Glucagon-Like peptide-1 receptor agonists (GLP-1-RAs) are increasingly prescribed for type 2 diabetes mellitus and chronic weight management, especially for the rapidly-growing population of older adults. However, older adults are also at heightened risk for sarcopenia and frailty, raising morbidity concerns about GLP-1-RA-induced lean body mass loss. This narrative review summarizes recent studies estimating skeletal muscle mass and/or volume, strength, composition, performance, and acute physiological responses during GLP-1-RA therapy in humans, with particular attention to implications for older adults. Because direct evidence in older adults is scarce, this review primarily synthesizes data from general adult populations and reasonably extrapolates implications for older adults. Most studies found that GLP-1-RA therapy was associated with a loss of skeletal muscle mass, accounting for up to 8.5% to 24.5% of total weight loss. Studies assessing muscle quality mostly saw improved muscle quality following GLP-1-RA therapy due to higher muscle density and decreased fat content. Studies measuring muscle strength generally found no significant change. However, from 21 included studies, only four studies specifically examined the older adult population, being methodologically heterogeneous and difficult to compare. The limited published literature in older adults provides insufficient evidence to determine age-related vulnerability to skeletal muscle loss while on GLP-1-RA and the potential clinical complications of resultant frailty; additional research in older adult populations is needed. Provisional considerations for preserving muscle mass during GLP-1-RA therapy are discussed, with particular relevance to older adults. This review demonstrates that the degree of skeletal muscle loss is variable but can account for a meaningful fraction of weight lost during therapy. Providers should consider these potential effects when prescribing GLP-1-RAs, especially in older adults at risk for frailty.
Background Prevention trials for Alzheimer’s Disease face significant challenges due to the slow and uncertain rate of cognitive decline in asymptomatic, amyloid-positive individuals. Biomarker positivity alone does not guarantee clinically meaningful progression, often leaving studies underpowered. Objectives Evaluate model-based operational trial enrichment within an amyloid-positive, cognitively normal subgroup. Methods Trained on a small cohort from the National Alzheimer’s Coordinating Center (N = 113), with external validation using baseline data of a similar small cohort from the Alzheimer's Disease Neuroimaging Initiative (N = 161). Gradient-boosted decision trees estimated progression risk and projected power under alternative enrollment strategies. Predictors included neuropsychological scores, demographics, medical history, and ApoE ε4 genotype. The primary outcome was clinical progression to cognitive impairment within 1- and 3-year follow-up windows. Results In the independent testing set, the model successfully increased the effective prevalence of the outcome. The Positive Predictive Value for the 1-year window was 0.27 (a 35% relative increase over the 0.20 baseline prevalence) and 0.43 for the 3-year window (a 23% relative increase over the 0.35 baseline). Power simulations for an emulated trial (N = 500) demonstrated that this enrichment strategy consistently increased statistical power, potentially reducing the required sample size to achieve 80% power by up to 32% for small treatment effect sizes. Conclusions This operational methodology functions as a screening filter to optimize event rates within a highly specific, preselected trial population.
Background: Frailty is a recognized predictor of adverse outcomes after percutaneous coronary intervention (PCI), but its long-term association with mortality and health-related quality of life (HRQoL) remains uncertain. This study evaluated the three-year association between discharge frailty and subsequent frailty, mortality, and HRQoL in post-PCI patients. Methods: This retrospective cohort study included patients with acute myocardial infarction (AMI) who underwent PCI, required ICU/CICU admission with mechanical ventilation and/or advanced life support, and remained alive at routine 6-month follow-up. Frailty was assessed at discharge and reassessed after three years. HRQoL was assessed using the EQ-5D-3 L descriptive system and summarised using a study-specific level-sum impairment score; this was not a preference-weighted EQ-5D utility index. Results: Among 164 patients, 131 (79.9%) were frail at discharge. During three-year follow-up, 51 patients (31.1%) died. Crude mortality did not differ significantly between frail and non-frail patients (32.1%vs. 27.3%; p = 0.595). In adjusted logistic regression, moderate-to-severe discharge frailty was independently associated with death during the follow-up interval (adjusted OR 2.55; 95% CI 1.06–6.11; p = 0.036). Among survivors, 43 (38.1%) remained frail at follow-up. Moderate-to-severe discharge frailty was associated with moderate-to-severe frailty at three-year follow-up (adjusted OR 12.75; 95% CI 1.84–88.35; p = 0.010), although the wide confidence interval indicates limited precision and supports an exploratory interpretation. Poor HRQoL, defined as an EQ-5D-3 L level-sum score ≥8, was present in 33 survivors. Neither age >60 years (adjusted OR 1.56; 95% CI 0.44–5.53; p = 0.492) nor discharge frailty was independently associated with poor HRQoL. Conclusion: Among mechanically ventilated AMI patients undergoing PCI who survived to routine 6-month follow-up, moderate-to-severe frailty at hospital discharge was independently associated with death during the three-year follow-up interval. It was also associated with moderate-to-severe frailty at follow-up, although this estimate was imprecise and should be interpreted as hypothesis-generating. Discharge frailty was not independently associated with poor long-term HRQoL.
