OBJECTIVE:To investigate whether assistive device (AD) use within the past 12 months (self-reported at baseline) affects the change in the amount of informal caregiving hours received over time (three-years), among community-dwelling older adults (≥ 65 years) in comparison to those who did not use AD at all. METHODS:Data from the Tracking (n = 236) and Comprehensive (n = 420) cohorts of the Canadian Longitudinal Study on Ageing (CLSA) were analysed using multiple linear regression models to regress the changes in the amount of informal caregiving hours received (follow-up - baseline) on AD use (yes/no) while accounting for a set of sociodemographic, health, functionality, psychological, and support covariates. RESULTS:We did not find significant associations between AD use and changes in the amount of informal care hours received among older adults (Tracking cohort:β̂= 3.10, 95% CI = -77.98 to 84.17; Comprehensive cohort:β̂= -5.05, 95% CI = -47.19 to 37.09). CONCLUSIONS:Our results did not provide sufficient evidence for an association between AD use and informal caregiver time. Future studies addressing this issue should employ longer follow-up periods, analyse by device type, and obtain caregiving hours directly from informal caregivers. Nonetheless, these findings remain valuable for informing future research directions, prompting re-examination of existing theories, and guiding evidence-based policy and practice decisions.

BACKGROUND AND OBJECTIVE:We undertook a qualitative descriptive study to explore participants' perceptions of whether marital status shapes how functional social support (FSS) relates to memory. METHODS:Semi-structured interviews were conducted with 18 community-dwelling middle-aged and older people representing various marital status categories. Each interview was audio-recorded, transcribed verbatim, and thematically analyzed. FINDINGS:Participants did not perceive marital status to shape the FSS-memory relationship. Three themes emerged to explain this view: learning to cope - participants used alternatives besides a spouse to deal with memory challenges; context matters - factors such as marital satisfaction must be considered; and doing more harm than good - some spouses may provide excessive support, reducing participants' autonomy to stimulate their own cognitive processes. DISCUSSION:These themes highlight that marital relationships are complex and that contextual factors such as marital quality and support adequacy should be considered to provide a comprehensive understanding of how social and marital dynamics shape cognitive trajectories in aging populations.

Background:Although peripheral visual field loss (PVFL) affects balance, previous research has produced mixed results and has not clearly distinguished the independent roles of different systems in balance impairment. This systematic review with meta-analysis is the first to comprehensively evaluate the proportion and contribution of different systems to balance in adults with PVFL, providing new insights for rehabilitation strategies. Methods:A systematic search was performed in five databases (PubMed, AMED, Scopus, CINAHL, and Web of Science) from 2003 to 2023, with a manual search covering 2024 to 2025. The review focused on observational studies in adults (≥18 years) with PVFL because of glaucoma or retinitis pigmentosa. Data were synthesized by summarizing the balance function into two aspects: sensory strategy and motor strategy. The sensory strategy was defined as the motor response to changes in altering visual, vestibular, or somatosensory inputs to maintain balance, whereas the motor strategy was defined as the response to other conditions besides visual, vestibular, or somatosensory conditions, such as response to external perturbation, muscle coordination, and reaction time. The meta-analysis was conducted where appropriate. Results:Seventeen studies comprising a total of 2456 participants were analyzed. The meta-analysis revealed that individuals with PVFL exhibited poorer balance than age-matched controls. Specifically, PVFL was associated with a reduced contribution from the visual system, an increased contribution from the somatosensory system, and poorer motor strategies in maintaining balance. Greater peripheral visual field loss correlated with poorer sensory strategy for balance, whereas the relationship between motor strategy and peripheral visual field loss remained inconclusive. Conclusions:Adults with PVFL demonstrate significant balance impairments compared to healthy peers, relying more on somatosensory input to compensate for visual deficits. These findings underscore the need for comprehensive balance assessments and targeted rehabilitation strategies. Further research should focus on identifying the most predictive balance parameters and developing targeted, evidence-based rehabilitation strategies for this population. Translational Relevance:By identifying the specific sensory-motor mechanisms of balance impairment in patients with PVFL, this study bridges the gap between clinical vision assessment and rehabilitation. The finding that these patients rely heavily on somatosensory compensation provides a strong clinical rationale to transition from generic balance exercises to personalized, targeted rehabilitation strategies (such as proprioceptive and motor-strategy training), ultimately reducing fall risks and improving mobility in patients with PVFL.

