Pub Date : 2025-10-01Epub Date: 2025-10-28DOI: 10.1016/j.lanhl.2025.100776
Natalia Dowgiałło-Gornowicz
{"title":"Metabolic and bariatric surgery in septuagenarians","authors":"Natalia Dowgiałło-Gornowicz","doi":"10.1016/j.lanhl.2025.100776","DOIUrl":"10.1016/j.lanhl.2025.100776","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 10","pages":"Article 100776"},"PeriodicalIF":14.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422959","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 : 2025-10-01Epub Date: 2025-11-11DOI: 10.1016/j.lanhl.2025.100767
Hanadi A Oughli MD , Nicholas J Ainsworth MD PhD , Prof Meryl A Butters PhD , Patrick J Brown PhD , Marie Anne Gebara MD , Torie R Gettinger PhD , Prof Jordan F Karp MD , Helen Lavretsky MD MS , Emily Lenard LMSW , Prof J Philip Miller AB , Prof Benoit H Mulsant MD MS , Ginger E Nicol MD , Prof Charles F Reynolds 3rd MD , Michael Yingling MS , Prof Eric J Lenze MD , OPTIMUM Research Group
<div><h3>Background</h3><div>The cognitive effects of various antidepressant strategies for treatment-resistant depression in older adults are unclear. We aimed to evaluate acute cognitive changes associated with various pharmacotherapy treatment strategies for treatment-resistant depression in older adults.</div></div><div><h3>Methods</h3><div>We did a prespecified secondary analysis of the OPTIMUM trial, which was a pragmatic, randomised, comparative effectiveness trial of various augmentation or switch pharmacotherapy strategies, enrolling adults aged 60 years or older with treatment-resistant depression. Participants were recruited from five academic medical centres (four in the USA and one in Canada). In Step 1 (n=391), participants were randomly assigned 1:1:1 to augmentation of their antidepressant with aripiprazole (to a maximum of 15 mg per day) or bupropion (to a maximum of 450 mg per day) or to a switch to bupropion (same dose as the bupropion-augmentation group). In Step 2 (n=182), participants who were ineligible for Step 1 or did not reach remission in this step were randomly assigned 1:1 to augmentation with lithium (titrated to attain a plasma concentration range of 0·4–0·8 mEq/L) or to a switch to nortriptyline (to reach a therapeutic plasma concentration of 80–120 ng/mL). Each step lasted 10 weeks, with 12 months of follow-up after completion of Step 1 or Step 2. The primary outcome was cognitive function at the end of Step 1 and Step 2, as evaluated with the National Institutes of Health (NIH) Toolbox Fluid Cognition Composite Score, part of the NIH Toolbox Cognition Battery. The primary outcome was analysed in the intention-to-treat population. An exploratory post-hoc analysis conducted in both the intention-to-treat and per-protocol populations examined changes in the individual cognitive tasks constituting the Fluid Cognition Composite Score. OPTIMUM was registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT02960763</span><svg><path></path></svg></span>) and is complete.</div></div><div><h3>Findings</h3><div>Between Feb 22, 2017, and Dec 31, 2019, 742 participants were enrolled in the OPTIMUM study. In Step 1, 619 (83%) participants were randomly assigned to aripiprazole augmentation (n=211), bupropion augmentation (n=206), or a switch to bupropion monotherapy (n=202); cognitive data were available for 128, 136, and 127 participants, respectively. 248 participants were enrolled in Step 2 and randomly assigned to lithium augmentation (n=127) or to a switch to nortriptyline monotherapy (n=121); cognitive data were available for 89 and 93 participants, respectively. Over 10 weeks, there were no significant differences between pharmacotherapy strategies in the Fluid Cognition Composite Score. In Step 1, a time × group interaction was observed for the Flanker Inhibitory Control and Attention test (<em>F</em>[2,266]=3·97; p=0·020), with a contrast analysis showing that aripiprazole au
