Innovation in Aging最新文献

Background and objectives: Multimorbidity is increasingly prevalent among the middle-aged population, yet it is largely often overlooked. We aimed to explore and compare the differences in multimorbidity patterns by sex and age among middle-aged inpatients from China and the United Kingdom.

Research design and methods: We analyzed 184 133 hospitalization records from Shaanxi, China, and 180 497 from the UK Biobank for -middle-aged populations. Using network analysis, we examined multimorbidity patterns by sex, age groups (40-44, 45-49, 50-54, and 55-59 years), and countries. We also identified hub diseases in both sex-specific and sex-age-specific networks and their corresponding roles in forming multimorbidity patterns.

Results: In both China and the United Kingdom, males exhibited higher multimorbidity prevalence (China: 58.51% vs 55.33%, 1.06×; United Kingdom: 31.15% vs 29.79%, 1.05×) and greater complexity of multimorbidity patterns (China: 1179 patterns vs 990 patterns, 1.19×; United Kingdom: 438 patterns vs 377 patterns, 1.16×) than females. In sex-specific networks, males in both countries demonstrated the specificity of circulatory, genitourinary, and endocrine/nutritional/metabolic-associated multimorbidity patterns, while females demonstrated specific genitourinary and neoplasm-associated multimorbidity patterns. Hub diseases in these networks are distributed in similar disease categories. In sex-age-specific networks, dominant multimorbidity patterns and hub diseases shifted by age. In males, both countries showed stable but dominating circulatory, endocrine/nutritional/metabolic and digestive-associated multimorbidity patterns with aging. In comparison, Chinese females demonstrated an increase in nervous system-associated multimorbidity patterns and a decrease in genitourinary-associated multimorbidity patterns with ageing; British females demonstrated an increase in mental/behavioral-associated multimorbidity patterns and a stable but dominating -genitourinary-associated multimorbidity patterns.

Discussion and implications: In both China and the United Kingdom, males demonstrated more complex multimorbidity than females. With ageing, multimorbidity patterns are stable in males, while females in China and the United Kingdom each develop different and specific multimorbidity patterns. These findings may inform targeted interventions for middle-aged inpatients with multimorbidity by sex and age.

[This corrects the article DOI: 10.1093/geroni/igae071.].

Background and objectives: Older adults differ widely both in the care they require and in who provides them care, often reporting significant unmet needs for assistance. Few studies have simultaneously considered the type of disability (self-care, mobility, and household activities) and multisource care networks (kin, extended-kin, non-kin, and paid help) to understand factors influencing unmet care needs among community-living older adults.

Research design and methods: Using data from the National Health and Aging Trends Study (2011; N = 3,265; M _Age [SD] = 77 [7.74] years, 62% women), we conducted a latent class analysis to identify care network types based on older adults' functional limitations and caregiver sources. Multinomial logistic regression models predicted network membership based on personal and structural predictors. Zero-inflated Poisson regression examined the relationship between network type and unmet care needs 1 year later.

Results: Seven distinct care network types emerged, characterized by combinations of caregiving sources and disability domains. Kin caregivers were involved across all network types. Older adults coresiding with kin typically received minimal paid help, which significantly increased their likelihood of unmet care needs in the subsequent year. Networks predominantly relying on non-kin caregivers tended to not use paid services and exhibited higher unmet care needs. Mismatches between disability type and the assistance received (e.g., requiring self-care assistance but primarily receiving household help) were associated with unmet care needs in the subsequent year.

Discussion and implications: The provision of adequate care was contingent upon the direct alignment of caregiving tasks with the functional limitations of aging adults and the effective coordination of informal and formal care resources. Enhancing care alignment through targeted assessments, supplementing family caregiving with formal services, and promoting coordinated caregiving arrangements could substantially reduce unmet care needs.

Background and objectives: Most people with dementia are undiagnosed and rely heavily on long-term care. Little is known about the relationship between dementia diagnosis and care costs, and inconsistent evidence exists on the cost implications of cognitive impairment severity. We examined how formal and informal care costs are associated with a dementia diagnosis and cognitive impairment levels across care settings.

Research design and methods: We used representative data from publicly funded long-term care recipients in residential care settings and community care settings in Hong Kong (n = 1,603). Staff time measurement was used to capture service utilization of both formal and informal care. Generalized linear model (log-link and gamma distribution) was used to estimate long-term care costs, controlling for covariates.

Results: A dementia diagnosis is associated with an additional 13% and 23% care costs in residential and community care settings, respectively. People with more severe cognitive impairment incur greater long-term care costs; the highest difference (a 189% increase) was found in informal care costs in community care settings among those with moderate-to-severe cognitive impairment. In community care settings, formal care costs were insensitive to cognition status but were consistently higher with a dementia diagnosis; in contrast, informal care costs were less associated with a diagnosis but increased with cognitive impairment severity.

