The current study sought to identify the barriers to and facilitators of connecting older adult cancer survivors (OACS) to mental health treatment in cancer survivorship and to better understand the opportunities to improve the likelihood that OACS receive appropriate services in survivorship. Four virtual focus groups with 22 stakeholders (i.e., OACS, social workers, and APPs) were conducted. A semi-structured focus group guide queried participants about their experiences of referring and connecting to mental health services during cancer survivorship with a focus on barriers and facilitators. Thematic content analysis guided the generation and interpretation of major and minor study themes from the focus groups. OACS were 56% female [n = 5; mean age = 74 (range: 66-85)]. Providers were 92% female (n = 12) and 69% (n = 9) had been working in oncology for over ten years. Three major conceptual themes were identified: (1) Care pathway characteristics (i.e., limited referral resources and knowledge); (2) Patient-level characteristics (i.e., motivation, stigma); (3) Perspectives on telehealth (i.e., overall increased access to care but may present challenges for some OACS). These overarching themes included sub-themes of barriers and facilitators to connecting OACS to mental health services. OACS remain disconnected from mental health services and providers struggle to overcome systemic barriers to getting survivors the care they need. Given the standard of care to screen for depression in cancer survivorship, OACS will continue to be identified as depressed with no clear recourse for intervention. Therefore, future research on how to mitigate barriers and improve existing care pathways to connect OACS to mental health treatment is warranted.
Adults with hearing loss experience poorer health outcomes than their hearing counterparts. As hearing loss becomes more prevalent in the United States, research examining how to reduce health disparities among this population is needed. This study aimed to estimate the associations between hearing loss and each of poor physical and mental health, evaluate health literacy as a mediator of these relationships, and estimate the proportion of cases of poor physical and mental health that are attributable to having lower health literacy among adults with hearing loss. The 2016 Behavioral Risk Factor Surveillance System survey included cross-sectional data on self-reported hearing difficulty, health literacy, and number of days of poor physical and mental health in the past 30 days in a subpopulation of adults aged 18 and over among 17 US states and territories (N = 104,792). The number of days of poor physical and mental health was split into 5 categories (0, 1 to 10, 11 to 20, 21 to 29, and all 30 days). Age-stratified weighted complex survey logistic regression models estimated the total and direct effects of hearing difficulty on poor physical and mental health, and the indirect effects mediated by health literacy. Outcomes for poor physical and mental health were modeled separately as 1+ days versus 0 days, 11+ days versus ≤10 days, 21+ days versus ≤20 days, and all 30 days versus <30 days. Models were adjusted for age, sex, race/ethnicity, education, income, marital status, and health insurance coverage. Population attributable fractions were used to estimate the proportion of adults with hearing difficulties who experienced poor physical and mental health due to having lower health literacy. Compared with those without hearing difficulties, those with hearing difficulties had a higher prevalence of lower health literacy (70.3% versus 56.2%), 30 days of poor physical health (16% versus 6.4%), and 30 days of poor mental health (10.7% versus 5.3%). Odds ratios for the total effect of hearing difficulty ranged from 1.68 (95% confidence interval [CI]: 1.44 to 1.92) to 1.87 (95% CI: 1.66 to 2.08) for poor physical health and 1.68 (95% CI: 1.51 to 1.85) to 2.20 (95% CI: 1.81 to 2.59) for poor mental health. The indirect effect of hearing difficulty mediated through health literacy explained between 3.8 and 4.8% of the total effect for poor physical health and 2.3 and 6.6% for poor mental health. When stratified by age, the total effect generally declined as age increased, while the indirect effect stayed relatively consistent. Over 218,000 cases of poor physical health lasting 30 days and over 115,000 cases of poor mental health lasting 30 days were attributable to having lower health literacy. The results show that those with hearing difficulties experience significantly poorer physical health, poorer mental health, and lower health literacy. Health literacy was determined to be a significant mediator between hearing difficulty and both poor physical and mental health. Findings suggest that improving health literacy among this population would reduce the number of days of poor physical and mental health in the past month experienced by adults with hearing difficulty in the United States.
