This study examined the risk of sarcopenia and its association with bone turnover markers, insulin resistance, and skeletal muscle mass among community-dwelling older adults in Ghana. In this cross-sectional study, 140 adults aged ≥60 years were assessed using the SARC-F questionnaire to estimate the risk of sarcopenia. Skeletal muscle mass was estimated using bioelectrical impedance analysis (Omron HBF-514), and metabolic and bone turnover markers were measured in fasting blood samples. The prevalence of sarcopenia risk was 44.3%, with women facing more difficulties climbing stairs. The risk of sarcopenia was more common in older age groups. Sarcopenia risk was associated with higher insulin resistance (τ = .475), C-telopeptide (τ = .540), urine calcium/creatinine ratio (τ = .620), and osteocalcin (τ = .651), but with lower skeletal muscle mass (τ = -.624; all p < .01). Nearly half of the older adults screened were at risk of sarcopenia, highlighting the need for early identification and preventive strategies. These findings underscore the importance of age and metabolic factors in sarcopenia risk, as well as the need for routine monitoring of bone turnover biomarkers in aging populations.
Chronic cough, defined as a persistent cough lasting >8 weeks, affects 16% of Canadian adults in the community. Chronic cough can be classified as refractory chronic cough when cough persists despite treatment of any identifiable underlying condition. The prevalence of refractory chronic cough is unclear, as is the number of patients who remain untreated despite having a persistent cough. This prospective cohort study included 26 606 adults of 45-85 years old from the Canadian Longitudinal Study of Aging (CLSA) with available chronic cough data at baseline and first follow-up at 3 years. Chronic cough was defined by self-reported daily cough for ≥12 months. In this cohort, 4059 participants had a cough at baseline. Among them, 26.2% had refractory chronic cough on medications, 27.4% had chronic cough without medication (untreated chronic cough), 19.3% had resolution of chronic cough with medication, and 27.1% had resolution of chronic cough without medication. Overall, the prevalence of refractory chronic cough was 4.0% (1063 out of 26 606) among patients on medication and 4.2% among the untreated chronic cough group. Refractory chronic cough was more common in men, persistent smokers and those with asthma, COPD, migraine and inflammatory bowel disease or irritable bowel syndrome. Smoking cessation and discontinuation of angiotensin-converting enzyme inhibitors were associated with resolution of cough. Despite guideline-recommended therapies, neuromodulators were infrequently prescribed by physicians. This population-based study was able to explore the outcomes of chronic cough over 3 years and identify risk factors with its development. Nearly one third of cases resolved without new medication, but likely by targeting treatable traits such as smoking and stopping angiotensin-converting enzyme inhibitor use.
Alzheimer disease (AD) biomarker and genetic testing results are increasingly disclosed to cognitively unimpaired adults in research and could in the future inform clinical treatment decisions in this population. To assess psychological outcomes after returning 3 categories of amyloid biomarker results as well as apolipoprotein E (APOE) genotypes. This cohort study was a secondary analysis of data collected as part of screening for the multisite AHEAD preclinical AD trial. Participants were individuals aged 55 to 80 years undergoing screening from July 14, 2020, to October 15, 2024. Participants were informed whether they had not-detected, intermediate, or elevated amyloid positron emission tomography levels, as well as their APOE genotype, which were categorized as noncarrier, ε4 heterozygote, or ε4 homozygote. Impact of Events Scale (IES; 15 items to assess intrusive thoughts and avoidance; each item is scored as not at all [0], rarely [1], sometimes [3], or often [5]; total range, 0-75), collected 24 to 72 hours after disclosure, and change in a scale measuring concerns about AD dementia (adapted scale using 6 items in which participants indicated their level of agreement with statements related to their perceived probability of developing AD dementia; items scored as strongly disagree [1] through strongly agree [5]; total range, 6-30), calculated by subtracting the score collected before biomarker testing from 1 collected after biomarker and genetic test results disclosure. Among 3414 included individuals, the mean (SD) age was 68.8 (6.0) years and 2116 (62%) were female. Group mean IES scores were below clinically significant thresholds. Nevertheless, across genetic groups, learning an elevated amyloid result (1184 participants) was associated with higher IES (mean [SD], 10.5 [10.9]) than intermediate amyloid (482 participants; mean [SD] IES, 8.8 [9.8]), and intermediate amyloid was associated with higher scores than not-detected amyloid (1748 participants; mean [SD] IES, 6.5 [8.4]). Across amyloid groups, learning APOE ε4 homozygosity (337 participants) was associated with higher mean (SD) IES (12.7 [11.6]) than heterozygosity (1609 participants; 9.1 [10.2]), and