Discussion and implications: Having a diagnosis of dementia and poorer cognition are associated with higher long-term care costs in both residential and community care settings. A dementia diagnosis is potentially a more important driver of formal care costs than cognitive impairment levels within the current care system, in contrast to what is observed with informal care costs. Practitioners and policymakers need to ensure that individuals with cognitive impairment without a dementia diagnosis receive the appropriate level of care.

Background and objectives: Augmented reality (AR) telepresence is a novel interactive communication modality that maps a user's 3D photorealistic avatar to another user's physical environment. However, AR's application with older adult populations is understudied. As such, we examined young and older adults' perceptions of utilizing this modality for social communication. Additionally, we tested the participants' ability to recognize 6 common emotions displayed by 3D photorealistic avatars compared to video clips of real people, examining whether age differences existed in communication perceptions and emotion recognition accuracy.

Research design and methods: To assess participants' perceptions, older (n = 31) and younger (n = 31) adults interacted with a volunteer's 3D photorealistic avatar using a structured conversational activity through a head-mounted display (HMD). Participants rated the quality of the HMD-AR communication based on physical and human realism, comfort while talking to the avatar, and the degree of social presence offered by the HMD-AR. Participants then identified 6 basic emotions exhibited by (1) video clips of a real person and (2) an animation of their 3D photorealistic avatars via an HMD. Each participant viewed a total of 36 video and avatar stimuli. Subgroup analyses were conducted by age group.

Results: Participants reported a positive communication experience with the 3D photorealistic avatar, with older adults rating the quality higher. Ratings were generally lowest for how life-like the model appeared (68% younger adults; 61% older adults). Most younger participants (93%) were able to accurately identify nonverbal emotions displayed by the avatar; older adults had less overall accuracy (80%).

Discussion and implications: Participants, including older adults, were enthusiastic regarding AR telepresence for interpersonal communication. Most were able to accurately identify emotions displayed by the 3D photorealistic avatars, although younger adults outperformed older adults. Further technology development will likely enhance the quality of AR communication for everyday use.

Background and objectives: Recently, cost-benefit analysis has been increasingly used to evaluate the value of interventions for dementia. This study aims to synthesize the methodology used in cost-benefit analysis (CBA) for dementia interventions.

Research design and methods: We conducted a scoping review with comprehensive systematic searches for original peer-reviewed articles published from January 2010 to December 2023, and included the studies if they (1) performed a CBA of interventions for dementia, (2) described either cost or benefit items, and (3) performed quantitative data analysis on either costs or benefits. The review adhered to the PRISMA Extension for Scoping Reviews Checklist to write the report.

Results: Of the 3415 articles found from the search, 15 were included in the review. Data analysis included the traditional CBA approach and its integration with the social return on investment approach. The set of cost and benefit items may vary depending on the intervention. Staff training, intervention supplies, building hire, and transportation were common cost items. Quality-adjusted life years (QALY), general practitioner visits, and emergency room visits were common benefit items. Cost data were often sourced from the study budget/assumptions. Benefit data were often sourced from the social value banks and literature. Market and shadow pricing were used for cost valuation. The value of statistical life was frequently used for benefit valuation.

Discussion and implications: This review synthesized data analysis methods, lists of cost and benefit items, data sources, and valuation methods used in the CBA of interventions for dementia. The findings provide helpful information for considering methodology in future CBA of interventions for dementia and similar interventions or conditions.

Background and objectives: Periodontitis is a prevalent chronic inflammatory gum disease in older adults and has been linked to cognitive decline, but underlying mechanisms are unclear. The geroscience hypothesis provides a framework for this link, positing that fundamental aging processes (eg, chronic inflammation) drive multiple age-related diseases. We aimed to determine whether accelerated biological aging mediates the association between periodontal disease and cognitive function in older adults.

Research design and methods: Data were analyzed from 1950 adults aged ≥60 years in the National Health and Nutrition Examination Survey 1999-2002. Periodontal status was clinically assessed (mean clinical attachment loss [CAL], periodontal probing depth [PD], and periodontitis defined by CDC/AAP thresholds). Cognitive performance was measured with the Digit Symbol Substitution Test (DSST). Biological aging was quantified using Klemera-Doubal method (KDM) and Phenotypic Age (PhenoAge) algorithms. Multivariable linear regressions and mediation analyses (adjusted for sociodemographic, behavioral, and health factors) were conducted to evaluate associations and the proportion of the periodontal-cognition link mediated by biological age acceleration (BAA).

Results: Periodontitis was significantly associated with poorer cognitive function (DSST standardized β=-0.095, P < .01) and higher KDM-BAA (β = 0.812, P < .001) and PhenoAge Acceleration (β = 1.004, P < .001). Each 1-mm increase in CAL was associated with lower DSST scores (β=-0.048, P < .01), greater KDM-BAA (β  =  0.221, P = .031), and higher PhenoAge Acceleration (β = 0.475, P < .001). Higher BAA was independently associated with lower cognitive scores (KDM-BAA β=-0.009, P = .021; PhenoAge Acceleration β=-0.008, P = .003). Mediation analyses showed KDM-BAA and PhenoAge Acceleration mediated approximately 5.7%-15.1% (all indirect effects P < .05) of the total periodontal-cognition relationship.

