OBJECTIVES:Falls represent an important inflection point in later life, increasing the risk of future adverse outcomes. This study aims to examine the association between an index fall, that is, a fall in a participant with no recent history of falls, and subsequent change in functional status, requirements for social care, and falls-related health care utilization. DESIGN:Longitudinal analysis of population-representative data. SETTING AND PARTICIPANTS:Participants (n = 2454) aged ≥65 years from waves 1 to 3 of The Irish Longitudinal Study on Aging. METHODS:Index falls were those reported at wave 2 in participants with no falls reported at wave 1. Falls/fractures, functional status (activities of daily living), and social care (home care, home help, and meals on wheels) were assessed by self-report. Regression models assessed the independent relationship between index falls and outcomes of interest. RESULTS:Twenty percent of participants (n = 493) reported an index fall. In participants who were functionally independent at baseline, an index fall was associated with functional impairment at 2-year follow-up (odds ratio [OR], 1.71; 95% CI, 1.19-2.47; P = .004). Almost 12% with index falls developed functional impairment. In those not requiring home care at baseline, an index fall was independently associated with an almost 3-fold higher likelihood of requiring home care (OR, 2.87; 95% CI, 1.38-5.97; P = .005) and a higher number of monthly home care hours (β = 0.76; 95% CI, 0.18-1.34; P = .010) at 2-year follow-up. Almost 12% with index falls required "new" social supports. An index fall was independently associated with future falls-related emergency department presentations (OR, 1.69; 95% CI, 1.14-2.49; P = .008), future fractures (OR, 1.52; 95% CI, 1.08-2.15; P = .018), but not more general practitioner visits during follow-up. CONCLUSIONS AND IMPLICATIONS:This study demonstrates that even a single fall can signal a significant shift in the health and functional trajectories of community-dwelling older people, reinforcing the need for proactive and coordinated prevention strategies.

OBJECTIVE:Falls represent the most frequent reason older people are admitted to hospital and significantly increase the likelihood of functional decline, healthcare utilisation and early mortality. The aim of this study is to comprehensively delineate the burden of falls amongst community-dwelling older people in Ireland. DESIGN:Population-representative analysis of Wave 6 of the Irish Longitudinal Study on Ageing (TILDA) estimating incidence of falls requiring medical attention and emergency department (ED) attendance, fractures and fear of falling over 12 months. Additional data detailing falls-risk increasing drugs (FRIDs) and prior falls were also analysed.Using Central Statistics Office Census 2022, the population of older people in Ireland was multiplied by the proportion of TILDA participants with each outcome of interest to yield population-level estimates. PARTICIPANTS/SETTING:Population-representative sample of 2299 (55% female) community-dwelling people in Ireland aged ≥70 years. RESULTS:Almost 12% (proportion 0.12 (95% CI 0.10 to 0.13)) of participants, corresponding to almost 62 000 older people in Ireland, reported a fall requiring medical attention in 12 months, with 6% (proportion 0.06 (95% CI 0.05 to 0.07)), or over 32 000 people, attending ED due to a fall. Over 3% (proportion 0.03 (95% CI 0.03 to 0.04)) reported sustaining a fracture. Almost half of participants reporting a fall requiring medical attention were prescribed FRIDs, and over half had also reported a fall when assessed at the prior wave of the study (ie, 2 years ago). CONCLUSIONS:The burden of falls amongst community-dwelling older people is considerable; 1 in 8 required medical attention for a fall and 1 in 16 attended the ED with falls over 12 months.Currently, there is no national falls strategy in Ireland. These findings, alongside our ageing population, underscore the need for strengthened falls-prevention strategies to reduce avoidable morbidity and healthcare utilisation.

