The increasing burden of multimorbidity is associated with a risk of poorer health outcomes and mortality; however, evidence on its long-term impact on quality of life (QoL) remains limited. This study aims to explore the association of multimorbidity and multimorbidity clusters with QoL over a five-year period in a multiethnic, semi-rural cohort across different age groups. This study utilized two-wave data from 8280 participants aged 18 years and above, collected as part of health surveys in 2013 and 2018 at the South East Asia Community Observatory (SEACO) Health and Demographic Surveillance System (HDSS) site in Malaysia. Multimorbidity was defined as having two or more of the following eight self-reported chronic conditions: diabetes, hypertension, heart disease, stroke, kidney disease (chronic kidney disease, end-stage renal failure), arthritis, asthma, and obesity. QoL was assessed using the WHOQOL-BREF, a 26-item questionnaire comprising four domains (physical, psychological, social relationships, and environmental health). Multivariable linear regression models were used for both count and clusters of chronic conditions to evaluate the association between multimorbidity and change in QoL over 5 years. At baseline, multimorbidity was significantly associated with better QoL in the social relationships domain only. Multimorbidity at baseline was not significantly associated with the change in QoL over 5 years across any age group. Two clusters of multimorbidity were identified: [1] cardiometabolic and musculoskeletal conditions and [2] cardiorespiratory and renal conditions. Among younger adults (18–34 years), cluster 1 was associated with improvement in the psychological domain (ß: 4.54, SE: 2.25, p-value = 0.03), whereas among adults (35–59 years), cluster 2 was associated with a decline in social relationships (ß: -6.57, SE: 2.87, p-value = 0.01). The study findings highlight that clinicians and policymakers need to focus on developing age-tailored interventions. Moreover, a simple count of chronic conditions fails to fully capture whether a certain group of conditions is resulting in a decline in QoL. Therefore, a cluster-based approach could provide a more useful insight.

BACKGROUND:Ascertaining the clinical relevance of reduced eGFR in older adults is challenging, particularly in those who may have decreased creatinine due to low muscle mass. This study investigated the potential of gait speed and grip strength (markers of muscle mass) to support the clinical interpretation of eGFR and its association with disability-free survival in older adults. METHODS:This was a cohort study of the ASPirin in Reducing Events in the Elderly (ASPREE) randomized trial and the ASPREE-eXtension observational follow-up study. Participants were recruited from community-based clinics. ASPREE enrolled adults aged ≥70 years, with African American and Hispanic adults eligible from age ≥65 years, all of whom were free of significant co-morbidity at baseline. Baseline eGFR categories (<60, 60-79, ≥80mL/min/1.73m2) combined with gait speed (<or ≥1 m/s), and in separate models, baseline eGFR categories combined with grip strength (weak vs not weak), were used as explanatory variables. Outcomes were disability-free survival, all-cause mortality, independence-limiting physical disability, or dementia. Survival analyses with undertaken with reference to individuals with 'eGFR 60-79mL/min/1.73m2 and slow gait' or 'eGFR 60-79mL/min/1.73m2 and not weak'. RESULTS:There were 16,925 participants, median follow-up was 8.4 years (interquartile range [IQR]:2.7,9.6), mean age was 75.0±4.5 years, and median eGFR was 79mL/min (IQR:68,89). In the presence of normal gait speed or grip strength, eGFR <60mL/min/1.73m2 did not increase the risk for disability-free survival or its components. Slow gait or weak grip accompanying any eGFR was associated with reduced disability-free survival, increased mortality, or increased disability. E.g: participants with eGFR ≥80mL/min/1.73m2 and slow gait were at risk for dementia (HR:1.48, 95%CI:1.23-1.79). CONCLUSIONS:In older, initially healthy adults, assessment of gait speed and grip strength may provide additional context when examining associations between eGFR and disability-free survival and its individual components.

