Sarcopenia, characterized by age-related muscle loss, poses a substantial public health challenge considering the aging global population. Studies on the quality of life (QOL) related to sarcopenia have gained increasing attention. The purpose of this study was to offer a comprehensive and scholarly analysis of the research pertaining to sarcopenia and its effects on QOL. A systematic search was carried out, covering the period from 1997 to 2023, in the Web of Science Core Collection to identify relevant articles. A total of 1,899 articles were extracted and analyzed, comprised of contributions from 82 countries, 3,012 research institutes, and 727 scholarly journals. Advanced bibliometric tools were employed to unravel intricate research patterns and themes. Visual analysis explored the co-occurrence of institutions, countries, and authors. Additionally, a comprehensive co-citation analysis was conducted to ascertain intellectual structure and knowledge dissemination. Keyword analyses revealed the primary research directions, elucidating clusters encompassing skeletal muscle, muscle strength, aging, and other related areas, thereby highlighting research hotspots. Furthermore, the identification of burst keywords discerned trending topics and areas of enquiry, including sarcopenia, QOL, skeletal muscle, Asian working groups, depression, bone, and fatigue. The findings underscore the escalating scholarly interest and advancement in sarcopenia QOL research. These outcomes signify a global collaborative effort among researchers and institutions to understand the impact of sarcopenia on the overall well-being of individuals. Importantly, this study emphasizes the imperative to overcome the prevailing academic barriers to interdisciplinary collaboration and further advance sarcopenia QOL research.
With the ever-increasing globalizing of aging, chronic comorbidity has become both common among the old population. The senile comorbidities pose as notable challenges of escalation of medication and medical expenditures, and loss in the quality of life of the mature patients. The increase in medication literacy would help reduce the land of unsafe drug administration, unfavorable feelings, and also improve the treatment rates among persons. But there is variation in the rate of medication literacy among the older adults living with varying comorbidities of chronic diseases. Thus, this paper utilizes latent profile analysis to segment medication literacy in this population group in an attempt to clarify the features that accompany medication Literacy among the older adults who with the presence of chronic comorbidities. Additionally, it discusses factors that contribute to medication literacy when using different types of chronic conditions, hence developing theoretical underpinnings to the upcoming individualized medication literacy interventions programs as per older adults patients with chronic comorbidities. The study is a cross-sectional study of 611 hospitalized patients over the age of 60 years with chronic comorbidities through Grade III hospitals in Shizuishan City in the period between January, 2024 and March, 2024 using the convenience sampling method. The General Data Scale, the Medication Literacy Scale among the Elderly Patients with Chronic Diseases, the Self-perceived Burden Scale and the Technophobia Scale were used to collect information. Latent profile analysis (LPA) disclosed that medication literacy of the older adults patients with chronic diseases could be classified into four different groups namely; high medication literacy (17.02%), medication Literacy-low critical type (38.13%), medication Literacy-high critical type (31.26%), and low medication Literacy (13.58%). Influential factor analysis showed that drinking history, educational level, marital status, occupational status, personal monthly income, family location, caregiver involvement, living style, type of medical insurance, daily exercise time, time duration of disease, number of hospitalizations in the past year, personal view of sleep status, age, and self-perceived burden, technophobia, had significant impact among the varied category of chronic disease patients in terms of medication literacy (p < 0.05). Medication literacy among chronic comorbidity patients is largely heterogeneous. It is advised that clinicians should do more specific interventional programs based on the nature of different levels of medication literacy to achieve better medication literacy rates within this category of population to improve treatment effects.
BackgroundWomen express lack of knowledge about the menopause transition, finding it hard to understand and navigate symptoms. This period may negatively influence quality of life and level of functioning.ObjectivesTo explore menopausal women's experiences, perspectives and coping strategies to comprehend, manage and find meaning in the menopausal transition.DesignIndividual interviews of women with different backgrounds and menopausal experiences, recruited by hairdressers in Norway.MethodsSemi-structured in-depth interviews were conducted with 11 women in 2024. Data were analysed using reflexive thematic analysis. The theory of Salutogenesis and Sense of Coherence developed by Antonovsky, was used as guiding theoretical lens.ResultsThree main themes were developed, incorporating the intercorrelated aspects of Sense of Coherence: Comprehensibility, Manageability and Meaningfulness. 1. A transition from the unknown to normalisation - without knowledge, understanding menopausal changes was challenged, but normalisation of menopause gave comprehension. 2. From distress and silence to empowerment - manageability increased with comprehension, discussions with other women and knowledge dissemination, but was challenged by inadequate health care. 3. Finding meaning in the change menopause brings - meaningfulness motivated to seek understanding and coping strategies, and gave acceptance and value to this transition, although often accompanied by an undesirable sense of aging.ConclusionsThis study shows the importance of enhancing knowledge among women, the public and general practitioners to understand and manage menopause, and to improve menopausal care and women's quality of life. The menopause transition may give various symptoms that challenge women’s quality of life and functioning. Without knowledge about menopause, it can be hard to understand what is happening as symptoms may be unknown to be related to this life phase. This study used in-depth individual interviews with 11 menopausal women about their strategies to cope during this transition. The women expressed frustration over their inability to comprehend the symptoms, as they did not associate them with menopause until the onset of the well-known hot flashes. At the same time, they appreciated the increased discourse in society about the menopause transition that normalised this life phase and gave them a feeling of not being alone. Better understanding of the symptoms made it possible to try to manage the changes, through discussions with others and by seeking help. Several women experienced a feeling of not getting the help they expected from their general practitioner (GP) and were also surprised by the GP’s relative lack of knowledge. Still, they kept looking for answers and strategies to understanding and to find solutions for better care. Many found meaning in the changes the menopause transition gave, through new opportunities and an awareness that made them look at their lives and their health strategies, although they at the same time often acknowledged an undesirable sense of aging. This study shows the importance of providing knowledge to women, the society and doctors about the menopause transition to improve understanding and management and finally enhance women’s quality of life.
