Background: To investigate the association between community members' participation in Ageless Gym and their age, chronic disease history, lifestyle, and place of residence, and to analyze the related factors that influence their continuous participation in gym activities and physical fitness improvements. Methods: This study was a retrospective intergenerational study in which 1896 people aged 60 or older, who participated in the integrated community screening in Ershui Township, Changhua County, were analyzed, and the dependent variable was the participation in the Ageless Gym (445 people in total, 23.5%). The independent variables were the most recent screening questionnaire, including chronic disease history, health behaviors, age, and distance from the health center. Cox proportional risk regression modeling has been used as a multivariate variance analysis, and all statistical analyses have been conducted using SAS 9.4. Results: The hypotheses were partially supported: (1) People with a history of diabetes and osteoporosis were 1.62 times more likely to participate in ageless fitness than those without disease, respectively. (2) With regard to lifestyle, those who had regular health checks were 1.54 times more likely to participate in Ageless Gym than those who did not. (3) The probability of participating in ageless gyms is 0.69 and 0.42 times higher for people aged 70 to 79 and 80 than for people aged 60 to 69. (4) Elderly people living far from a health center were 0.67 times more likely to participate in Ageless Gym than those living nearby. (5) Comparison between those who are willing to participate and those who have consistently participated in the Ageless Gym revealed that factors that influence consistent participation include exercise habits, chronic diseases, and emphasis on healthy eating. (6) The fitness of people who regularly participate in the gym has improved considerably. Conclusions: This retrospective study provides insights for promoting exercise among the elderly, emphasizing the relationships between participation, age, health conditions, and proximity to health facilities.
Frailty and cognitive impairment are two major geriatric syndromes occurring at a rapid rate in low- and middle-income countries (LMIC) in Asia. This study aimed to provide a detailed overview of the Transforming Cognitive Frailty into Later-life Self-Sufficiency (AGELESS) cohort and to perform a bibliometric analysis. Participants were recruited from eight of the 14 states in Malaysia. Basic demographics, cognitive function, medical history, psychological well-being, health care utilization, physical performance and laboratory, including blood and stool, samples were collected. A Google Scholar search and bibliometric analysis was conducted to identify publications, journals, keywords and main findings. The AGELESS dataset contains data from 6064 individuals aged ≥55 years at recruitment from 2012. One hundred and eighty-seven papers have been published to date on healthy ageing, dementia and health care. Key published findings were in the areas of cognitive health and ageing, blood-based biomarkers, frailty, chronic disease, social support, quality of life, technology, as well as nutrition and lifestyle. In conclusion, the AGELESS study contributed to data addressing the imbalance in published research from LMIC. While the continuity of the cohort had been challenged by resource and infrastructure constraints, findings from the longitudinal cohort had been invaluable for informing local practices and policies.
Cognitive frailty (CF) is a major precursor to dementia, and multidomain interventions have the potential to delay, prevent or reverse its early onset. However, the successful translation and sustainability of such interventions in real-life settings remain uncertain. In this study, we aimed to explore the insights of older adults with CF and their caregivers regarding the impact and participation in the AGELESS multidomain intervention. This qualitative study was conducted following the completion of AGELESS multidomain intervention. Semi-structured interviews covering domains such as perceptions, benefits, barriers, facilitators, and program preferences were conducted among 17 older adults with CF and 10 caregivers following the completion of the intervention. The data obtained were transcribed verbatim and analyzed using thematic analysis. Each transcript was reviewed and coded to identify prevailing themes derived from the interview data. The analysis revealed five distinct themes: (1) impact of the program, (2) facilitators enhancing participation, (3) barriers hindering participation, (4) suggestions for improving participation and (5) challenges to adopt digital platforms. Based on the findings, the AGELESS multidomain intervention had a positive impact on the participants and their caregivers. It was noted that they showed preference for in-person sessions over virtual ones. The study highlighted key factors critical for successful participation, including diversity and inclusivity. It emphasized incorporating a multi-component, group-based approach with social aspects. The intervention should be people-centered, dignified, affordable, and customized to meet the unique needs of each participant. The AGELESS multidomain intervention was well received by older adults with CF and their caregivers who participated in this study. Moving forward, it is recommended that future initiatives focus on identifying opportunities to implement existing evidence-based programs on a larger scale for the prevention of dementia in older adults.
