Pub Date : 2025-06-01DOI: 10.1016/j.lanhl.2025.100736
Claire von Mollendorf
{"title":"Is pneumococcal vaccination required for new residents of care facilities for older adults?","authors":"Claire von Mollendorf","doi":"10.1016/j.lanhl.2025.100736","DOIUrl":"10.1016/j.lanhl.2025.100736","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 6","pages":"Article 100736"},"PeriodicalIF":13.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565284","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 : 2025-06-01DOI: 10.1016/j.lanhl.2025.100726
Fariyo Abdullahi MSc , Tara Patel MSc , Kelly Stoker MSc , Catherine Carey PhD , Nick Andrews PhD , Prof Mary Ramsay FFPH , Prof Jackie Cassell FRCP , Shamez N Ladhani PhD
Background
The incidence of invasive pneumococcal disease (IPD) increases rapidly with age. In the UK, adults aged 65 years are eligible for the 23-valent pneumococcal polysaccharide vaccine (PPV23) as part of the national immunisation programme, and a 20-valent pneumococcal conjugate vaccine (PCV20) was recently licensed for adults. Residents of care homes for older adults have a higher risk of IPD and death than the general population. We estimated the potential effect of an additional dose of PPV23 or PCV20 for new residents entering older adult care homes.
Methods
In this observational surveillance study, we used national IPD surveillance and care home resident data from England. Care homes for older adults were defined as residential care and nursing homes registered with the Care Quality Commission for adults aged 65 years and older. IPD in adults aged 65 years and older in England was assessed in the 2022–23 epidemiological year (July 1, 2022, to June 30, 2023) by sex and 5-year age bands using data obtained from UK Health Security Agency national IPD surveillance. We calculated the number needed to vaccinate (NNV) with PPV23 or PCV20 in the population of new care home residents to prevent one vaccine-type IPD case and one death compared with adults aged 65 years who were vaccinated as part of the national immunisation programme in England.
Findings
In 2022–23, there were 2574 IPD cases among 10 629 867 people aged 65 years and older in England. Of these, 603 109 were aged 65 years. Of the 2574 cases, 69·4% (1787 of 2574) were due to PPV23 serotypes and 60·8% (1566 of 2574) were due to PCV20 serotypes. Under the assumption of 36% vaccine effectiveness against PPV23-type IPD and 18% vaccine effectiveness against death, PPV23, when offered to all 603 109 adults aged 65 years in the general population, could prevent 163 (36%) of 452 cases (NNV 3700) and 31 (47%) of 66 PPV23-type IPD associated deaths over 5 years (NNV 19 455). However, vaccinating 121 587 new care home residents with PPV23 could prevent 177 (36%) of 492 lifetime cases (NNV 687) and 111 (48%) of 233 deaths (NNV 1095). In all adults aged 65 years in the general population, PCV20 could prevent 303 (75%) of 404 cases (NNV 1990) and 43 (80%) of 54 PCV20-type IPD deaths (NNV 14 026), assuming 75% vaccine effectiveness against PCV20-type IPD and 18% against death. However, vaccinating 121 587 new care home residents with PCV20 could prevent 317 (75%) of 422 cases (NNV 384) and 157 (80%) of 197 deaths (NNV 774).
Interpretation
Pneumococcal vaccination for new care home residents could prevent substantially more cases and deaths per dose and would require only 20% more doses than the current national PPV23 programme for adults aged 65 years. PCV20 is likely to have a greater impact against IPD and death than PPV23.