South Korea became a "super-aged society" in December 2024, as baby boomers entered the senior population (65+) amid declining birth rates and population aging. In response, the government introduced the Korean-version Continuing Care Retirement Community (K-CCRC) policy in 2020 to encourage baby boomers in metropolitan areas to relocate to non-metropolitan regions, interact with diverse generations, and enjoy a healthy, vibrant retirement. The policy was originally based on a 2011 web-based survey reporting a 66.3% potential rural relocation rate. However, this data is now outdated due to limited geographic scope, exclusion of digitally illiterate older adults, and over a decade of social and economic changes. A new face-to-face interview survey was therefore conducted to assess current relocation intentions, preferred areas, and housing types among metropolitan baby boomers. The results were analyzed using Necessity-Effectiveness Analysis (NEA) and Importance-Performance Analysis (IPA) to identify priority areas for relocation promotion and settlement support. Findings show that respondents were predominantly middle class, with high education levels, monthly incomes of 4-5 million KRW, and average household assets of 835 million KRW-suggesting a need to expand housing support beyond low-income groups. Willingness to participate in the K-CCRC reached 80.6% in the current survey. Direct comparison with the 2011 Fig. of 66.3% should be interpreted with caution given substantial differences in geographic scope, target cohort, survey administration mode, and question framing between the two studies (see Table 1). Preferred destinations were within an hour of the Seoul metropolitan area (76.3%) and near medical facilities (35.7%). Desired housing types included low-rise apartments (34.1%), 66-99m² units (33.4%), and mixed ownership-rental complexes (43.8%). Key relocation support needs included financial assistance and regulatory easing to facilitate the sale of existing properties. Settlement support priorities included improved parks, local amenities, safety infrastructure, and access to public services.
Background:Community and senior centers are focal points of community-based services. Despite their pivotal role in the aging continuum of care and in light of anticipated budgetary cuts impacting the Older Americans Act, their relevance is suggested to decrease in the US. Methods:Using NHANES (National Health and Nutrition Examination Survey) data from 2009 to 2023, we described national secular trends in the proportion of US adults aged ≥60 years reporting community/senior center meals (CSCMs). Sociodemographic factors associated with CSCMs consumption were identified using multivariable logistic regression. Results:Data from 514 participants eating CSCMs were analyzed. The proportion of individuals reporting CSCMs ranged from 6.4% (in 2009-2010) to 2.4% (in 2021-2023). Participants reporting CSCMs were predominantly female (64.43%), widowed/divorced (47%), and had an annual income <20,000$ (35.85%). In comparison to males, females who did not complete the 9th grade and female college graduates were less likely to eat CSCMs (Odds Ratios (OR): 0.31 (0.18-0.55) and 0.30 (0.14-0.66), respectively; P = 0.001). Conclusions:>2% of the older population currently obtains CSCMs. Given their participation-based reimbursement model, community and senior centers offering meals could soon become a relic of the past. Public health strategies may consider the herein presented participation predictors to tailor individualized programs, increasing attendance.
Background:Older adults face multiple barriers that limit their engagement with social media. Objective:This systematic review aims to identify, categorize, and synthesize the barriers to social media adoption among older adults. Methods:A systematic search was conducted across six electronic databases without time restrictions. Studies were included if they involved participants aged 60+ years (or mean age 60+ years) and reported barriers to social media. Quality appraisal was performed using the Mixed Methods Appraisal Tool (MMAT). A total of 32 studies were included and synthesized thematically. Results:Technical competency issues, including difficulties with device operation, updates, and Information and Communication Technology (ICT) literacy, were prevalent. Privacy and security concerns were consistently reported as critical obstacles. Educational support limitations, reduced learning speed, psychosocial factors (e.g., low self-efficacy), and socioeconomic constraints were also reported. This review synthesizes reported barriers and can inform the design of future studies and the development of strategies to promote digital inclusion among older adults.
