epileptiform activity in older patients presenting with acute confusional state (ACS), but its added value outside critical care and in resource-limited settings remains uncertain. Methods: We conducted a prospective observational pilot study including 40 patients aged >= 65 years admitted with acute confusional state of unknown aetiology after initial clinical, laboratory, and neuroimaging work-up in a resource-limited setting. All patients underwent sequential EEG recordings of 20 min, 30 min, and 3 h using a standard 10-20 electrode system. EEGs were independently reviewed by two EEG-trained neurologists and classified according to established consensus criteria. Potentially clinically significant findings included interictal epileptiform discharges, periodic and rhythmic patterns. Results: Only one patient (2.5 %) demonstrated a new potentially clinically significant EEG finding on 30 min compared to 20 min EEG. Seven of 40 EEGs (17.5 %) revealed additional abnormalities on 3 h EEG compared with the initial 30 min recording. However, only four cases (10 %) were considered potentially clinically significant. The increase in diagnostic yield with prolonged EEG was not statistically significant (p = 0.125), and no clinical, laboratory, or imaging predictors of additional findings were identified. Conclusion: In older patients with acute confusional state of unknown aetiology, extending EEG recording to 3 h resulted in a small, statistically non-significant increase in diagnostic yield. Most clinically relevant EEG abnormalities were detected within the first 30 min, suggesting limited added value of routine prolonged EEG in resource-limited setting.
Background: Older adults residing in long-term care homes often experience isolation, resulting in increased feelings of vulnerability, reduced quality of life, and poorer health outcomes. Social support interventions may serve to mitigate or improve these outcomes; however, the effectiveness of such interventions on life satisfaction has not been formally compared in a systematic review. This systematic review aims to assess the comparative effectiveness of social support-based interventions for adults 65 years and older living in long-term care homes on life satisfaction. Methods: A systematic literature review was conducted in Ovid EMBASE, Ovid MEDLINE, CINAHL, and Cochrane CENTRAL from database inception through November 23, 2025. To be eligible for inclusion, studies had to be comparative and report on the outcome of life satisfaction. Two reviewers screened titles and abstracts, and full-text records independently and in duplicate. Reviewers assessed study limitations using the Cochrane Risk of Bias 2.0 instrument. Certainty of evidence was assessed using the GRADE approach. Results: Of 13,004 records identified, fourteen studies met the eligibility criteria for this review. Social support interventions reported in the literature include life reminiscence program, intergenerational program, music intervention, general support, mentorship program and group activities. Life satisfaction was reported using Life Satisfaction Index (LISA), Life Satisfaction Scale (LSS), Quality of Life Index (QLI), Satisfaction with Life Scale (SWLS), PGC Morale Scale, and Satisfaction with life in the home. Evidence of support intervention effectiveness on life satisfaction was found to be moderate in both randomized (SMD = 0.79 [95% CI, -0.66 to 2.25]) and non-randomized studies (SMD = 0.55 [95% CI, 0.01 to 1.08]) due to concerns with risk of bias and imprecision. Conclusions: This review demonstrates that social support interventions may improve life satisfaction in adults 65 years and older. However, further analysis and research should be conducted.
Background: The gut microbiome is increasingly recognized as a key modulator of frailty. a systematic bibliometric assessment of this rapidly evolving research domain has been lacking. This study aimed to conduct a comprehensive bibliometric analysis to map the research landscape, intellectual structure, and thematic trends in the field of gut microbiota and frailty. Methods: 1,405 publications indexed in the Web of Science Core Collection(from 2010 to 2025) using bibliometric tools (VOSviewer and CiteSpace). The analysis evaluated annual publication outputs, international collaborations, journal contributions, and thematic evolution, with particular focus on microbiota-specific methodologies (e.g., 16S rRNA sequencing, metagenomics) and interventions (e.g., probiotics, fecal microbiota transplantation). Results: 1405 publications related to gut bacteria and aging have been published.Publication output exhibited exponential growth, increasing from 16 in 2010 to 248 in 2024 (R² = 0.994). The United States(386 papers) and China (n = 364 papers) were the most productive countries, whereas European nations—particularly the Netherlands and France—achieved the highest average citation impact. Thematic progression revealed an evolution from early descriptive studies of microbiome composition to mechanistic investigations of host–microbe interactions and, more recently, clinical trials involving dietary and other interventions. Keyword analysis identified central mechanistic themes such as the gut–brain axis, short-chain fatty acids, and inflammatory biomarkers, alongside emerging topics including post-COVID-19 frailty and exercise-based microbiota modulation. Conclusion: Research investigating the association between gut microbiota composition and frailty is expanding rapidly. To advance mechanistic understanding and support clinical translation, future studies should prioritize the integration of multi-omics data and the implementation of rigorously designed randomized controlled trials to establish causal inference and inform evidence-based interventions.
Dementia is becoming a growing public health concern around the world, and in low-resource environments like Sub-Saharan Africa, where under diagnosis and lack of access to specialist care are significant challenges, the condition is a growing burden. Artificial intelligence (AI) has become one of the promising tools to aid in the diagnosis, management, and care of dementia; however, its implementation in resource- limited settings requires careful consideration. This letter identifies the possible use of AI to improve early detection with mobile and computerized cognitive screening devices, assist caregivers by using digital technologies, and monitor individuals with dementia. At the same time, it underscores critical challenges, including infrastructural limitations, cultural acceptability, data privacy concerns, algorithmic bias due to underrepresentation of African populations, and weak governance frameworks. Our argument is that to effectively integrate AI into dementia care in Africa, it is important to focus on context sensitive design, ethical oversight, capacity building, and robust local and global partnerships to achieve this goal.
