Pub Date : 2025-03-26DOI: 10.1016/j.lanhl.2025.100697
Wenjian Zhou, Muqi Guo, Bo Hu, Yuling Jiang, Yao Yao
Background: With population ageing, the development and implementation of pragmatic care strategies for older people with functional dependencies have become critical issues. In alliance with WHO's Integrated Care for Older People framework, China implemented the Integrated Medical and Social Care Policy (IMSCP) in several cities in 2016. This study aims to evaluate whether and to what extent the IMSCP has achieved its primary objectives of reducing functional dependency and addressing care needs in Chinese older adults aged 65 years and older.
Methods: The IMSCP was initiated in 2016 in several pilot cities from various provinces. We did a quasi-experimental study with a difference-in-differences analysis by using the data collected in the 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Participants from pilot cities constituted the intervention group, whereas participants from non-pilot cities were assigned into the control group. Functional dependency was measured based on activities of daily living and instrumental activities of daily living. Care deficits were recorded for those who were functionally dependent, and for whom care needs were unmet. We used fixed-effects models to examine between-group differences in functional dependency and care deficits.
Findings: 3080 individuals who participated in both the 2014 and 2018 surveys were included (mean age 81·7 years [SD 9·1] in 2014; 1621 [52·6%] were female and 1459 [47·4%] were male). Of these, 1146 (37·2%) were in the intervention group and 1934 (62·8%) were in the control group. Implementing the IMSCP was associated with a reduced risk of functional dependency (odds ratio [OR] 0·72 [95% CI 0·58-0·89], p=0·0024). Among those who were functionally dependent, the IMSCP was also associated with less care deficits (0·62 [0·41-0·95], p=0·029). We also examined the relatively long-term impact of the IMSCP with duration from 2014 to 2021; the influence of the IMSCP on mitigating functional dependency remained in male participants (OR 0·45 [95% CI 0·23-0·87], p=0·017) but not in female participants (0·85 [0·52-1·39], p=0·524); while its association with bridging care deficits remained among the total participants.
Interpretation: Implementing integrated medical and social care policy could reduce the risk of both functional dependency in older adults and care deficits in those who need care. These findings support the continued and expanded implementation of the IMSCP to address the growing care needs of China's ageing population.
Funding: National Natural Science Foundation of China, National Key Research and Development Project of China, and National Science and Technology Major Project of China.
{"title":"The effect of China's Integrated Medical and Social Care Policy on functional dependency and care deficits in older adults: a nationwide quasi-experimental study.","authors":"Wenjian Zhou, Muqi Guo, Bo Hu, Yuling Jiang, Yao Yao","doi":"10.1016/j.lanhl.2025.100697","DOIUrl":"https://doi.org/10.1016/j.lanhl.2025.100697","url":null,"abstract":"<p><strong>Background: </strong>With population ageing, the development and implementation of pragmatic care strategies for older people with functional dependencies have become critical issues. In alliance with WHO's Integrated Care for Older People framework, China implemented the Integrated Medical and Social Care Policy (IMSCP) in several cities in 2016. This study aims to evaluate whether and to what extent the IMSCP has achieved its primary objectives of reducing functional dependency and addressing care needs in Chinese older adults aged 65 years and older.</p><p><strong>Methods: </strong>The IMSCP was initiated in 2016 in several pilot cities from various provinces. We did a quasi-experimental study with a difference-in-differences analysis by using the data collected in the 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Participants from pilot cities constituted the intervention group, whereas participants from non-pilot cities were assigned into the control group. Functional dependency was measured based on activities of daily living and instrumental activities of daily living. Care deficits were recorded for those who were functionally dependent, and for whom care needs were unmet. We used fixed-effects models to examine between-group differences in functional dependency and care deficits.