Objective: To investigate the prevalence and etiologies of blindness and visual impairment in China from 1990 to 2021, and to provide references for formulating prevention and treatment strategies for blindness and visual impairment. Methods: This study was an ecological trend study based on the Global Burden of Disease (GBD) 2021 database. Data on the number of cases, prevalence, age-standardized prevalence and etiologies of blindness and visual impairment in China from 1990 to 2021 were extracted. The prevalence and changes in etiological composition in different genders and age groups were analyzed. Joinpoint regression model was used to calculate the Average Annual Percentage Change (AAPC). Decomposition analysis was performed to quantify the contributions of population aging, population growth and epidemiological change to the changes in the number of cases. Results: In 2021, the number of cases of blindness, severe visual impairment and moderate visual impairment in China was 8.768 2 million, 4.178 9 million and 47.757 2 million, respectively, which increased by 64.90%, 129.47% and 139.80% compared with 1990, with AAPCs of 1.70%, 2.87% and 2.89%, respectively (all P<0.05). The age-standardized prevalence rates were 465.14 per 100 000 population, 214.09 per 100 000 population and 2 501.72 per 100 000 population, respectively, which showed changes of -28.63%, -8.73% and+7.74% compared with 1990, with AAPCs of -1.03% (P<0.05), -0.15% (P=0.281) and 0.28% (P<0.05), respectively. The prevalence of visual impairment was higher in females than in males. In 2021, the highest number of cases of blindness and severe visual impairment was in the 70-74-year age group; the highest number of cases of moderate visual impairment was in the 65-69-year age group. Population aging contributed 133.40%, 87.49% and 68.54% to the changes in the number of cases of blindness, severe visual impairment and moderate visual impairment, respectively; population growth contributed 39.82%, 23.78% and 22.18%, respectively; epidemiological change contributed -73.22%, -10.56% and 9.28%, respectively. Refractive error and cataract were the top two etiologies of blindness and visual impairment. Conclusion: The number of cases of blindness and visual impairment in China showed an upward trend from 1990 to 2021. With population growth and aging, the disease burden will further increase. Focusing on cataract in the elderly and refractive error in children and adolescents is an important strategy to reduce the burden of blindness and visual impairment in China. 目的： 探讨1990至2021年中国盲和视力损伤患病情况及病因，为制定盲和视力损伤防治策略提供参考。 方法： 本研究为基于全球疾病负担（GBD）2021数据库的生态趋势研究。提取该数据库1990至2021年中国盲和视力损伤的患病人数、患病率、年龄标准化患病率及病因数据，分析不同性别、年龄人群的患病情况及病因变化；应用Joinpoint回归模型计算平均年度变化百分比（AAPC）；采用分解分析方法，量化人口老龄化、人口增长和流行病学因素对患病人数变化的贡献。 结果： 2021年中国盲、重度视力损伤和中度视力损伤的患病人数分别为876.82万、417.89万和4 775.72万，相较于1990年分别增加64.90%、129.47%和139.80%，AAPC分别为1.70%、2.87%和2.89%（均P<0.05）；标化患病率分别为465.14/10万、214.09/10万和2 501.72/10万，相较于1990年分别减少28.63%、8.73%和增加7.74%，AAPC分别为-1.03%（P<0.05）、-0.15%（P=0.281）和0.28%（P<0.05）。女性视力损伤率高于男性。2021年盲和重度视力损伤人数最多的年龄段均为70~74岁，中度视力损伤人数最多的年龄段为65~69岁。人口老龄化分别贡献盲、重度和中度视力损伤患病人数增长的133.40%、87.49%和68.54%；人口增长分别贡献39.82%、23.78%和22.18%；流行病学因素分别贡献-73.22%、-10.56%和9.28%。屈光不正和白内障是引起盲和视力损伤的前两位病因。 结论： 1990至2021年中国盲和视力损伤患病人数呈上升趋势，随着人口增长和老龄化加剧，疾病负担将进一步加重。重点关注老年人白内障、儿童青少年屈光不正，是降低我国盲和视力损伤疾病负担的重要方向。.
The aim of this systematic review is to provide insight into whether response shift impacts the conclusions about change in patient-reported outcome measures (PROMs) in terms of statistical significance, magnitude, and decisions made. Response shift studies from Sawatzky et al. (2025; QLR) were analyzed: longitudinal quantitative studies that examined response shift using PROMs, published before May 2023. We determined whether: 1) impact of response shift was investigated, 2) information about change in the scores of a PROM (i.e., PROM-result) before and after taking response shift into account was provided, and 3) impact of response shift was evidenced in terms of statistical significance, magnitude, or decisions made. A total of 173 response shift studies that included 943 PROM-results were evaluated. 55% of studies (N = 96) investigated impact of response shift and information about impact was available for 51% of studies (N = 89). The corresponding percentages based on PROM-results were 47% (N = 446) and 53% (N = 502), respectively. Impact of response shift was evidenced in 69% of studies (N = 61) and 41% of PROM-results (N = 207), where impact on statistical significance and/or magnitude of change were most often evidenced (49-53% of studies and 20-31% of PROM-results), whereas impact on decisions was evidenced less often (8% and 2% respectively). About half of the studies addressed impact of response shift and showed evidence of impact, however, impact on decisions was rarely addressed. Future research should focus on evaluating impact of response shift on conclusions about change in PROMs, especially in the context of healthcare decision-making.