Background:Anti-amyloid monoclonal antibodies (lecanemab and donanemab) represent the first disease-modifying therapies for early symptomatic Alzheimer's disease (AD)- Italy's National Health Service (SSN) must determine whether to include these therapies within Essential Levels of Care (LEA), requiring reimbursement across all regions. Objective:To conduct a three-year budget impact analysis and implementation feasibility assessment for anti-amyloid therapies in Italy. The analysis was scenario-based rather than empirical. Methods:Deterministic budget modeling, combined with Proctor's 8-Domain Implementation Outcomes Framework and the Consolidated Framework for Implementation Research (CFIR), was employed. Four implementation scenarios were modeled based on cumulative patient uptake rates. Cost analysis incorporated diagnostic pathways, drug acquisition, clinical surveillance, and management of amyloid-related imaging abnormalities (ARIA). Infrastructure capacity was assessed through national survey data of Centers for Cognitive Disorders and Dementia (CCDDs). Results:An estimated 42,000 patients in Italy are potentially eligible for anti-amyloid therapy. The moderate scenario (5-10-15% uptake over three years, reaching 14,100 cumulative patients) represents the optimal policy target, with estimated three-year total costs of €557.3 million (0.4% of the annual SSN budget), penetration of 33.6% of eligible patients, and a feasibility score of 1.5, underscoring a high implementation success probability. The moderate scenario remains financially sustainable but requires targeted infrastructure investment in the Central and Southern regions. Conclusions:Anti-amyloid therapy implementation is feasible within Italian healthcare system constraints under a moderate uptake scenario. However, achievement of equitable access requires substantial capacity building in underserved regions, clarified reimbursement policies, integrated diagnostic networks, and robust workforce planning before full LEA inclusion is recommended.
Hip fractures in older adults are associated with substantial morbidity, loss of independence, and increased mortality, particularly in an aging society such as Japan. Although the risk of subsequent fractures after hip fracture is well recognized, discharge-related risk factors have not been fully evaluated. We conducted a retrospective cohort study using electronic medical records from Higashi-Kawaguchi Hospital, including patients hospitalized for hip fractures between April 1, 2015, and March 31, 2020. Patients were followed from the date of discharge to the date of subsequent fracture or to the last date of a confirmed medical record by our hospital until March 31, 2022. The incidence of subsequent fractures was determined, and hazard ratios (HRs) were calculated using Cox proportional hazards analysis to identify discharge-related risk factors. Among the 620 patients included, 131 patients (21.1%) experienced subsequent fractures, with 60 (9.7%) occurring within 12 months after discharge. Patients with subsequent fractures were more likely to be female, significantly older, and showed differences in osteoporosis medication use and the use of fracture risk-associated drugs in unadjusted analyses. The Cox proportional hazards model identified age by decade (HR: 1.71; 95% CI 1.35-2.16) and lower body mass index (BMI) (HR: 0.92; 95% CI: 0.86-0.97) as significant risk factors for subsequent fractures. These findings highlight the importance of discharge-based risk assessment and targeted post-discharge interventions for older patients and those with low BMI, given the high incidence of subsequent fractures within 12 months after discharge.
Background:Community-based lifestyle interventions, including nature-based and Green Care activities, are associated with improved psychological well-being among older adults. However, these programs are often delivered as standardized interventions without systematic alignment with individual functional capacity or psychosocial needs. The World Health Organization's Integrated Care for Older People (ICOPE) framework is a person-centred, integrated care approach spanning assessment, care planning, and community linkage, offering a multidimensional structure for assessing intrinsic capacity and guiding personalized participation. Objective:This study examined the association between participation in community-based lifestyle intervention domains and psychological well-being among rural older adults and evaluated the potential of the ICOPE framework as a classification structure for precision community participation. Methods:A cross-sectional study was conducted among community-dwelling older adults in rural Taiwan. Psychological well-being was assessed using the WHO-5 Well-Being Index. Participation in lifestyle intervention domains was analyzed, and cluster analysis was used to identify heterogeneous participation profiles. Results:Distinct participation clusters with varying well-being profiles were identified. Higher engagement in community-based and nature-based interventions was associated with significantly higher psychological well-being. Conclusion:Community-based lifestyle and Green Care interventions were associated with psychological well-being outcomes among rural older adults. As a person-centred, integrated care framework, ICOPE offers a promising conceptual structure for organizing community participation programs and supporting precision social prescribing, though direct testing of ICOPE-guided intervention matching was beyond the scope of this study. Personalized community-based health promotion.