Religious participation may be protective against social isolation, which itself is a risk factor for poor health outcomes in aging adults. Research extending back to Durkheim’s work on religion and suicide, and frameworks such as Stryker and Statham’s Interactional Role Theory, link religion to social integration, which is the opposite of social isolation. However, little empirical research has examined the association between religious participation and social isolation in middle-aged and older adults. We investigated this association using two waves of data (n = 22,139) from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. We regressed follow-up social isolation onto baseline religious participation and controlled for a series of socio-demographic, health, and social connection variables at baseline. Social isolation was measured using an index aggregating social network size, frequency of contact with network members, social activity participation, marital status, and retirement status. Religious participation was measured using a three-level variable asking about the frequency of participation in religious activities over the past year. Religious participation was not statistically significantly associated with social isolation over three years of follow-up. Among populations that experience healthier aging, our results did not show an association between religious participation and social isolation. Future research warrants longer follow-ups in less healthy populations to further investigate the association.

PURPOSE:To investigate whether self-reported assistive device (AD) use within the past 12 months preceding baseline data collection is associated with a change in life satisfaction (LS) between baseline and three years of follow-up among community-dwelling older adults (≥ 65 years) compared to those who did not use AD at all. MATERIALS AND METHODS:Using multiple linear regression models, the change in LS (follow-up - baseline), measured with the Satisfaction with Life Scale (SWLS), was regressed on AD use (yes/no) and a series of sociodemographic, health, functionality, psychological, and support covariates. Complete cases from the Tracking (n = 5,502) and Comprehensive (n = 9,760) cohorts of the Canadian Longitudinal Study on Ageing (CLSA) were analysed. RESULTS:The results did not provide evidence for an association between self-reported AD use and changes in LS over time (Tracking cohort: β^ = 1.16, 95% CI = -0.57 to 2.89; Comprehensive cohort: β^ = 0.47, 95% CI = -0.89 to 1.82). CONCLUSIONS:The non-significant findings may partly be explained by the fact that a majority of the study sample reported high LS scores and low usage of AD. Nonetheless, null findings are valuable as they can guide future research and prevent biased policies and practices. Future research can employ longer follow-up periods, collect data on additional confounding factors such as device satisfaction, conduct analyses by specific device type (e.g. mobility devices versus vision-related devices), and use refined LS questions related to AD use to structure future studies towards investigating LS in the context of AD use.

Background For adults living with depression, social support interventions may offer a potential strategy to protect key cognitive domains, such as executive function. However, the extent to which the association between depression and executive function is mediated by social support, and how this varies by specific subtypes of support, is unknown. The objective of this study was to investigate whether functional social support subtypes mediated the association between depressive symptoms and executive function, and whether this mediation was moderated by age and sex. Methods Using the Canadian Longitudinal Study on Aging Comprehensive cohort (n=14,133) of community-dwelling adults 45 to 85 years at baseline and conditional process analysis of baseline and 3-year follow-up data, this study investigated whether functional (perceived) social support subtypes mediated the association between depressive symptoms and executive function, and whether this mediation was moderated by age and sex. Results Functional social support significantly mediated the association between depression and executive function, with this mediation varying by subtype of support, age, and sex. Overall, low levels of emotional/informational support, affectionate support, and positive social interactions (but not tangible support) showed more pronounced and consistent mediation for females 75 and older, compared to males or younger age groups. Conclusions Clinical and health policy interventions targeting specific subtypes of functional social support may be useful in mitigating the negative impacts of depression on cognitive function; these interventions to support cognitive health may be particularly relevant for older females.

Ageing populations face increasing burdens from frailty and social isolation, which are two inter-related public health challenges that increase the risk of dementia, hospitalisation, and mortality. Despite health systems' potential to intervene, the co-occurrence of frailty and social isolation remains overlooked in policy, research, and routine care, leading to fragmented and insufficient responses. Structural barriers (eg, cultural and linguistic obstacles, low health literacy, complex system navigation, financial constraints, geographical isolation, and care coordination) further limit access. In this Viewpoint, we highlight four priorities to address these challenges: (1) screening in primary and acute care; (2) integrated medical and social care; (3) social prescribing; and (4) equity-focused policy and research within ageing strategies. Coordinated and cross-sector action that addresses social determinants of health and embeds frailty prevention and social wellbeing as core health system functions is urgently needed to enable healthy ageing.