Maternal sleep deprivation (MSD) is a common but usually unnoticed issue during pregnancy, and in recent years, it has been increasingly recognised as an important prenatal stressor that may adversely influence maternal physiology, placental function, and fetal neurodevelopment. Sleep disturbances during pregnancy, including reduced sleep duration, fragmented sleep, poor sleep quality, circadian disruption, and rapid eye movement sleep restriction, have been associated with altered hypothalamic-pituitary-adrenal axis activity, systemic inflammation, oxidative stress, and impaired circadian regulation. Emerging evidence from clinical and preclinical studies suggests that these alterations may affect fetal neurogenesis, synaptic development, neuroimmune signaling, and maturation of brain circuits involved in cognition and emotional regulations. Within the framework of the Developmental Origins of Health and Disease, maternal sleep disturbances may contribute to epigenetic modifications, mitochondrial dysfunction, microglial activation, and altered neuroplasticity-related pathways, which are increasingly implicated in long-term neurological vulnerability. Experimental findings further indicate that prenatal sleep disruption may impair offspring cognitive performance, emotional behavior, and stress responsiveness, while potentially influencing biological pathways associated with brain aging-related processes. However, the extent to which MSD directly contributes to pathological brain aging in humans remains incompletely understood. Factors such as timing and duration of exposure, sex-specific responses, and postnatal environmental conditions may further influence offspring outcomes. Therefore, this narrative review critically summarizes current evidence regarding MSD and examines the molecular, cellular, and neurodevelopmental mechanisms through which prenatal sleep disturbances may influence long-term neurological health and vulnerability to brain aging-associated alterations in offspring.This graphical abstract illustrates the mechanistic framework connecting maternal sleep deprivation to the developmental programming of brain aging in offspring. [ MSD: maternal sleep deprivation; DOHaD: Developmental Origins of Health and Disease; 11β HSD2: 11β hydroxysteroid dehydrogenase type 2; ROS: reactive oxygen species; REM: rapid eye movement; HPA axis: hypothalamic pituitary adrenal axis; BDNF: brain derived neurotrophic factor].
Older adults (people aged >60 years) are often stereotyped as being asexual, reflecting a broader lack of research into the sexual lives of this age group. Few studies have examined sexual well-being among older adults in low- and middle-income countries, especially in Africa. This scoping review aims to identify and synthesize the factors that affect sexual functioning and quality of sexual life among older adults in Africa. Following the approach of Arksey and O'Malley, a scoping review was conducted on determinants affecting the quality of sexual life among older adults in Africa. Seven databases were searched: PubMed, Google Scholar, CINAHL, Scopus, Web of Science, ProQuest and AJOL. Full texts were reviewed to determine the final set of papers for inclusion. Included papers were published, with publication dates between January 2010 and January 2025. Data were extracted on the study population, study design, mean age of the study participants, aims of the study and the determinants affecting the quality of sexual life, and summarized using narrative synthesis. A total of 14,398 citations were identified in the database search, and seven studies were included in the review. The age of study participants averaged approximately 70 years. The research consisted of three qualitative and four quantitative articles. Four studies were conducted in Nigeria, and one each from South Africa, Morocco and Tanzania. Our review identified four categories of determinants influencing the quality of sexual life among older adults in Africa: psychological, sociocultural, physiological and health. Psychological determinants, including past trauma, performance anxiety and societal expectations, were identified across five studies. Sociocultural determinants, including sexual attitudes and culturally embedded behaviors, were examined in six studies, and found to shape the sexual functioning and behaviors of older adults. Physiological determinants, such as menopause and erectile dysfunction, were reported in four studies and associated with reduced sexual activity. Health determinants, including chronic conditions and pharmacological factors (medications), were identified in five studies as influencing older adults' sexual function and intimacy. Multiple, complex determinants affect the quality of sexual life among older adults in Africa. Our study findings have implications for designing sexual health services among older adults in Africa.
Established in 2014, the Melbourne Ageing Research Collaboration (MARC) was designed to close evidence-to-practice gaps in care of older people by bringing together consumers, clinicians, policymakers, advocates and researchers in a co-designed program of work. MARC's collaborative model combines bottom-up co-design with top-down systems influences, engaging the diverse membership as active partners in research. MARC has convened cross-sector events, undertaken targeted research, embedded co-production and invested in capacity building through grants, forums and masterclasses. Examples of policy and practice impacts include evaluation of the use of language translation technologies, enabling equitable access to end-of-life care services, and guidelines for implementing technology in home-based aged care. Evaluations have demonstrated strengthened inter-organisational relationships and enhanced knowledge exchange amongst partners. MARC offers a scalable model for collective impact. Its shared agendas, consumer and community-informed approach, co-design, transparent governance and acknowledgement of real-world challenges have contributed to achieving partner organisation goals of improving care and outcomes for older people.