</p><p><strong>Findings: </strong>3080 individuals who participated in both the 2014 and 2018 surveys were included (mean age 81·7 years [SD 9·1] in 2014; 1621 [52·6%] were female and 1459 [47·4%] were male). Of these, 1146 (37·2%) were in the intervention group and 1934 (62·8%) were in the control group. Implementing the IMSCP was associated with a reduced risk of functional dependency (odds ratio [OR] 0·72 [95% CI 0·58-0·89], p=0·0024). Among those who were functionally dependent, the IMSCP was also associated with less care deficits (0·62 [0·41-0·95], p=0·029). We also examined the relatively long-term impact of the IMSCP with duration from 2014 to 2021; the influence of the IMSCP on mitigating functional dependency remained in male participants (OR 0·45 [95% CI 0·23-0·87], p=0·017) but not in female participants (0·85 [0·52-1·39], p=0·524); while its association with bridging care deficits remained among the total participants.</p><p><strong>Interpretation: </strong>Implementing integrated medical and social care policy could reduce the risk of both functional dependency in older adults and care deficits in those who need care. These findings support the continued and expanded implementation of the IMSCP to address the growing care needs of China's ageing population.</p><p><strong>Funding: </strong>National Natural Science Foundation of China, National Key Research and Development Project of China, and National Science and Technology Major Project of China.</p>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":" ","pages":"100697"},"PeriodicalIF":13.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-19DOI: 10.1016/j.lanhl.2025.100700
Laurie E Davies, David R Sinclair, Christopher Todd, Barbara Hanratty, Fiona E Matthews, Andrew Kingston
Background: More evidence of socioeconomic inequalities in disability-free life expectancy (DFLE) is needed to help develop approaches to narrow the gap between the most and least socioeconomically deprived people. Activities of daily living (ADL) disability represents the most severe and expensive disablement stage. Using combined longitudinal data, we aimed to quantify area-level socioeconomic inequalities in ADL-DFLE and the total person-years lived with ADL disability, in older men and women in England.
Methods: In this modelling study, we harmonised data on ADL disability, area deprivation, age, and self-reported gender for individuals aged 50 years or older from three longitudinal studies in England: the English Longitudinal Study of Ageing (n=11 337), the Cognitive Function and Ageing Study II (n=7469), and the Newcastle 85+ Study (n=847). We used multistate modelling, and calculated the remaining life expectancy with and without ADL disability by gender and area-level socioeconomic status (<20%, 20-80%, and >80% of Index of Multiple Deprivation). From these data and Office for National Statistics population figures for the year 2024, we estimated the extra person-years lived with ADL disability by those aged 65 years from the most socioeconomically deprived areas.
Findings: Those living in the least deprived areas had a reduced risk of ADL disability compared with those in the most deprived areas (hazard ratio [HR] 0·61 [95% CI 0·55-0·69]; p<0·0001), as did those in the middle area-level socioeconomic group (HR 0·76 [0·69-0·84]; p<0·0001). Increasing area-level socioeconomic disadvantage was associated with reduced life expectancy and more time spent with ADL disability, particularly for women. Living in the most disadvantaged areas was associated with people having ADL disability 11·0 years earlier for men and 12·0 years earlier for women, compared with living in the least deprived areas. An extra 59 000 person-years for men and 88 000 person-years for women were lived with ADL disability by those in the most deprived areas, at the population level, compared with the least deprived areas.
Interpretation: Targeted policies to address underlying socioeconomic inequalities in health are likely to be the long-term definitive solution.
Funding: National Institute for Health and Care Research Policy Research Unit in Healthy Ageing.