INTRODUCTION:Air pollution is linked to dementia, but evidence from low-exposure settings is limited. We examined sex-specific associations between long-term exposure to fine particulate matter ≤2.5 µm in diameter (PM2.5) and dementia risk in older adults living in Australia. METHODS:In 16,145 dementia-free Aspirin in Reducing Events in the Elderly (ASPREE) participants (≥70 years; median follow-up 10.3 years), Cox models assessed associations between 1-year mean PM2.5 (continuous and guideline-based categories) and incident dementia, adjusting for demographic, lifestyle, environmental, and genetic factors. Subgroup analyses by sex, apolipoprotein E genotype (APOE), and age were conducted. RESULTS:Overall associations were null, but with a trend for increased risk at exposures >10 versus ≤5 µg/m3. In subgroup analyses, positive associations were observed among females, with larger effect estimates at exposure >10 µg/m3, whereas associations remained null among males. No differences were observed across APOE genotypes or age groups. DISCUSSION:Findings suggest a threshold of >10 µg/m3 and heightened susceptibility in females. Further research in low-exposure settings is warranted.

BACKGROUND:As populations age, extending healthspan, or years lived in good health, is a global priority. Most evidence on healthy lifestyle and prolonged healthspan comes from middle-aged or comorbid populations, leaving it unclear whether benefits apply to healthy older adults. This study evaluates whether combined lifestyle behaviors are associated with disability-free survival in community-dwelling older adults. METHODS:The study included 11,287 Australian participants (median age 74 [IQR 72-77]) from the ASPirin in Reducing Events in the Elderly (ASPREE) study, with a median follow-up of 6.6 years (IQR 5.5-7.9). Participants received one point for adherence to each of the following lifestyle factors: Mediterranean diet, moderate physical activity, non-smoking, and moderate alcohol consumption and categorized as having low (0-1 factors), moderate (2 factors), or favorable (≥ 3 factors) lifestyle. The primary outcome was a composite endpoint comprised of the first occurrence of either death, dementia, or persistent physical disability. Associations of lifestyle categories with the composite endpoint and the individual components were examined, alongside effect modification by key demographic and health variables. Years gained in disability-free survival and compression of morbidity were calculated. RESULTS:Compared to those with an unfavorable lifestyle, a moderate [HR 0.75 (95% CI 0.65-0.87)] and favorable [HR 0.60 (95% CI 0.52-0.70)] lifestyle were associated with a lower risk of the composite endpoint. Over a median of 6.6 years, a favorable lifestyle was prospectively associated with a 10% gain in years of healthspan and a moderate compression of morbidity. Associations did not differ across groups of age, sex, education, aspirin treatment, BMI, diabetes, and hypertension. CONCLUSION:In healthy older adults, adherence to a healthy lifestyle was associated with a greater likelihood of surviving free from disability and dementia and was prospectively linked with a prolonged healthspan and a compression of morbidity, highlighting its potential importance in promoting healthy aging. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT01038583.

INTRODUCTION:Aquaporin-4 (AQP4) is thought to facilitate Alzheimer's disease (AD) protein clearance during sleep. We examined whether AQP4 genetic variation was associated with AD pathology or modified the association between sleep duration and AD biomarkers. METHODS:A total of 450 dementia-free participants (mean age = 58 ± 9.9; women = 54%) from the Framingham Heart Study (FHS) with sleep duration measured by self-report and amyloid-β (Aβ) and tau burden quantified using positron emission tomography (PET) were analyzed. RESULTS:AQP4 was not associated with Aβ or tau burden in the overall sample. However, for participants aged less than 60, minor allele carriers displayed lower regional tau burden compared to homozygote majors. AQP4 modified the relationship between short sleep (≤6 hours) and medial temporal tau; short sleep duration was associated with higher medial temporal tau in minor allele carriers, while the opposite was observed in homozygote majors. DISCUSSION:AQP4 genetic variation may influence early tau accumulation and vulnerability to sleep-related AD pathology.