OBJECTIVES:We evaluated the association between two measures of social connection prior to COVID-19-social isolation and functional social support-and loneliness during the pandemic. METHOD:The study was a retrospective longitudinal analysis of 20,129 middle-aged and older adults enrolled in the Canadian Longitudinal Study on Aging (CLSA). We drew upon two waves of CLSA data spanning three years and the supplemental COVID-19 Questionnaire Study of eight months to conduct our analysis. RESULTS:Social isolation prior to COVID-19 was associated with loneliness during COVID-19 only among persons who were lonely before the pandemic (adjusted odds ratio [aOR]: 1.17; 95% confidence interval [CI]: 1.02, 1.35). Higher functional social support prior to COVID-19 was inversely associated with loneliness during the pandemic, when adjusting for pre-COVID-19 loneliness (aOR: 0.37; 95%CI: 0.34, 0.41) and when assessing incident loneliness during the pandemic (adjusted relative risk: 0.59; 95% CI: 0.55, 0.63). CONCLUSION:Policies are needed to identify people who are both socially isolated and lonely, and provide them with functional social support, to prevent worsening loneliness during public health crises.

With growing recognition of psychosocial risks for cognitive impairment, research on social isolation (SI) and loneliness (LON) and their relationship to memory has increased over the past decade. However, most studies have examined SI and LON separately, leaving their combined influence on memory underexplored, particularly in qualitative research. This study presents the qualitative arm of a larger mixed-methods investigation, exploring how SI and LON, separately and together, shape memory in middle-aged and older adults. Ten individuals aged 47 - 81 were recruited through purposive and snowball sampling for semi-structured interviews, analyzed using thematic analysis informed by descriptive phenomenology. Participants generally viewed LON as more damaging to memory than SI, noting that mental stimulation is still possible during isolation, whereas LON often drains the motivation to engage in such activities. Some described SI positively (form of self-care), though extended SI was seen as detrimental due to increased social anxiety (further limits social engagement), disrupted routines, and diminished sense of purpose, all critical for memory. The combination of SI and LON was perceived as most harmful, creating a feedback loop that exacerbates both conditions and increases vulnerability to selfdestructive behaviours (smoking, physical inactivity, poor diet). This research identifies distinctive indicators and psychosocial needs of those experiencing SI, LON, or both, supporting more precise screening and intervention triage in clinical and community settings. It underscores the value of targeted, multimodal brain health interventions addressing diverse contributing factors through strategies like social connection, purpose-driven living, cognitively stimulating activities, chronic disease management, and healthy lifestyle habits.

We assessed the risk of bias in randomized controlled trials (RCTs) of nutrition-only interventions and holistic frailty outcomes in older adults. We also explored associations between study-level factors and risk of bias. We searched Cochrane, PubMed, and Scopus for published trials between 01/01/2000 and 11/13/2024. Two persons independently screened each citation at the title and abstract, and full text, levels. They also independently conducted data extraction and assessed risk of bias using the Cochrane Risk of Bias 2 tool. We used responses on the tool to develop index scores between 0-1 for each included article, with higher scores indicating lower risk of bias. We regressed the index scores on four study-level factors, i.e., region of publication, year of publication, journal impact factor, and reported use of CONSORT guidelines. Fifteen articles were included in the study: three had low risk of bias, two had some concerns with bias, and ten had high risk of bias. Domain 2 on the Cochrane tool generated the most challenges with bias, largely due to poor reporting of intention-to-treat analysis and lack of information on how this issue might affect trial results. Median index scores were 0.52, 0.53, and 0.86 for articles with high, some concerns, and low risk of bias, respectively (p = 0.0479). However, the index scores were not associated with any study-level factors. Researchers in the field should note potential biases in the design and conduct of RCTs, especially in data analysis and, more specifically, intent-to-treat analysis. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study is a scoping review that uses information contained in published scientific articles. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data are freely available from the corresponding author. The R code and datasets for median index scores, Kruskal-Wallis test, figures 4 and 5, regression in table 2, and Supplementary appendix 4 are available on GitHub (https://github.com/moremus/Tawfik_Oremus.git).

Social connection is associated with memory function in aging adults. However, little understanding exists of the pathways by which two distinct aspects of social connection-social isolation and functional social support-are related to each other and to memory. Using baseline and three-year follow-up data from the Tracking Cohort of the Canadian Longitudinal Study on Aging (n = 12,834), we explored whether functional social support mediated the relation between social isolation and memory in community-dwelling adults aged 45-85 years. We found the association between social isolation and memory operated through, not independently of, functional social support. We did not find effect modification by age group or sex. Health professionals can use gerontological care appointments to evaluate whether social relationships meet the functional social support needs of aging adults.