背景：需要更多关于无残疾预期寿命（DFLE）的社会经济不平等的证据，以帮助制定缩小社会经济最贫困和最贫困人群之间差距的方法。日常生活活动残疾是最严重和最昂贵的残疾阶段。使用联合纵向数据，我们旨在量化英格兰老年男性和女性ADL- dfle和ADL残疾总人年生活的区域层面的社会经济不平等。方法：在这项建模研究中，我们统一了来自英国三个纵向研究的50岁或以上个体的ADL残疾、区域剥夺、年龄和自我报告性别的数据：英国老龄化纵向研究（n= 11337）、认知功能和老龄化研究II （n=7469）和纽卡斯尔85+研究（n=847）。我们使用多状态模型，并按性别和地区社会经济地位（多重剥夺指数的80%）计算有和没有ADL残疾的剩余预期寿命。根据这些数据和英国国家统计局（Office for National Statistics） 2024年的人口数据，我们估计了来自社会经济最贫困地区的65岁以上ADL残障人士的额外年人数。结果：生活在最贫困地区的人与生活在最贫困地区的人相比，生活在最贫困地区的人发生ADL残疾的风险较低(风险比[HR] 0.61 [95% CI 0.55 ~ 0.69]；解读：解决健康方面潜在的社会经济不平等的有针对性的政策可能是长期的最终解决办法。资助：国家卫生和保健研究所健康老龄化政策研究单位。
{"title":"Area-level socioeconomic inequalities in activities of daily living disability-free life expectancy in England: a modelling study.","authors":"Laurie E Davies, David R Sinclair, Christopher Todd, Barbara Hanratty, Fiona E Matthews, Andrew Kingston","doi":"10.1016/j.lanhl.2025.100700","DOIUrl":"https://doi.org/10.1016/j.lanhl.2025.100700","url":null,"abstract":"<p><strong>Background: </strong>More evidence of socioeconomic inequalities in disability-free life expectancy (DFLE) is needed to help develop approaches to narrow the gap between the most and least socioeconomically deprived people. Activities of daily living (ADL) disability represents the most severe and expensive disablement stage. Using combined longitudinal data, we aimed to quantify area-level socioeconomic inequalities in ADL-DFLE and the total person-years lived with ADL disability, in older men and women in England.</p><p><strong>Methods: </strong>In this modelling study, we harmonised data on ADL disability, area deprivation, age, and self-reported gender for individuals aged 50 years or older from three longitudinal studies in England: the English Longitudinal Study of Ageing (n=11 337), the Cognitive Function and Ageing Study II (n=7469), and the Newcastle 85+ Study (n=847). We used multistate modelling, and calculated the remaining life expectancy with and without ADL disability by gender and area-level socioeconomic status (<20%, 20-80%, and >80% of Index of Multiple Deprivation). From these data and Office for National Statistics population figures for the year 2024, we estimated the extra person-years lived with ADL disability by those aged 65 years from the most socioeconomically deprived areas.</p><p><strong>Findings: </strong>Those living in the least deprived areas had a reduced risk of ADL disability compared with those in the most deprived areas (hazard ratio [HR] 0·61 [95% CI 0·55-0·69]; p<0·0001), as did those in the middle area-level socioeconomic group (HR 0·76 [0·69-0·84]; p<0·0001). Increasing area-level socioeconomic disadvantage was associated with reduced life expectancy and more time spent with ADL disability, particularly for women. Living in the most disadvantaged areas was associated with people having ADL disability 11·0 years earlier for men and 12·0 years earlier for women, compared with living in the least deprived areas. An extra 59 000 person-years for men and 88 000 person-years for women were lived with ADL disability by those in the most deprived areas, at the population level, compared with the least deprived areas.</p><p><strong>Interpretation: </strong>Targeted policies to address underlying socioeconomic inequalities in health are likely to be the long-term definitive solution.</p><p><strong>Funding: </strong>National Institute for Health and Care Research Policy Research Unit in Healthy Ageing.</p>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":" ","pages":"100700"},"PeriodicalIF":13.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.lanhl.2025.100689
Bronwen E Warner MBChB , Prof Mary Wells PhD , Prof Cecilia Vindrola PhD , Prof Stephen J Brett MD
Background
Shared decision making (SDM) in treatment escalation planning (TEP) involves patients and clinicians determining together a contingency for future health deterioration. Patients’ role in health-care decision making is subject to ongoing debate. This study aimed to understand the perspectives of older patients in the UK on SDM in TEP for the acute hospital setting.