heterozygosity was associated with higher IES than noncarrier status (1468 participants; mean [SD] IES, 6.2 [8.1]). Both types of information were significant in an analysis of covariance model; no interaction effect was observed. In contrast, only biomarker disclosure was associated with differential change in concerns about AD dementia. Those with elevated amyloid showed a mean (SD) increase in concern (0.8 [3.5]), those with intermediate amyloid showed a smaller increase (0.4 [3.7]), and those with not-detected amyloid showed decreased concerns (-1.1 [4.2]). In this cohort study of cognitively unimpaired adults, associations with intrusive thoughts were observed to differ among genetic and biomarker subgroups; such associations were limited to biomarker subgroups for measures of perceived dementia risk.
An older adult affordable housing community and a Federally Qualified Health Center partnered to improve the health of low-income older adults. The Unite Care Model included establishing onsite primary care, wellness support, and social needs assistance. The RE-AIM framework guided our mixed-methods evaluation. We sought to determine whether the model was associated with change in blood pressure, social or physical environment and understand model reach and implementation. Of the 251 residents, 13.1% had a clinic visit, and of respondents 70% attended at least one wellness event, and 35% received social needs assistance (reach). Clinic utilization was not associated with improved blood pressure or environment change (effectiveness). Residents reported barriers to clinic utilization including an established provider, uncertainty in transferring care, lack of urgent visits, and insurance barriers. Administrators echoed policy, staffing, and patient barriers to utilization (implementation). Expanding appointment options, increasing staffing, and overcoming insurance barriers may increase effectiveness.
Social and structural determinants of health (SSDOH) must be measured longitudinally to understand how lived experiences shape trajectories of Alzheimer's disease and related dementias (ADRD). This study evaluated the feasibility of administering an SSDOH survey to cognitively unimpaired older adults, examining response consistency, changes over time, and missing data patterns. A follow-up survey was conducted with participants in the UPenn Alzheimer's Disease Research Center clinical cohort an average of 1.7 years after the initial survey. The 225-item questionnaire covered domains including education, social networks, and stressors. At follow-up, markers of feasibility included a 60% completion rate (81 of 135 participants), high item completion (>93%), and minimal missing data (<3% missed more than 10% of data). Logistic regression identified gender, social network size, and social readjustment experiences as predictors of nonrandom missingness. Response changes between administrations were likely due to ambiguity in item phrasing, instructions, or changes in participants' experiences. Overall, repeated administration of the SSDOH survey was feasible. The response rate was reasonable but lower than expected for a volunteer research sample, suggesting multiple modes of completion may increase engagement. Repeated administration also helped identify ambiguous items and methods for improving the validity and reliability of SSDOH measures.
Population aging is increasing demand for competent geriatric care. This is the first multicenter study in Palestine to assess physician geriatric knowledge using a validated instrument (Revised Facts on Aging Quiz), providing baseline data for curriculum reform in a country with no accredited geriatrics fellowship program. 378 physicians of the Palestinian Ministry of Health completed a self-administered questionnaire covering demographics, professional level, geriatrics education, and knowledge using the validated Revised Facts on Aging Quiz. Among 378 physicians (mean age 30.17±8.07 years; 65.34% male), the mean knowledge score was 20.35±4.14 (A score of 56.5% correct, while indicating foundational knowledge, leaves a 43.5% gap in understanding, a deficit that may translate into suboptimal care for older adults, including missed geriatric syndromes and inappropriate prescribing). Knowledge was not significantly associated with age, or gender. Physicians trained in Palestine scored higher than those trained abroad (20.82±4.28 vs. 19.84±3.94; p=0.022). Scores differed by professional level (ANOVA p=0.025), with interns highest (20.90±3.93) and general practitioners lowest (18.80±4.20). Common misconceptions involved older adults' adaptability, work capacity, and depression prevalence. Overall geriatric knowledge was moderate, but prevalent misconceptions highlight significant educational deficiencies. Knowledge differed by professional level and country of medical education, suggesting both career stage and educational environment affect geriatrics competency. We recommend that Palestinian medical schools integrate a minimum of 20 contact hours of geriatrics content into existing internal medicine and family medicine rotations, including clinical exposure to well-elderly care, geriatric syndromes, and polypharmacy management.