Cognitive frailty (CF) in older adults is a potentially reversible syndrome that may benefit from lifestyle-based multidomain interventions. This study assessed the AGELESS intervention's impact on cognitive, physical, vascular, dietary, and psychosocial outcomes, along with its cost-effectiveness, in a Low-Middle-Income Country (LMIC). The AGELESS randomized controlled trial recruited 106 older adults (above 60 years) from Klang Valley, Malaysia, with (pre)-CF (≥ 1 Fried's criteria and Clinical Dementia Rating scale = 0.5). Participants were randomly assigned to a 24-month multidomain intervention (physical activity, cognitive training, nutritional and psychological counselling, cardiovascular care) or control group (educational module). Primary outcomes, assessed at baseline, 12 and 24 months, included the modified Neuropsychological Tests Battery (mNTB) and physical performance measures. Intervention costs were calculated to determine Incremental Cost-Effectiveness Ratios (ICERs). An intention-to-treat analysis was conducted to account for attrition. The trial occurred during the COVID-19 pandemic. Despite a 50% dropout rate, adherence among remaining participants was over 50% for all intervention components (range 53%-91%). The intervention led to significant improvements in selected parameters of cognitive function, physical performance, anthropometry, and dietary patterns (for all parameters, p < 0.05 for interaction time*group in repeat-measures ANOVA). The cost per participant was RM 1592.74 (≈USD 355.05) in the multidomain arm, and RM 488.21 (≈USD 108.83) in the control arm. The ICER computation indicated the 2-min step test as the most cost-effective measure (ICER RM 149.19 ≈USD33.26). The AGELESS trial demonstrates that a multidomain, lifestyle-based intervention can improve cognitive and physical function in older adults with (pre)-CF. This cost-effective approach highlights CF as a modifiable health condition and supports its potential inclusion in health policy to promote healthy aging and reduce health risks in LMICs, where there is a larger prevention potential due to prevalent lifestyle-related risk factors.
Susan B. Levin argues that the human confidence that an ageless body would be better is irrational. She offers a Kantian-inspired argument to show that human understanding cannot rationally access the experiences of a post-human and ageless existence. We challenge this rationale with a three-step argument: first, an ageless body does not have to be post-human. One should distinguish between the transhumanist projects of life extension and accounts focused on enhancing well-being and quality of life. An existence without aging does not require a radical change in one's temporal intuitions, which makes rational discussion possible. Second, we defend that biological aging does not entail any valuable goods. These goods refer to the chronological dimension of aging. Finally, we argue that biological aging is indeed negative and one may need biotechnological interventions in aging to achieve internal transcendence. Thus, we rationally argue that an ageless body would be better.