CONTEXT:Omega-3 fatty acids are suggested to have protective effects against dementia and cardiovascular disease (CVD). Some evidence suggests that genetic elements, including the apolipoprotein E epsilon-4 (APOE-ε4) allele, may modify this association. However, the findings are inconsistent. OBJECTIVE:In this study we sought to systematically review whether genetic variants modify the association between fish intake or omega-3 fatty acids and cognitive decline or CVD in community-dwelling adults aged 65 years and older. DATA SOURCES:We searched the Embase, Medline, and Scopus electronic databases, along with the platform Web of Science, from inception to December 10, 2024. DATA EXTRACTION:The search yielded 2349 papers. Title and abstract screening, along with full-text review, were independently performed by 2 reviewers. 15 studies met the inclusion criteria. Data extraction was completed by 1 reviewer and independently cross-checked by another. Risk of bias was assessed using standard tools. DATA ANALYSIS:Due to substantial heterogeneity in the available evidence, instead of meta-analysis, a narrative review approach was adopted. A relatively small number of studies reported conflicting results for the dementia, Alzheimer disease (AD), and CVD outcomes; however, higher omega-3 biomarker levels/fish intake appeared to be associated with slower cognitive decline in APOE-ε4 carriers. CONCLUSIONS:There is some limited evidence suggesting that APOE-ε4 may modify the association between omega-3 intake and cognitive decline in older adults, although the current body of research is inconsistent. This inconsistency highlights the need for additional research to better understand this association to support the development of personalized nutrigenetic-informed interventions to optimize health in later life. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration No. CRD42024623183.

BACKGROUND:Physical function decline and depression are major challenges of the rapidly growing older population. This longitudinal study aimed to investigate the bidirectional longitudinal association between physical function and depressive symptoms, which are poorly understood in older adults. METHODS:We utilised data from the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial and extended follow-up cohort between 2010 and 2022. The presence of depressive symptoms was defined as a score of ≥ 8 on the Center for Epidemiologic Studies Depression 10-item scale. Physical function was assessed using gait speed for physical performance and handgrip strength for muscle strength. Gait speed and handgrip strength were categorised using the European Working Group on Sarcopenia in Older People (EWGSOP2) cut-off points. The bidirectional association between physical function and depressive symptoms was estimated using generalised estimating equations models. The robustness of the longitudinal bidirectional relationship was assessed using random-intercept cross-lagged panel models. RESULTS:Among 19 114 ASPREE participants, 15 854 (56% females) older adults (mean age 75 years) were included in the analysis. During a median follow-up of 8.4 years, participants with combined poor physical performance and weak muscle strength had 81% higher odds of developing depressive symptoms compared to those with good performance and strength (OR = 1.81, 95% CI: 1.55-2.11). Conversely, participants with depressive symptoms had 70% higher odds of reduced physical function (combined poor physical performance and weak muscle strength) compared to those with no depressive symptoms (OR = 1.70, 95% CI: 1.61-1.80). The random-intercept cross-lagged panel models verified the bidirectional longitudinal associations between physical function and depressive symptoms across the follow-up waves. CONCLUSIONS:Reduced physical function and depressive symptoms are associated bidirectionally over time of a similar magnitude. Understanding this reciprocal association is crucial for developing effective prevention and treatment strategies for physical and mental health conditions.

The American Heart Association (AHA) recently introduced a new clinical entity; the cardiovascular-kidney-metabolic syndrome (CKMS), to promote a multi-disciplinary approach for chronic disease management. This study aims to investigate the relationship between CKMS and major adverse outcomes in older populations in primary care. This study utilized data from 18,367 community-dwelling individuals aged ≥ 65, free from prior cardiovascular disease (CVD). Participants were classified into four CKMS stages (stage 0-no CKMS risk factor to stage 3-high CKMS risk) at baseline based on the AHA definition. The association with 14 health outcomes was analysed using multivariable cause-specific hazard models. Additional stratifications were performed by social disadvantage, inflammation levels, and number of CKMS components within each stage to refine risk staging. Over a median follow-up of 8.6 years, the prevalence of CKMS stages 0 to 3 was 2.8