For the segmental ossification of cervical posterior longitudinal ligament (OPLL) accompanied by spinal cord compression, anterior cervical corpectomy and fusion (ACCF) can achieve direct decompression through removal of most of the involved vertebral body. However, reconstruction-related complications such as titanium mesh cage subsidence, loss of cervical lordosis, and poor bone fusion are common after surgery. This study aims to investigate the clinical efficacy of a novel anterior cervical mortise-tenon corpectomy and fusion (ACMTF) technique, designed based on principles of biological reconstruction and traditional structural mechanics, for the treatment of segmental cervical OPLL, and to compare its outcomes with those of conventional ACCF. A retrospective analysis was conducted on patients with segmental cervical OPLL who underwent anterior surgery in the Department of Spinal Surgery, Xiangya Hospital, Central South University, between January 2020 and May 2024. Among them, 30 patients underwent ACMTF (ACMTF group). Using propensity score matching at a 1꞉1 ratio, 30 patients who underwent conventional ACCF during the same period were selected as controls (ACCF group). In the ACMTF group, an ultrasonic osteotome was used to perform V-shaped osteotomy of the anterior vertebral body. After removal of the posterior ossified lesion, the V-shaped autologous bone block was restored in situ to form a mortise-tenon structure and fixed with an intervertebral fusion cage and anterior titanium plate. The ACCF group underwent conventional subtotal corpectomy and titanium mesh reconstruction. Surgical time, intraoperative blood loss, perioperative and follow-up complications, and Japanese Orthopaedic Association (JOA) score, JOA recovery rate, Neck Disability Index (NDI), and Visual Analogue Scale (VAS) score at different follow-up time points before and after surgery were compared between the two groups. Imaging examinations were used to evaluate and compare occupation ratio (OR), space available for the spinal cord (SAC), fusion rate, implant subsidence rate, and changes in cervical lordosis angle. After propensity score matching, there were no statistically significant differences between the 2 groups in baseline characteristics including sex, age, disease duration, body mass index, and surgical segments (all P>0.05), indicating good comparability. The mean operative time in the ACMTF group was 164.5 minutes, which was significantly longer than 128.4 minutes in the ACCF group (P<0.05). The mean intraoperative blood loss was 385.9 mL and 352.4 mL in the ACMTF and ACCF groups, respectively, with no statistically significant difference (P>0.05). At the final follow-up, JOA score, VAS score, and NDI in both groups were significantly improved compared with preoperative values (all P<0.05), while no statistically significant differences were found between the groups at the same time points (P>0.05). Postoperatively, OR was significantly decreased and SAC was significantly increased in both groups compared with preoperative levels (all P<0.05), with no statistically significant intergroup differences (P>0.05). At 12 months after surgery, the fusion rate was 100% in the ACMTF group and 93.3% in the ACCF group, with no statistically significant difference (P>0.05). No severe implant subsidence occurred in the ACMTF group, which was significantly lower than the 20.0% incidence in the ACCF group (P<0.05). At 6 and 12 months postoperatively, maintenance of cervical lordosis angle was significantly better in the ACMTF group than in the ACCF group (P<0.05). Regarding complications, one case of cerebrospinal fluid leakage occurred in each group (3.3%), both of which healed after lumbar cistern drainage and local compressive dressing. Six cases of severe titanium mesh subsidence occurred in the ACCF group, but none of the patients showed obvious clinical symptoms or required revision surgery. No other severe complications occurred in either group. ACMTF for segmental cervical OPLL can achieve neurological decompression, neurological recovery, and pain relief comparable to those of ACCF. The in situ restoration design of the autologous bone block based on the mortise-tenon principle enables stable mechanical interlocking at the surgical site, effectively prevents severe graft subsidence, better maintains physiological cervical curvature, and achieves reliable bony fusion. Therefore, ACMTF represents a safe and effective anterior biological reconstruction strategy for the treatment of segmental cervical OPLL. 目的: 对于伴有脊髓损害的节段型颈椎后纵韧带骨化症(ossification of cervical posterior longitudinal ligament，OPLL)，颈椎前路椎体次全切除融合术(anterior cervical corpectomy and fusion，ACCF)可通过切除大部分受累椎体直接减压，但术后易出现钛网沉降、颈椎生理曲度丢失、植骨融合不佳等重建相关问题。探讨1种基于生物学重建及传统结构力学原理设计的颈椎前路榫卯截骨还纳融合术(anterior cervical mortise-tenon corpectomy and fusion，ACMTF)治疗节段型OPLL的临床疗效，并与ACCF进行对比分析。方法: 回顾性分析2020年1月至2024年5月在中南大学湘雅医院脊柱外科接受颈椎前路手术治疗的节段型OPLL患者。其中，30例接受了ACMTF治疗(ACMTF组)，同时通过倾向性评分匹配按1꞉1的比例从同期接受传统ACCF治疗的患者中匹配30例作为对照(ACCF组)。ACMTF组采用超声骨刀行椎体前部V形截骨，切除后方骨化灶后将V形骨块原位还纳，形成榫卯结构，并联合椎间融合器与前路钛板进行固定;ACCF组行传统椎体次全切除及钛网重建。对比2组患者的手术时间、术中出血量、围手术期和术后随访并发症发生情况，以及术前与术后不同随访时间点的日本骨科协会(Japanese Orthopaedic Association，JOA)评分、JOA评分改善率、颈椎功能障碍指数(neck disability index，NDI)、视觉模拟评分法(Visual Analogue Scale，VAS)评分;通过影像学检查评估并对比2组的椎管侵占率(occupation ratio，OR)、脊髓有效空间(space available for the spinal cord，SAC)、植骨融合率、植入物沉降率及颈椎前凸角度的变化。结果: 2组患者经倾向性评分匹配后，性别、年龄、病程、体重指数(body mass index，BMI)、手术节段等基线资料的差异均无统计学意义(均P>0.05)，具有良好的可比性。ACMTF组平均手术时间为164.5 min，长于ACCF组的128.4 min，差异有统计学意义(P<0.05);2组术中平均出血量分别为385.9 mL、352.4 mL，差异无统计学意义(P>0.05)。末次随访时，2组的JOA评分、VAS评分及NDI均较术前显著改善(均P<0.05)，组间同时间点各项指标及JOA评分的差异均无统计学意义(均P>0.05)。术后2组OR均较术前大幅下降，SAC均较术前显著增加(均P<0.05)，但组间差异无统计学意义(P>0.05)。术后12个月，ACMTF组的植骨融合率为100%，ACCF组为93.3%，组间差异无统计学意义(P>0.05);ACMTF组未发生植入物严重沉降，显著低于ACCF组的20.0%，差异有统计学意义(P<0.05)。术后6个月及12个月，ACMTF组的颈椎前凸角度维持效果显著优于ACCF组，差异有统计学意义(P<0.05)。并发症方面，2组各发生1例脑脊液漏，发生率均为3.3%，经腰大池引流及局部加压包扎后愈合;ACCF组出现6例钛网严重沉降，患者均无明显临床症状，未行翻修手术;2组均未发生其他严重并发症。结论: ACMTF治疗节段型OPLL可获得与ACCF相当的神经减压、神经功能恢复、疼痛症状改善效果。ACMTF基于榫卯原理的自体骨块原位还纳设计可实现术区稳定的力学嵌合，有效预防移植物严重沉降的发生，更好地维持颈椎生理曲度，同时可实现确切的骨性融合，是治疗节段型OPLL安全有效的前路生物学重建策略。.