BACKGROUND:Frailty is a common syndrome among older adults, associated with multiple adverse health outcomes. Work harmonizing frailty measurement across 25 countries and regions and different socioeconomic environments is limited. A harmonized definition is needed to assess frailty across settings to inform comparative studies of health and healthcare. METHODS:Data on adults aged 50+ from 8 health and retirement surveys were analyzed: CHARLS (China), ELSA (England and Wales), ELSI (Brazil), HRS (USA), LASI (India), MHAS (Mexico), SHARE (Europe and Israel), and TILDA (Ireland). We produced a 30-item deficit accumulation frailty index (FI) from shared variables. We assessed within-survey distributions and, in 4 surveys with available data (HRS, MHAS, SHARE, and TILDA), association with mortality. RESULTS:A total of 184 715 participants were included; mean (SD) age was 65.1 (9.80) and 55.1% were female. Mean (SD) FI was 0.196 (0.133), and 39.2% were frail. Frailty distributions were right-skewed, with higher median FI for females than males (p < .0001). Kaplan-Meier analysis showed lower survival with greater frailty in studies with survival data. Hazard ratios (95% CI, p value) for severe frailty (FI ≥0.4) compared with non-frailty (FI <0.1) after adjustment for age, gender, and smoking status were 5.50 (4.89-6.19), 4.36 (3.67-5.18), 8.81 (6.44-12.05), and 3.97 (2.99-5.27) for HRS, MHAS, SHARE, and TILDA, respectively, all with p < .0001. CONCLUSIONS:This is a harmonized FI developed using data from multiple settings, with strong associations with mortality. This is a useful tool to better understand aging in a global context.

AimTo examine the relationship between wish to die (WTD) and healthcare use in primary and secondary care among older adults living in Ireland.Subject and methodsSecondary analysis of a nationally representative sample of community-dwelling older adults from The Irish Longitudinal Study on Ageing (TILDA). Primary outcomes were self-reported general practitioner (GP) and emergency department (ED) visits in the last 12 months. Negative binomial regression was used to examine the associations between WTD and healthcare use.ResultsOut of 8174 individuals aged 50 and older, a total of 8149 provided information relating to WTD at wave 1. Of these, 279 (3.4%) individuals disclosed a WTD, while 7870 did not. The mean number of self-reported GP visits in the last 12 months was 4.81 (standard error [SE] = 0.29, 95% confidence interval [CI] 4.25-5.37) for those disclosing a WTD (n = 261), while it was 3.59 (SE = 0.04, 95% CI 3.51-3.67) for those without a WTD (n = 7791). WTD was associated with a higher number of GP visits (incidence rate ratio [IRR] = 1.03, p = 0.03, 95% CI 1.00-1.06). After adjusting for relevant covariates, associations between WTD and ED visits were not observed. Female gender, lower education levels, living alone, depressive and anxiety symptoms, chronic health conditions, severe chronic pain, problematic alcohol consumption, smoking, falls, disability, and regular medication use showed significant associations with WTD. Limitations of the study include the presentation of cross-sectional results; thus we do not make causal inferences or conclusions on the directionality/trajectory of WTD and healthcare use.ConclusionOlder adults reporting WTD presented to GPs approximately five times within the previous 12 months. While effect sizes were small, these findings may help inform health services. Future research can further examine potential longitudinal associations and whether GP and ED attendance patterns change over time.

Background This study examined the Big 5 personality traits as potential sources of heterogeneity in changes in depressive symptoms while accounting for pre-pandemic trends in depressive symptoms. Methods Data from 5 waves of The Irish Longitudinal Study on Ageing (TILDA), including a COVID-19 specific sub-study were included.. Linear mixed effects models fit by maximum likelihood examined personality traits as potential sources of heterogeneity in changes in depressive symptoms associated with the COVID-19 pandemic occurring over time. Results Participants (n=3,404, 56.7% female) were aged 50 years and older. In the COVID-19 Wave, depressive symptoms were 0.29 points higher (b=0.29, 95%CI: 0.16–0.42; p <0.001) per 1-SD increase in neuroticism, 0.12 points higher (b=0.12. 95%CI: 0.00–0.24; p =0.045) per 1-SD increase in extraversion, and 0.14 points lower (b=-0.14, 95%CI: -0.25–-0.03; p =0.014) per 1-SD increase in openness than would have been expected from the trends observed before the pandemic. Conclusions Depressive symptoms were significantly higher during COVID-19 compared to what would have been expected from the trends observed prior to the pandemic. People who scored higher in neuroticism and extraversion, and lower on openness, reported the greatest increases in depressive symptoms.