Reversal of cognitive frailty through a multidomain intervention is desirable to prevent dementia. AGELESS Trial was conducted to determine the effectiveness of a comprehensive, multidomain intervention on older adults with cognitive frailty in Malaysia. However, conducting a clinical trial, particularly during and after Covid-19, posed unique challenges. We aimed to investigate the recruitment process and baseline characteristics of the AGELESS Trial participants to better understand an at-risk population and those who agree to participate in an intervention. 24-month, randomized controlled trial. Community-dwelling older adults with independent mobility, aged ≥ 60 years, with a mini mental state examination score of 19-25, a clinical dementia rating of 0.5 ≥ 1 Fried's physical frailty criteria, and < 22 Beck depression inventory. Participants were randomized 1:1 to a structured multidomain intervention consisting of vascular management, diet, exercise, cognitive and psychosocial stimulation, or to the arm, including routine care and general health consultation. We analyzed the group differences between (1) cognitive frailty and non- cognitive frailty screened subjects, (2) recruited and non-recruited participants, (3) baseline characteristics of participants by arm, (4) adherence to AGELESS intervention at 12 months, and (5) preliminary findings on the effectiveness of the intervention at 12 months. A total of 957 older adults from two locations, i.e., urban (n = 764) and rural (n = 193) areas, were screened, of whom 38.9% had cognitive frailty and were eligible to participate. Those with cognitive frailty had fewer years of education (B = -0.08; 95%CI = 0.88-0.97; p = 0.002), and lower functioning cognition (B = -0.24; 95%CI = 0.74-0.84; p < 0.001). Among those from urban areas, only 33.1% (n = 106) agreed to participate, particularly those with multimorbidity (B = 0.86; 95%CI = 1.31-4.30; p = 0.01), higher physical activity (B = -1.02; 95%CI = 0.19-0.69; p = 0.002), slower walking speed (B = 1.26; 95%CI = 1.62-7.61; p = 0.001), and higher systolic blood pressure (B = 0.02; 95%CI = 1.00-1.03; p = 0.03). At baseline, participants' mean age was 68.1±5.6, years of education was 8.3±3.9, body mass index was 27.5±5.3 kg/m2, and mini mental state examination score was 22.7±4.0. Generally, there were no significant differences between the intervention and control groups for the main outcomes, except those in the intervention group had higher body mass index, mid-upper-arm circumference, and waist circumference (p < 0.05 for all parameters). Overall intervention adherence at 12 months was 52.8%, ranging from 52.8%-90.6% for each of the modules. Preliminary analysis of the effectiveness of the intervention at 12 months was positive on most of the cognitive domains, some of the nutrient intake and food groups, physical function, and vascular outcomes (p < 0.05 for all parameters). Despite the challenges posed by the pandemic, screening, recruitment, and 12-month intervention delivery were achieved in a Malaysian multidomain preventive randomized controlled trial in older adults at risk of dementia, with a satisfactory adherence rate and cognitive benefits at 12 months.
Transhumanists and their fellow travelers urge humanity to prioritize the development of biotechnologies that would eliminate aging, delivering 'an endless summer of literally perpetual youth.' Aspiring not to age instantiates what philosopher Martha Nussbaum calls the yearning for 'external transcendence,' or the fundamental surpassing of human bounds due to confidence that life without them would be better. Based on Immanuel Kant's account of the parameters of human understanding, I argue that engineering agelessness could not be a rational priority for humanity on the level of public policy. This stance is complemented by an argument focused on individual decision-making in liberal-democratic milieus, where no governing conception of the good is presumed and the first-personal level matters greatly. Here, drawing on philosopher and cognitive scientist Laurie Ann Paul's concept of 'transformative experience,' I maintain that individuals could not 'rationally,' meaning, here, 'prudentially,' say 'yes' to agelessness. Absorbing the irrationality of human zeal to eliminate aging, based on assurance that an ageless existence would be better, should spur a redoubled dedication to human flourishing.
As biological organisms, we age and, eventually, die. However, age's deteriorating effects may not be universal. Some theoretical entities, due to their synthetic composition, could exist independently from aging-artificial general intelligence (AGI). With adequate resource access, an AGI could theoretically be ageless and would be, in some sense, immortal. Yet, this need not be inevitable. Designers could imbue AGIs with artificial mortality via an internal shut-off point. The question, though, is, should they? Should researchers curtail an AGI's potentially endless lifespan by deliberately making it mortal? It is this question that this article explores. First, it considers what type of AGI is under discussion before outlining how such beings could be ageless. Then, after clarifying the type of immortality under discussion and arguing that imbuing an AGI with synthetic aging would be person-affecting, the article explores four core conundrums: (i) deliberately causing a morally significant being's death; (ii) immortality's associated harms; (iii) concerns about immortality's unequal assignment; and (iv) the danger of immortal AGI overlords. The article concludes that while prudence requires we create an aging AGI, in the face of the material harm such an action would constitute, this is an insufficient reason to justify doing so.