Introduction and aim:Texture-modified diets (TMDs) are commonly required for older adults but are associated with nutritional risks. The nutritional quality of TMDs provided in long-term care (LTC) facilities in Ireland is understudied. This study evaluated the nutritional quality of TMDs in one LTC facility against international menu standards and dietary reference values. Methods:A cross-sectional nutritional analysis of TMDs (International Dysphagia Diet Standardisation Initiative Levels 3-6) was conducted over two non-consecutive days in a residential long-term care facility in Ireland, encompassing all foods, drinks, and recipes as served over two typical days for Levels 3-6. Items were quantified and analysed using Nutritics (v6) and R (v4.3.3). Mean (SD) daily and per-meal energy and protein provision were compared with standards from the British Dietetic Association (BDA) Nutrition and Hydration Digest, the BDA Care Home Digest, and Canadian Menu Planning in LTC guidance. Other macro- and micronutrients were assessed against dietary reference values. Results:Mean daily energy and protein provision were below recommended standards for all TMDs, except energy at Level 3. Per-meal provision was also suboptimal for most meals, except protein at Level 3 for lunch. All TMDs exceeded recommended total and saturated fat ranges and failed to meet dietary fibre targets, while sodium met guidelines. All TMD Levels were below recommendations for vitamin D (except for Level 3), vitamin C, potassium, magnesium, iron and zinc. Conclusion:Routine TMD provision in this facility did not meet key nutrient standards, highlighting potential nutritional vulnerability among LTC residents. Improved menu planning, enrichment strategies, staff training, and clearer guidance are required, although further work examining intake and outcomes is needed.
Background/Objective:Frailty predicts adverse outcomes in critically ill patients. Characterizing and measuring frailty in the intensive care unit is challenging since most frailty scales are created for the outpatient population. Temporalis muscle thickness (TMT), measured on head imaging, decreases in patients with sarcopenia and may offer an objective index of frailty among patients with SABI. The objective of this study was to test the relationship between TMT and the Clinical Frailty Scale (CFS) in this population. Methods:In this prospective, single-center, observational cohort study, we enrolled subjects with SABI who had routine head computed tomography within 48 h of hospital admission. We calculated Spearman and Pearson correlation coefficients between CFS, TMT, and age. We also tested the relationship between CFS and TMT using multivariable ordinal regression. Finally, we compared the values of TMT and CFS in this cohort with those observed in a post-cardiac arrest cohort. Results:In 51 enrolled patients, TMT was negatively correlated with CFS (ρ = -0.32, p = 0.02) and age (r = -0.45, p = 0.001), while CFS was positively correlated with age (ρ = 0.31, p = 0.03). The relationship between TMT and CFS remained significant when adjusted for albumin level and body mass index (OR 0.63, 95%CI 0.40-0.98). Median TMT and CFS values did not differ between the SABI and post-arrest cohorts, though the shapes of their distributions did. Conclusions:TMT demonstrated a moderate correlation with pre-morbid CFS in patients with SABI, suggesting it might aid in characterizing frailty in this population.