An integrated haemodynamic response during standing may serve as a marker of neuro-cardiovascular function. Individual components of both heart rate (HR) and blood pressure (BP) responses to active stand (AS) have been linked with cardiovascular disease (CVD) and mortality. We hypothesised that integrating BP/HR information from the entire haemodynamic response curve may uncover otherwise unknown associations with both CVD and mortality. Beat-to-beat measurements of dynamic HR/BP responses to AS were conducted in 4336 individuals (61.5 ± 8.2 years; 53.7

OBJECTIVES:To investigate whether tooth loss is associated with all-cause and cause-specific mortality in older Irish adults. METHODS:A total of 8494 participants from The Irish Longitudinal Study on Ageing (TILDA) were included. Survey data were linked to death registration records, covering individuals who participated in TILDA Wave 1 (2009/2010) and died by 31st January 2022. Cox proportional hazards regressions and competing risk survival analyses were employed to examine the longitudinal relationship between tooth loss and both all-cause and cause-specific mortality. RESULTS:The mean age of participants at baseline was 63.2 years (SD 10.2). Among the cohort, 3951 (46.5%) were categorized as "Dentate, no denture," 3041 (35.8%) as "Dentate, with denture(s)," and 1502 (17.7%) as "Edentulous." Over a median follow-up of 12 years, 1430 (16.8%) participants died. After adjusting for confounders, edentulous participants had a significantly higher hazard ratio (HR) for all-cause mortality compared to dentate participants with no dentures (HR = 1.42, 95% CI 1.23-1.65, p < 0.001). For cause-specific mortality, edentulism had the greatest sub-distribution hazard ratio (SHR) with respiratory mortality (SHR = 1.57, 95% CI 1.03-2.41, p = 0.04), followed by cancer mortality (SHR = 1.31, 95% CI 1.01-1.71, p = 0.04). There was a nonsignificant association with cardiovascular mortality (SHR = 1.25, 95% CI 0.96-1.63, p = 0.10). CONCLUSIONS:Edentulism was independently associated with all-cause mortality in a cohort of 8494 men and women from Ireland. Edentulism was significantly associated with respiratory and cancer mortality.

IntroductionSocial disconnection and deaths by suicide among older adults are both important public health concerns, particularly in the context of ageing populations. The association between death ideation and behaviours, and social disconnection is well established and both functional and structural social relationships have been identified as predictive of suicide-related thoughts and behaviours. The “Wish to Die” (WTD) involves thoughts of or wishes for one’s own death or that one would be better off dead is a commonly used indicator to capture death ideation. It has been shown to be as predictive as active ideation of future suicide attempt.MethodsData were from a large cohort of community-dwelling older adults aged 50+, The Irish Longitudinal Study on Ageing (TILDA). Cross-sectional analyses of the association between numerous markers of social disconnection (loneliness, social isolation, living alone, marital status, social participation, volunteering, and attending religious service) and WTD were conducted.ResultsMultiple markers of social disconnection were associated with a “wish to die”. However, loneliness was the strongest risk factor while attendance of religious services was an important protective behaviour.DiscussionThere is a strong association between social disconnection and a WTD among older adults. There is also a strong association between depression and a WTD, while attending religious services or similarly prosocial settings may protect older adults from experiencing negative thoughts about dying.