Treatment-Resistant Late-Life Depression (TRLLD) represents a significant clinical and research challenge. Studies on TRLLD use heterogeneous diagnostic criteria limiting the interpretation of results and the development of clinical guidelines.This study aimed to establish expert consensus on the core components and definition of TRLLD through a Delphi process conducted by a European Task Force of clinicians and researchers with experience in late-life depression. We conducted an electronic Delphi study with 30 European experts to identify key definitional elements of TRLLD. In the 1st survey round (SR), participants responded to open-ended questions on definitions of TRLLD. Responses informed the development of 70 structured items for 2nd SR, involving 58 closed (yes/no) items and 12 multiple-choice questions across six domains: symptom presentation, cognitive impairment, comorbidities, pharmacotherapy, treatment adherence, and psychosocial factors. Consensus was defined as ≥70% agreement. In 3rd SR, participants reviewed comments and validated the final categorical definition, the operational staging model, and the derived decision algorithm for TRLLD. Consensus was reached for 72.4% of the 58 closed items. Experts agreed that the categorical definition of TRLLD should correspond to major depressive disorder in individuals aged ≥65 years who show insufficient response to two adequate antidepressant treatments, in the absence of dementia and medical conditions that could account for depressive symptoms. An operational staging model and decision-making algorithm were developed from consensus items. This study provides the first European consensus definition of TRLLD and highlights the need for age-adapted diagnostic criteria that reflect the clinical complexity of depression in older adults.
With global population aging, the prevalence of gastric cancer among patients aged 60 years and older continues to rise. Radical gastrectomy frequently induces postoperative skeletal muscle loss, which correlates with poor clinical prognosis. Currently, few prediction models are available to screen for new-onset postoperative low muscle mass in older gastric cancer patients. This study aimed to construct and internally validate a preoperative prediction model for low muscle mass at six months after radical gastrectomy in this elderly population. A total of 69 eligible older adult patients with pTNM stage I-III gastric adenocarcinoma were retrospectively enrolled. Those with preoperative low muscle mass, neoadjuvant therapy, or incomplete clinical and imaging data were excluded. Postoperative low muscle mass was diagnosed using L3-level skeletal muscle index based on Asian cutoff criteria. Univariate and multivariate logistic regression analyses were applied to screen independent predictors. Model performance was assessed via ROC curves, calibration curves, and leave-one-out cross-validation (LOOCV). Among all participants, 17 patients (24.6%) developed postoperative low muscle mass. Preoperative BMI, skeletal muscle area, lymphocyte-monocyte ratio, and surgical method were confirmed as independent influencing factors. The established model yielded an AUC of 0.857, with a sensitivity of 94.1% and specificity of 67.3%, and the LOOCV AUC reached 0.832. Total gastrectomy was linked to a higher risk of low muscle mass compared with partial gastrectomy. Preoperative BMI, SMA, and LMR can independently predict postoperative low muscle mass in older adult gastric cancer patients. The model shows moderate-to-good predictive performance in this single-center cohort and may help identify high-risk patients preoperatively. Prioritizing partial gastrectomy when oncologically safe and providing preoperative nutritional and exercise support may help reduce muscle loss.