Recent years have witnessed significant growth in aging research due to groundbreaking discoveries in gerotherapeutics and an ever-increasing interest in longevity. Such advances beg the question, what if the physical and functional declines we associate with aging were no longer inevitable, but instead treatable through the next frontier of medical innovation? In this article, we explore the broader social and ethical implications of advancing healthspan and mitigating age-related decline. We also highlight dermatology's unique role as a catalyst of aging research, serving as a model for integrating aesthetic and functional innovations. Finally, we discuss the curious role and the ethical challenges of the aesthetic dermatology industry in the healthspan debate.
Schizophreniform disorders tend to have an early onset. Early intervention in psychosis (EIP) services aim to provide early treatment, reduce long-term morbidity and improve social functioning. In 2016, changes to mental health policy in England mandated that the primarily youth-focused model should be extended to an ageless one, to prevent ageism; however, this was without strong research evidence. An inner-city London EIP service compared sociodemographic and clinical factors between the under-35 years and over-35 years caseload cohorts utilising the EIP package following the implementation of the ageless policy. Both groups received similar care, despite the younger group having significantly more clinical morbidity and needs. Our results may indicate that service provisions are being driven by policy rather than clinical needs, potentially diverting resources from younger patients. These findings have important implications for future provision of EIP services and would benefit from further exploration.
Significant recent efforts have facilitated increased access to clinical genetics assessment and genomic sequencing for children with rare diseases in many centres, but there remains a service gap for adults. The Austin Health Adult Undiagnosed Disease Program (AHA-UDP) was designed to complement existing UDP programs that focus on paediatric rare diseases and address an area of unmet diagnostic need for adults with undiagnosed rare conditions in Victoria, Australia. It was conducted at a large Victorian hospital to demonstrate the benefits of bringing genomic techniques currently used predominantly in a research setting into hospital clinical practice, and identify the benefits of enrolling adults with undiagnosed rare diseases into a UDP program. The main objectives were to identify the causal mutation for a variety of diseases of individuals and families enrolled, and to discover novel disease genes. Unsolved patients in whom standard genomic diagnostic techniques such as targeted gene panel, exome-wide next generation sequencing, and/or chromosomal microarray, had already been performed were recruited. Genome sequencing and enhanced genomic analysis from the research setting were applied to aid novel gene discovery. In total, 16/50 (32%) families/cases were solved. One or more candidate variants of uncertain significance were detected in 18/50 (36%) families. No candidate variants were identified in 16/50 (32%) families. Two novel disease genes (TOP3B, PRKACB) and two novel genotype-phenotype correlations (NARS, and KMT2C genes) were identified. Three out of eight patients with suspected mosaic tuberous sclerosis complex had their diagnosis confirmed which provided reproductive options for two patients. The utility of confirming diagnoses for patients with mosaic conditions (using high read depth sequencing and ddPCR) was not specifically envisaged at the onset of the project, but the flexibility to offer recruitment and analyses on an as-needed basis proved to be a strength of the AHA-UDP. AHA-UDP demonstrates the utility of a UDP approach applying genome sequencing approaches in diagnosing adults with rare diseases who have had uninformative conventional genetic analysis, informing clinical management, recurrence risk, and recommendations for relatives.