Importance:Prior studies, largely among middle-aged adults, reported aspirin reduces cancer risk after 10 years, particularly for colorectal cancer (CRC). In contrast, the Aspirin in Reducing Events in the Elderly (ASPREE) randomized clinical trial (RCT) reported that low-dose aspirin (LDA) treatment for a median of 4.7 years had no effect on overall cancer incidence but increased risk of incident late-stage cancer and cancer-related mortality. Objective:To assess whether LDA is associated with cancer incidence and mortality in 10 years of follow-up in older adults (aged ≥70 years) and to assess the association with cancer after prior LDA exposure (legacy effects). Design, Setting, and Participants:This community-based binational (Australian and US) cohort study included community-dwelling older adults (aged ≥70 years for Australian participants and ≥65 years for US minority group participants) free from overt cardiovascular disease, dementia, or independence-limiting physical disability. The cohort was derived from the ASPREE randomized clinical trial conducted from 2010 to 2017, with the observational extension study (ASPREE-XT) following up participants from 2018 to 2024. This study reports data from 2010 through 2022 (long-term outcomes) as well as reports analyses confined to the observation phase only (legacy analyses). Data were analyzed from May to November 2025. Intervention:Daily 100-mg aspirin or placebo from randomization until cessation of study drug. Main Outcomes and Measures:Outcomes were physician-adjudicated incident cancer, type, stage at diagnosis, and cancer mortality. Results:In 19 114 community-dwelling older adults (mean [SD] age, 75.1 [4.5] years; 56.4% female), a total of 3448 incident cancers and 1173 cancer-related deaths occurred over 10 years of follow-up (median, 8.6 [IQR, 7.4-10.0] years) during ASPREE and ASPREE-XT. LDA was not associated with overall cancer incidence over the long term (hazard ratio [HR] = 0.98; 95% CI, 0.92-1.05), by stage at diagnosis or cancer type, including colorectal cancer (HR = 1.01; 95% CI, 0.84-1.21). However, LDA was associated with increased cancer-related mortality (HR = 1.15; 95% CI, 1.03-1.29). Among 14 907 participants without cancer during the RCT and consented into ASPREE-XT (median age, 78.6 years [IQR, 76.2-82.1]; 57.5% female), 1451 incident cancers and 376 cancer deaths occurred in the post-RCT period, during which original aspirin assignment during the RCT was not associated with differences in cancer incidence (HR = 0.91; 95% CI, 0.82-1.01) or cancer-related mortality (HR = 1.02; 95% CI, 0.83-1.25) compared with original placebo assignment. Conclusions and Relevance:In this study, over a median of 8.6 years, LDA was not associated with incident cancer among older adults, but cancer mortality risk was significantly elevated. However, the elevated cancer mortality risk seen with aspirin for participants in the RCT period did not persist into the post-RCT observation period, suggesting no legacy effect.

BACKGROUND AND OBJECTIVES:The aquaporin-4 (AQP4) water channel plays an integral role in clearing brain waste. However, little is known about whether variations in the AQP4 gene contributes to brain health or dementia risk. We aimed to determine whether a functional AQP4 haplotype was associated with cognition, brain volumes, or incident dementia. METHODS:This study included participants from 2 prospective cohort studies. First, participants from the original, offspring, new offspring spouse, and generation 3 cohorts from the Framingham Heart Study (FHS; enrolled 1948-2005) were included with dementia follow-up until 2022. Original FHS participants were from Framingham, Massachusetts at the time of enrollment. Analyses were replicated for brain MRI outcomes and incident dementia with UK Biobank participants (enrolled 2006-2010) who were followed until 2022. All participants were dementia-free at the time of cognitive assessment, brain MRI, and commencement of dementia follow-up. Linear regression models were conducted to analyze the associations between AQP4 and the cognitive and brain MRI outcomes. Cox proportional hazard regression models were conducted to analyze the association between AQP4 and incident all-cause dementia risk. Data analysis spanned February 2023 to July 2025. RESULTS:The FHS sample comprised 3,847 participants (65% homozygote major, 31% heterozygote, 4% homozygote minor) with cognitive testing (mean age 61 ± 11 years; 54% women); 3,332 had brain MRI. Heterozygotes displayed better verbal episodic memory (β = 0.32, 95% CI 0.09-0.55, p = 0.007, N = 1,201) and larger hippocampal volumes (β = 0.09, 95% CI 0.02-0.16, p = 0.012, N = 1,052) compared with homozygote majors. Similar findings were observed in the UK Biobank; homozygote minors displayed larger hippocampal volumes (β = 0.05, 95% CI < 0.01-0.11, p = 0.035, N = 32,219) and lower amounts of diffusion tensor imaging measured free water (β = -0.09, 95% CI -0.16 to -0.03, p = 0.005, N = 31,807) compared with homozygote majors. Heterozygotes displayed a statistically significant lower rate of incident all-cause dementia (hazard ratio 0.93, 95% CI 0.88-0.98, p = 0.012, N = 114,868, incident cases = 5,625) compared with homozygote majors. DISCUSSION:Carrying at least 1 minor allele at an AQP4 haplotype (homozygote minors or heterozygotes) was linked to better verbal episodic memory, larger hippocampal volumes, lower amounts of free water, and lower dementia risk. Further studies are required to replicate these results among diverse samples.