{"title":"Cognitive changes in older adults receiving pharmacotherapy for treatment-resistant depression: a secondary analysis of the OPTIMUM randomised controlled trial","authors":"Hanadi A Oughli MD , Nicholas J Ainsworth MD PhD , Prof Meryl A Butters PhD , Patrick J Brown PhD , Marie Anne Gebara MD , Torie R Gettinger PhD , Prof Jordan F Karp MD , Helen Lavretsky MD MS , Emily Lenard LMSW , Prof J Philip Miller AB , Prof Benoit H Mulsant MD MS , Ginger E Nicol MD , Prof Charles F Reynolds 3rd MD , Michael Yingling MS , Prof Eric J Lenze MD , OPTIMUM Research Group","doi":"10.1016/j.lanhl.2025.100767","DOIUrl":"10.1016/j.lanhl.2025.100767","url":null,"abstract":"<div><h3>Background</h3><div>The cognitive effects of various antidepressant strategies for treatment-resistant depression in older adults are unclear. We aimed to evaluate acute cognitive changes associated with various pharmacotherapy treatment strategies for treatment-resistant depression in older adults.</div></div><div><h3>Methods</h3><div>We did a prespecified secondary analysis of the OPTIMUM trial, which was a pragmatic, randomised, comparative effectiveness trial of various augmentation or switch pharmacotherapy strategies, enrolling adults aged 60 years or older with treatment-resistant depression. Participants were recruited from five academic medical centres (four in the USA and one in Canada). In Step 1 (n=391), participants were randomly assigned 1:1:1 to augmentation of their antidepressant with aripiprazole (to a maximum of 15 mg per day) or bupropion (to a maximum of 450 mg per day) or to a switch to bupropion (same dose as the bupropion-augmentation group). In Step 2 (n=182), participants who were ineligible for Step 1 or did not reach remission in this step were randomly assigned 1:1 to augmentation with lithium (titrated to attain a plasma concentration range of 0·4–0·8 mEq/L) or to a switch to nortriptyline (to reach a therapeutic plasma concentration of 80–120 ng/mL). Each step lasted 10 weeks, with 12 months of follow-up after completion of Step 1 or Step 2. The primary outcome was cognitive function at the end of Step 1 and Step 2, as evaluated with the National Institutes of Health (NIH) Toolbox Fluid Cognition Composite Score, part of the NIH Toolbox Cognition Battery. The primary outcome was analysed in the intention-to-treat population. An exploratory post-hoc analysis conducted in both the intention-to-treat and per-protocol populations examined changes in the individual cognitive tasks constituting the Fluid Cognition Composite Score. OPTIMUM was registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (<span><span>NCT02960763</span><svg><path></path></svg></span>) and is complete.</div></div><div><h3>Findings</h3><div>Between Feb 22, 2017, and Dec 31, 2019, 742 participants were enrolled in the OPTIMUM study. In Step 1, 619 (83%) participants were randomly assigned to aripiprazole augmentation (n=211), bupropion augmentation (n=206), or a switch to bupropion monotherapy (n=202); cognitive data were available for 128, 136, and 127 participants, respectively. 248 participants were enrolled in Step 2 and randomly assigned to lithium augmentation (n=127) or to a switch to nortriptyline monotherapy (n=121); cognitive data were available for 89 and 93 participants, respectively. Over 10 weeks, there were no significant differences between pharmacotherapy strategies in the Fluid Cognition Composite Score. In Step 1, a time × group interaction was observed for the Flanker Inhibitory Control and Attention test (<em>F</em>[2,266]=3·97; p=0·020), with a contrast analysis showing that aripiprazole au","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 10","pages":"Article 100767"},"PeriodicalIF":14.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521262","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 : 2025-10-01Epub Date: 2025-10-28DOI: 10.1016/j.lanhl.2025.100772
Patricia M Ortega PhD , Elena Brachimi MBBS , Ahmed R Ahmed PhD , Prof Sanjay Purkayastha MD , Christos Tsironis MD , Krishna Moorthy MD , Sherif Hakky PhD , Jonathan Cousins MBBS , Harvinder Chahal PhD , Saira Hameed PhD , Prof Tricia Tan PhD , Samantha Scholtz PhD , Karen O'Donnell BSc , Louisa Brolly BSc , Ciara Price BSc , Anna Sackey MSc , Candace Bovill-Taylor BSc , Joanne Boyle BSc , Rhian Houghton BSc , Jonathan Sullivan MSc , Chioma Izzi-Engbeaya PhD
Background
The prevalence of obesity is rising alongside population ageing, yet the long-term benefits of metabolic and bariatric surgery (MBS) in older adults is unclear. We aimed to evaluate the impact of MBS on survival in individuals aged 69 years and older with obesity.