The World Falls Guidelines (WFG) Task Force published a falls risk stratification algorithm in 2022. However, its adaptability is uncertain in low- and middle-income settings such as Malaysia due to different risk factors and limited resources. We evaluated the effectiveness of the WFG risk stratification algorithm in predicting falls among community-dwelling older adults in Malaysia. Data from the Malaysian Elders Longitudinal Research subset of the Transforming Cognitive Frailty into Later-Life Self-Sufficiency cohort study was utilized. From 2013-2015, participants aged ≥55 years were selected from the electoral rolls of three parliamentary constituencies in Klang Valley. Risk categorisation was performed using baseline data. Falls prediction values were determined using follow-up data from wave 2 (2015-2016), wave 3 (2019) and wave 4 (2020-2022). Of 1,548 individuals recruited, 737 were interviewed at wave 2, 858 at wave 3, and 742 at wave 4. Falls were reported by 13.4 %, 29.8 % and 42.9 % of the low-, intermediate- and high-risk groups at wave 2, 19.4 %, 25.5 % and 32.8 % at wave 3, and 25.8 %, 27.7 % and 27.0 % at wave 4, respectively. At wave 2, the algorithm generated a sensitivity of 51.3 % (95 %CI, 43.1-59.2) and specificity of 80.1 % (95 %CI, 76.6-83.2). At wave 3, sensitivity was 29.4 % (95 %CI, 23.1-36.6) and specificity was 81.6 % (95 %CI, 78.5-84.5). At wave 4, sensitivity was 26.0 % (95 %CI, 20.2-32.8) and specificity was 78.4 % (95 %CI, 74.7-81.8). The algorithm has high specificity and low sensitivity in predicting falls, with decreasing sensitivity over time. Therefore, regular reassessments should be made to identify individuals at risk of falling.
The aim of the current study is to compare the clinical outcomes of cast immobilization (CI) versus surgical treatment after 1 year for distal radius fractures (DRFs) in the elderly population. The cohort included patients aged 70-89 who suffered an acute, closed, and displaced DRF and who were treated conservatively or surgically at our clinic between August 2018 and January 2022. Those who had pathological fractures, open fractures, concomitant ulna fractures (except ulna styloid fractures), were not between the ages of 70 and 89, or refused to participate were excluded from the study. The study gathered data on patient demographics, initial radiological measurements, clinical measurements after 1 year, treatment models employed, and rates of complications. Of the total number of patients (276), CI was used on 77.2% (213), whereas the other 25 had volar-locked plates (VLP), 25 received external fixators with percutaneous pinning (EFPP), and 13 had isolated percutaneous pinning (IPP). 19 of 276 individuals had complications, with Complex Regional Pain Syndrome and Carpal Tunnel Syndrome being the most often documented. EFPP resulted in significantly higher Disability of the Arm, Shoulder, and Hand (DASH) score values than VLP and IPP at the 1st postoperative year (p < 0.05). No statistically significant difference was found between the DASH score and ROM values at the 1st postoperative year for patients who received CI versus those who underwent surgery (p > 0.05). In the first postoperative year, CI still retains its validity and performs similarly to surgery for DRFs in older individuals. VLPP and IPP methods outperformed EFPP surgeries.
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Cognitive frailty describes the co-occurrence of cognitive impairment and physical frailty and is classified into reversible and irreversible phenotypes. Data on the impact of COVID-19 pandemic imposed lockdowns, locally known as the Movement Control Order (MCO), on the psychological status of cognitively frail older adults remain scarce. Therefore, this study aimed to determine the relationship between depression, anxiety, stress and cognitive frailty among older adults during the MCO. Participants aged above 60 years from three ageing cohorts in Malaysia were interviewed virtually. The Fatigue, Resistance, Ambulation, Illness and Loss of Weight scale, blind Montreal Cognitive Assessment, 15-item Geriatric Depression Scale, anxiety subscale of Depression, Anxiety and Stress Scale and four-item Perceived Stress Scale measured frailty, mild cognitive impairment (MCI), depression, anxiety and stress, respectively. Cognitive frailty data were available for 870 participants, age (mean ± SD) = 73.44 ± 6.32 years and 55.6% were women. Fifty-seven (6.6%) were robust, 24 (2.8%) had MCI, 451 (51.8%) were pre-frail, 164 (18.9%) were pre-frail+MCI, 119 (13.7%) were frail and 55 (6.3%) were frail+MCI. There were significant differences in depression and anxiety scores between the controlled MCO and recovery MCO. Using multinomial logistic regression, pre-frail (mean difference (95% confidence interval, CI) = 1.16 (0.932, 1.337), frail (1.49 (1.235, 1.803) and frail+MCI (1.49 (1.225, 1.822)) groups had significantly higher depression scores, frail (1.19 (1.030, 1.373)) and frail+MCI (1.24 (1.065, 1.439)) had significantly higher anxiety scores and pre-frail (1.50 (1.285, 1.761)), frail (1.74 (1.469, 2.062)) and frail+MCI (1.81 (1.508, 2.165)) had significantly higher stress scores upon adjustments for the potential confounders. The MCO was a potential confounder in the relationship between depression and prefrail+MCI (1.08 (0.898, 1.340)). Frail individuals with or without MCI had significantly higher depression, anxiety and stress than those who were robust. Increased depression and stress were also observed in the pre-frail group. Interventions to address psychological issues in older adults during the COVID-19 pandemic could target prefrail and frail individuals and need further evaluation.