Methods
In this qualitative study, we recruited older adults with varying levels of frailty and diverse ethnicity via primary care in an Inner London borough. We excluded individuals who did not have the capacity to make TEP decisions, could not be interviewed in English, or whose main chronic clinical problem was cancer or an established severe single organ failure. We used purposive stratified sampling to capture a variety of age, frailty, and ethnicity. We conducted semistructured interviews from March 31 to Dec 19, 2023, and audiorecorded them. We then performed a reflexive thematic analysis.
Findings
We conducted 27 interviews with 32 participants. Participants were aged 63–101 years, clinical frailty ranged from none to severe and was distributed across age groups, and 19 participants were female and 13 participants were male. We identified four themes from the interviews: (1) Focusing on a Natural Life Lived Well, which reflects participants’ ideas around expected life and death trajectory; (2) Making Sense of an Unfamiliar Medical Narrative, where detailed planning for medical intervention was not expected; (3) My Body, My Decision, in which there was emphasis on retaining control over health-care decisions; and (4) Expert, Imperfect Doctors in an Essential, Imperfect System, in which the context of decision making involving health-care professionals in a stretched UK health service was considered.
Interpretation
Patients did not immediately perceive the relevance of detailed planning for future treatment, but nonetheless showed determination to be final arbiters on health-care decisions. Viewed in the context of increasing emphasis on patient autonomy, future steps include public education on possibilities and limitations for intensive medical intervention, clinician reflection on approaches to TEP conversations and policy-level deliberation to define expectations for patient involvement in TEP decisions.
Funding
HCA International and NIHR Imperial Biomedical Research Centre.
{"title":"Shared decision making with older people on treatment escalation planning for acute deterioration in the emergency medical setting: a UK-based qualitative study of patient perspectives (STREAMS-P)","authors":"Bronwen E Warner MBChB , Prof Mary Wells PhD , Prof Cecilia Vindrola PhD , Prof Stephen J Brett MD","doi":"10.1016/j.lanhl.2025.100689","DOIUrl":"10.1016/j.lanhl.2025.100689","url":null,"abstract":"<div><h3>Background</h3><div>Shared decision making (SDM) in treatment escalation planning (TEP) involves patients and clinicians determining together a contingency for future health deterioration. Patients’ role in health-care decision making is subject to ongoing debate. This study aimed to understand the perspectives of older patients in the UK on SDM in TEP for the acute hospital setting.</div></div><div><h3>Methods</h3><div>In this qualitative study, we recruited older adults with varying levels of frailty and diverse ethnicity via primary care in an Inner London borough. We excluded individuals who did not have the capacity to make TEP decisions, could not be interviewed in English, or whose main chronic clinical problem was cancer or an established severe single organ failure. We used purposive stratified sampling to capture a variety of age, frailty, and ethnicity. We conducted semistructured interviews from March 31 to Dec 19, 2023, and audiorecorded them. We then performed a reflexive thematic analysis.</div></div><div><h3>Findings</h3><div>We conducted 27 interviews with 32 participants. Participants were aged 63–101 years, clinical frailty ranged from none to severe and was distributed across age groups, and 19 participants were female and 13 participants were male. We identified four themes from the interviews: (1) Focusing on a Natural Life Lived Well, which reflects participants’ ideas around expected life and death trajectory; (2) Making Sense of an Unfamiliar Medical Narrative, where detailed planning for medical intervention was not expected; (3) My Body, My Decision, in which there was emphasis on retaining control over health-care decisions; and (4) Expert, Imperfect Doctors in an Essential, Imperfect System, in which the context of decision making involving health-care professionals in a stretched UK health service was considered.