Methods
We conducted a retrospective cohort study of patients aged 69 years and older managed in a UK tertiary bariatric centre between Jan 1, 2015, and Dec 31, 2024. Patients were eligible for inclusion if they had complete clinical data. Patients who underwent MBS were compared with matched controls who did not undergo MBS. Mahalanobis distance matching was performed (1:1) using age, BMI, American Society of Anesthesiologists grade, type 2 diabetes, and cardiovascular disease. Data were retrieved from electronic health records. The primary outcome was all-cause mortality after matching. Cox regression was used to assess survival.
Findings
Of the 186 patients, 44 (24%) underwent MBS. The median age was 71 years (IQR 70–74), 114 (61%) of 186 patients were women, 72 (39%) were men, median BMI was 41 kg/m2 (IQR 37–45), and median follow-up was 39 months (IQR 22–70). After matching, 44 MBS patients were compared with 34 control participants. Matched Kaplan–Meier analysis showed superior survival among MBS patients compared with control patients (log-rank p=0·010). MBS was associated with a 68% reduction in all-cause mortality on univariate analysis (hazard ratio 0·32 [95% CI 0·11–0·92]; p=0·036) and a 75% reduction in all-cause mortality on multivariate analysis (0·25 [0·08–0·77]; p=0·015). In MBS patients, the postoperative 30-day morbidity rate was 9%: Dindo-Clavien grade III-IV complications occurred in three (7%) of 44 patients, and one person (2%) died.
Interpretation
In a specialist setting, MBS was independently associated with improved survival in individuals aged 69 years and older, with acceptable perioperative risk. Chronological age alone should not preclude consideration for MBS. These findings support further evaluation of surgical options in well selected older adults with obesity.
{"title":"Metabolic and bariatric surgery in adults aged 69 years and older in England: a matched survival retrospective cohort study","authors":"Patricia M Ortega PhD , Elena Brachimi MBBS , Ahmed R Ahmed PhD , Prof Sanjay Purkayastha MD , Christos Tsironis MD , Krishna Moorthy MD , Sherif Hakky PhD , Jonathan Cousins MBBS , Harvinder Chahal PhD , Saira Hameed PhD , Prof Tricia Tan PhD , Samantha Scholtz PhD , Karen O'Donnell BSc , Louisa Brolly BSc , Ciara Price BSc , Anna Sackey MSc , Candace Bovill-Taylor BSc , Joanne Boyle BSc , Rhian Houghton BSc , Jonathan Sullivan MSc , Chioma Izzi-Engbeaya PhD","doi":"10.1016/j.lanhl.2025.100772","DOIUrl":"10.1016/j.lanhl.2025.100772","url":null,"abstract":"<div><h3>Background</h3><div>The prevalence of obesity is rising alongside population ageing, yet the long-term benefits of metabolic and bariatric surgery (MBS) in older adults is unclear. We aimed to evaluate the impact of MBS on survival in individuals aged 69 years and older with obesity.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of patients aged 69 years and older managed in a UK tertiary bariatric centre between Jan 1, 2015, and Dec 31, 2024. Patients were eligible for inclusion if they had complete clinical data. Patients who underwent MBS were compared with matched controls who did not undergo MBS. Mahalanobis distance matching was performed (1:1) using age, BMI, American Society of Anesthesiologists grade, type 2 diabetes, and cardiovascular disease. Data were retrieved from electronic health records. The primary outcome was all-cause mortality after matching. Cox regression was used to assess survival.</div></div><div><h3>Findings</h3><div>Of the 186 patients, 44 (24%) underwent MBS. The median age was 71 years (IQR 70–74), 114 (61%) of 186 patients were women, 72 (39%) were men, median BMI was 41 kg/m<sup>2</sup> (IQR 37–45), and median follow-up was 39 months (IQR 22–70). After matching, 44 MBS patients were compared with 34 control participants. Matched Kaplan–Meier analysis showed superior survival among MBS patients compared with control patients (log-rank p=0·010). MBS was associated with a 68% reduction in all-cause mortality on univariate analysis (hazard ratio 0·32 [95% CI 0·11–0·92]; p=0·036) and a 75% reduction in all-cause mortality on multivariate analysis (0·25 [0·08–0·77]; p=0·015). In MBS patients, the postoperative 30-day morbidity rate was 9%: Dindo-Clavien grade III-IV complications occurred in three (7%) of 44 patients, and one person (2%) died.