Zusammenfassung Mit steigendem Alter nimmt die Prävalenz von Adipositas, aber auch von sarkopenischer Adipositas (einer relativen Adipositas, die vor allem durch eine geringe Muskelmasse charakterisiert ist), zu. Während die gesundheitlichen Auswirkungen durch Adipositas bei älteren und vor allem hochbetagten Menschen in Bezug auf manche medizinische Outcomes kontrovers diskutiert werden, ist sarkopenische Adipositas sehr eindeutig mit reduzierter Selbstständigkeit, Einbußen der Lebensqualität, Pflegebedürftigkeit, Institutionalisierung, und erhöhter Morbidität und Mortalität verbunden. Gut abgesicherte präventive Maßnahmen zur Verhinderung dieser negativen Outcomes inkludieren vor allem körperliches, muskelkräftigendes Training und eine proteinreiche, kalorien-adäquate Ernährung.

Objective: To evaluate the effects of a 4-week "BikeRacer-Multitasking" computer-based training program on various outcomes, such as multitasking ability, and performance in complex situations on a bicycle exercise course, in comparison with two active control groups. Materials and Methods: Randomized controlled study including 56 participants aged 65 years or older. The intervention group (IG) performed 4 weeks of training with the BikeRacer-Multitasking computer game, in which two tasks had to be carried out at the same time: steering a bicycle on a given path, reacting to a target stimulus as quickly as possible, and ignoring three further distractor stimuli. The first control group (CG1) trained with a version of the BikeRacer game without the multitasking component, and the second control group (CG2) played Sudoku. All three groups performed questionnaire-based psychometric performance tests and tasks on a real-life bicycle exercise course twice, before and after the intervention. Results: Processing speed improved significantly over time in all three groups. Selective attention (correct answers) significantly improved in the IG and CG1, but not in CG2 (P = 0.022 for the interaction). Multitasking ability and divided attention significantly improved in IG, decreased in CG1, and showed no change in CG2 (P = 0.005 for the interaction). All three groups showed significantly better performances in some of the multitasking components in the bicycle course after the training compared with before (no significant group interaction). Conclusion: BikeRacer-Multitasking game increased the multitasking ability of senior cyclists as well as their performance in complex situations of a bicycle exercise course.

Health-related quality of life (QoL) is a key indicator of health and care quality in geriatric nursing homes. We assessed QoL in 190 residents of three nursing homes with questionnaires developed by the World Health Organization (WHO), the WHOQOL-BREF and the WHOQOL-OLD, and compared them to two control groups. The mean global QoL score was 60.1 in nursing homes, slightly higher than in a comparable home-living group (54.8; P = 0.085) but significantly lower than in the general population (72.4; P < 0.001). The highest rated domain was fear of death and dying (81.2), the lowest autonomy (56.3). Multivariate analyses showed that female sex and surviving cancer improved some WHOQOL-BREF domains, while older age, higher care level, diabetes, and stroke reduced certain WHOQOL-OLD domains. Overall, QoL in nursing homes was high, even higher than among home-living peers, but lower than in healthier, younger populations. Fear of the end of life was low; autonomy declined most. Stroke notably reduced QoL, whereas long-term cancer survival was linked to better outcomes.