</div></div><div><h3>Interpretation</h3><div>Patients did not immediately perceive the relevance of detailed planning for future treatment, but nonetheless showed determination to be final arbiters on health-care decisions. Viewed in the context of increasing emphasis on patient autonomy, future steps include public education on possibilities and limitations for intensive medical intervention, clinician reflection on approaches to TEP conversations and policy-level deliberation to define expectations for patient involvement in TEP decisions.</div></div><div><h3>Funding</h3><div>HCA International and NIHR Imperial Biomedical Research Centre.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100689"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.lanhl.2025.100701
Lucette A Cysique
{"title":"Understanding ageing with HIV in sub-Saharan Africa to improve care","authors":"Lucette A Cysique","doi":"10.1016/j.lanhl.2025.100701","DOIUrl":"10.1016/j.lanhl.2025.100701","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100701"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.lanhl.2025.100683
Wanchun Xu MPhil , Yuk Kam Yau PhD , Yanyu Pan MSc , Emily Tsui Yee Tse MBBS , Prof Cindy Lo Kuen Lam MD , Eric Yuk Fai Wan PhD
<div><h3>Background</h3><div>There remains a scarcity of evidence on initiating statin therapy for the primary prevention of cardiovascular diseases among older adults with chronic kidney disease due to the under-representation of this population in randomised controlled trials. This study aimed to evaluate the effectiveness and safety of using statin therapy for the primary prevention of cardiovascular diseases in older adults (aged 75–84 years) and very old adults (aged ≥85 years) with chronic kidney disease.</div></div><div><h3>Methods</h3><div>Using territory-wide public electronic health records in Hong Kong, patients older than 60 years with chronic kidney disease and with hyperlipidaemia (defined as elevated LDL cholesterol of ≥2·6 mmol/L) were identified for inclusion in the analyses and were included on a rolling basis in each calendar month from January, 2008, to December, 2015. Patients were categorised into different age groups (ie, 60–74 years, 75–84 years, and ≥85 years) for analysis, and the 60–74 years age group was used as a benchmark group to test the validity of our emulated trial since the effect of statin therapy is well established in this age group. The framework of target trial emulation was adopted to investigate the association between statin therapy and the risk of overall cardiovascular disease incidence, specific cardiovascular disease subtypes (ie, myocardial infarction, heart failure, and stroke), and all-cause mortality, as well as major adverse events (ie, myopathies and liver dysfunction). The primary outcome was overall cardiovascular disease incidence. The hazard ratios for the outcomes were estimated by pooled logistic models in the intention-to-treat analysis and the per-protocol analysis.</div></div><div><h3>Findings</h3><div>711 966 person-trials from 96 trials were eligible for inclusion in the study. 19 423 unique individuals with chronic kidney disease aged 60–74 years, 22 565 unique individuals with chronic kidney disease aged 75–84 years, and 8811 unique individuals with chronic kidney disease aged 85 years and older were identified for inclusion in the analyses. In patients aged 75–84 years, a significant risk reduction was observed for overall cardiovascular disease incidence in both the intention-to-treat analysis (hazard ratio [HR] 0·94 [95% CI 0·89–0·99]) and in the per-protocol analysis (0·86 [0·80–0·92]) and for all-cause mortality (0·87 [0·82–0·91] in the intention-to-treat analysis and 0·78 [0·72–0·84] in the per-protocol analysis). This risk reduction was also observed among patients aged 85 years and older for cardiovascular diseases (HR 0·88 [0·79–0·99] in the intention-to-treat analysis and 0·81 [0·71–0·92] in the per-protocol analysis), and for all-cause mortality (0·89 [0·81–0·98] in the intention-to-treat analysis and 0·80 [0·71–0·91] in the per-protocol analysis). Substantial risk reduction for myocardial infarction, heart failure, and stroke were also observed across all age groups. N