{"title":"Pneumococcal vaccination for new residents entering older adult care homes in England: national observational surveillance study","authors":"Fariyo Abdullahi MSc , Tara Patel MSc , Kelly Stoker MSc , Catherine Carey PhD , Nick Andrews PhD , Prof Mary Ramsay FFPH , Prof Jackie Cassell FRCP , Shamez N Ladhani PhD","doi":"10.1016/j.lanhl.2025.100726","DOIUrl":"10.1016/j.lanhl.2025.100726","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of invasive pneumococcal disease (IPD) increases rapidly with age. In the UK, adults aged 65 years are eligible for the 23-valent pneumococcal polysaccharide vaccine (PPV23) as part of the national immunisation programme, and a 20-valent pneumococcal conjugate vaccine (PCV20) was recently licensed for adults. Residents of care homes for older adults have a higher risk of IPD and death than the general population. We estimated the potential effect of an additional dose of PPV23 or PCV20 for new residents entering older adult care homes.</div></div><div><h3>Methods</h3><div>In this observational surveillance study, we used national IPD surveillance and care home resident data from England. Care homes for older adults were defined as residential care and nursing homes registered with the Care Quality Commission for adults aged 65 years and older. IPD in adults aged 65 years and older in England was assessed in the 2022–23 epidemiological year (July 1, 2022, to June 30, 2023) by sex and 5-year age bands using data obtained from UK Health Security Agency national IPD surveillance. We calculated the number needed to vaccinate (NNV) with PPV23 or PCV20 in the population of new care home residents to prevent one vaccine-type IPD case and one death compared with adults aged 65 years who were vaccinated as part of the national immunisation programme in England.</div></div><div><h3>Findings</h3><div>In 2022–23, there were 2574 IPD cases among 10 629 867 people aged 65 years and older in England. Of these, 603 109 were aged 65 years. Of the 2574 cases, 69·4% (1787 of 2574) were due to PPV23 serotypes and 60·8% (1566 of 2574) were due to PCV20 serotypes. Under the assumption of 36% vaccine effectiveness against PPV23-type IPD and 18% vaccine effectiveness against death, PPV23, when offered to all 603 109 adults aged 65 years in the general population, could prevent 163 (36%) of 452 cases (NNV 3700) and 31 (47%) of 66 PPV23-type IPD associated deaths over 5 years (NNV 19 455). However, vaccinating 121 587 new care home residents with PPV23 could prevent 177 (36%) of 492 lifetime cases (NNV 687) and 111 (48%) of 233 deaths (NNV 1095). In all adults aged 65 years in the general population, PCV20 could prevent 303 (75%) of 404 cases (NNV 1990) and 43 (80%) of 54 PCV20-type IPD deaths (NNV 14 026), assuming 75% vaccine effectiveness against PCV20-type IPD and 18% against death. However, vaccinating 121 587 new care home residents with PCV20 could prevent 317 (75%) of 422 cases (NNV 384) and 157 (80%) of 197 deaths (NNV 774).</div></div><div><h3>Interpretation</h3><div>Pneumococcal vaccination for new care home residents could prevent substantially more cases and deaths per dose and would require only 20% more doses than the current national PPV23 programme for adults aged 65 years. PCV20 is likely to have a greater impact against IPD and death than PPV23.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 6","pages":"Article 100726"},"PeriodicalIF":13.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565285","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 : 2025-06-01DOI: 10.1016/j.lanhl.2025.100722
Urza Bhattarai , Sanjib Kumar Sharma
{"title":"Older adults as health volunteers in Nepal for individual and community wellbeing","authors":"Urza Bhattarai , Sanjib Kumar Sharma","doi":"10.1016/j.lanhl.2025.100722","DOIUrl":"10.1016/j.lanhl.2025.100722","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 6","pages":"Article 100722"},"PeriodicalIF":13.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250005","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 : 2025-05-01DOI: 10.1016/j.lanhl.2025.100711
Heidi J Welberry PhD , Prof Louisa R Jorm PhD , Kim M Kiely PhD , Hamidul Huque PhD , Prof Ruth Peters PhD , Prof Kaarin J Anstey PhD
Background
Potentially modifiable risk factors could account for approximately 45% of dementia cases globally. For targeted prevention, understanding population-specific patterns of risk is essential. We aimed to track changes in dementia prevalence across Australia, and calculate population attributable fractions of dementia, for 12 risk factors (ie, low education, hypertension, obesity, high cholesterol, smoking, high alcohol intake, poor diet, physical inactivity, hearing loss, depression, diabetes, and social isolation).
Methods
In this cross-sectional, time series analysis we calculated the prevalence of dementia using five national Australian health surveys from 2007–08 to 2022. Adjusted prevalence ratios and combined population attributable fractions were estimated. Population subgroups were defined by sex and socioeconomic disadvantage (lowest 40% household income vs highest 60%). Results were disaggregated by life-stage (mid-life aged 45–64 years and late life aged 65–84 years).