Dementia is on the rise globally due to increasing life expectancies and population growth. Digital technologies may help detect early signs, enabling timely interventions to slow or reverse cognitive decline. However, to support the successful implementation of these digital technologies into health care settings, they must be acceptable to target users. Older adults and those with mild cognitive impairment (MCI) are at risk of developing dementia in later life and need to be able to use these technologies in order for this intervention to be approved and implemented in clinical practice. This study explored the perspectives of older adults and those living with a clinical diagnosis of MCI on the acceptability of using various digital technologies that have the potential to support early dementia detection. Participants were recruited from Boston University's Alzheimer's Disease Research Center. Participants selected at least 2 technologies from 9 different wearables and software to use for 2 weeks, at 3-month intervals, over a total duration of 2 years. A subgroup of self-selecting participants was interviewed after the first 2 weeks of use to gather initial perspectives regarding the acceptability of using the digital technologies. An inductive framework thematic analysis approach was used, assisted by NVivo (version 14.23.2; QSR International). In total, 13 individuals living with a clinical diagnosis of MCI and 11 adults aged 65 years and older were interviewed. Our analysis identified five key themes: (1) gamification, (2) wearability, (3) user guidance, (4) burden of use, and (5) usefulness. Gamified apps were generally liked, although users with little experience of digital games needed time to adjust. Wearables resembling everyday accessories (eg, watches) were preferred, but complaints about tight or uncomfortable straps were frequently reported. Clear instructions were critical to support correct use, but many participants would have liked more troubleshooting support when technical issues arose. The use of 5 or more devices led to a high burden, especially when devices had practicality issues such as not being waterproof. Devices offering personal feedback were perceived as useful to satisfy personal interests, though some questioned their usefulness within health care. Participants raised concerns about losing valued personal interactions with health care professionals and questioned how their existing health conditions and treatment for such conditions may affect the validity of the data collected by the devices. These findings can guide researchers in choosing appropriate devices and minimizing burden. Future work should explore the views of those experiencing digital exclusion to ensure equitable access to dementia-detection technologies.
While contemporary ageing policies emphasise the importance of supporting older people's agency, research on how people living with dementia themselves perceive and articulate agency remains limited. Existing studies have often focused on the loss of agency or on external factors that enable or constrain it, leaving a gap in understanding the subjective, lived experience of agency as dementia progresses. This study examines the sense of agency among people living with dementia from their own perspectives, utilising Jyrki Jyrkämäs modalities of agency framework. Based on interviews with 19 participants living with dementia (aged 68-85), the research reveals how agency is experienced, maintained and adapted in everyday life. People with dementia express strong desires to maintain control over their daily lives and decision-making, particularly within their home environments and social relationships. Rather than focusing on limitations, they express agency through capabilities, desires and possibilities. Emotional processing, including humour and acceptance, plays a crucial role in adapting to cognitive changes. The study also highlights the importance of relational agency, whereby it is sustained through social connections and support from family members. This interdependence represents not a loss of agency but a reconfiguration that enables individuals to maintain meaningful expressions of agency even as cognitive functions decline. The research contributes to a more nuanced understanding of agency in dementia as constant, adaptive and often shared, with implications for service design and policy that emphasise remaining abilities, relational and emotional support, and the strengthening of both individual and shared forms of agency.