Diabetes substantially increases the burden of multimorbidity in later life, posing a major challenge for healthy aging in India. Using nationally representative data, this study examined the prevalence, likelihood, and population-attributable risk (PAR) of cardiovascular disease (CVD), lung disease, musculoskeletal disorders, and eye problems among older adults and elderly persons. The prevalence of CVD was considerably higher among adults aged 60 years and above with diabetes than among non-diabetics. Diabetes contributed substantially to the CVD burden across socioeconomic and demographic groups, with the highest PAR estimates observed among overweight women aged 45 to 59 years and urban women. Eye problems also showed consistently elevated attributable risks, particularly among women aged 45 to 59 years, residents of Central India, and socially disadvantaged groups. In contrast, diabetes-attributable risks for lung disease and musculoskeletal disorders were comparatively modest and significant mainly among specific age-sex groups. Overall, the findings indicate that diabetes is an important contributor to chronic disease burden in later life, especially for CVD and eye disorders, with considerable variations across sex, socioeconomic status, region, and body mass index. These findings highlight the need for targeted diabetes management and prevention strategies to reduce chronic morbidity and improve healthy aging outcomes nationally.
While research steadily demonstrates that family functions as the central component in the provision of care for persons with dementia, little is known about support dynamics among those who reside alone in the community. Even less is known about those who reside alone with dementia and lack familial care options. To address this gap, data were drawn from an interview-based pilot (N = 30) that focused on community-dwelling live-alone persons with dementia. Qualitative descriptive analyses were conducted on the subsample who had no identifiable family and their collaterals (n = 10). Analyses indicated several themes including: (1). transient informal care, (2). consequential peripheral ties, and (3). discordant care preference and care planning. The present study expands on the limited information on those aging at home alone with dementia, providing a lens for understanding the complex intersection of dementia, residing alone, and aging without familial support.
China's rapidly aging population has intensified demands on the healthcare system, particularly for complex elderly and critical care, creating an urgent need for a highly skilled nursing workforce. The five-year consistent nursing program, which admits junior high school graduates and provides over 8 months of clinical practice before higher vocational enrollment, represents a crucial training pathway. However, the psychological foundations-specifically academic self-efficacy (ASE), learning engagement (LE), and professional identity (PI)-of first-year students in this program remain inadequately studied, despite their importance for developing clinical competence in geriatric care. This study aimed to investigate the interrelationships and mediating mechanisms between ASE, LE, and PI among first-year students in China's five-year nursing program, with the goal of informing training optimization for elderly and critical care. This cross-sectional study enrolled 321 first-year nursing students who completed validated questionnaires measuring PI, LE, and ASE. Bias-corrected bootstrapping mediation analysis (5,000 samples, 95% CI) was performed to test the hypothesized model, with only-child status as a covariate. Participants demonstrated moderate-to-high levels of all three constructs. Correlation analysis revealed ASE was strongly positively correlated with LE (r = 0.806, p < 0.001) and moderately with PI (r = 0.566, p < 0.001), while LE showed a significant positive correlation with PI (r = 0.654, p < 0.001). Mediation analysis confirmed LE fully mediated the ASE-PI relationship, with a significant indirect effect (β = 0.569, 95% CI [0.420, 0.749]) and a not significant direct effect (β = 0.089, p = 0.309). These findings identified learning engagement as a crucial mechanism through which academic self-efficacy enhances professional identity. Educational interventions should simultaneously strengthen students' academic confidence and actively promote learning engagement through tailored clinical training and simulated scenarios to develop nurses who are better prepared for China's aging-related healthcare challenges.
Severe acute pancreatitis (SAP) is a common emergency condition associated with high mortality. Intestinal barrier dysfunction plays a critical role in the pathogenesis of SAP. Mammalian sterile 20-like kinase 1 (Mst1) has been shown to coordinately regulate autophagy and apoptosis in cardiac and aging-related diseases. However, the precise role of Mst1 in SAP-induced intestinal barrier dysfunction remains largely unknown. This study aimed to investigate the pathophysiological impact of Mst1 on SAP-induced intestinal barrier dysfunction. Mst1-knockout and wild-type mice were challenged intraperitoneally with caerulein combined with lipopolysaccharide (LPS) to establish an experimental SAP model. TNF-α-stimulated MODE-K cells were used to analyze the impact on autophagy and apoptosis and to elucidate the underlying mechanisms. Mst1 knockout up-regulated tight junction proteins, alleviated apoptosis and enhanced autophagy in the ileocolic mucosa tissue of SAP mice, which consequently improved cumulative survival and alleviated intestinal barrier dysfunction. Conversely, Mst1 overexpression inhibited autophagy and promoted apoptosis in TNF-α-stimulated MODE-K cells. Mst1 plays an important role in SAP-related intestinal barrier dysfunction by inhibiting autophagy and enhancing apoptosis.