Social relationships are crucial for healthy ageing, but the role of social network size in older adults' mental health remains underexplored in nationwide studies. We examined associations between social network size and mental health in a national sample of older Japanese adults. We analysed cross-sectional data from the 2024 Japan COVID-19 and Society Internet Survey (JACSIS), a nationwide internet survey, including 6786 respondents aged 65-84 years. Mental health outcomes were poor mental health days in the past 30 days (any vs none; ≥7 vs < 7 days) and psychological distress (moderate: K6 ≥5; severe: K6 ≥13). Social network size was measured using the Lubben Social Network Scale (LSNS-6: family/friends; LSNS-8: including professional contacts) and categorized into tertiles. Logistic regression estimated odds ratios (ORs) adjusted for demographic, socioeconomic, health, lifestyle, and work-related factors. Overall, 11.8% reported any poor mental health day, 16.3% had moderate distress, and 1.9% had severe distress. In fully adjusted models, smaller social network size was consistently associated with poorer mental health in graded patterns. Compared with the highest LSNS-6 tertile, the lowest tertile had lower odds of no poor mental health days (OR = 0.80, 95% CI: 0.70-0.92) and higher odds of moderate (OR = 2.74, 95% CI: 2.28-3.29) and severe distress (OR = 6.54, 95% CI: 3.42-12.51). Similar patterns were observed for LSNS-8. Larger social networks were associated with fewer poor mental health days and lower psychological distress among older Japanese adults.
PurposeOnline directories play an important apomediary role in shaping how older adults find and compare potential providers. However, little is known about how this type of health information represents older adult needs and aging-related mental health expertise. This study examines how mental health professionals represent older adults and age-related care in their Psychology Today profiles.MethodsWe conducted a mixed-methods content analysis of 281 Psychology Today provider profiles across 8 U.S. cities. We used frequency counts and descriptive statistics to characterize provider attributes and areas of expertise. Using thematic analysis, we examined how providers describe their approach to serving older adults and aging-related mental health care. Quantitative findings informed and contextualized the qualitative analysis.ResultsWe identified one overarching theme "Older Adults at the Limits of Apomediated Visibility" and four subthemes: "Absent Narratives of Aging," "Token Mentions of Older Adults", "Misaligned Descriptions of Expertise", and "Generalist Framings Obscure Age-Specific Care". These results suggest that apomediary signals of relevance may not consistently match substantive descriptions of provider expertise in older adult mental health care.ConclusionsFindings reveal gaps between platform filters and profile narratives that may undermine the directory's apomediary role, making "older adult" care appear searchable while obscuring the age-relevant information older adults need to make informed health decisions. Better alignment between structured search criteria and narrative self-representation would strengthen informed decision-making and advance equitable access to age-responsive mental health services.
Individuals from historically underrepresented groups such as sexual minorities may experience aging in unique ways. This study aimed to examine potential differences in the longitudinal psychological health trajectories (i.e., depressive symptoms, life satisfaction, psychological distress, and self-rated mental health) of heterosexual, lesbian, gay, and bisexual middle-aged and older adults in Canada. Longitudinal data across three time points spanning up to 10 years were obtained from the Canadian Longitudinal Study on Aging. We applied propensity score matching to compare the trajectories of 1,057 individuals self-identifying as lesbian, gay, or bisexual with 1,057 case-matched heterosexual individuals using linear growth models. At baseline, lesbian individuals reported higher life satisfaction than heterosexual individuals. Gay individuals did not differ in any of the outcomes from heterosexual individuals. Bisexual individuals reported higher depressive symptoms and distress, and poorer self-rated mental health than heterosexual individuals. Longitudinal findings show that depressive symptoms, distress, and self-rated mental health decreased, while life satisfaction increased over time among heterosexual individuals. Lesbian individuals showed a dampened increase in life satisfaction compared to heterosexual individuals. No other significant differences in longitudinal psychological health trajectories were observed. Lesbian, gay, and bisexual individuals may differ in their aging experiences from heterosexual individuals, but they may not always show poorer psychological health than heterosexual individuals. Notably, findings suggest that bisexual middle-aged and older adults may be more vulnerable to psychological health challenges than individuals self-identifying as lesbian, gay, or heterosexual.