Background: The pivotal role of CD40-CD40L interactions in systemic lupus erythematosus (SLE) pathogenesis stems from the orchestration of a range of immune and inflammatory responses involving B cells, T cells, and other antigen-presenting cells.[1] Dapirolizumab pegol (DZP) is a polyethylene glycol-conjugated antigen-binding fragment lacking a functional Fc domain that inhibits CD40L,2 and is under investigation in a phase 3 trial in patients (pts) with SLE (PHOENYCS GO; NCT04294667). In the phase 2b RISE trial (NCT02804763), DZP was associated with improvements in several measures of disease activity.[2] Objectives: To conduct a post hoc pharmacodynamic analysis to explore the impact of DZP on T cell responses and serum cytokine levels using data from the phase 2b RISE trial.[2] Methods: In RISE, pts received placebo (PBO) or DZP (6/24/45 mg/kg) alongside standard of care (SOC) for 24 weeks (wks); adults with active SLE with moderate-to-severe disease manifestations receiving stable doses of SOC treatments were included in the trial.[2] Analyses focused on a subgroup of pts from RISE similar to the PHOENYCS GO population, namely those with persistent active SLE or acute worsening of SLE in the scope of frequent flaring/relapsing-remitting disease (n=131), previously identified as predictors of a lower response to SOC+PBO.[3] Results are shown for the PBO and DZP 24 mg/kg arms. Protein analysis was conducted on all available serum samples at baseline and Wks 2, 8, and 24, using the Olink® Target 96 Inflammation panel of protein biomarkers. RNA sequencing was performed on available blood samples at baseline and Wks 2, 4, 12, and 24. Samples were not available for all pts at all timepoints. Gene expression changes were analyzed and competitive gene set analyses performed for pathways relevant to SLE immunopathology, selected from Gene Ontology Biological Processes and augmented with gene signatures that discriminate immune cell types in SLE.[4-6] Differential expression results for DZP treatment were corrected for SOC effects. Pts were also stratified post hoc by baseline T cell-associated gene expression using a T cell gene signature derived from single cell gene expression data.[5] Results: Of the 92 proteins measured, DZP significantly downregulated 4 proteins (CCL19, IL12B, TNFRSF9 [CD137], and TNF [TNFA]) across all timepoints, and 3 (TNFB, CXCL9, and CD6) at Wks 2 and 8, compared with PBO. These were mostly co-stimulatory proteins associated with T cell activation, including IL12B (primarily produced by professional antigen presenting cells)[7] and the co-stimulatory molecule TNFSFR9 (CD137), which alongside CD40 play critical roles in T cell activation. The proinflammatory cytokines TNF and TNFB were also significantly downregulated. At baseline, across all treatment arms, 54/120 (45%) pts showed high T cell-associated gene expression. In pts with high baseline expression, DZP significantly downregulated various biological pathways associated with T cell activation and related adaptive immune processes, including antigen processing/presentation and type II interferon (IFN-γ) responses, compared with PBO. All effects described above were observed as early as Wk 2 following a single DZP dose. Conclusion: Beyond its known effects on B cells and IFN signaling,[8] these data demonstrate targeted effects of DZP on T cell activation and additional proinflammatory cytokines, such as IFN-γ, involved in T cell activation and adaptive immune responses related to SLE. The identified biomarkers will undergo further validation in planned pharmacodynamic studies in relation to clinical efficacy. REFERENCES: [1] Ramanujam M. Autoimmun Rev. 2020;19(11):102668. [2] Furie RA. Rheumatology (Oxford). 2021;60:5397–407. [3] Askanase A. Ann Rheum Dis. 2023;82(Suppl 1):272. [4] Wu D. Nucleic Acids Res. 2012;40(17):e133. [5] Mandric I. Nat Commun. 2020;11(1):5504. [6] Gene Ontology Consortium. Nucleic Acids Res. 2021;49(D1):D325–34. [7] Ullrich KA. EXCLI J. 2020;19:1563–89. [8] Cutcutache I. Arthritis Rheumatol. 2023;75(suppl 9). Acknowledgements: Funded by UCB Pharma and Biogen Inc. Medical writing support provided by Costello Medical and funded by UCB Pharma and Biogen Inc. Disclosure of Interests: Alex S. Powlesland Former employee of UCB Pharma, Ioana Cutcutache Shareholder of UCB Pharma, Employee of UCB Pharma, Andrew Skelton Shareholder of UCB Pharma, Employee of UCB Pharma, Anthony Shock Shareholder of UCB Pharma, Employee of UCB Pharma, Matthew Page Shareholder of UCB Pharma, Employee of UCB Pharma, Eris Bame Shareholder of Biogen Inc., Employee of Biogen Inc., Janine Gaiha-Rohrbach Shareholder of Biogen Inc., Employee of Biogen Inc., George Stojan Shareholder of UCB Pharma, Employee of UCB Pharma, Ania Skowera Shareholder of UCB Pharma, Employee of UCB Pharma, Christian Stach Shareholder of UCB Pharma, Employee of UCB Pharma, Thomas Dörner Received travel support to KCR 2023 from Novartis, Received honoraria for conducting clinical trials (paid to the university) and honoria for scientific advice from AbbVie, Eli Lilly, Janssen, Roche/GNE, and UCB Pharma.

The climate crisis is developing into a life-changing event on a global level. Health promotion with the aim to increase the health status of individuals, independent of the present health status, has been developed on a scientific basis at least for the last eight decades. There are some basic principles which are prerequisites for both health promotion and climate protection. Those principles include (1) sustainability, (2) orientation on determinants, and (3) requirement of individual as well as community approaches. People are generally aiming to protect their lifestyle habits (e.g., traveling and consumer habits) and personal property (e.g., car and house) with easy solutions and as little effort as possible, and this can affect both health and climate. To reduce the emission of greenhouse gases and to protect our environment, changes towards a sustainable lifestyle have to be embedded into everybody’s mind. Examples for domains that need to be addressed in health promotion as well as in climate protection include (health and climate) literacy, physical activity and active mobility, and nutrition and dietary habits. If health promotion fails to tackle those domains, this will continue to drive the climate crisis. And climate change, in turn, will affect health. On the other hand, developing and promoting health resources in the domains mentioned could help to mitigate the health-damaging effects of climate change. Success in the joint efforts to promote health and protect the climate would improve the One Health approach, the health of people and the environment.