Providing high-quality advance care planning conversations for nursing home residents living with Alzheimer's Disease and Related Dementias is a persistent challenge, but implementation of advance care planning interventions remains limited. This study explored barriers and enablers to implementing the Goals of Care video with nursing home staff and identified strategies to implement the video intervention. Nursing home administrators identified staff members involved in ACP discussions with residents and families. A research team member contacted these individuals by email or telephone. Fourteen staff members across six Florida nursing homes participated in in-person or virtual semi-structured interviews. A summative content analysis quantified the frequency of each CFIR construct coded as an enabler or barrier, with frequencies calculated at the nursing home level. The primary enabler was the alignment of the Goals of Care video with nursing homes' organizational mission. The most identified barrier was the video's perceived length. Strategies to improve implementation included adapting materials, assessing readiness, and addressing site-specific challenges. Tailoring the Goals of Care video to the organizational context is essential. Addressing barriers, such as video concerns, while leveraging existing enablers can strengthen adoption and support more consistent advance care planning practices.
In vivo biomarkers for detecting neuropathologies from repetitive head impacts (RHI), including chronic traumatic encephalopathy (CTE), are needed. To evaluate the utility of plasma phosphorylated tau 217 (p-tau217), assess its performance as a beta-amyloid (Aβ) biomarker in participants with RHI exposure at risk for CTE, and explore concordance with CTE neuropathology in a postmortem subsample. This longitudinal, multicenter, case-control study used data from the Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of CTE (DIAGNOSE CTE) Research Project, collected from September 2016 to October 2023. Participants were former American football players (case participants) and asymptomatic men unexposed to RHI (control participants). A subsample had available neuropathologic data. RHI, traumatic encephalopathy syndrome (TES) diagnoses, and levels of CTE certainty. Plasma p-tau217 (classified as positive [≥0.63 pg/mL], intermediate [0.40-0.62 pg/mL], and negative [<0.40 pg/mL]), Aβ-positron emission tomography (PET; 18F-florbetapir; with Aβ-positive defined as a standardized uptake value ratio [SUVR] ≥1.10), and tau-PET (18F-flortaucipir). TES diagnoses were assigned by multidisciplinary consensus conference. Analyses of postmortem brains controlled for age, race, and APOE ε4 status. Among 231 participants (mean [SD] age, 57.75 [8.25] years), 177 were former football players (117 professional and 60 college) and 54 were unexposed participants. Former football players had higher baseline mean (SD) p-tau217 concentrations than unexposed participants (0.35 [0.26] pg/mL vs 0.27 [0.14] pg/mL; P = .008), although this was driven by a higher proportion of Aβ-PET-positive participants among former players. Plasma p-tau217 increased over time across the sample (B = 0.207 [95% CI, 0.117-0.298]; P < .001), with no significant time × exposure group interactions. Among football players, p-tau217 showed no time × group interactions with TES diagnosis, TES-CTE certainty, or RHI metrics. Higher p-tau217 concentration correlated with higher global Aβ-PET SUVR (B = 0.058 [95% CI, 0.053-3.501; P = .01), with a few discordant cases (5 participants were p-tau217-negative and Aβ-PET-positive; 7 participants were p-tau217-positive and Aβ-PET-negative). P-tau217 had similar areas under the curve for projecting Aβ-PET positivity as cerebrospinal fluid (CSF) p-tau181/Aβ42 and CSF Aβ40/42 measures (p-tau217: AUC, 0.88 [95% CI, 0.80-0.96]; CSF p-tau181/Aβ42: AUC, 0.89 [95% CI, 0.79-1.00]; CSF Aβ40/42: AUC, 0.85 [95% CI, 0.72-0.98]). Among 9 brain donors, 6 had CTE (stages II-IV; none with Alzheimer disease). Seven had negative or intermediate p-tau217, concordant with Aβ-PET. Two p-tau217 outliers with stage III CTE had normal concentrations upon additional testing. The findings of this study suggest that plasma p-tau217 concentration is unlikely to be useful for the detection of CTE, but it does show utility for ruling out Aβ pathology in participants at risk for CTE.