{"title":"Effectiveness and safety of using statin therapy for the primary prevention of cardiovascular diseases in older patients with chronic kidney disease who are hypercholesterolemic: a target trial emulation study","authors":"Wanchun Xu MPhil , Yuk Kam Yau PhD , Yanyu Pan MSc , Emily Tsui Yee Tse MBBS , Prof Cindy Lo Kuen Lam MD , Eric Yuk Fai Wan PhD","doi":"10.1016/j.lanhl.2025.100683","DOIUrl":"10.1016/j.lanhl.2025.100683","url":null,"abstract":"<div><h3>Background</h3><div>There remains a scarcity of evidence on initiating statin therapy for the primary prevention of cardiovascular diseases among older adults with chronic kidney disease due to the under-representation of this population in randomised controlled trials. This study aimed to evaluate the effectiveness and safety of using statin therapy for the primary prevention of cardiovascular diseases in older adults (aged 75–84 years) and very old adults (aged ≥85 years) with chronic kidney disease.</div></div><div><h3>Methods</h3><div>Using territory-wide public electronic health records in Hong Kong, patients older than 60 years with chronic kidney disease and with hyperlipidaemia (defined as elevated LDL cholesterol of ≥2·6 mmol/L) were identified for inclusion in the analyses and were included on a rolling basis in each calendar month from January, 2008, to December, 2015. Patients were categorised into different age groups (ie, 60–74 years, 75–84 years, and ≥85 years) for analysis, and the 60–74 years age group was used as a benchmark group to test the validity of our emulated trial since the effect of statin therapy is well established in this age group. The framework of target trial emulation was adopted to investigate the association between statin therapy and the risk of overall cardiovascular disease incidence, specific cardiovascular disease subtypes (ie, myocardial infarction, heart failure, and stroke), and all-cause mortality, as well as major adverse events (ie, myopathies and liver dysfunction). The primary outcome was overall cardiovascular disease incidence. The hazard ratios for the outcomes were estimated by pooled logistic models in the intention-to-treat analysis and the per-protocol analysis.</div></div><div><h3>Findings</h3><div>711 966 person-trials from 96 trials were eligible for inclusion in the study. 19 423 unique individuals with chronic kidney disease aged 60–74 years, 22 565 unique individuals with chronic kidney disease aged 75–84 years, and 8811 unique individuals with chronic kidney disease aged 85 years and older were identified for inclusion in the analyses. In patients aged 75–84 years, a significant risk reduction was observed for overall cardiovascular disease incidence in both the intention-to-treat analysis (hazard ratio [HR] 0·94 [95% CI 0·89–0·99]) and in the per-protocol analysis (0·86 [0·80–0·92]) and for all-cause mortality (0·87 [0·82–0·91] in the intention-to-treat analysis and 0·78 [0·72–0·84] in the per-protocol analysis). This risk reduction was also observed among patients aged 85 years and older for cardiovascular diseases (HR 0·88 [0·79–0·99] in the intention-to-treat analysis and 0·81 [0·71–0·92] in the per-protocol analysis), and for all-cause mortality (0·89 [0·81–0·98] in the intention-to-treat analysis and 0·80 [0·71–0·91] in the per-protocol analysis). Substantial risk reduction for myocardial infarction, heart failure, and stroke were also observed across all age groups. N","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100683"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.lanhl.2025.100698
Ariela R Orkaby , Julie M Paik
{"title":"Evidence on the benefits of statins for CVD prevention in older adults with CKD","authors":"Ariela R Orkaby , Julie M Paik","doi":"10.1016/j.lanhl.2025.100698","DOIUrl":"10.1016/j.lanhl.2025.100698","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100698"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.lanhl.2025.100690