Findings
In mid-life, the sample sizes ranged from 4100 in 2022 to 5589 in 2017–18 and in late-life from 2799 in 2011–12 to 3762 in 2017–18. Smoking, high alcohol intake, physical inactivity, hearing loss, and low education in mid-life decreased and obesity, depression, and poor diet increased; resulting in no change in population attributable fraction (47·2% [95% CI 46·5–48·0] in 2007–08 and 46·9% [45·9–47·7] in 2022). High alcohol intake, physical inactivity, and low education in late-life decreased; depression and poor diet increased; and there was no change in population attributable fraction (51·5% [50·9–52·5] in 2007–08 and 51·4% [50·7–52·4] in 2022). In mid-life, modifiable risk was higher among low-income groups and males and depression was the leading modifiable risk factor in 2022, disproportionately affecting low-income households and females.
Interpretation
The modifiable population attributable fraction of dementia in Australia in the past 15 years remained stable, but the profile of risk has changed. Low-income groups (compared with high-income groups) have substantially higher modifiable risk and targeted multidomain interventions could help reduce disparities.
{"title":"Sex and socioeconomic differences in 15-year prevalence trends for modifiable dementia risk factors in Australia: a cross-sectional, time series analysis","authors":"Heidi J Welberry PhD , Prof Louisa R Jorm PhD , Kim M Kiely PhD , Hamidul Huque PhD , Prof Ruth Peters PhD , Prof Kaarin J Anstey PhD","doi":"10.1016/j.lanhl.2025.100711","DOIUrl":"10.1016/j.lanhl.2025.100711","url":null,"abstract":"<div><h3>Background</h3><div>Potentially modifiable risk factors could account for approximately 45% of dementia cases globally. For targeted prevention, understanding population-specific patterns of risk is essential. We aimed to track changes in dementia prevalence across Australia, and calculate population attributable fractions of dementia, for 12 risk factors (ie, low education, hypertension, obesity, high cholesterol, smoking, high alcohol intake, poor diet, physical inactivity, hearing loss, depression, diabetes, and social isolation).</div></div><div><h3>Methods</h3><div>In this cross-sectional, time series analysis we calculated the prevalence of dementia using five national Australian health surveys from 2007–08 to 2022. Adjusted prevalence ratios and combined population attributable fractions were estimated. Population subgroups were defined by sex and socioeconomic disadvantage (lowest 40% household income <em>vs</em> highest 60%). Results were disaggregated by life-stage (mid-life aged 45–64 years and late life aged 65–84 years).</div></div><div><h3>Findings</h3><div>In mid-life, the sample sizes ranged from 4100 in 2022 to 5589 in 2017–18 and in late-life from 2799 in 2011–12 to 3762 in 2017–18. Smoking, high alcohol intake, physical inactivity, hearing loss, and low education in mid-life decreased and obesity, depression, and poor diet increased; resulting in no change in population attributable fraction (47·2% [95% CI 46·5–48·0] in 2007–08 and 46·9% [45·9–47·7] in 2022). High alcohol intake, physical inactivity, and low education in late-life decreased; depression and poor diet increased; and there was no change in population attributable fraction (51·5% [50·9–52·5] in 2007–08 and 51·4% [50·7–52·4] in 2022). In mid-life, modifiable risk was higher among low-income groups and males and depression was the leading modifiable risk factor in 2022, disproportionately affecting low-income households and females.</div></div><div><h3>Interpretation</h3><div>The modifiable population attributable fraction of dementia in Australia in the past 15 years remained stable, but the profile of risk has changed. Low-income groups (compared with high-income groups) have substantially higher modifiable risk and targeted multidomain interventions could help reduce disparities.</div></div><div><h3>Funding</h3><div>National Health and Medical Research.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 5","pages":"Article 100711"},"PeriodicalIF":13.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162539","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 : 2025-05-01DOI: 10.1016/j.lanhl.2024.100681