This study investigates physical activity within dyadic relationships as a predictor of cognitive function using data from the Survey of Health, Aging, and Retirement in Europe (SHARE). A two-wave dyadic analysis was conducted for 33 opposite-sex couples (mean age 67.7 years). Physical activity was measured with a three-axial accelerometer, and cognitive function through verbal fluency at baseline and follow-up. Multilevel lagged dependent variable models were estimated using mixed effects in Stata Version 18/SE. Verbal fluency remained stable over time (β = .62, p < .001). Individuals' own physical activity (steps) predicted better cognitive function at follow-up (β = .30, p < .001). Spouses' physical activity also showed a positive association, though weaker (β = .25, p < .01). Individual activity was more strongly associated with cognitive outcomes than partner activity. However, partner effects remained significant after accounting for individuals' own activity, indicating that dyadic influences contribute uniquely beyond personal behavior. These findings underscore the relevance of dyadic processes for cognitive health in later life. Future research should examine underlying mechanisms and evaluate couple-based interventions.
The growing aging population has led to an increasing number of older adults with chronic illnesses such as stroke, placing significant caregiving responsibilities on informal caregivers. However, little is known about how health literacy (HL) affects caregiver burden (CB), particularly in Middle Eastern countries. This study explores the relationship between CB and HL among informal caregivers of older adult stroke survivors in Iran and Iraq. Conducted in 2021 with 300 participants selected through convenience sampling from Ghaem Hospital in Iran and Al-Sadr Hospital in Iraq, data were collected using the Health Literacy Instrument for Adults (HELIA) and the Caregiver Burden Inventory (CBI). Results indicated that Iranian caregivers experienced higher CB and HL than Iraqi caregivers. A multivariable linear regression analysis showed that CB was significantly associated with HL (β = -.25, p < .01), caregiver age (β = .21, p < .05), and the age of the stroke survivor (β = .18, p < .05), explaining 15% of the variation in CB. Higher HL correlated with lower CB, while older caregiver and patient ages were linked to higher CB. The study concludes that improving HL through educational programs can reduce CB, and health officials should consider demographic factors to enhance caregiver support.
International migration is a stressful life event that contributes to significant health disparities and well-being concerns among aging migrants living their retirement years in a host country. This study utilized a qualitative cross-sectional design employing semi-structured interviews with a diverse sample of 16 older migrants, aged 60 to 79, residing in the United States. Narratives were analyzed using thematic analysis with a reflexive approach. Three key themes emerged from the data, defining the experience of well-being and ambiguous loss: (1) The fluid nature of "Home" and belonging, reflecting profound identity-based ambiguous loss; (2) Active engagement and social connection as a foundation for well-being, highlighting structured activity as a vital coping mechanism against isolation and decline; and (3) Maintaining core identity and values, illustrating the participants' successful selective acculturation strategies to preserve internal cultural, religious, and ethical values as a source of stability. The findings confirm that older migrants experience significant ambiguous loss centered on a disrupted sense of self and place. The study identifies active engagement and preservation of core identity as strategies for resilience and mitigating psychological distress. These results underscore the need for culturally responsive care practices that prioritize community integration, promote purposeful activity, and support the maintenance of transnational and internal cultural continuity to enhance the well-being of this growing population.