Frailty is a proxy for biologic aging that confers risk independently of chronologic age. Most frailty indices correlate strongly with chronologic age, making independent features of biologic aging challenging to identify. We aimed to create a novel Age Less-Dependent Frailty (AGELESS) Score less-associated with chronologic age than the Fried frailty phenotype. Among Cardiovascular Health Study participants with available echocardiographic data, we identified demographic, clinical, serologic, and echocardiographic variables more correlated with a continuous version of the Fried frailty phenotype than age, then used LASSO regression for variable selection. In a 25% leave-out sample, we internally validated the score's association with age-adjusted all-cause and cardiovascular mortality and compared model characteristics with the Fried frailty phenotype. In 4,029 individuals (mean age 72 ± 5.0 years, 59.6% female), serum cystatin C, depression, diabetes, educational attainment, forced expiratory volume in 1 s, and income were more associated with frailty than age and selected for inclusion in the AGELESS Score. Adjusted for age, individuals in the highest vs. lowest quartiles of the AGELESS Score had a higher risk of all-cause (HR: 1.44, 95% CI: 1.17-1.79, p < 0.001) and CV death (HR: 1.64, 95% CI: 1.43-1.87, p = 0.002). The AGELESS Score was less correlated with age (AGELESS r = 0.23, 95% CI: 0.16-0.30; Fried r = 0.28, 95% CI: 0.21-0.34; p-value for comparison of correlations < 0.001) and more closely associated with all-cause and CV mortality within each age quartile than the Fried frailty phenotype. We derived and internally validated a novel frailty score that is less associated with chronologic age than existing indices and predicts mortality within age strata better than the existing reference standard for phenotypic frailty. This score could help identify high-risk patients with frailty across the age spectrum and may provide insights into mechanisms of biologic aging.
The coronavirus disease (COVID-19) pandemic has affected the physical and mental well-being of people worldwide. This study aimed to explore and address the prevalence and characteristics of depression, anxiety and stress symptoms among Malaysian individuals aged 60 years and older during the COVID-19 pandemic. The focus of the study involved the psychological health of older persons and the characteristics that influenced their mental health during the COVID-19 pandemic. Quantitative data were obtained from the TrAnsforminG CognitivE Frailty into Later-LifE Self-Sufficiency (AGELESS) study. Depression, anxiety and stress symptoms were measured by using the Geriatric Depression Scale; Depression Anxiety and Stress Scale-Anxiety domain; and Perceived Stress Scale, respectively. Individual items in the scale were examined to understand the associations between the items and depression, anxiety and stress levels. Depression, anxiety and stress data were available for 1354 participants, of whom 200 (14.8%) exhibited depressive symptoms, 148 (11%) exhibited mild symptoms and 52 (3.8%) exhibited moderate-to-severe symptoms. Among the 77 participants (5.7%) who reported anxiety symptoms, 40 (3%) demonstrated mild symptoms, and 37 (2.7%) demonstrated moderate-to-severe symptoms. More than one-fifth (294, 21.7%) of the participants reported mild-to-severe stress. The prevalence of depressive symptoms increased from 11.2% (pre-pandemic, NHMS 2018) to 14.8% during the COVID-19 pandemic (weighted prevalence: 14.3%). A cross-sectional study was conducted utilizing pre-existing cohort data involving depression and depressive symptoms among Malaysians aged 60 years and older during the COVID-19 pandemic. Future studies should seek to determine the factors that increase the risk of adverse psychological effects among older adults during major life-changing events to develop effective prevention strategies for such events, to which older adults are particularly susceptible.