Metabolic dysfunction–associated steatotic liver disease (MASLD) is a common, often overlooked liver condition. Its impact on quality-of-life in older adults is not well understood. We examined the association between MASLD and physical and mental quality of life in a well-characterized cohort of Australians aged 70 and older. MASLD was identified using Fatty Liver Index ≥ 60 and consensus lifestyle and cardiometabolic criteria and assessed at baseline and at 3 years. PCS and MCS scores were measured annually using the 12-Item Short Form Health Survey. Generalized estimating equations adjusted for key confounders were used to evaluate the association of baseline and time-updated MASLD with longitudinal HRQoL outcomes. Analysis of 8880 participants (median follow-up 5.5 years) showed that baseline MASLD was associated with lower, then declining PCS over follow-up compared with no MASLD (mean difference −1.3; 95

Background:Multimorbidity is common in older adults, but sex differences in chronic condition clustering remain unclear. This study explored multimorbidity clusters and their associations with all-cause mortality among community-dwelling adults aged 70 years and over. Methods:This was a secondary analysis of data from 16,095 Australian ASPREE participants aged ≥70 years without prior dementia or cardiovascular disease. Fifteen baseline chronic conditions were grouped using latent class analysis (LCA). Observed-to-expected (O/E) ratios characterised conditions over-represented within clusters, and Cox proportional hazards models assessed associations with all-cause mortality. Results:Among 16,095 participants (mean age 74 years), 88.3% had multimorbidity at baseline; 4,217 deaths occurred over a median follow-up of 10.85 years. Five clusters were identified overall: hypertension & dyslipidemia (52.1%), gout & metabolic (14.4%), depressive symptoms, osteoporosis & frailty (10.0%), anaemia & kidney disease (10.2%), and hypotension, thyroid disorder & past cancer (13.3%). Sex-stratified analyses revealed three clusters in males and four in females. The frailty, depressive symptoms & osteoporosis cluster was associated with higher mortality in both sexes (aHR 1.56 [95% CI 1.40-1.73] in males; 1.68 [1.49-1.89] in females). Higher mortality was also observed for the metabolic, gout & kidney disease cluster in males (aHR 1.63 [1.47-1.81]) and the gout, anaemia & kidney disease cluster in females (aHR 1.96 [1.74-2.21]). Conclusions:Distinct multimorbidity clusters differed by sex and were associated with increased all-cause mortality. These findings may support risk stratification, targeted screening, and more person-centred management of older adults with multimorbidity.