Mental health conditions, such as post-traumatic stress disorder (PTSD), anxiety and depressive symptoms, are more prevalent among in women living with HIV and immigrant women as compared with men living with HIV and the general population. However, less is known about the intersection of these identities and their impact on the mental health of immigrant women living with HIV. This cross-sectional analysis of survey data from the British Columbia CARMA-CHIWOS Collaboration (BCC3) Study estimates the prevalence of mental health conditions among immigrant women living with and without HIV and explores potential risk (i.e., experiences of racism, sexism, childhood violence and adulthood violence) and protective (e.g., resilience, social support) factors contributing to mental health. Among n = 62 women living with HIV and n = 79 women without HIV, the prevalence of PTSD (50.0% vs. 37.0%, respectively (X2(1) = 1.994, p = 0.16), anxiety (X2(1) = 1.929, 29.0% vs. 17.7% (p = 0.76)), and depressive symptoms (X2(1) = 0.912, 50.0% vs. 40.5% (p = 0.34)) did not differ significantly. Among all immigrant women (both living with or without HIV), lower resilience scores (aOR (adjusted odds ratio), 0.94 [95% CI, 0.89-0.97], p = 0.004), lower social support (0.73 [0.63-0.83], p < 0.001), higher experiences of sexism (1.08 [1.03-1.14], p < 0.001), racism (1.06 [1.02-1.11], p = 0.002) and childhood abuse (0.94 [0.90-0.98], p = 0.003) were associated with higher odds of having one or more mental health conditions. Policies and interventions aimed at strengthening social networks, promoting resiliency and addressing systemic barriers such as racism and sexism are essential to improving mental health outcomes among immigrant women.
Screening for mental health and addiction disorders is a priority due to the rising prevalence of these conditions. This clinical practice guideline (CPG) sought to systematically synthesize evidence to address screening for mental health and addiction disorders among children, adolescents, and adults. This CPG followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to CPG development recommended by the Department of Health, including GRADE Adolopment, a systematic process of adapting evidence summaries, and the GRADE Evidence to Decision (EtD) framework. The Steering Committee set the objectives, scope, target, and audience. The Steering Committee also led the formulation of clinical questions, and prioritized and finalized the questions after gathering inputs from relevant stakeholders. The Technical Working Group reviewed and synthesized the evidence, and a multisectoral Consensus Panel reviewed the evidence summaries and formulated recommendations through a formal consensus method, and the external reviewers evaluated the final recommendations. This CPG was completed in June 2022. The CPG provides ten (10) recommendations on nine (9) prioritized questions on mental health and addiction. Screening for depression among high-risk groups, anxiety in adults, substance use disorders in adults and adolescents, depression and anxiety among children and adolescents, and stress and sleep disturbances as risk factors for possible mental health or addiction disorders were recommended. Recommendations were made AGAINST screening for dementia in older adults (60 and above) using standardized instruments and substance use disorders using standardized drug tests. The CPG provided recommendations on the prioritized clinical questions in the screening for certain conditions on mental health and addiction. The recommendations are based on the appraisal of the best available evidence.
Close friend death is a common experience in later adulthood, yet its mental health consequences remain understudied. This study examines whether the death of a close friend is associated with changes in depressive symptoms among older adults and whether this association varies by baseline social support and social contact. Data come from the Wisconsin Longitudinal Study. Analyses focus on 3,448 respondents observed at two waves when respondents were in their mid-60s and early 70 s. Two-wave individual fixed-effects models estimate within-person changes in depressive symptoms following the recent death of a close friend, net of time-varying covariates. Moderation analyses test whether associations differ by baseline levels of perceived social support and social contact. On average, recent close friend death is not associated with changes in depressive symptoms. However, significant heterogeneity emerges by social context. Among respondents with low baseline social support, recent close friend death is associated with substantial increases in depressive symptoms, whereas no detectable effects are observed among those with moderate or high support. A similar pattern is observed for social contact: adverse mental health effects of friend death are concentrated among individuals with infrequent social contact. These findings suggest that close friend death does not uniformly affect mental health in later life but poses significant risks for socially vulnerable individuals. Results underscore the importance of social resources in shaping responses to non-kin bereavement and highlight the need to move beyond average effects when assessing the mental health consequences of social loss in aging populations.