</div></div><div><h3>Interpretation</h3><div>In a specialist setting, MBS was independently associated with improved survival in individuals aged 69 years and older, with acceptable perioperative risk. Chronological age alone should not preclude consideration for MBS. These findings support further evaluation of surgical options in well selected older adults with obesity.</div></div><div><h3>Funding</h3><div>National Institute for Health and Care Research.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 10","pages":"Article 100772"},"PeriodicalIF":14.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422947","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 : 2025-10-01Epub Date: 2025-10-18DOI: 10.1016/j.lanhl.2025.100782
Shahmir H Ali
{"title":"Care beyond caregivers: a wider spectrum of social support for older adults","authors":"Shahmir H Ali","doi":"10.1016/j.lanhl.2025.100782","DOIUrl":"10.1016/j.lanhl.2025.100782","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 10","pages":"Article 100782"},"PeriodicalIF":14.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145348939","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 : 2025-09-01Epub Date: 2025-09-30DOI: 10.1016/j.lanhl.2025.100764
Raj C Shah MD , Prof Joanne Ryan PhD , Katherine L Webb MA , Prof Rory Wolfe PhD , Prof Andrew Chan MD , Trevor T-J Chong MBBS , Prof Michael E Ernst PharmD , Prof Sara E Espinoza MD , Olivia Flynn BMed , Song Yuin Lee MBBS , John McNeil MBBS , Prof Mark R Nelson MBBS , Suzanne G Orchard PhD , Prof Christopher M Reid PhD , Kerry Sheets MD , Prof Nigel P Stocks MBBS , Prof Nilakshi S Weerasinghe MBBS , Michelle E Wilson PhD , Robyn L Woods PhD , Prof Anne M Murray MD
Background
In the Aspirin in Reducing Events in the Elderly (ASPREE) clinical trial, low-dose aspirin was not associated with survival free of dementia and persistent physical disability (a measure of a healthy lifespan); however, there was a small increased risk of death. Given the long pre-clinical phase of many ageing conditions, we aimed to examine the legacy effect (post-trial) and the longer-term effect of aspirin versus placebo through extended follow-up in the ASPREE-XT observational study.
Methods
Between March 10, 2010, and Dec 24, 2014, 19 114 community-dwelling people in Australia and the USA, aged predominantly 70 years and older, were randomly assigned to low-dose aspirin or placebo for a median of 4·7 years as part of the ASPREE trial. Post-trial observational follow-up continued for a median of 4·3 years (IQR 4·1–4·6). All components of the primary endpoint (ie, incident dementia, persistent physical disability, and death) were adjudicated by masked expert panels. Analyses used Cox proportional hazards models with intention-to-treat.
Findings
15 633 participants (8836 [56·5%] were women, 6797 [43·5%] were men; 981 [6·3%] were not White) were eligible for and agreed to observational follow-up. There was no effect of randomisation to aspirin (34·37 events per 1000 person-years) versus placebo (33·68 per 1000 person-years) on the primary endpoint (hazard ratio [HR] 1·02; 95% CI 0·94–1·11; p=0·63) in the ASPREE-XT period. Similarly, over the period of both ASPREE and ASPREE-XT, no long-term effect of aspirin versus placebo was observed on the composite outcome of death, dementia, or persistent physical disability over almost a decade of follow-up (HR 1·01; 95% CI 0·95–1·08; p=0·65), including no long-term effect on deaths (1·06; 0·99–1·14; p=0·10). No effect of aspirin on incident major haemorrhagic events as compared with placebo was found in ASPREE-XT; however, aspirin was associated with an increased hazard for incident major haemorrhagic events across both ASPREE and ASPREE-XT (1·24; 1·10–1·39).