Background and ObjectivesHearing loss is a risk factor of cognitive decline and dementia. We sought to investigate the effect of hearing aid (HA) use on cognition and dementia risk in older adults with hearing impairment.MethodsWe emulated a target trial using data from Australian participants of the ASPirin in Reducing Events in the Elderly study. In the target trial, eligible participants were dementia-free, had moderate hearing impairment, and had no previous HA use. The treatment strategies were "use HAs" and "do not use HAs." Outcomes included overall cognition, dementia (DSM-IV criteria), and cognitive impairment (cognitive decline or dementia). The emulation used new HA prescription and frequency-of-use data measured by questionnaire, as well as cognition data from semiannual assessments over 7 years. Self-reported hearing problems were used as a proxy for moderate hearing impairment. Using the parametric g-formula, we estimated observational analogs of the intention-to-treat effect, using HA prescription to emulate allocation. Analyses for cognition outcomes were restricted to survivors. Multiple imputation was used for missing covariate and cognitive outcome data. We also emulated a second target trial with treatment strategies of (1) never, (2) rarely/sometimes, and (3) often/always use HAs.ResultsAcross imputed data sets, a median of 2,777 eligible individuals were included, with a median of 664 receiving a new HA prescription. The mean age was 75 years, and 48% were female. The estimated 7-year mean overall cognition scores among survivors were similar under HA prescription and no HA prescription (mean difference 0.03 SDs; 95% CI -0.14 to 0.21). The estimated 7-year risk of dementia was 5.0% under HA prescription and 7.5% under no HA prescription (risk ratio [RR] 0.67; 95% CI 0.37-0.97), and that of cognitive impairment was 36.1% under HA prescription and 42.4% under no HA prescription (RR 0.85; 95% CI 0.70-1.00). The risks of dementia and cognitive impairment were inversely associated with the frequency of HA use.DiscussionWe found that HA use in older people with hearing impairment may reduce dementia risk, although differences in age-related cognitive change were insubstantial. We cannot rule out residual confounding as an explanation for our findings. Long-term randomized trials of HAs for dementia risk are justified.Classification of EvidenceThis study provides Class III evidence that the use of hearing aids did not change overall cognitive scores in people 70 years and older with moderate hearing impairment as compared to those who used hearing aids.

Frailty is a common geriatric syndrome associated with higher risks of hospitalisation and falls. The extent to which social and cognitive engagement activities (lifestyle enrichment) influence frailty is still largely unexplored. This study investigates the association between such enrichment and changes in frailty and frailty risk; 12,862 community-dwelling Australians aged ≥70 (54.4

Introduction: Cardiovascular risk factors (CVRFs) have been associated with cognitive impairment; however, the underlying mechanisms remain unclear. This study used twins modeling, to investigate whether shared twin factors contribute to the associations between CVRFs and cognitive function. Methods: This study used a cross-sectional design, and participants were from the UK adult twin registry. Clinically validated cognitive tests were administered during routine clinical research visits between 2013 and 2016, measuring overall global cognition, recall, verbal fluency, processing speed, and episodic memory and learning. CVRFs were total cholesterol (TC), high-density lipoprotein (HDL), systolic blood pressure (SBP), type 2 diabetes, and smoking status. Results: Participants were between 1,300 and 2,300 twins (depending on the cognitive test), and the mean age of twins was approximately 56 years. Cholesterol levels (both TC and HDL) were significantly associated (p < 0.05) with overall global cognition, recall, and verbal fluency with effect sizes (standardized) ranging from 0.5 to 0.11. In the twins modeling, after adjusting for genetic and shared environmental factors, the associations disappeared. Similarly, higher SBP levels were associated with poorer verbal fluency performance (-0.05 [-0.10 to 0.00]), and while between-pair effects were found to be significant (-0.09 [-0.15 to -0.03]), within-pair effects (after adjusting of shared environmental factors) were not. Conclusion: Higher TC and HDL and lower SBP were all associated with better performance on a range of validated cognitive tests. However, findings suggest that the association between CVRFs and cognitive function is predominantly explained by shared twin-pair factors which may be genetic or shared environment.