Adult children increasingly provide care to parents from varying distances, yet the relationship between proximity and caregiver mental health is not well understood. This study characterizes caregiving activities of adult-child caregivers based on residential proximity to their parent and examines associations with depression and anxiety symptoms. Data from the 2021 National Health and Aging Trends Study Round 11 was linked with National Study of Caregiving IV. The sample included adult-child caregivers of Medicare beneficiaries aged 71 and older. Bivariate and multivariable logistic regression models assessed associations between proximity (travel time between the caregivers and their parents), caregiving activities, and symptoms of depression and anxiety. Analyses were weighted to produce nationally representative estimates. Among 932 caregivers representing more than 9 million caregivers nationwide, 26.3% co-reside with care-recipients, 47.4% live 1-20 minutes away, 13.1% live 21-59 minutes away, and 13.2% are long-distance caregivers living ≥1 hour away. Co-residing caregivers were more likely to perform health management, health care, ADL, and IADL tasks. However, proximity was not associated with differences in health system logistics, patient advocacy, and financial support activities. Proximity did not predict of depression or anxiety in adjusted models. Adult children engage in diverse caregiving activities regardless of distance, especially in logistics, advocacy, and financial support. Factors beyond proximity likely influence caregiver mental health. Findings highlight the need for tailored policies and services supporting both distance and proximal caregivers of older adults.
World Trade Center (WTC) general responders (GRs) continue to experience long-term mental health conditions, including posttraumatic stress disorder (PTSD), depression, anxiety, and sleep disturbance. A growing number of GRs reside in Florida, where barriers such as stigma, limited access to specialty care, and age-related limitations contribute to persistent unmet mental health needs. PTSD Coach, a mobile app originally developed for trauma-exposed veterans, has shown promise but has not been evaluated with WTC GRs or adapted for Spanish-speaking responders. This study aims to evaluate the feasibility, acceptability, and efficacy of Clinician-Supported (CS) PTSD Coach for reducing PTSD symptoms among English-speaking and Spanish-speaking WTC GRs living in Florida. Secondary objectives include evaluating effects on depression, anxiety, and sleep disturbance; comparing CS PTSD Coach with Self-Managed (SM) PTSD Coach and a waitlist control; and adapting and delivering a Spanish-language version of the intervention. This study is a 3-arm randomized controlled trial comparing CS PTSD Coach, SM PTSD Coach, and a waitlist control for reducing PTSD, depression, anxiety, and sleep disturbance among English-speaking and Spanish-speaking WTC GRs living in Florida. A total of 120 participants are randomized and assessed at baseline, 8 weeks, and a 12-week follow-up. CS PTSD Coach includes 4 clinician-guided sessions integrated with app-based activities, whereas SM PTSD Coach includes a single orientation session. Outcomes include PTSD symptoms (PTSD Checklist for DSM-5), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and sleep disturbance (Insomnia Severity Index). Feasibility and acceptability are assessed using app use data, satisfaction ratings, and usability measures. Primary analyses focus on between-group differences after the intervention (8 weeks), with secondary longitudinal analyses incorporating all assessment time points. The notice of award was received in September 2024, and institutional review board approval, including amendments, was granted in January 2025. Recruitment began in February 2025, with data collection initiated in March 2025. As of April 2026, 63 participants have been enrolled, and outcome data collection is ongoing. Data analysis will commence following completion of follow-up assessments, with dissemination of results anticipated in 2027. This trial will provide the first randomized controlled evaluation of a clinician-supported mobile PTSD intervention for WTC responders, including Spanish-speaking GRs. Findings will inform the feasibility, acceptability, and potential scalability of supported digital mental health interventions for aging, geographically dispersed disaster-exposed populations.
There is great interest in characterizing the activities or lifestyle factors that are important for successful aging; nevertheless, rigorous investigations using multimodal neuroimaging measures in conjunction with validated measures of activities are underrepresented in the literature. To address this gap, we assessed whether engagement in complex mental activities across early, middle, and late life, is associated with metrics of brain health in a sample of cognitively unimpaired older adults (N = 76). Complex mental activities were measured using a validated questionnaire indexing lifetime engagement in various pursuits (e.g., occupational complexity, stimulating activities). Indices of late life brain health were quantified using simultaneous PET-MRI, which included estimates of gray matter volume, cortical thickness, and tau burden. The integrity of the locus coeruleus (LC) was also assessed in a subsample of participants (N = 60) using MRI. We found that overall higher levels of complex mental activities were associated with larger estimates of gray matter volume and cortical thickness in the cingulate cortex and higher integrity of the LC. There were no associations between complex mental activities and tau burden. Exploratory analyses suggest that the associations between complex mental activities and late life brain health are life stage specific. Greater engagement in complex mental activities in early life was associated with cingulate cortex volumes and thickness, whereas greater levels of complex mental activities in late life were associated with the integrity of the LC. Together, these findings suggest that a mentally stimulating life may help to confer benefits towards brain health in late life.