Juan Luis Sánchez-Sánchez PhD , Rosario Ortolá MD PhD , Prof Jose R Banegas MD PhD , Prof Alejandro Lucia MD PhD , Prof Fernando Rodríguez-Artalejo MD PhD , Mercedes Sotos-Prieto PhD , Pedro L Valenzuela PhD
<div><h3>Background</h3><div>Intrinsic capacity—the composite of all the physical and mental capacities of an individual—has been proposed by WHO as a marker of healthy ageing. However, the association of movement behaviours (physical activity and sedentary behaviour) with intrinsic capacity remains largely unexplored. We aimed to prospectively analyse the association of movement behaviours with intrinsic capacity in older adults.</div></div><div><h3>Methods</h3><div>The Seniors-ENRICA-2 prospective, population-based study included a cohort of male and female community-dwelling older adults aged 65–94 years living in Spain. Accelerometer-based levels of sedentary, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) were assessed at baseline. An intrinsic capacity composite score (with higher scores indicating higher intrinsic capacity) was calculated at baseline and at two follow-up assessments across six domains: vitality (handgrip strength, appetite, and weight loss), cognition (Mini-Mental State Examination), psychological (Geriatric Depression Scale), locomotion (Short Physical Performance Battery), vision, and hearing.</div></div><div><h3>Findings</h3><div>Between Dec 2, 2015, and Nov 23, 2017, 3273 participants were recruited to the Seniors-ENRICA-2 study. 2477 (75·7%) of 3273 participants had complete data for movement behaviours and intrinsic capacity at baseline and were therefore included in the analyses. 1314 (53·0%) of 2477 participants were female and 1163 (47·0%) were male. 1463 (59·1%) of 2477 participants provided follow-up data over a median of 2·3 years (IQR 2·1 to 2·5) and 940 over 5·5 years (5·2 to 5·8). When analysed as a continuous variable, higher levels of MVPA (mean percentage change [MPC] per 15 min 0·63%, 95% CI 0·06 to 1·21), but not LPA (–0·39%,–0·85 to 0·07), were associated with improvements in intrinsic capacity during follow-up, whereas higher levels of sedentary behaviour were associated with declines in intrinsic capacity (–0·29%, –0·57 to –0·01). Analyses by tertiles of physical activity confirmed that the highest (MPC 4·83%, 95% CI 1·98 to 7·75) and intermediate (5·44%, 2·52 to 8·45) tertiles of MVPA were associated with improvements in intrinsic capacity compared with the lowest tertile. By contrast, compared with the highest tertile, the lowest (MPC 5·48%, 95% CI 2·88 to 8·02) and intermediate (5·73%, 3·16 to 8·22) tertiles of sedentary behaviour were associated with improvements in intrinsic capacity.</div></div><div><h3>Interpretation</h3><div>Sedentary behaviour was associated with a reduction of intrinsic capacity, and MVPA (but not LPA) was associated with an improvement in intrinsic capacity in older adults. Our findings support the importance of promoting physical activity and reducing sedentary behaviour for healthy ageing.</div></div><div><h3>Funding</h3><div>Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, French Agence Nationale de la Recherch
背景：内在能力——一个人的所有生理和心理能力的综合——已被世卫组织提出作为健康老龄化的标志。然而，运动行为（身体活动和久坐行为）与内在能力之间的关系在很大程度上仍未被探索。我们的目的是前瞻性地分析老年人运动行为与内在能力的关系。方法：senior - enrica -2前瞻性、基于人群的研究纳入了一组居住在西班牙的65-94岁社区老年人。以加速度计为基础的久坐、轻度体力活动（LPA）和中度至剧烈体力活动（MVPA）水平在基线时进行评估。内在能力综合评分（分数越高表明内在能力越强）在基线和两次后续评估中计算，涉及六个领域：活力（握力、食欲和体重减轻）、认知（迷你精神状态检查）、心理（老年抑郁量表）、运动（短体能表现电池）、视力和听力。研究结果：2015年12月2日至2017年11月23日，3273名参与者被招募到senior - enrica -2研究中。3273名参与者中有2477名（75.7%）在基线时具有完整的运动行为和内在能力数据，因此被纳入分析。2477名参与者中，女性1314人（53.0%），男性1163人（47.0%）。2477名参与者中有1463名（59.1%）提供了中位数为2.3年（IQR为2.1至2.5）的随访数据，940名提供了中位数为5.5年（5.2至5.8）的随访数据。当作为一个连续变量进行分析时，较高水平的MVPA（每15分钟平均百分比变化[MPC] 0.63%, 95% CI 0.06至1.21）与随访期间内在能力的改善相关，但LPA没有（- 0.39%,- 0.85至0.07），而较高水平的久坐行为与内在能力的下降相关（- 0.29%,- 0.57至- 0.01）。体力活动的分位数分析证实，与最低分位数相比，MVPA的最高分位数（MPC 4.83%, 95% CI 1.98 ~ 7.75）和中等分位数（5.44%,2.52 ~ 8.45）与内在能力的改善相关。相比之下，与最高分位数相比，最低分位数（MPC 5.48%, 95% CI 2.88至8.02）和中间分位数（5.73%，3.16至8.22）的久坐行为与内在能力的改善有关。解释：久坐行为与老年人内在能力的降低有关，而MVPA（而不是LPA）与内在能力的提高有关。我们的研究结果支持促进体育活动和减少久坐行为对健康老龄化的重要性。资助：卡洛斯三世研究所、西班牙科学与创新部、法国国家研究局、欧洲区域发展基金/欧洲社会基金、卫生调查基金会、欧盟下一代计划Recuperación和Transformación y Resiliencia。