Luicer A Ingasia Olubayo PhD , Theophilous Mathema MSc , Chodziwadziwa Kabudula PhD , Prof Lisa K Micklesfield PhD , Shukri F Mohamed PhD , Isaac Kisiangani MSc , Cairo B Ntimane MSc , Solomon S Choma MSc , Prof Brian Houle PhD , Prof Scott Hazelhurst PhD , Prof Nigel Crowther PhD , Stephen Tollman PhD , Furahini D Tluway PhD , Prof Michele Ramsay PhD , Prof F Xavier Gómez-Olivé PhD , AWI-Gen and H3Africa Consortium
<div><h3>Background</h3><div>Sub-Saharan Africa’s ageing population includes a rising number of adults aged 50 years and older living with HIV. Although antiretroviral therapy (ART) has extended life expectancy, data on HIV incidence and treatment outcomes among older adults remain scarce. To inform targeted public health interventions, we aimed to examine the prevalence and incidence of HIV, as well as sociodemographic determinants associated with HIV acquisition and treatment outcomes, among older adults in sub-Saharan Africa.</div></div><div><h3>Methods</h3><div>AWI-Gen is a multicentre, longitudinal cohort study. We assessed data from random community-based samples of adults aged 40–60 years collected between Aug 5, 2013, and Aug 19, 2016 (wave 1) and of adults aged 40 years and older collected between Jan 24, 2019, and Nov 23, 2022 (wave 2) from Nairobi (Kenya) and from Soweto, Agincourt, and Dikgale Mamabolo Mothiba (South Africa). Sociodemographic data were collected through interviewer-administered questionnaires and structured interviews. The primary outcome was HIV status at both wave 1 and wave 2, classified as either HIV-positive or HIV-negative. We evaluated the prevalence and incidence of HIV, ART coverage, and self-reported HIV awareness and used logistic regression to examine risk factors associated with HIV acquisition and treatment outcomes.</div></div><div><h3>Findings</h3><div>Among 7919 participants in wave 1 who were recruited and followed up, 6505 (82·1%) participants were aged 40–60 years, of whom 5730 (88·1%) contributed HIV-related data. 3148 (54·9%) participants were women and 2582 (45·1%) were men. In wave 2, 4520 participants from wave 1 were followed up with an additional 579 participants recruited. 5076 (99·5%) participants were aged 40 years and older, of whom 4931 (97·1%) contributed HIV-related data. 2767 (56·1%) participants were women and 2164 (43·9%) were men. Overall, 1271 (22·2%) of 5730 participants in wave 1 and 1073 (21·8%) of 4931 participants in wave 2 were living with HIV, with regional variability (χ<sup>2</sup> p<0·0001) and higher prevalence in women than in men (χ<sup>2</sup> p<0·0001). Prevalence was highest among individuals aged 40–45 years (454 [26·7%] of 1698 participants) in wave 1 and those aged 46–50 years (297 [29·9%] of 994 participants) in wave 2, decreasing significantly in older age groups (χ<sup>2</sup> p<0·0001). Overall HIV incidence was 0·35 per 100 person-years (95% CI 0·26–0·48), with a reduced risk of seroconversion in participants aged 51–55 years (incidence rate ratio [IRR] 0·42 [95% CI 0·17–0·93]; p=0·039) and 56–60 years (0·19 [0·05–0·52]; p=0·0033). Compared with participants with formal education, incidence among those with no formal education was nearly four times higher (IRR 0·96 [95% CI 0·50–1·85] <em>vs</em> 0·26 [0·16–0·44]). Women and men residing in rural areas showed consistently higher predicted probabilities of HIV status than their counterparts in urban
{"title":"The prevalence, incidence, and sociodemographic risk factors of HIV among older adults in sub-Saharan Africa (AWI-Gen): a multicentre, longitudinal cohort study","authors":"Luicer A Ingasia Olubayo PhD , Theophilous Mathema MSc , Chodziwadziwa Kabudula PhD , Prof Lisa K Micklesfield PhD , Shukri F Mohamed PhD , Isaac Kisiangani MSc , Cairo B Ntimane MSc , Solomon S Choma MSc , Prof Brian Houle PhD , Prof Scott Hazelhurst PhD , Prof Nigel Crowther PhD , Stephen Tollman PhD , Furahini D Tluway PhD , Prof Michele Ramsay PhD , Prof F Xavier Gómez-Olivé PhD , AWI-Gen and H3Africa Consortium","doi":"10.1016/j.lanhl.2025.100690","DOIUrl":"10.1016/j.lanhl.2025.100690","url":null,"abstract":"<div><h3>Background</h3><div>Sub-Saharan Africa’s ageing population includes a rising number of adults aged 50 years and older living with HIV. Although antiretroviral therapy (ART) has extended life expectancy, data on HIV incidence and treatment outcomes among older adults remain scarce. To inform targeted public health interventions, we aimed to examine the prevalence and incidence of HIV, as well as sociodemographic determinants associated with HIV acquisition and treatment outcomes, among older adults in sub-Saharan Africa.