Children with overweight or obesity are at elevated risk for later-life mental health challenges, but the role of accelerometer-derived waking movement behaviors remains uncertain. Thus, we examined longitudinal associations of sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) at age 7 with later-life internalizing and externalizing problems. We used data from the UK Millennium Cohort Study, focusing on children with overweight or obesity at age 7 who had valid accelerometer data and a complete set of predefined analytic variables (N = 858). Exposures were average daily minutes of SB, LPA, and MVPA. Outcomes were parent-reported Strengths and Difficulties Questionnaire-based internalizing and externalizing problems scores at ages 11 and 14. A generalized random forests approach was used to estimate average treatment effects (ATEs) and conditional average treatment effects (CATEs), adjusted for relevant demographic, socioeconomic, body mass index, parental distress, baseline mental health, and co-occurring movement intensities; day-of-week activity-pattern variables were used as exploratory candidate moderators. Estimated ATEs were small. After applying the Benjamini-Hochberg false-discovery-rate (FDR) correction across the 12 primary exposure-outcome tests, only the association between higher SB and lower internalizing problems at age 11 remained statistically significant (ATE = -0.013 SDQ points per additional min/day; 95% CI, -0.019 to -0.007; q < 0.001). No other pathway survived FDR correction, and other nominal or directionally suggestive estimates were interpreted as exploratory. CATE summaries and calibration tests provided limited evidence of reproducible heterogeneity. Accelerometer-derived waking movement behaviors at age 7 were associated with later SDQ problems scores in small and outcome-specific ways among children with overweight or obesity. Since the study is based on observational data and relies on measured-confounder assumptions, the findings should be interpreted cautiously, and as model-based estimates rather than definitive causal evidence.
Population ageing has intensified long-term care demands globally, necessitating innovative, data-driven, and technology-enabled approaches to support caregivers. This study aimed to assess mental health and quality of life among caregivers of older adults in the Northeast of Thailand and to examine structural relationships among key determinants. A cross-sectional analytical study was conducted between January and August 2025 among 438 caregivers using multistage stratified random sampling. Standardized instruments were used. Multivariate logistic and linear regression analyses, along with Structural Equation Modeling were conducted to identify predictors and examine direct and indirect pathways. The prevalence of depression was 24.2% (95% CI: 20.2-28.5). High caregiver burden (AOR = 3.48, 95% CI: 2.12-5.71), poor social support (AOR = 3.02, 95% CI: 1.82-5.01), and low income (AOR = 2.31, 95% CI: 1.29-4.14) were significantly associated with depression. Social support positively predicted QoL (β = 0.38, p < 0.001), while depression negatively influenced QoL (β = -0.44, p < 0.001). SEM demonstrated good fit (CFI = 0.95, RMSEA = 0.045), confirming depression as a mediator. Caregiver burden and inadequate social support emerged as key determinants, highlighting opportunities for integrating predictive analytics and digital health interventions in long-term care systems.
The global aging population is rapidly increasing, prompting the United Nations to declare the "Decade of Healthy Aging" (2021-2030) to improve the quality of life for older adults. Health-related quality of life (HRQoL) is crucial in this context, and the International Classification of Functioning, Disability and Health (ICF) provides a standardized framework for its evaluation. This study aimed to apply a previously proposed method for converting SF-36 domain scores into ICF qualifiers in community-dwelling older adults attending primary care services in a middle-income country, describing the resulting classification of functioning domains using standardized ICF qualifiers. A cross-sectional study was conducted with older adults aged 60 and above who accessed primary healthcare services and had no cognitive impairment. Participants underwent HRQoL assessment using the SF-36, and ICF codes previously linked to SF-36 domains were classified using ICF qualifiers. A simple calculation method was developed to convert SF-36 scores into ICF qualifiers. The study included 52 participants, with a mean age of 71.6 ± 7.0 years, 92.3% of whom were women. The ICF framework qualified 27 codes from SF-36 domains. Moderate impairments were observed in "Bodily Pain," "General Health," and "Vitality" domains, while "Physical Functioning," "Social Functioning," and "Mental Health" domains showed mild impairments. No impairments were noted in the "Role Physical" and "Role Emotional" domains. The application of ICF qualifiers to SF-36 domain scores yielded standardized classifications of HRQoL domains across the ICF framework, allowing HRQoL outcomes to be described according to the severity levels defined by the ICF qualifier scale.