Background:Frailty in older adults with type 2 diabetes mellitus (T2DM) is metabolically heterogeneous, but whether multicomponent exercise (MCE) produces phenotype-specific functional benefit remains unclear. We asked two linked clinical questions: does a supervised 24-week MCE program improve physical function and frailty versus usual care, and are those effects modified by metabolic frailty phenotype (anorexic-malnourished [AM] phenotype vs sarcopenic-obese [SO] phenotype)? Methods:In this 24-week, phenotype-stratified, parallel-group randomized controlled trial, 146 community-dwelling adults aged ≥65 years with long-standing T2DM and frailty/pre-frailty who met predefined AM or SO criteria were randomized within phenotype to supervised MCE or usual care (AM-Control/MCE 31; SO-Control/MCE 42). Co-primary outcomes were Short Physical Performance Battery (SPPB) score and Fried frailty phenotype count. Key secondary outcomes were 4-m gait speed, five-chair-stand time, and grip strength. Covariate-adjusted generalized estimating equation models of change from baseline to 12 and 24 weeks included intervention, phenotype, visit, and all interactions, and adjusted for baseline outcome, age, sex, BMI, baseline HbA1c, metformin, SGLT2 inhibitor, GLP-1RA, insulin, diabetic retinopathy, diabetic peripheral neuropathy, chronic kidney disease stage ≥3, and hypertension. Benjamini-Hochberg false-discovery-rate correction was applied across functional outcome comparisons. Results:Arm-level baseline balance was good overall, whereas AM and SO were intentionally distinct at baseline in adiposity, nutrition, glycemia, inflammation, and insulin resistance. Compared with usual care, MCE improved all functional outcomes at both follow-up visits. At 24 weeks, adjusted MCE-control differences were +1.14 points for SPPB (95 % CI 0.99 to 1.28), -0.64 for Fried count (95 % CI -0.77 to -0.51), +0.111 m/s for gait speed (95 % CI 0.095 to 0.127), -1.42 s for chair-stand time (95 % CI -1.70 to -1.14), and +0.94 kg for grip strength (95 % CI 0.72 to 1.16); all BH q < 0.001. Treatment-by-phenotype interactions at 24 weeks favored SO for SPPB (+0.50 points, 95 % CI 0.22 to 0.79; q = 0.005), gait speed (+0.048 m/s, 95 % CI 0.016 to 0.080; q = 0.012), and chair-stand time (-0.82 s, 95 % CI -1.37 to -0.27; q = 0.012), whereas the Fried-count interaction was not significant. Conclusions:A supervised 24-week MCE program improved physical function and frailty in older adults with T2DM and frailty/pre-frailty. Functional gains were larger in the SO than AM phenotype for several performance-based outcomes, suggesting phenotype-dependent responsiveness. Because this trial deliberately focused on two endpoint phenotypes and excluded intermediate presentations, the findings should be interpreted as clinically informative but not definitive for phenotype-guided care. Trial Registration:Registered prospectively in the Chinese Clinical Trial Registry (ChiCTR), a WHO ICTRP primary registry (registration no ChiCTR2400090109; http://www.chictr.org.cn/), on 24 September 2024, before enrollment.
Background Rapid advancements in diagnostic biomarkers and criteria have created a complex and evolving environment for clinicians managing patients with cognitive complaints. Real-world data on current diagnostic processes used among diverse populations remains limited. Objectives This study aimed to investigate diagnostic patterns and use of diagnostic tests among U.S. adults with mild cognitive impairment, Alzheimer’s disease, and/or dementia, stratified by gender, age, and race/ethnicity before clinical availability of blood-based biomarkers and the most recent diagnostic updates. Design Retrospective, observational cohort study. Setting The Optum® Market Clarity database from January 1, 2017, to September 30, 2021, was utilized. Participants 338,739 patients diagnosed with dementia, 81,267 with AD, and 179,419 with MCI were included in the analysis. Measurements Demographics information identified from electronic health records at the time of diagnosis was utilized. Occurrence and timing of diagnostic tests was pulled from insurance claims and electronic health records. Results Mean age at diagnosis was 69.3 years for MCI, 78.9 years for AD, and 78.6 years for dementia. Computerized tomography (CT) and magnetic resonance imaging (MRI) were used infrequently (MCI: MRI 16.6%, CT 17.5%; AD: MRI 9.0%, CT 18.4%; dementia: MRI 9.5%, CT 25.9%). Cerebrospinal fluid (CSF) biomarker tests and positron emission tomography (PET) were rarely used (MCI: PET 0.6%, CSF 1.6%; AD: PET 0.5%, CSF 0.9%; dementia: PET 0.2%, CSF 1.6%). Conclusions During the study period, diagnosis of MCI, AD, and dementia involved low use of brain imaging or CSF biomarkers, despite recommendations from guidelines. By better understanding how patients navigate their diagnostic journey in real-world settings, diagnostic practices can improve and faster support can be provided.