Background and Objectives: Evidence suggests that functional social support (FSS) may promote memory, although the role of marital status in shaping this association remains underexplored. FSS from a spouse, apart from FSS from other providers, may foster more effective coping efforts and reduce stress during physical and mental hardships, thereby providing added protection against memory decline. However, a recent quantitative study by the authors found that marital status did not modify the association between FSS and memory. To better understand and contextualize this finding, we undertook a qualitative descriptive study to explore the perspectives of middle-aged and older adults on the extent to which marital status influences the FSS-memory relationship. Research Design and Methods: Semi-structured interviews were conducted with 18 purposively-sampled community-dwelling adults representing various marital status categories. Each interview was audio-recorded, transcribed verbatim, and thematically analyzed. Results Three major themes emerged to explain why marital status may not impact the FSS-memory relationship: “learning to cope” – participants used alternatives besides a spouse to deal with memory challenges; “context matters” – contextual factors such as marital satisfaction must be considered to provide a deeper understanding of this relationship; and “doing more harm than good” – some spouses may provide excessive support, reducing participants’ autonomy to stimulate their cognitive processes. Discussion and Implications: These themes highlight that marital relationships are complex, and contextual factors such as marital quality and support adequacy should be considered to provide a comprehensive understanding of how social and marital dynamics impact cognitive trajectories in aging populations.

COVID-19 severity has been correlated with older age, male sex, and the presence of comorbidities; it is hypothesized that SARS-CoV-2 antibody responses are also correlated.159 unvaccinated patients with SARS-CoV-2 infections were assessed for IgA, IgG, and IgM titers, which were compared with disease severity, age, sex, presence of comorbidities, and time since infection. Anti-S and anti-Nucleocapsid (N) IgG responses were compared between unvaccinated and vaccinated SARS-CoV-2 positive patients. Anti-S IgA and IgM were better indicators of disease severity than IgG. IgG responses were more likely for patients over 60 years old. Female patients over 60 were more likely to have an antibody response than female patients under 60. Vaccinated patients had a stronger IgG response against S protein than against N protein likely due to immune imprinting. Disease severity was correlated with anti-S antibody responses and comorbidities in unvaccinated patients.

Purpose Although several studies have reported positive associations between functional social support (FSS) and memory, few have explored how other social variables, such as marital status, may affect the magnitude and direction of this association. We examined whether marital status modifies the association between FSS and memory in a sample of community-dwelling, middle-aged and older adults. Methods Data at three timepoints, spanning six years, were analyzed from the Tracking Cohort of the Canadian Longitudinal Study on Aging (n = 10,318). Linear mixed models were used to regress memory onto FSS across all three timepoints, adjusting for multiple covariates. The moderating effect of marital status was assessed by adding its interaction with FSS in the model. Separate regression models were built for overall FSS and four subtypes (positive interactions, affectionate, emotional/informational, and tangible support). Results We found significant and positive adjusted associations for overall FSS (β: 0.07; 95 % CI: 0.01, 0.13), positive interactions (β: 0.06; 95 % CI: 0.01, 0.11), and affectionate support (β: 0.05; 95 % CI: 0.00, 0.11) with memory. However, the interaction between marital status and FSS (overall and subtypes) was not statistically significant (likelihood ratio test p-value = 0.75), indicating that FSS does not have differing effects on memory depending on marital status. Conclusion Our findings do not provide evidence to suggest that marital status affects the association between FSS and memory in middle-aged and older adults. Nonetheless, policymakers and practitioners should take a comprehensive approach when exploring how various dimensions of social relationships may uniquely influence cognitive trajectories.

BACKGROUNDVisual perceptual learning (PL) shows promise for enhancing visual functions in individuals with visual impairment.OBJECTIVEThis systematic review aimed to evaluate the effectiveness of PL in improving visual function.STUDY ELIGIBILITYEligible studies were those examining the efficacy of PL in individuals with low vision.STUDY APPRAISAL AND SYNTHESIS METHODSThe review protocol was registered with the international Prospective Register of Systematic Reviews (ID CRD42022327545) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Screened studies were synthesized using random-effects meta-analysis and narrative synthesis following Synthesis Without Meta-analysis guidelines. The quality of the evidence was assessed using the Cochrane risk-of-bias tool and the JBI Critical Appraisal Tool for Quasi-Experimental studies.RESULTSFifty studies were included, covering various visual impairments and employing different PL interventions. Most studies had low risk of bias. Meta-analysis showed significant improvement in visual search for individuals with cortical blindness (Hedges'g= 0.71; 95% confidence interval, 0.48 to 0.93; p=0.002); all other analyses did not show significant improvements—reading in central vision loss and cortical blindness, and visual field in peripheral vision loss and cortical blindness. However, the narrative synthesis provided evidence showing effectiveness, particularly in individuals with central vision loss and cortical blindness, demonstrating positive effects on reading, contrast sensitivity, visual field, and motion perception.LIMITATIONSVariations in study design, PL protocols, outcome measures, and measurement methods introduced heterogeneity, limiting the analysis.CONCLUSIONSThe efficacy of PL in vision rehabilitation remains uncertain. Although meta-analysis results were mostly inconclusive, the narrative synthesis indicated improved visual functions following PL, consistent with individual study findings.IMPLICATIONS OF KEY FINDINGSFuture research should optimize intervention parameters, explore long-term effects, and assess generalizability across diverse populations and visual impairment etiologies. Larger randomized controlled trials using standardized outcome measures are needed to advance the field.