Discussion and implications: Accelerated biological aging partially mediates the relationship between periodontal disease and cognitive function, supporting a novel geroscience-based mechanism linking oral inflammation and cognitive decline. Future interventions targeting oral health could simultaneously mitigate systemic aging and protect cognitive function.

Background and objectives: Early-onset dementia (EOD, onset before age 65) is relatively rare but often devastating for patients and families. Individuals with dementia face stigma and psychosocial burdens; however, it is unclear whether those with EOD experience worse psychosocial outcomes than those with late-onset dementia (LOD) or no dementia. This study examined differences in psychosocial outcomes across EOD, LOD, and no-dementia groups.

Research design and methods: This cross-sectional study used data from the All of Us Research Program surveys and linked electronic health records (EHR). Diagnosis of dementia was identified through electronic health records (EOD [n = 442], LOD [n = 658], and without dementia [n = 79,035]). Outcomes included everyday discrimination, discrimination in healthcare settings, perceived stress, and loneliness. Negative binomial regression models were employed to compare outcomes by dementia status, adjusting for demographic, socioeconomic, and health-related covariates.

Results: EOD participants reported the highest mean levels of all psychosocial outcomes (e.g., everyday discrimination score of 8.3 in EOD vs 4.6 in LOD and 6.8 in no-dementia). In the fully-adjusted models, EOD was associated with significantly higher everyday discrimination (incidence rate ratio [IRR] = 1.30, 95% CI 1.05-1.62), discrimination in healthcare settings (IRR = 1.08, 95% CI 1.01-1.15), and perceived stress (IRR = 1.09, 95% CI 1.02-1.15) compared with LOD. No difference in loneliness was observed between EOD and LOD (IRR = 1.03, 95% CI 0.98-1.09). Compared with those without dementia, the EOD group also showed elevated levels of all outcomes. All differences remained significant after adjusting for covariates.

Discussion and implications: Findings highlight the unique challenges faced by young adults with EOD and underscore the need for targeted interventions to reduce psychosocial burden in this growing population. As the prevalence of EOD continues to rise, clinicians and policymakers should prioritize supportive resources to mitigate these disparities for EOD patients and their families.

Background and objectives: Cognitive function is crucial for older adults' independence and quality of life. This study investigated the longitudinal relationship between fear of falling and cognitive function using data from the Korean Longitudinal Study of Ageing. Specifically, it examined whether social engagement (regular informal contact and social activities) and physical activity mediate the impact of fear of falling on cognitive function, informing targeted strategies to mitigate cognitive decline.

Research design and methods: This study analyzed seven waves (2006 to 2018) of a nationally representative longitudinal survey involving 3,453 older adults in Korea. To minimize omitted variable bias, the research applied ordinary least squares models with lagged dependent variables and conducted Sobel-Goodman mediation tests for additional insights.

Results: Developing a fear of falling over 2 years is negatively associated with cognitive function. Additionally, although fear of falling negatively impacts social activities and informal contacts, it does not significantly alter physical activity. Mediation analyses show that reduced social activities account for 31% of the cognitive decline associated with fear of falling, compared to 15% for informal social contacts. These findings highlight active social participation as a key factor in protecting cognitive health. Physical activity did not mediate this relationship.

Discussion and implications: Interventions should prioritize enhancing social engagement to mitigate cognitive decline related to fear of falling. Facilitating active community participation can effectively support cognitive health and overall well-being in aging populations.

While opioid overdoses impact Americans of all ages, the full extent of the impact of the evolving opioid crisis on older adults remains poorly understood due to significant gaps in data reporting. Inaccurate documentation of drug poisoning deaths-where opioids are often not listed as primary or secondary causes-obscures the real toll. Additionally, less is known about non-fatal overdoses due to inconsistent reporting and a lack of standardized data collection. To address these challenges, there is a need to reimagine data systems that link local, state, and federal sources to capture geographical risk factors. This article will reflect on current opioid overdose prevalence rates, discuss challenges in existing data solutions, and highlight novel attempts toward building better data systems to enhance our understanding of the risks for and effectiveness of different opioid prevention efforts. Texas A&M University's efforts in leveraging its data integration capabilities to link overdose events with specific interventions, utilizing diverse datasets to offer a more holistic view of the crisis and tailoring responses based on regional needs will serve as a case example. However, achieving optimal data systems will require further improvements, such as standardizing data across districts and enhancing interoperability between public health agencies. This coordinated effort, integrating geographical and demographic risk factors, will be essential to creating timely, accurate data systems that inform targeted interventions for persons of all ages and reduce direct and indirect impacts on older adults and their families.