The evolution of trauma-informed care (TIC) since its inception has resulted in myriad models and frameworks across a variety of settings. However, there is a lack of a consistent definition and understanding of what constitutes TIC. We conducted an integrative review, using a rapid review methodology, concept and content analysis, and thematic synthesis to identify the existing models and frameworks of TIC and their common values, components and principles, and synthesise these to inform a contemporary understanding of TIC. Two-hundred and eighty-eight included sources from the academic and grey literature internationally were analysed, resulting in 10 values, 10 principles, and 28 components of TIC. Foundational components of TIC were identified as understanding trauma, ensuring safety and trust, empowerment and collaboration, supporting trauma recovery and emotional management, and taking a whole-of-organisation approach. We present a proposed integrated definition of TIC, core values, conceptual model, and framework for application across settings. The integrated model and framework have potential utility in the implementation of TIC and development of setting-specific practice strategies, particularly in new settings. It provides a contemporaneous description of TIC that has the potential to inform future research, policy development, and practice that can support its application.

Resting heart rate (RHR) is an accessible measure that may reflect age-related cardiovascular and autonomic dysregulation relevant to cognitive ageing. However, evidence linking RHR with cognitive outcomes is inconsistent, and most studies relied on single baseline measurements that may not capture cumulative exposure. This study examined the associations of baseline and longitudinally averaged RHR with cognitive decline and dementia in older adults. This was a secondary analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) study, including 19,114 community-dwelling participants aged ≥ 65 years without cardiovascular disease or dementia at baseline. RHR was assessed at baseline and follow-up visits using an oscillometric device. Cognitive decline was defined as a decrease of > 1.5 standard deviations from baseline performance in global cognition, episodic memory, psychomotor speed, or verbal fluency. Incident dementia was adjudicated using DSM-IV criteria. Compared with baseline RHR of 60–69 bpm, those with RHR ≥ 80 bpm had a 9

BACKGROUND:Antibiotics are commonly prescribed in older community-dwelling adults, contributing to adverse effects, antimicrobial resistance and increased healthcare costs. Prescribing patterns in dementia are unclear, although healthcare use and goals of care change around diagnosis. OBJECTIVE:To describe trends in antibiotic dispensing and prevalence amongst Australians aged ≥70 years, compare dispensing between those with and without dementia and identify factors associated with dispensing. METHODS:We analysed data from 13 659 ASPREE and ASPREE-XT participants (2010-20). Antibiotic dispensing was assessed using Pharmaceutical Benefits Scheme records, with rates stratified by age group. Interrupted time-series analysis compared dispensing rates and the proportion of broad- versus narrow-spectrum antibiotics dementia case and matched controls (matched on time since randomisation, age and sex). Negative binomial regression identified factors associated with dispensing. RESULTS:Dispensing rates increased to 1651 per 1000 person-years (95% CI: 1604-99) by year 9. Annual prevalence averaged 47%. Broad-spectrum antibiotics were dispensed twice as often as narrow-spectrum. Individuals with dementia had higher dispensing both before and after diagnosis, but dementia was not independently associated with dispensing (IRR 1.06, 95% CI: 0.95-1.18). Female sex, polypharmacy, pre-frailty and higher depressive symptom scores were linked to higher dispensing, whilst hypertension, dyslipidaemia and alcohol use were linked to lower dispensing. CONCLUSIONS:Antibiotic dispensing in older adults remains high, dominated by broad-spectrum agents. Dementia was not independently associated with increased dispensing. Female sex, polypharmacy, pre-frailty and depressive symptoms identified groups who may benefit most from targeted antimicrobial stewardship interventions.

This study aimed to examine the longitudinal associations between public library visits and multiple health and well-being outcomes in older adults. We analysed data from over 12,000 (n range, 12,124–12,896) relatively healthy community-dwelling Australians aged 70+ years. We categorised public library visits as never, ≤ 3 times/month, and ≥ once/week. Using an outcome-wide analytical approach, we examined associations between public library visits and 44 outcomes across physical, cognitive/major health events, psychological, social, and behavioural domains. Most outcomes were assessed at 2 years of follow-up, with extended follow-up for time-to-event outcomes (median duration range, 6–9 years). We performed gender-disaggregated regressions, adjusting for multiple covariates. Participants were aged 70–95 years (mean 75.2 ± 4.3) at baseline, and 54.5