Introduction: Given the accelerated aging processes and elevated fall risk associated with functional decline in correctional settings, developing effective exercise programs for older inmates is increasingly important. Methods: This study examined the potential effects of a six‑week balance‑training program on static and dynamic balance performance, well‑being, and enjoyment of physical activity among older inmates in an open German prison. Ten male inmates (mean age = 62.1 ± 4.4 years) participated, with five assigned to an intervention group and five to a control group. The intervention comprised three 60‑minute sessions per week. based on a standardized balance‑training protocol for older adults. A repeated‑measures design assessed pre‑ and post‑intervention changes in anthropometric data, static balance, static balance on unstable surfaces, dynamic balance, well‑being, and physical activity enjoyment. Results: The training group showed significant improvements in static balance and static balance on unstable surfaces, corresponding to functional gains of approximately 26% and 33%, respectively. Dynamic balance, well‑being, and enjoyment of physical activity did not change significantly. Discussion: The observed improvements in static balance suggest that even limited interventions may yield meaningful physical benefits in older inmates. However, the absence of effects on dynamic balance and psychosocial outcomes may reflect the short intervention duration, small sample size, and ongoing stressors inherent to incarceration. Future studies should extend program length and include follow‑up assessments to evaluate long‑term benefits. Conclusion: A short, resource‑efficient balance‑training program was associated with improved balance performance in older inmates and may help preserve mobility, autonomy, and quality of life in aging prison populations.
Older individuals generally have decreased food intake owing to physical, social, psychological, and behavioral limitations. However, the characteristics of food and nutrient intake resulting from these limitations are poorly organized. Organizing knowledge for practical application in older adults is necessary when considering nutrition care strategies. This review aimed to characterize food and nutrient intake according to these exposure factors in older individuals. This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PROSPERO, CRD42024582151). MEDLINE and Web of Science were searched in September 2024 using the following inclusion criteria: community-dwelling older adults aged ≥65 years (participants); factors contributing to physical, social, psychological, or behavioral limitations affecting food and nutrient intake (exposure); food and/or nutrient intake, dietary patterns, and overall diet quality (outcomes); and cross-sectional and cohort studies (study design). Among the 2,354 studies screened, 29 studies were analyzed. These included studies addressed the following exposure factors: oral function and physical activity (physical); economic status, marital status, household size, and educational attainment (social); depressive symptoms (psychological); and food security, nutritional knowledge, and cooking skills (behavioral). Reduced oral function was associated with lower intakes of meat, fish, legumes, vegetables, and fruits. Low economic status and educational level were associated with poor diet quality. However, there was limited research characterizing the dietary intakes of individuals with other factors, such as poor cooking skills or decreased sense of taste and smell. Further research is needed.
Background: Social determinants of health and biological processes are shaped by the exposome, which provides a framework for understanding how social adversity drives molecular and cellular mechanisms underlying Alzheimer’s disease risk. Individuals with low premorbid intellectual ability (pIQ ≤70) may be particularly vulnerable to adverse social determinants of health due to reduced cognitive reserve, yet this relationship is understudied. Methods: Data from the Health and Aging Brain Study–Health Disparities (n = 2691) were analyzed. Participants were classified as low pIQ (IQ ≤70) or average pIQ (IQ 90–100) via word reading scores. Using a machine learning approach, an XGBoost model evaluated education, income, Area Deprivation Index (ADI), social support, stress, health status, and worry in prediction of pIQ grouping. Results: The model achieved and AUC of 0.72 [0.64, 0.81]. Top predictors included worry, ADI, income, high school completion, and tangible support. Low pIQ was associated with greater neighborhood deprivation, lower income, and reduced support resources. Conclusion: Low pIQ, when combined with SDoH factors reflects a vulnerable psychosocial-cognitive phenotype that may accelerate pathways to cognitive decline potentially through inflammatory mechanisms.
Background:Subjective memory complaints (SMC) are associated with increased risk of cognitive decline and dementia. SMCs are also influenced by mood and anxiety symptoms, which increased among older adults during the COVID-19 pandemic. Objective:We investigated whether a single-item SMC measure predicts one-year cognitive decline and whether this predictive relationship remained stable during the early COVID-19 period (2020). Methods:We analyzed longitudinal data (2011-2023) from the National Health And Aging Trends Study (NHATS), an annual survey of Medicare beneficiaries in the United States. Mixed-effects models assessed the association between self-perceived memory worsening and next-year cognitive outcomes, and tested whether this association differed in 2020. Results:A total of 33,244 observations from 6676 elderly individuals were included. Higher age, male sex, non-white race, education at or below high school level, lower scores on basic and instrumental activities of daily living, poorer social activity, anxiety symptoms, lower annual income, and self-perceived memory decline each predicted worse cognitive function one year later. However, the interaction between self-perceived memory decline and the COVID-19 pandemic (in 2020) was not significant. Discussion:A single-item measure of self-perceived memory decline effectively predicts next-year cognitive decline in older adults, independent of the broader social impacts observed during the 2020 COVID-19 pandemic.