A Data Management Plan (DMP) is a formal document that outlines the management and stewardship of data generated over the lifecycle of a research project from data collection, and governance structures, to the long-term preservation of data outputs. DMPs are an important feature of good research practice. Our aim is to provide details of the development of a DMP that others can learn from and adapt to their specific needs. Our DMP was developed as part of a COVID-19 sub-study of The Irish Longitudinal Study on Ageing (TILDA), titled “Altered lives in a time of crisis: preparing for recovery from the impact of the COVID-19 pandemic on the lives of older adults”. TILDA is a longitudinal study of community-dwelling older adults. In 2009/2010, an initial nationally representative sample of 8,500 adults aged 50 years and older were selected. The sample for the COVID-19 study were recruited from this existing sample. The objective of the sub-study was to document the lives and experiences of older adults during the COVID-19 pandemic to better understand the effect of the pandemic and public health responses on their well-being. This DMP describes the study design and objectives; data collection tools and procedures; data preparation; data storage and security; data sharing and preservation; and ethical and legal considerations within the European Union and Irish Health Research legislative context. Responsible data governance in Ireland is complex, requiring adherence to both European and Irish legislation. Implementation of the Health Information Bill (2023) may bring further complexities to this context. It is therefore crucial that researchers, data stewards, and other practitioners, share their expertise freely, as we have done here, so that others can learn from their experiences and the health research community can develop standards of best practice.

Background Religious attendance has been shown to have a positive effect on psychological health among the older people [1]. Due to COVID-19 lockdown restrictions and precautionary health advice, many older adults struggled to attend service in-person. However, 87% of faith organisations provided a form of remote service between June and December 2020 [2]. Methods Data were from Wave 6 (2021) of The Irish Longitudinal Study on Ageing (TILDA). Data were collected via telephone interview and self-completion questionnaires. The analysis sample was made up of 3,961 community-dwelling adults living in Ireland aged 60 years and older. To assess religious attendance, participants were asked about how often they attended in-person and how often they attended remotely using radio, television, or internet streaming. Relationships between religious attendance, Quality of Life (QoL), Loneliness, Stress, and Anxiety were modelled using linear regressions. Results The sample was 44.1% male and 55.9% female, with a mean age of 72.0 years. In-person religious attendance was positively related to higher QoL [Beta=192.92, 95% Confidence Intervals (CI)=9.45, 376.39, p<0.05]. Remote religious attendance was positively related to higher anxiety [IRR=1.03, 95% CI=1.02, 1.04, p<0.001]. Conclusion Results show that in-person attendance was positively related to QoL, while remote attendance was positively related to higher anxiety. This may be a result of the lack of social connectedness felt when practicing religion remotely or the higher level of anxiety during the COVID-19 pandemic. Future research should focus on social connectedness felt during in-person religious practice and during remote practice.

Abstract Background There is a strong culture of sports club membership amongst older people in Ireland. It has been suggested that this confers health benefits due to increased physical activity and social connection, but studies examining this are currently lacking. The aim of this study therefore was to assess the relationship of sports club membership with markers of health and well-being in a large population-representative cohort of older people. Methods Over 3,500 participants ≥65 years at Wave 5 (mean 74 years, 54% female) of the Irish Longitudinal Study on Ageing were included. Sports club membership (GAA, soccer, rugby, tennis, golf) was elicited by self-report. Depressive symptoms (Centre for Epidemiological Studies Depression Scale), loneliness (UCLA Scale), and quality of life (Control Autonomy Self-Realization Please Scale) were assessed with internationally validated scales. Physical Activity was by self-report and mobility impairment was defined as Timed-Up-and-Go≥14s. The associations between sports club membership and these outcomes were assessed with regression models adjusted for age, sex, education, polypharmacy, chronic disease burden and heart disease. Results One fifth (708/3,510) of participants were a member of a local sports club. Sports club membership was associated with lower rates of depressive symptoms (Odds ratio 0.51 (95% CI 0.34,0.75)), lower levels of loneliness (Beta = -0.28 (95% CI -0.46, -0.10)) and better quality of life (Beta= 0.93 (95% CI 0.49,1.38)) in fully-adjusted models. Sports club members spent more days doing moderate physical activity per week (2.0 (95% CI 1.85,2.21) vs 1.64 (95% CI 1.54,1.73); p<0.001) and had lower likelihood of mobility impairment (Adjusted Odds Ratio 0.49 (95% CI 0.36,0.68)). Conclusion Sports Club Membership is prevalent amongst community-dwelling older people in Ireland and is associated with lower rates of loneliness, depressive symptoms and mobility impairment, and better quality of life. Older sports club members should be encouraged to maintain this activity where feasible.