To investigate the demographic and clinical characteristics of fall-related deaths in Chinese communities and provide clinical insights for fall prevention strategies. A retrospective study was conducted on decedents (n = 1455) from a deeply aging urban community (Kaiyuan, Quanzhou, China) between 2020 and 2024. Fall-related deaths were identified by screening death certificates for specific keywords, with confirmation documented in the cause of death. Demographic, clinical, and temporal trend analyses were conducted. Kaplan-Meier and multivariate Cox proportional hazards regression were used to identify factors associated with survival time from fall to death. Fall-related deaths constituted 5.5% of community deaths, predominantly affecting individuals aged ⩾60 years (93.8%). Significant gender differences were observed in marital status, occupation, and education level (all p < 0.05). Age-standardized mortality rates fluctuated from 9.17 to 16.29 per 100,000 population (2020-2024) with no significant temporal trend (Z = 0.490, p = 0.624). Univariate survival analysis revealed a notably shorter median survival in patients with comorbidities (1.0 vs. 6.0 months, p = 0.116). Multivariate analysis identified age of fall (Hazard ratio (HR) = 1.023, 95% Confidence interval (CI): 1.001-1.046, p = 0.044) and comorbidities (HR = 1.793, 95% CI: 1.022-3.147, p = 0.042) as independent predictors of shorter survival. Fall-related mortality is a major public health issue among older adults in the community. Advanced age of fall and comorbidities are key factors independently associated with shorter post-fall survival. Evidence-based multidimensional prevention and management interventions are essential to alleviate the fatal burden of falls.
The aim of this study was to determine whether adherence, satisfaction, and overall satisfaction in a remote case management-based intervention influence changes in functional physical performance in older adults with a history of recurrent falls. A clinical trial was conducted with 28 older adults randomized to the intervention group (IG), who received an online case management program focused on fall prevention and reducing modifiable risk factors for 16 weeks. The control group (CG) consisted of 26 participants who received general health guidance. Performance was assessed using the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), and Timed Up and Go Dual Task (TUGDT) tests at three time points (baseline, after 16 weeks, and after 1 year). After 16 weeks, adherence was evaluated based on participation frequency in the intervention, and satisfaction with remote interventions was assessed using a questionnaire based on the Short Assessment of Patient Satisfaction (SAPS). Adherence significantly influenced changes in postural balance (p = 0.044, R² = 0.09) and in muscle strength gain in lower limbs (sit-to-stand, seconds) (p = 0.034, R² = 0.11). Overall satisfaction positively influenced changes in verbal fluency (p = 0.048, R² = 0.11). Good adherence and satisfaction contributed to improvements in muscle strength, mobility and postural balance in older adults.
Long-term effect of COVID-19 (Long COVID) may persist for months or years after SARS-CoV-2 infection, but longer-term cardiopulmonary manifestations have not been previously reported. The objective of the study was to characterize cardiopulmonary function after SARS-CoV-2 infection in a digital health substudy of the nationwide Researching COVID-19 to Enhance Recovery Adult Cohort Study. Associations between wearable sensor device measures of cardiopulmonary fitness and survey-derived Long COVID symptoms were estimated over a 6-month window at least 6 months after infection using linear regression models adjusted for wear time, age, sex, race/ethnicity, and body mass index. Among 1,475 participants (72% female, 65% non-Hispanic White) a median of 21 months (IQR: 15-31 months) after infection, 498 (34%) had high symptom burden as characterized by the Researching COVID-19 to Enhance Recovery Long COVID Research Index (LCRI). High LCRI (vs low LCRI) was associated with significantly lower heart rate variability (-4.4 ms; 95% CI: -6.5 to -2.4; P < 0.001), higher resting heart rate (+1.5 beats/min [+0.7 to +2.4]; P < 0.001), fewer metabolic equivalent of task minutes (-96.3 [-128.8 to -63.8]; P < 0.001), lower step counts (-1,624 steps/day [-1,952 to -1,296]; P < 0.001), and lower activity levels (-7.9 minutes/day very or fairly active [-10.9 to -5.0]; P < 0.001). Hierarchal clustering analysis identified two subphenotypes with abnormal cardiovascular measures associated with low quality of life scores. Long COVID is associated with worse cardiovascular fitness. Additional studies are needed to determine if Long COVID is a novel risk factor for incident cardiovascular disease.