Low-temperature dielectric-field heating has emerged as a non-ablative modality that selectively engages water-rich dermal and fibro-septal structures while sparing adipose tissue. Operating within a controlled thermal-shock window (∼42-45 °C), the Dermis Layer Targeted Dielectric Heating System (DLTD) -when utilized at low-to-moderate intensity levels-induces reversible collagen recoil and early dermal tightening without high-temperature injury. Although conceptually suited for mid- and lower-face rhytids, clinical data remain limited. To evaluate the clinical efficacy, three-dimensional structural elevation, and safety of a single DLTD session, applied within a low-to-moderate energy range, for improving nasolabial folds and marionette lines in Asian women. Thirty-two women aged 35-65 years with visible nasolabial folds and marionette lines received one DLTD session delivered at low-to-moderate intensity levels along the midface-to-lower-face axis. Outcomes were evaluated at baseline, immediately after treatment, and at weeks 4 and 8. Wrinkle severity was assessed using WSRS and the Merz scale, and structural changes were quantified by 3D vector analysis of midface elevation and marionette descent. GAIS ratings were obtained at week 8, and pain and adverse events were documented. WSRS improved from 3.1 to 2.0 (35.5%), and Merz scores from 2.6 to 1.9 (26.9%) at week 8. Three-dimensional analysis showed progressive vertical elevation and improved perioral support, with midface elevation increasing from +0.6 mm to +1.9 mm and marionette descent improving from -0.4 mm to -1.2 mm. At week 8, 95% of investigator and 92% of patient GAIS ratings indicated improvement. Pain was minimal (0.4/10), and no serious adverse events occurred. A single DLTD session at low-to-moderate intensity produced consistent wrinkle reduction, measurable three-dimensional structural elevation, and high satisfaction with negligible discomfort and no downtime. These findings support DLTD as a promising non-ablative option for mid- and lower-face rejuvenation. Larger controlled studies are needed to establish long-term durability and comparative efficacy.
This article explores how menopause is narrated, embodied, and re-signified by minority ethnic women in the UK, drawing on in-depth qualitative research with participants of Chinese and Black ethnicities. Dominant narratives in the Global North frequently frame menopause through a biomedical lens of loss, dysfunction, and hormonal deficit, or more recently, as a postfeminist site of "ageless empowerment" marked by pharmaceutical rescue. This study challenges both framings by foregrounding the culturally situated accounts of women whose experiences remain marginal within mainstream menopause discourse. Participants often interpreted menopause as a rite of passage - inflected with spiritual, moral, and generational significance - and located this transition within the wider reproductive life course and within culturally distinct epistemologies. Chinese-heritage women drew on the cosmology of Traditional Chinese Medicine and seven-year life cycles, while Black participants evoked ancestral wisdom, intergenerational legacies, and culturally embedded notions of "strength". While clinical encounters were often fraught with misrecognition or silence, most participants refused narratives of decline and framed their decision not to use Hormone Replacement Therapy (HRT) as a moral and culturally grounded choice rather than an outcome of exclusion. The paper argues for a reconceptualisation of menopause as a culturally mediated life transition and calls for greater narrative plurality in feminist and clinical understandings of ageing. By centring women's own meanings and metaphors, this research contributes to an emergent body of work that resituates midlife not as rupture or rescue, but as a site of reflection, reckoning, and redefinition.