Omega-3 fatty acids play a key role in multiple biological processes relevant to health. The menopausal transition represents a critical stage in a woman's life, associated, in some cases, with abundant clinical symptoms and a significant increase in disease risk. The aim of this study was to update the current evidence on the role of omega-3 fatty acids in women's health during this critical period of life, with respect to bone health, cardiovascular health, vasomotor symptoms, mental health, cognitive function, and depression, as well as breast health. Although there is scientific evidence of the benefits of omega-3s in various areas of health, specific studies at this stage are limited. The low dietary intake of these fatty acids often necessitates supplementation. Further research is needed to develop recommendations tailored to the menopausal transition to improve quality of life and promote healthy ageing.
Social participation is a modifiable determinant of healthy aging and has been linked to better mental health and life satisfaction. However, evidence from rapidly aging East Asian societies remains limited, particularly regarding the discriminatory ability of social participation levels to identify older adults at risk of low well-being. This study examined associations between social participation and subjective well-being and evaluated item-level activity patterns among community-dwelling older adults. A cross-sectional study of 1,099 adults aged ≥ 65 years was conducted across rural and semi-rural communities in Taiwan. Subjective well-being was assessed using the WHO-5, and social participation using a multi-dimensional 12-item scale. Group comparisons, multivariable logistic regression, item-level correlations, and Receiver Operating Characteristic (ROC) analysis were performed. Older adults with high well-being reported significantly higher social participation than those with low well-being (40.0 ± 9.0 vs. 32.8 ± 9.6, p < 0.001). Social participation independently predicted high well-being after adjusting for age, gender, and living status (AOR = 1.089; 95% CI: 1.07-1.11). ROC analysis showed acceptable discrimination (AUC = 0.707), with an optimal cut-off score of 32 (sensitivity = 85.2%; specificity = 48.4%). All participation items correlated positively with well-being (p < 0.001), with visiting friends/relatives (r = 0.307) and health-related activities (r = 0.298) showing the strongest associations. Higher social participation is strongly associated with better subjective well-being in older adults, particularly through relational and health-oriented activities. Social participation scores may serve as a useful community-based indicator for detecting low well-being. Culturally sensitive interventions that promote meaningful, voluntary, and inclusive participation-alongside structural supports such as transportation and social prescribing-may help enhance psychological well-being in aging East Asian communities.
To (1) identify cardiac arrest (CA) survivors' and their caregivers' stressors and coping and compensation strategies related to brain health and (2) gather feedback on a proposed brain health lifestyle intervention for this population. We conducted two focus groups with dyads of CA survivors and their caregivers (N = 9 dyads) and ten interviews (N = 10 dyads), recruited from the Sudden Cardiac Arrest Foundation's Cardiac Arrest Survivor Alliance, BuildClinical, and provider referrals between 9/2024 and 5/2025. We purposefully sampled to include populations at-risk for cognitive decline based on race and ethnicity. We conducted rapid qualitative data analysis of our focus groups and interview transcripts. Dyads described several sources of brain health stress including survivors' cognitive changes, fear of further decline, and concerns about caregiver stress. Dyads reported using coping strategies including peer support, professional mental health treatment, acceptance strategies, and physical activity, and compensation strategies including delegating more tasks to the caregiver, using organizational aids, visual aids, and pacing strategies. Dyads endorsed proposed program content and recommended additional content on nutrition and diet, managing emotional distress, and psychoeducation on the impact of CA on the brain. Survivors and caregivers experience ongoing stressors related to brain health, though they develop coping and compensation strategies that merit further study.