Interpretation
Low-dose aspirin does not appear to be effective in promoting a healthy lifespan in initially healthy, community-dwelling older people.
Funding
National Institute on Aging and the National Cancer Institute (USA).
{"title":"Aspirin and healthy lifespan in older people: main outcome of the ASPREE-XT observational study","authors":"Raj C Shah MD , Prof Joanne Ryan PhD , Katherine L Webb MA , Prof Rory Wolfe PhD , Prof Andrew Chan MD , Trevor T-J Chong MBBS , Prof Michael E Ernst PharmD , Prof Sara E Espinoza MD , Olivia Flynn BMed , Song Yuin Lee MBBS , John McNeil MBBS , Prof Mark R Nelson MBBS , Suzanne G Orchard PhD , Prof Christopher M Reid PhD , Kerry Sheets MD , Prof Nigel P Stocks MBBS , Prof Nilakshi S Weerasinghe MBBS , Michelle E Wilson PhD , Robyn L Woods PhD , Prof Anne M Murray MD","doi":"10.1016/j.lanhl.2025.100764","DOIUrl":"10.1016/j.lanhl.2025.100764","url":null,"abstract":"<div><h3>Background</h3><div>In the Aspirin in Reducing Events in the Elderly (ASPREE) clinical trial, low-dose aspirin was not associated with survival free of dementia and persistent physical disability (a measure of a healthy lifespan); however, there was a small increased risk of death. Given the long pre-clinical phase of many ageing conditions, we aimed to examine the legacy effect (post-trial) and the longer-term effect of aspirin versus placebo through extended follow-up in the ASPREE-XT observational study.</div></div><div><h3>Methods</h3><div>Between March 10, 2010, and Dec 24, 2014, 19 114 community-dwelling people in Australia and the USA, aged predominantly 70 years and older, were randomly assigned to low-dose aspirin or placebo for a median of 4·7 years as part of the ASPREE trial. Post-trial observational follow-up continued for a median of 4·3 years (IQR 4·1–4·6). All components of the primary endpoint (ie, incident dementia, persistent physical disability, and death) were adjudicated by masked expert panels. Analyses used Cox proportional hazards models with intention-to-treat.</div></div><div><h3>Findings</h3><div>15 633 participants (8836 [56·5%] were women, 6797 [43·5%] were men; 981 [6·3%] were not White) were eligible for and agreed to observational follow-up. There was no effect of randomisation to aspirin (34·37 events per 1000 person-years) versus placebo (33·68 per 1000 person-years) on the primary endpoint (hazard ratio [HR] 1·02; 95% CI 0·94–1·11; p=0·63) in the ASPREE-XT period. Similarly, over the period of both ASPREE and ASPREE-XT, no long-term effect of aspirin versus placebo was observed on the composite outcome of death, dementia, or persistent physical disability over almost a decade of follow-up (HR 1·01; 95% CI 0·95–1·08; p=0·65), including no long-term effect on deaths (1·06; 0·99–1·14; p=0·10). No effect of aspirin on incident major haemorrhagic events as compared with placebo was found in ASPREE-XT; however, aspirin was associated with an increased hazard for incident major haemorrhagic events across both ASPREE and ASPREE-XT (1·24; 1·10–1·39).</div></div><div><h3>Interpretation</h3><div>Low-dose aspirin does not appear to be effective in promoting a healthy lifespan in initially healthy, community-dwelling older people.</div></div><div><h3>Funding</h3><div>National Institute on Aging and the National Cancer Institute (USA).</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100764"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226141","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 : 2025-09-01Epub Date: 2025-09-03DOI: 10.1016/j.lanhl.2025.100757
Ruby Yu PhD , Derek Lai MSc , Grace Leung MSc , Lok-yan Tam BNurs , Clara Cheng MASSM , Sara Kong BSc , Cecilia Tong MSc , Matthew Yu BSc , Prof Jean Woo MD