{"title":"Association between physical activity and sedentary behaviour and changes in intrinsic capacity in Spanish older adults (Seniors-ENRICA-2): a prospective population-based study","authors":"Juan Luis Sánchez-Sánchez PhD , Rosario Ortolá MD PhD , Prof Jose R Banegas MD PhD , Prof Alejandro Lucia MD PhD , Prof Fernando Rodríguez-Artalejo MD PhD , Mercedes Sotos-Prieto PhD , Pedro L Valenzuela PhD","doi":"10.1016/j.lanhl.2024.100681","DOIUrl":"10.1016/j.lanhl.2024.100681","url":null,"abstract":"<div><h3>Background</h3><div>Intrinsic capacity—the composite of all the physical and mental capacities of an individual—has been proposed by WHO as a marker of healthy ageing. However, the association of movement behaviours (physical activity and sedentary behaviour) with intrinsic capacity remains largely unexplored. We aimed to prospectively analyse the association of movement behaviours with intrinsic capacity in older adults.</div></div><div><h3>Methods</h3><div>The Seniors-ENRICA-2 prospective, population-based study included a cohort of male and female community-dwelling older adults aged 65–94 years living in Spain. Accelerometer-based levels of sedentary, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) were assessed at baseline. An intrinsic capacity composite score (with higher scores indicating higher intrinsic capacity) was calculated at baseline and at two follow-up assessments across six domains: vitality (handgrip strength, appetite, and weight loss), cognition (Mini-Mental State Examination), psychological (Geriatric Depression Scale), locomotion (Short Physical Performance Battery), vision, and hearing.</div></div><div><h3>Findings</h3><div>Between Dec 2, 2015, and Nov 23, 2017, 3273 participants were recruited to the Seniors-ENRICA-2 study. 2477 (75·7%) of 3273 participants had complete data for movement behaviours and intrinsic capacity at baseline and were therefore included in the analyses. 1314 (53·0%) of 2477 participants were female and 1163 (47·0%) were male. 1463 (59·1%) of 2477 participants provided follow-up data over a median of 2·3 years (IQR 2·1 to 2·5) and 940 over 5·5 years (5·2 to 5·8). When analysed as a continuous variable, higher levels of MVPA (mean percentage change [MPC] per 15 min 0·63%, 95% CI 0·06 to 1·21), but not LPA (–0·39%,–0·85 to 0·07), were associated with improvements in intrinsic capacity during follow-up, whereas higher levels of sedentary behaviour were associated with declines in intrinsic capacity (–0·29%, –0·57 to –0·01). Analyses by tertiles of physical activity confirmed that the highest (MPC 4·83%, 95% CI 1·98 to 7·75) and intermediate (5·44%, 2·52 to 8·45) tertiles of MVPA were associated with improvements in intrinsic capacity compared with the lowest tertile. By contrast, compared with the highest tertile, the lowest (MPC 5·48%, 95% CI 2·88 to 8·02) and intermediate (5·73%, 3·16 to 8·22) tertiles of sedentary behaviour were associated with improvements in intrinsic capacity.</div></div><div><h3>Interpretation</h3><div>Sedentary behaviour was associated with a reduction of intrinsic capacity, and MVPA (but not LPA) was associated with an improvement in intrinsic capacity in older adults. Our findings support the importance of promoting physical activity and reducing sedentary behaviour for healthy ageing.</div></div><div><h3>Funding</h3><div>Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, French Agence Nationale de la Recherch","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 5","pages":"Article 100681"},"PeriodicalIF":13.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143859","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 : 2025-05-01DOI: 10.1016/j.lanhl.2025.100715