Cognitive function is an important indicator of healthy aging as it is central to maintaining functional independence, performing job-related tasks, decision-making, and improving quality of life. Therefore, researchers seek to identify biopsychosocial factors that can help preserve cognitive function in aging individuals. One such factor is the maintenance of good quality marital relationships. Research has consistently shown that married individuals fare better in terms of both physical and psychological health compared to their unmarried counterparts. However, being married is not universally beneficial - the quality of a marriage is also important to consider. To explore the issue further, we conducted a systematic review to examine the association between marital quality and cognitive function. PubMed, PsycINFO, and Scopus were searched for eligible articles examining any measure of marital quality and any cognitive outcome from the inception of each database to January 9th, 2024. Following two levels of citation screening by two independent reviewers, we included 15 articles representing 11 unique studies. Data were synthesized narratively following the Synthesis without Meta-Analysis guidelines and a risk of bias assessment was conducted using the Joanna Briggs Institute checklist. Most articles had a low risk of bias. Although some findings suggested more positive marital quality was associated with improved cognitive function, the results were not uniformly positive; some results were inverse or null, depending upon factors such as differences in study designs and measures of marital quality or cognition. This review is the first attempt to synthesize the literature on this topic. Our findings highlight that any examination of marital status and cognition should also consider contextual factors such as marital quality.

Memory plays a crucial role in cognitive health. Social isolation (SI) and loneliness (LON) are recognized risk factors for global cognition, although their combined effects on memory have been understudied in the literature. This study used three waves of data over six years from the Canadian Longitudinal Study on Aging to examine whether SI and LON are individually and jointly associated with memory in community-dwelling middle-aged and older adults (n = 14,208). LON was assessed with the question: "In the last week, how often did you feel lonely?". SI was measured using an index based on marital/cohabiting status, retirement status, social activity participation, and social network contacts. Memory was evaluated with combined z-scores from two administrations of the Rey Auditory Verbal Learning Test (immediate-recall, delayed-recall). We conducted our analyses using all available data across the three timepoints and retained participants with missing covariate data. Linear mixed models were used to regress combined memory scores onto SI and LON, adjusting for sociodemographic, health, functional ability, and lifestyle variables. Experiencing both SI and LON had the greatest inverse effect on memory (least-squares mean: -0.80 [95 % confidence-interval: -1.22, -0.39]), followed by LON alone (-0.73 [-1.13, -0.34]), then SI alone (-0.69 [-1.09, -0.29]), and lastly by being neither lonely nor isolated (-0.65 [-1.05, -0.25]). Sensitivity analyses confirmed this hierarchy of effects. Policies developed to enhance memory in middle-aged and older adults might achieve greater benefits when targeting the alleviation of both SI and LON rather than one or the other individually.

We investigated the association between pre-COVID-19 memory function and (a) receipt of a COVID-19 test and (b) incidence of COVID-19 using the COVID-19 Questionnaire Study (CQS) of the Canadian Longitudinal Study on Aging (CLSA). The CQS included 28,565 middle-aged and older adults. We regressed receipt of a COVID-19 test on participants' immediate and delayed recall memory scores and re-ran the regression models with COVID-19 incidence as the outcome. All regression models were adjusted for sociodemographic, lifestyle, and health covariates. In the analytical sample (n = 21,930), higher delayed recall memory (better memory) was significantly associated with lower COVID-19 incidence. However, this association was not significant for immediate recall memory. Immediate and delayed recall memory were not associated with receipt of a COVID-19 test. Health policymakers and practitioners may viewmemory status as a potential risk for COVID-19. Memory status may not be a barrier to COVID-19 testing.