Depression is a common mental disorder, particularly among women of childbearing age (WCBA). There is a lack of comprehensive epidemiological analysis on the longitudinal trends and changing patterns of depression in WCBA. The study utilized data obtained from the Global Burden of Disease (GBD) 2021 database to analyze incidence, prevalence, and years lived with disability (YLDs) of depression among WCBA across regions, age groups, and sociodemographic index (SDI). We also examined temporal trends, driving factors, age patterns, and projections up to 2035. Globally, from 1990 to 2021, the incidence rate increased by 17.65% (95% UI, 13.51 to 21.84), prevalence rate by 15.00% (95% UI, 11.53 to 18.39), and YLDs rate by 16.03% (95% UI, 12.39 to 19.86). Among the five SDI regions, the highest EAPCs were observed in the high SDI regions for incidence rate (0.49; 95% UI, 0.26 to 0.72), prevalence rate (0.33; 95% UI,0.15 to0.50), and YLDs rate (0.40; 95% CI, 0.20 to 0.60). Regionally, a U-shaped association was found between the SDI and rate of incidence, prevalence, and YLDs. Nationally, Greenland reported the highest rates of three indicators in 2021, whereas Mexico exhibited the largest growth over time. This study found that the 15-19 age group showed a particularly severe new burden of depression among WCBA in 2021, especially in high SDI. The highest burden of depression among WCBA was reported in the older age groups such as 40-44 and 45-49 age groups. Population growth and epidemiological change were the primary drivers of this change except in low SDI which aging was the primary driver. Our study predictions suggested that the burden of depression among WCBA will continue to grow in the future. Overall, the burden of depression among WCBA has significantly increased globally over the past 32 years, particularly in high SDI regions and among the 15-19 age group. The findings underscore the need for tailored interventions to control the projected rise burden of depression among WCBA.
This study aimed to assess aspects of validity of four FACE-Q Aesthetics scales in a sample of patients undergoing and planning facial minimally invasive cosmetic procedures (MICPs), such as botulinum toxin, lip augmentation and soft tissue augmentation treatments. In 2023, a cross-sectional survey included 210 Hungarian women who had undergone and 147 planning facial MICPs, with similar mean ages Respondents completed four FACE-Q scales (Aging Appraisal, Appearance Distress, Early Life Impact and Age VAS), EQ-5D-5L, Rosenberg Self-Esteem Scale (RSES) and the Brief Fear of Negative Evaluation Scale-Straightforward Items (BFNE-S). Comprehensibility, ceiling/floor effects, structural validity (principal component analysis, confirmatory factor analysis), internal consistency, and construct validity (convergent, divergent, known-group validity) of the four FACE-Q scales were assessed. All FACE-Q scales, except the Age VAS, showed a ceiling effect (20-28%). Appearance Distress showed strong convergent validity with RSES (r = 0.742), BFNE-S (r = - 0.702), and EQ-5D-5L anxiety/depression (r = - 0.519). Aging Appraisal and Appearance Distress scales were unidimensional, whereas Early Life Impact Scale had a three-factor structure. All four FACE-Q scales were able to differentiate between known groups of patients based on self-esteem, fear of negative evaluation and acceptance of bodily appearance. Women who had undergone procedures reported higher Aging Appraisal (72.9 vs. 63.3) and Appearance Distress (77.1 vs. 68.4) scores and felt younger (- 5.0 vs. - 2.8 years) than those planning them (p < 0.001 for all). Our findings provide initial support for the validity of the four FACE-Q scales in MICP populations, but further validation (e.g. assessment of responsiveness and test-retest reliability) is needed.
Dementia caregiving entails chronic, fluctuating stress with downstream risks to caregivers' mental health and quality of care. Mindfulness-based interventions can reduce caregiver stress; however, moment-to-moment fluctuations in stress may limit receptivity to practice at any given time. We developed a brief mindfulness just-in-time adaptive intervention (JITAI) that aims to deliver support at the right moment by using machine learning algorithms to optimize notification timing based on receptivity to engage in brief mindfulness practices. This study aims to evaluate the feasibility, acceptability, and effectiveness of a brief mindfulness JITAI for caregivers of people with dementia on stress, depressive symptoms, caregiver burden, sleep, quality of life, and trait mindfulness. A single-arm, pretest or posttest design was adopted. A total of 120 community-dwelling caregivers were recruited to participate in the 18-day intervention, which included 4 days of psychoeducation delivered via videos and phone coaching, alongside an in-app brief, low-dose mindfulness-based stress reduction component. From days 5 to 11, prompts were delivered either by a static machine learning model trained on prior pilot data or at random times, with equal probability. From days 12 to 18, three delivery models were used with equal probability, namely static, random, and adaptive models, which updated per participant using accumulating receptivity data. Feasibility and acceptability were assessed post intervention. Standardized measures of stress, depressive symptoms, caregiver burden, positive aspects of caregiving, sleep, quality of life, and trait mindfulness were collected via phone interviews at baseline and post intervention. Retention was 100%. Most participants (111/120, 92.5%) found the app easy to use, 81.7% (98/120) perceived it as helpful for stress management, and 80% (96/120) would recommend it to other caregivers. Pre-post analyses indicated significant reductions in perceived stress (P<.001), depressive symptoms (P<.001), and caregiver burden (P=.003), as well as a significant increase in positive aspects of caregiving (P<.001) and subjective sleep quality (P=.02). Health-related quality of life and trait mindfulness did not change significantly. A brief, smartphone-delivered mindfulness JITAI for caregivers of people with dementia was feasible and acceptable, with high retention and positive user evaluations. Pre-post findings suggest reductions in perceived stress, depressive symptoms, and caregiving burden, alongside increased positive aspects of caregiving and improved sleep, supporting the potential of adaptive, technology-enabled interventions to provide timely support to caregivers.