Alice M Ornago MD , Elena Pinardi MD , Giulia Grande PhD , Martina Valletta MD , Amaia Calderón-Larrañaga PhD , Sarah Andersson MSc , Riccardo Calvani PhD , Anna Picca PhD , Emanuele Marzetti PhD , Prof Bengt Winblad PhD , Claudia Fredolini PhD , Prof Giuseppe Bellelli MD , Davide L Vetrano PhD
<div><h3>Background</h3><div>Age-related muscle function decline is a major impediment to healthy ageing. We aimed to investigate the association between a panel of Alzheimer’s disease-related biomarkers and longitudinal trajectories of muscle strength, while exploring the influence of cognitive function.</div></div><div><h3>Methods</h3><div>In this cohort study, we gathered data from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K), an ongoing prospective study that includes adults aged 60 years and older, from central Stockholm, Sweden. We included data from baseline to the fourth follow-up (March 21, 2001, to Dec 31, 2016). Seven Alzheimer’s disease-related blood biomarkers were measured in dementia-free, community dwelling participants: total tau, phosphorylated tau181 (p-tau181), phosphorylated tau217 (p-tau217), amyloid β 40 and 42, neurofilament light chain, and glial fibrillary acidic protein (GFAP). Muscle strength was measured through the handgrip strength and chair-stand tests. Linear mixed models were used to explore the association between baseline Alzheimer’s disease-related biomarkers and muscle strength trajectories.</div></div><div><h3>Findings</h3><div>The baseline SNAC-K cohort included 3363 individuals, of whom 1953 participants were included in our analyses (mean age 70·2 [SD 9·1] years; 780 [39·9%] male and 1173 [60·1%] female participants). In adjusted models, higher concentrations of p-tau181 (β per year 0·93 [95% CI 0·71 to 1·16]; p<0·0001), p-tau217 (β per year 1·31 [1·03 to 1·58]; p<0·0001), neurofilament light chain (β per year 0·76 [0·56 to 0·96]; p<0·0001), and GFAP (β per year 0·37 [0·21 to 0·53]; p<0·0001) were associated with an accelerated decline of chair-stand performance over time. The adjustment for Mini-Mental State Examination (MMSE) score led to the attenuation of these associations. Higher concentrations of p-tau181 (β per year –0·12 [95% CI –0·17 to –0·07]; p<0·0001), p-tau217 (β per year –0·13 [–0·20 to –0·07]; p<0·0001), and neurofilament light chain (β per year –0·05 [–0·09 to –0·001]; p=0·047) were also associated with faster handgrip strength decline, with no attenuation after adjusting for MMSE score. Sex-specific differences were observed, with female participants showing a stronger association between biomarker concentrations and muscle strength decline than male participants, particularly in the chair-stand test.</div></div><div><h3>Interpretation</h3><div>Our findings suggest that blood Alzheimer’s disease-related biomarkers might help estimate progressive muscle strength decline among older adults, elucidating the influence of brain pathology and cognitive ageing on this association. These Alzheimer’s disease-related biomarkers could aid in identifying individuals for early intervention to prevent sarcopenia.</div></div><div><h3>Funding</h3><div>The Swedish Research Council, the Swedish Ministry of Health and Social Affairs, and the County Councils and Mun
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Pub Date : 2025-05-01DOI: 10.1016/j.lanhl.2025.100708
Lina Gonzalez MSc , Prof Penny Rapaport PhD , Prof Gill Livingston MD , Sarah Amador PhD , Mariam O Adeleke PhD , Prof Julie A Barber PhD , Prof Sube Banerjee MD , Prof Georgina Charlesworth PhD , Chris Clarke DClinPsy , Prof Colin A Espie DSc , Prof Simon D Kyle PhD , Malgorzata Raczek PhD , Prof Zuzana Walker MD , Lucy Webster PhD , Monica Manela BM , Prof Rachael Maree Hunter MSc