<div><h3>Background</h3><div>Declines in intrinsic capacity have been associated with increased risks of frailty, disability, and hospitalisation. We estimated population attributable fractions (PAFs) for these outcomes with respect to intrinsic capacity-related conditions and traditional modifiable risk factors in different age groups.</div></div><div><h3>Methods</h3><div>We analysed data from a territory-wide, multicentre, community-based, prospective cohort study (2023–24) in Hong Kong. Among 22 237 Chinese adults aged 60 years and older with follow-up data, we calculated age-specific PAFs for incident frailty, instrumental activities of daily living (IADL) disability, and hospitalisation associated with 13 modifiable risk factors. These risk factors included intrinsic capacity conditions, cardiometabolic conditions, and socioeconomic and lifestyle factors, and combinations of these.</div></div><div><h3>Findings</h3><div>Between March 21, 2023, and Dec 31, 2024, 47 776 participants were recruited to the study. 41 226 (86·3%) had complete baseline data for all intrinsic capacity conditions, cardiometabolic conditions, socioeconomic and lifestyle factors, demographic covariates, and outcome variables and were therefore included in our study sample. 22 237 (53·9%) of 41 226 participants completed follow-up assessments at least 6 months after baseline with a mean follow-up of 360·4 days (SD 71·6, median 348·0, IQR 307·0–399·0), 1398 (7·1%) of 19 777 participants had incident frailty, 1152 (6·0%) of 19 171 participants had incident IADL disability, and 2068 (11·1%) of 18 622 participants were hospitalised. Limited mobility was the leading risk factor associated across all outcomes (PAFs 9·8–25·3%). Depressive symptoms were a strong risk factor associated with frailty (PAF 19·1%). Age-stratified analyses revealed that limited mobility had the highest PAFs in adults aged 80 years and older, whereas depressive symptoms showed peak PAFs in those aged 60–69 years in most cases. Hypertension contributed to all outcomes (PAFs 8·4–19·6%) only in adults younger than 80 years. In adults aged 60–69 years physical activity was the predominant risk factor associated with frailty (PAF 21·9%) and disability (PAF 22·3%). The attributable risk of lower education with frailty increased with age, reaching its peak in adults aged 80 years and older (PAF 20·2%). Regarding the joint effects of the risk factors, intrinsic capacity decline was the factor associated with the highest overall attributable risk for all outcomes, exceeding the impact of cardiometabolic diseases and socioeconomic and lifestyle risk.</div></div><div><h3>Interpretation</h3><div>Our findings provide insights into age-specific risk factors for frailty, disability, and hospitalisation in older people, underlining the importance of targeted prevention strategies across age groups. Our findings further support a shift towards prioritising intrinsic capacity to better support healthy ageing at the popu
{"title":"Age-specific population attributable fractions for frailty, functional disability, and hospitalisation in Chinese older people: an ICOPE-based prospective cohort study","authors":"Ruby Yu PhD , Derek Lai MSc , Grace Leung MSc , Lok-yan Tam BNurs , Clara Cheng MASSM , Sara Kong BSc , Cecilia Tong MSc , Matthew Yu BSc , Prof Jean Woo MD","doi":"10.1016/j.lanhl.2025.100757","DOIUrl":"10.1016/j.lanhl.2025.100757","url":null,"abstract":"<div><h3>Background</h3><div>Declines in intrinsic capacity have been associated with increased risks of frailty, disability, and hospitalisation. We estimated population attributable fractions (PAFs) for these outcomes with respect to intrinsic capacity-related conditions and traditional modifiable risk factors in different age groups.</div></div><div><h3>Methods</h3><div>We analysed data from a territory-wide, multicentre, community-based, prospective cohort study (2023–24) in Hong Kong. Among 22 237 Chinese adults aged 60 years and older with follow-up data, we calculated age-specific PAFs for incident frailty, instrumental activities of daily living (IADL) disability, and hospitalisation associated with 13 modifiable risk factors. These risk factors included intrinsic capacity conditions, cardiometabolic conditions, and socioeconomic and lifestyle factors, and combinations of these.</div></div><div><h3>Findings</h3><div>Between March 21, 2023, and Dec 31, 2024, 47 776 participants were recruited to the study. 41 226 (86·3%) had complete baseline data for all intrinsic capacity conditions, cardiometabolic conditions, socioeconomic and lifestyle factors, demographic covariates, and outcome variables and were therefore included in our study sample. 