Lateralization is a hallmark of brain organization, yet the structural basis underlying this phenomenon remains a critical, unresolved question in cognitive and systems neuroscience. In this study, we applied multivariate machine learning techniques to investigate variations of global brain asymmetry and their associations with cognitive functions, aging, and aging-related diseases, using large-scale datasets. Our findings revealed substantial and previously unknown structural differences between the hemispheres, and established key associations between structural asymmetries and lateralized functions. At the population level, we identified unique aging trajectories of hemispheric differences and uncovered diagnosis-specific variations in patients with Alzheimer's and Parkinson's disease, and in APOE ε4 carriers at genetic risk. Notably, we identified a "left hemi-aging" pattern that challenges the conventional "right hemi-aging" model. Together, these results advance our understanding of functional lateralization in the human brain and highlight the potential of global brain asymmetry as a biomarker for brain aging and related diseases.
As the proportion of the geriatric population has increased worldwide, increases in mortality and morbidity are inevitable. To ensure healthy aging, preventive measures must be taken at the earliest stage. SDG 2.2 aims to overcome malnutrition, including malnutrition, among the older population. Thus, this study was designed to assess the prevalence of malnutrition among older people who visit hospitals for various ailments so that suggestive measures can be advised. The study was conducted after approval from the Institutional Ethics Committee (IEC) and permissions from the administration of the institution. Older people aged above 60 years who provided consent to participate were considered for the study, while those who were not in a position to provide responses were excluded from the study. A sample of 117 participants was interviewed using a semistructured validated questionnaire consisting of sociodemographic details and the MNA-SF questionnaire. The collected data were entered and then analysed using IBM SPSS (ver 29). A total of 69 (59%) patients received health care from government hospitals, whereas 48 (41%) patients sought health care from private hospitals, with almost equal participation from both genders. One-third of them had hypertension and diabetes mellitus. Upon screening, 40.2% of the older people had a normal nutritional status, whereas the rest of them were either at risk or already having malnutrition. With 58.1% of the participants being malnourished or at risk of malnourishment in the 60-69 age group, among the participants in the lower/upper lower socioeconomic status category, 62.9% were malnourished or at risk of malnutrition, while 56.4% were in the lower middle/upper middle socioeconomic status category. The present study highlights the substantial burden of malnutrition among older individuals. Two-thirds of the individuals were either at risk of developing malnutrition or had already developed malnutrition. As none of the sociodemographic factors were found to be associated, qualitative studies are needed to explore the various other reasons for developing malnutrition.
Depression is a common mental health disorder which frequently co-occurs with increased body mass index or increased waist circumference (hereafter 'overweight'), causing heightened cardiovascular risk. Unhealthy lifestyle behaviours underlie both conditions. The Multimodal Lifestyle Intervention (MLI) LEEF integrates physical activity, nutrition, and behavioural strategies, tailored to motivational challenges common in depression, offering a dual focus on mental and physical health. However, unpublished process data revealed very limited referral to MLI‑LEEF from both primary and secondary care, and consequently low initiation rates, signalling clear implementation challenges. This study addresses this gap by translating prioritised implementation determinants into conceptually and empirically grounded implementation strategies and examining what works, how, and under which conditions. This quasi‑experimental, explanatory sequential mixed‑methods study will implement MLI‑LEEF across ten general practices and three secondary mental health care outpatient clinics in the Northern Netherlands. Implementation strategies will be developed and tailored using Causal Pathway Diagramming and applied over a six‑month period. Quantitative data will be collected before, during, and after implementation to assess proximal implementation outcomes (the immediate, observable effects of an implementation strategy), distal implementation outcomes (adoption and sustainability), service‑level penetration, and patient outcomes. Following the implementation period, semi‑structured interviews will be conducted with referrers from each participating organisation. Site‑specific topic guides, informed by each organisation's implementation plan, causal pathway diagrams, and quantitative implementation outcomes, will probe how strategies generate change (mechanisms), how they influence targeted determinants, and which contextual conditions (preconditions, moderators) shape implementation strategy functioning. This study will respond to fieldwide calls in implementation science for rigorous, transparent, and context-sensitive approaches to developing and evaluating implementation strategies. By examining how strategies shape referral and initiation in routine general practice and specialist mental health services, and by clarifying the mechanisms and contextual conditions under which they are effective, the study will generate actionable insight into why implementation succeeds or falters in real-world care. These insights will provide essential groundwork for strengthening the reach and adoption of MLI-LEEF and will offer transferable guidance for embedding multimodal lifestyle interventions into everyday care, while advancing generalizable knowledge of how implementation strategies produce change. 10.17605/OSF.IO/XJHCB.