<div><h3>Background</h3><div>People living at home with dementia frequently have disturbed sleep. The multicomponent, non-pharmacological intervention DREAMS START has shown to be effective at improving sleep in this population. We aimed to conduct a cost–utility analysis of DREAMS START compared with treatment as usual (TAU).</div></div><div><h3>Methods</h3><div>This economic evaluation within a single-masked, phase 3, parallel-arm, superiority randomised controlled trial involved dyads of people with dementia and sleep disturbance and their family carer. Participants were recruited from the National Health Service and the Join Dementia Research service in England. Dyads were randomly assigned (1:1) to receive the DREAMS START intervention (plus TAU) or TAU. Randomisation was blocked, with stratification by site, and a web-based system was used for allocation. Researchers collecting outcome data were masked to allocation group. The primary outcome was sleep disturbance measured by the Sleep Disorders Inventory (SDI) at 8 months. At baseline, 4 months, and 8 months, family carers completed the 5-level EuroQoL 5 dimensions (EQ-5D-5L) proxy, the Dementia Quality of Life Instrument (DEMQOL)-Proxy, and EQ-5D-5L questionnaires, and resource use for the patient and family carer was measured. We calculated the probability that the DREAMS START intervention is cost-effective from a health and personal social services perspective and from a wider societal perspective for a range of decision thresholds per quality-adjusted life-year (QALY) gained using the EQ-5D-5L scores to calculate QALYs and imputing missing data, reported with a cost-effectiveness acceptability curve. This trial was registered with ISRCTN, 13072268, and is complete.</div></div><div><h3>Findings</h3><div>From Feb 24, 2021, to March 5, 2023, we randomly assigned 377 dyads: 188 to the intervention group and 189 to the TAU group. The mean age of participants with dementia was 79⋅4 years (SD 9⋅0), 206 (55%) of whom were women and 171 (45%) were men. As previously reported, the mean SDI score at 8 months was lower in the intervention group than in the TAU group (adjusted difference in means –4·70 [95% CI –7·65 to –1·74], p=0·002). The mean incremental difference in health and personal social services costs was £59 less per dyad (95% CI −5168 to 5050) and, when incorporating wider societal costs, was £116 less per dyad (−5769 to 5536) for the intervention group than the TAU group, although these figures were non-significant. The mean incremental difference in QALYs per person with dementia was 0·016 more (95% CI 0·000 to 0·033) for the intervention group than for the TAU group, indicating no significant difference in quality of life. At a £20 000 per QALY gained decision threshold, there was a 78% probability that DREAMS START is cost-effective, compared with TAU.</div></div><div><h3>Interpretation</h3><div>DREAMS START is likely to be cost-effective. Given its clinical effectiveness, we reco
背景：住在家里的痴呆症患者经常有睡眠障碍。多组分、非药物干预的DREAMS START已被证明对改善这一人群的睡眠是有效的。我们的目的是对DREAMS START与常规治疗（TAU）进行成本效用分析。方法：在一项单盲、3期、平行对照、优势随机对照试验中进行经济评估，该试验涉及痴呆和睡眠障碍患者及其家庭护理人员。参与者是从英国国民健康服务中心和痴呆症研究中心招募的。二人组被随机分配（1:1）接受DREAMS START干预（加TAU）或TAU。随机化被阻止，按地点分层，并使用基于网络的系统进行分配。收集结果数据的研究人员被屏蔽到分配组。主要结局是8个月时通过睡眠障碍量表（SDI）测量睡眠障碍。在基线、4个月和8个月时，家庭护理人员完成了5级EuroQoL 5维度（EQ-5D-5L）代理、痴呆生活质量工具（DEMQOL）代理和EQ-5D-5L问卷，并测量了患者和家庭护理人员的资源使用情况。我们从健康和个人社会服务的角度计算了DREAMS START干预具有成本效益的可能性，并从更广泛的社会角度计算了每个质量调整生命年（QALY）的决策阈值范围，使用EQ-5D-5L评分计算QALY并输入缺失数据，报告了成本效益可接受曲线。该试验已在ISRCTN注册，编号13072268，现已完成。研究结果：从2021年2月24日至2023年3月5日，我们随机分配了377对：干预组188对，TAU组189对。痴呆患者的平均年龄为79⋅4岁（SD 9⋅0），其中女性206人（55%），男性171人（45%）。如先前报道，干预组8个月时的平均SDI评分低于TAU组（调整后的平均值差为- 4.70 [95% CI - 7.65至- 1.74],p= 0.002）。健康和个人社会服务成本的平均增量差异为每双少59英镑（95% CI -5168至5050），当纳入更广泛的社会成本时，干预组比TAU组每双少116英镑（-5769至5536），尽管这些数字不显著。与TAU组相比，干预组每位痴呆患者QALYs的平均增量差异为0.016 (95% CI为0.000至0.033)，表明生活质量无显著差异。在每个QALY获得的决策阈值为20,000英镑时，与TAU相比，DREAMS START具有成本效益的可能性为78%。解读：DREAMS START很可能具有成本效益。鉴于其临床效果，我们建议将这种干预作为痴呆症和睡眠障碍患者常规护理的一部分。资助：国家卫生与保健研究所卫生技术评估。
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