Exposure to extreme heat is associated with both increased morbidity and mortality, especially in older people. Health burdens associated with heat include heat stroke, diabetes mellitus, hypertension, ischemic heart diseases, heart failure and arrhythmia, pulmonary diseases but also injuries, problems with activities of daily living, and mental disorders. In Europe, there are remarkable spatial differences in heat exposure between urban and less populated areas. In Austria, for example, there is a significant gradual association between population density and the number of heat days, where the gradient of urbanization also follows the gradient of sea level. The European population is continuously ageing, especially in rural areas. Older adults are especially vulnerable to negative health consequences resulting from heat exposure, due to a lack of physiological, social, cognitive, and behavioral resources. Older people living in urban areas are particularly at risk, due to the urban heat island effect, the heat-promoting interplay between conditions typically found in cities, such as a lack of vegetation combined with a high proportion of built-up areas; however, older people living in rural regions often have less infrastructure to cope with extreme heat, such as fewer cooling centers and emergency services. Additionally, older adults still engaged in agricultural or forestry activities may be exposed to high temperatures without adequate protection or hydration. More research is required to examine factors responsible for heat vulnerability in older adults and the interactions and possibilities for increasing resilience in older urban and rural populations to the health consequences of heat.

BACKGROUND:Choosing the right intensity of medical care is a huge challenge particularly in long-term geriatric care. The Nascher score was developed to assess future medical care needs. The aim of this study was to determine whether the Nascher score and a revised version can predict future medical needs. METHODS:In this retrospective cohort study, 396 residents in long-term care hospitals, who were admitted over a period of two years and followed up to two and a half yeare, were analysed. Outcome parameters were: (1) number of medication changes, (2) number of ward doctor documentations and (3) number of acute illnesses treated with antibiotics, and mortality risk. Based on the first results, an alternative scoring of the Nascher score with 12 instead of 26 items was developed, called the revised Nascher score. RESULTS:The Nascher score significantly correlated with the number of medication changes, the number of ward doctor documentations, and the number of acute ilnesses treated with antibiotics with Spearman correlation coefficients of 0.30, 0.26, and 0.15, respectively. The revised Nascher score showed a higher correlation with correlation coefficients of 0.36, 0.26, and 0.21, respectively. Residents with a Nascher score in the highest quartile had a significantly higher mortality risk than residents in the lowest quartile (hazard ratio, HR 2.97, 95% confidence interval, CI 1.80-4.34). The corresponding values for the revised Nascher score were HR 3.03, 95% CI 2.03-4.54 in the highest and HR 1.80, 95% CI 1.24-2.60 in the middle quartiles. CONCLUSION:The Nascher score and even more so the revised Nascher score are well suited to predicting the various parameters of future medical needs and mortality risk.

Analyses of late-life disability based on survey data of the oldest old often suffer from non-representative samples due to selective participation and attrition. Here, we use register data on the Austrian long-term care allowance (ALTCA) as a proxy for late-life disability. In this retrospective mortality follow-back study, we analyze receipt of ALTCA, a universal cash benefit based on physician-assessed disability in activities of daily living during the last 10 years of life, among all decedents aged 65 years and over from 2020 in Austria (n = 76,781) and its association with sex, age at death, and underlying cause of death. We find that on average, ALTCA was received for 3.5 and 5.3 years in men and women. At 10 years before death, 10

Providing health care is a balancing act among human resources, financial pressures and system-intrinsic factors. Understanding the utilization behaviour of primary and secondary care facilities [general practitioners (GPs) vs. specialists, as well as in- and outpatient hospital care] is crucial for a country like Austria, which has free access to all levels of care. The aim of this study was to reassess access point consultations in relation to sociodemographic variables over time. The databases used for this cross-sectional analysis were the Austrian Health Interview Surveys 2006/07, 2014, and 2019, with sample sizes of 15 474, 15 770, and 15 461 persons, respectively. Analyses included patterns of utilization behaviour, multivariable logistic regression models, and diff-in-diff analyses highlighting differences between the observation periods. GP and secondary care consultations increased from 2014 to 2019. While there were fewer GP visits in 2014 than in 2006/07, GP consultation rates grew by 3.2% between 2014 and 2019. Secondary care utilization increased by 5.4%-8.2% between 2006/07 and 2019, with the highest growth in older and less-educated persons. Secondary-level utilization without prior GP visits decreased again in 2019 after peaking in 2014. Utilization of all access points increased over the entire observation period, especially regarding secondary-level care. Higher GP visit rates do not seem to result in a drop in secondary-level consultations. These results emphasize the coordinator role of primary care in ongoing structural health reforms in European countries, such as Austria.