Head and neck cancer (HNC) is a common malignant tumor, and its treatment often leads to functional impairments in speech, swallowing, and appearance, severely affecting patients' quality of life. Older individuals with HNC, due to the combined stress of aging and disease, face heightened mental health challenges. This study aims to evaluate the effect of AI-driven personalized health education on mental health, social support and quality of life in older patients after HNC surgery. A single-center, two-group, randomized controlled trial will be conducted. One hundred of postoperative HNC patients aged ≥ 60 years will be randomly assigned to the intervention group (n = 50) or the control group (n = 50). The intervention group will receive 12 months of personalized and phased health education through the "Kangkang" AI assistant, including video/graphic and real-time AI Q&A. The control group received standardized SMS health education at the same frequency. The outcomes will include Perceived Stress Scale, Barthel Index, Patient Assessment of Constipation Quality of Life, Nutritional Risk Screening 2002, Numerical Rating Scale for Pain, Rosenberg Self-Esteem Scale, Pittsburgh Sleep Quality Index, UCLA Loneliness Scale (3rd edition), Fear of Cancer Progression Questionnaire-Short Form, World Health Organization Quality of Life Assessment for Older Adults, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Morse Fall Scale. All assessments will be performed 5 times at baseline (preoperative) and 1, 3, 6, and 12 months postoperatively. Statistical analysis will be conducted using intention-to-treat analysis. Linear mixed models with maximum likelihood estimation will be used to analyze the continues variables and manage missing data. This will provide evidence on whether AI-driven, personalized health education can improve mental health, social support and quality of life in older patients after HNC surgery. The single-center design and reliance on self-reported outcomes may limit generalizability, and future multicenter studies are warranted. The trial has been prospectively registered in the China Clinical Trials Registry on December 5, 2025, with registration number of ChiCTR2500114052.
The enactment of the Korean Nursing Act emerged through a prolonged and conflict-laden policy process shaped by workforce instability, interprofessional conflict, and changing political conditions within the Korean healthcare system. Recent healthcare crises, including the COVID-19 pandemic and the 2024 healthcare service vacuum, further intensified policy attention toward nursing workforce governance and healthcare system sustainability. This study examines the legislative trajectory and postenactment policy developments of the Korean Nursing Act between 2005 and 2025 through the analytical lens of Kingdon's Multiple Streams Framework (MSF). Using qualitative document analysis, this study analyzed legislative bills, National Assembly records, government documents, organizational statements, media reports, and academic literature related to the Nursing Act. The analysis focused on interactions among the problem, policy, and politics streams, as well as the role of policy windows and policy entrepreneurs throughout the legislative process. The findings indicate that longstanding issues-including poor working conditions, ambiguity in nursing roles, workforce instability, and concerns regarding healthcare sustainability-gradually evolved from profession-specific grievances into broader public policy concerns. Focusing events such as the COVID-19 pandemic and the 2024 healthcare service vacuum substantially strengthened the problem stream and altered the political environment surrounding the legislation. The policy stream evolved through repeated revision, negotiation, and conflict over issues including professional boundaries, the "community" clause, and physician assistant (PA) nurses. Within the politics stream, partisan realignment, organized interest-group conflict, and executive intervention significantly influenced the trajectory of policy change. Although convergence among the problem, policy, and legislative political streams enabled passage of the Nursing Act during the 21st National Assembly, presidential veto power ultimately disrupted policy adoption. Enactment during the 22nd National Assembly became possible only after crisis-driven political realignment weakened institutional resistance and enabled renewed stream coupling. This study demonstrates that stream convergence within healthcare policymaking processes may remain unstable under presidential systems characterized by strong executive authority. The findings extend existing applications of the MSF by illustrating how executive veto power may destabilize policy convergence even after substantial legislative agreement has emerged. The study provides important implications for healthcare workforce governance, nursing leadership, and policy advocacy in aging societies facing healthcare workforce shortages. The findings suggest that effective nursing policy reform requires sustained interprofessional coordination, strategic policy entrepreneurship, and governance systems capable of responding flexibly to healthcare crises and workforce instability.