</div></div><div><h3>Methods</h3><div>AWI-Gen is a multicentre, longitudinal cohort study. We assessed data from random community-based samples of adults aged 40–60 years collected between Aug 5, 2013, and Aug 19, 2016 (wave 1) and of adults aged 40 years and older collected between Jan 24, 2019, and Nov 23, 2022 (wave 2) from Nairobi (Kenya) and from Soweto, Agincourt, and Dikgale Mamabolo Mothiba (South Africa). Sociodemographic data were collected through interviewer-administered questionnaires and structured interviews. The primary outcome was HIV status at both wave 1 and wave 2, classified as either HIV-positive or HIV-negative. We evaluated the prevalence and incidence of HIV, ART coverage, and self-reported HIV awareness and used logistic regression to examine risk factors associated with HIV acquisition and treatment outcomes.</div></div><div><h3>Findings</h3><div>Among 7919 participants in wave 1 who were recruited and followed up, 6505 (82·1%) participants were aged 40–60 years, of whom 5730 (88·1%) contributed HIV-related data. 3148 (54·9%) participants were women and 2582 (45·1%) were men. In wave 2, 4520 participants from wave 1 were followed up with an additional 579 participants recruited. 5076 (99·5%) participants were aged 40 years and older, of whom 4931 (97·1%) contributed HIV-related data. 2767 (56·1%) participants were women and 2164 (43·9%) were men. Overall, 1271 (22·2%) of 5730 participants in wave 1 and 1073 (21·8%) of 4931 participants in wave 2 were living with HIV, with regional variability (χ<sup>2</sup> p<0·0001) and higher prevalence in women than in men (χ<sup>2</sup> p<0·0001). Prevalence was highest among individuals aged 40–45 years (454 [26·7%] of 1698 participants) in wave 1 and those aged 46–50 years (297 [29·9%] of 994 participants) in wave 2, decreasing significantly in older age groups (χ<sup>2</sup> p<0·0001). Overall HIV incidence was 0·35 per 100 person-years (95% CI 0·26–0·48), with a reduced risk of seroconversion in participants aged 51–55 years (incidence rate ratio [IRR] 0·42 [95% CI 0·17–0·93]; p=0·039) and 56–60 years (0·19 [0·05–0·52]; p=0·0033). Compared with participants with formal education, incidence among those with no formal education was nearly four times higher (IRR 0·96 [95% CI 0·50–1·85] <em>vs</em> 0·26 [0·16–0·44]). Women and men residing in rural areas showed consistently higher predicted probabilities of HIV status than their counterparts in urban","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 3","pages":"Article 100690"},"PeriodicalIF":13.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.lanhl.2024.100673
Almar A L Kok PhD , Prof Martijn Huisman PhD , Erik J Giltay MD PhD , Gabriela Lunansky PhD
Functional ageing, related to but distinct from biological and environmental systems, is defined as the changes in physical, psychological, cognitive, and social functioning, as well as behavioural factors of individuals as they age. In this Personal View, we propose that a complex systems perspective to functional ageing can show how outcomes such as quality of life and longevity, and success in prevention and treatment, emerge from dynamic interactions among these domains, rather than from single causes. We support this view in three ways. First, we explain how three key principles of complex systems science—namely, resilience, non-linearity, and heterogeneity—apply to functional ageing. Second, we show how established gerontological theories and geriatric models align with these principles. Third, we illustrate the use of novel methodological tools available from complex systems science for studying functional ageing. Finally, we offer a glossary of key concepts and recommendations for researchers to adopt this perspective in future studies on functional ageing.
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