Summary Background Difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults are associated with diminished quality of life and increased demand for long-term care. The present study examined the prevalence of disability among individuals aged 65 years and older in Austria, using data from the Austrian Health Interview Surveys (ATHIS). Methods The ATHIS 2014 and 2019 surveys were used ( N = 5853) for the analysis. Binary logistic regression was performed to measure the association between disability in at least one ADL or IADL limitation and independent variables adjusted for sociodemographic, health-related behavior and survey year. Results The prevalence of ADL or IADL limitations increased in both sexes during the 5‑year follow-up period. For ADL limitations, the prevalence rose from 12.8% to 17.9% in men ( p < 0.001) and from 19.2% to 25.7% in women ( p < 0.001). The IADL limitations increased from 18.9% to 35.1% in men ( p < 0.001) and from 38.2% to 50.8% in women ( p < 0.001). Women reported significantly higher odds for ADL (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.93–1.26) and IADL limitations (OR: 1.74, 95% CI: 1.53–1.98). In both sexes, participants aged 80 years and older reported higher odds for ADL (OR: 4.37, 95% CI:3.77–5.07) and IADL limitations (OR: 4.43, 95% CI: 3.86–5.09) compared to the younger group. Participants with at least one chronic disease reported higher odds for ADL (OR: 4.00, 95% CI: 3.41–4.70) and IADL limitations (OR: 4.37, 95% CI: 3.85–4.96). Primary education, single status, being born in non-EU/EFTA countries, and residing in Vienna were associated with higher odds of ADL and IADL limitations. Conclusion Gender, age, education, country of birth, residence, partnership status, number of chronic diseases, noncompliance with physical activity, and nutrition recommendations had a strong association with increased vulnerability to disability. Public health policy must address these factors for disability prevention strategies.

Choosing the right intensity of medical care is a huge challenge particularly in long-term geriatric care. The Nascher score was developed to assess future medical care needs. The aim of this study was to determine whether the Nascher score and a revised version can predict future medical needs. In this retrospective cohort study, 396 residents in long-term care hospitals, who were admitted over a period of two years and followed up to two and a half yeare, were analysed. Outcome parameters were: (1) number of medication changes, (2) number of ward doctor documentations and (3) number of acute illnesses treated with antibiotics, and mortality risk. Based on the first results, an alternative scoring of the Nascher score with 12 instead of 26 items was developed, called the revised Nascher score. The Nascher score significantly correlated with the number of medication changes, the number of ward doctor documentations, and the number of acute ilnesses treated with antibiotics with Spearman correlation coefficients of 0.30, 0.26, and 0.15, respectively. The revised Nascher score showed a higher correlation with correlation coefficients of 0.36, 0.26, and 0.21, respectively. Residents with a Nascher score in the highest quartile had a significantly higher mortality risk than residents in the lowest quartile (hazard ratio, HR 2.97, 95

Frailty is associated with adverse health outcomes in ageing populations, yet its long-term effect on the development of disability is not well defined. The study examines to what extent frailty affects disability trajectories over 15 years in older adults aged 50+. Using seven waves of data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the study estimates the effect of baseline frailty on subsequent disability trajectories by multilevel growth curve models. The sample included 94 360 individuals from 28 European countries. Baseline frailty was assessed at baseline, using the sex-specific SHARE-Frailty-Instrument (SHARE-FI), including weight loss, exhaustion, muscle weakness, slowness, and low physical activity. Disability outcomes were the sum score of limitations in activities of daily living (ADL) and Instrumental ADL (IADL). Analyses were stratified by sex. Over 15 years, baseline frailty score was positively associated with disability trajectories in men [βADL = 0.074, 95% confidence interval (CI) = 0.064; P = .083; βIADL = 0.094, 95% CI = 0.080; P = 0.107] and women (βADL = 0.097, 95% CI = 0.089; P = .105; βIADL = 0.108, 95% CI = 0.097; P = .118). Frail participants showed higher ADL and IADL disability levels, independent of baseline disability, compared with prefrail and robust participants across all age groups. Overall, participants displayed higher levels of IADL disability than ADL disability. Study findings indicate the importance of early frailty assessment using the SHARE-FI in individuals 50 and older as it provides valuable insight into future disability outcomes.