Self-perceptions of ageing have an important influence on the physical function in later life, yet little is known about how these perceptions relate to foot and lower limb health. Exploring how self-perceptions of ageing interact with subjective reports of foot health as well as objective measures such as lower limb joint movement, muscle strength and functional mobility may provide important insights to support more person-centred and responsive models of care. This study aimed to determine the association between self-perceptions of ageing and subjective and objective measures of foot and lower limb health in older adults. This cross-sectional study included 40 community-dwelling adults ≥ 65 years who completed the five subscales of the Brief Ageing Perceptions Questionnaire (B-APQ) alongside patient-reported outcomes (100 mm Visual Analogue Scale [VAS] for foot pain, Manchester Foot Pain and Disability Index [MFPDI] and Lower Limb Task Questionnaire [LLTQ]). Objective assessments of joint range of motion, foot and ankle muscle strength and functional mobility tasks (timed up and go [TUG] and Short Physical Performance Battery [SPPB]) were also conducted. B-APQ subscale scores were direction-aligned so that higher scores reflect more negative ageing perceptions. Relationships between B-APQ subscales and foot and lower limb outcomes were modelled using linear regression. All models were adjusted for key clinical and demographic confounders. Omnibus block tests evaluated the joint contribution of the five B-APQ subscales. The B-APQ dimension block showed no evidence of association with foot pain (VAS, MFPDI). The B-APQ block was associated with plantarflexion and inversion strength, with more adverse beliefs about consequences/low control (consequences-control negative) and lower perceived control (control-positive) associated with weaker strength. Consequences-control negative was also associated with slower TUG, whereas SPPB total and joint motion showed no evidence of association. Associations between self-perceptions of ageing and lower limb function and mobility appear dimension-specific with beliefs about adverse consequences and perceived control most consistently related to neuromuscular strength and mobility, rather than pain. Interventions combining progressive strengthening with strategies addressing specific ageing-belief dimensions, may support mobility in older adults.
Guillain-Barré syndrome (GBS) is an immune-mediated neuropathy that may be influenced by infectious, demographic, and healthcare-related factors. Although increasing attention has been paid to neurological complications during the COVID-19 pandemic, the global burden, inequalities, and future trends of GBS remain insufficiently characterized. This population-based observational epidemiological study used data from the Global Burden of Disease Study 2021 to assess the burden of GBS across 204 countries and territories from 1990 to 2021. The main outcomes included prevalence, years lived with disability (YLDs), age-standardized prevalence rate (ASPR), age-standardized YLD rate (ASYR), and estimated annual percentage change (EAPC). Analyses were stratified by sex, age group, country, region, and socio-demographic index (SDI). Inequality analysis, decomposition analysis, Joinpoint regression, and Bayesian age-period-cohort modeling were further used to assess socioeconomic disparities, driving factors, temporal changes, and future trends. From 1990 to 2021, the global burden of GBS increased substantially. In 2021, the global number of prevalent cases reached 471,850, and the ASPR was 5.91 per 100,000 population. The corresponding number of YLDs was 139,639, with an ASYR of 1.75 per 100,000 population. The burden was lowest among children younger than 5 years and increased progressively with age. Males generally had a higher burden than females, particularly among older adults. Low-SDI regions experienced disproportionately higher ASPR and ASYR, indicating substantial global inequalities. The increases observed after 2019 temporally coincided with the COVID-19 pandemic; however, this association should be interpreted cautiously. Decomposition analysis suggested that epidemiological changes, population growth, and population aging collectively contributed to the increasing burden of GBS. The global burden of GBS increased markedly from 1990 to 2021, with substantial regional, sex-, age-, and SDI-related heterogeneity. The post-2019 increase temporally coincided with the COVID-19 pandemic, but causal inference should be avoided due to the observational nature of this study. Strengthening neurological surveillance, improving early diagnosis and treatment capacity, and reducing healthcare disparities in low-SDI regions may help mitigate the future burden of GBS.
The Health Assessment Tool (HAT) is a validated instrument designed to comprehensively assess the health of older adults. This study examinedthe feasibility and acceptability of implementing the HAT in Swedish primary care, while exploring older patients' needs and professional perspectives, drawing on experiences from a multicenter prospective validation study. A qualitative design was employed using reflexive thematic analysis. Data were collected through semi-structured interviews with patients and healthcare managers, and a focus group discussion with healthcare staff familiarized with the HAT in six Swedish primary care centers. Analysis followed Braun and Clarke's six-phase thematic approach, integrating inductive and deductive reasoning. The analysis constructed one overarching theme: 'For the needs left waiting, the HAT is a feasible bridge to holistic care of older adults', supported by two main themes: 'Voices of aging, unmet needs unveiled' and 'The HAT: a dependable compass for decision making in the care of older people'. Findings revealed challenges for older adults, including rapid health decline, loss of independence, loneliness, and gaps in primary care. The HAT was positively received for its comprehensive, person-centered approach, despite some concerns regarding time required for its assessment. The HAT was perceived as feasible and acceptable by older patients and healthcare providers, with the potential to transform care of older adults through proactive, holistic assessments. Its use may foster collaboration between health and social care professionals, a key prerequisite for meeting the complex needs of older people. Future research should evaluate a HAT-based model to support its integration into routine primary care.
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by cysteine-altering NOTCH3 variants. We examined whether neuroimaging-defined brain age is altered in CADASIL and its association with disease severity and outcomes. A brain-age prediction model was constructed using magnetic resonance imaging from 1482 healthy individuals and applied to 153 individuals with NOTCH3 variants and 30 controls. Brain age gap (BAG) was calculated as predicted minus chronological age. Associations between BAG, imaging markers, and clinical outcomes were analyzed. Individuals with NOTCH3 variants exhibited significantly higher BAG than controls. Higher BAG was associated with greater disease severity, neuroimaging markers - most prominently peak width of skeletonized mean diffusivity - and poorer clinical performance. In addition, BAG showed a partial mediation effect in the association between disease stage and cognitive performance. Accelerated brain aging is evident in CADASIL, and the BAG reflects the cumulative microvascular injury burden and may be involved in the pathophysiological pathway linking disease progression to cognitive impairment.