22 237 (53·9%) of 41 226 participants completed follow-up assessments at least 6 months after baseline with a mean follow-up of 360·4 days (SD 71·6, median 348·0, IQR 307·0–399·0), 1398 (7·1%) of 19 777 participants had incident frailty, 1152 (6·0%) of 19 171 participants had incident IADL disability, and 2068 (11·1%) of 18 622 participants were hospitalised. Limited mobility was the leading risk factor associated across all outcomes (PAFs 9·8–25·3%). Depressive symptoms were a strong risk factor associated with frailty (PAF 19·1%). Age-stratified analyses revealed that limited mobility had the highest PAFs in adults aged 80 years and older, whereas depressive symptoms showed peak PAFs in those aged 60–69 years in most cases. Hypertension contributed to all outcomes (PAFs 8·4–19·6%) only in adults younger than 80 years. In adults aged 60–69 years physical activity was the predominant risk factor associated with frailty (PAF 21·9%) and disability (PAF 22·3%). The attributable risk of lower education with frailty increased with age, reaching its peak in adults aged 80 years and older (PAF 20·2%). Regarding the joint effects of the risk factors, intrinsic capacity decline was the factor associated with the highest overall attributable risk for all outcomes, exceeding the impact of cardiometabolic diseases and socioeconomic and lifestyle risk.</div></div><div><h3>Interpretation</h3><div>Our findings provide insights into age-specific risk factors for frailty, disability, and hospitalisation in older people, underlining the importance of targeted prevention strategies across age groups. Our findings further support a shift towards prioritising intrinsic capacity to better support healthy ageing at the popu","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100757"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008445","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 : 2025-09-01Epub Date: 2025-09-25DOI: 10.1016/j.lanhl.2025.100763
Prof Mikel Izquierdo PhD , Robinsón Ramírez-Vélez PhD , Prof Maria A Fiatarone Singh MD FRACP
Integrating exercise prescriptions with medication management represents a novel approach for enhancing health and function, optimising medication effectiveness, and reducing adverse drug reactions and polypharmacy in older adults (ie, those aged ≥60 years). This Personal View highlights the need for a comprehensive assessment of lifestyle, diagnoses, geriatric syndromes, and medications with an emphasis on fully incorporating exercise treatment into geriatric care. Exercise is an alternative to less effective or unsafe medications for many conditions, including depression, anxiety, insomnia, osteoarthritis, and dementia. Exercise is an important adjunct to pharmacotherapy for many common chronic conditions such as coronary artery disease, heart failure, diabetes, osteoporosis, cancer, and chronic obstructive pulmonary disease. Adding exercise to drug management can mitigate adverse drug reactions, enhance medication compliance, and reduce the adverse effects of sedentary behaviour and ageing processes on chronic disease expression. Targeted exercise programmes have also been shown to ameliorate drug-induced side-effects, including anorexia, falls, sarcopenia, osteoporosis, and orthostatic hypotension, and to overcome constraints such as reduced aerobic fitness, balance impairment, and muscle atrophy due to some medications. Health-care professionals require additional training and support to ensure that exercise assumes a key, central role in older adults with multimorbidity and polypharmacy, as supported by the current literature. This Personal View describes practical approaches to incorporating exercise into clinical practice as a step towards an integrated geriatric care model, with the ultimate aim of increasing health span and minimising disability.
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Pub Date : 2025-09-01Epub Date: 2025-09-18DOI: 10.1016/j.lanhl.2025.100761
Giulia Gregori MS , Sanjay Mediwala MD , Michael Liebschner PhD , Daeseung Kim PhD , Mon S Bryant PhD PT , Nina Klonis BS , Prof Reina Armamento-Villareal MD , Prof Clifford Qualls PhD , Prof Dennis T Villareal MD
Background
Lifestyle interventions for weight loss might exacerbate age-related bone loss and osteoporosis. However, there is limited knowledge about their effects on bone quality. We examined whether lifestyle intervention can preserve or enhance bone quality, despite reductions in bone mineral density.
Methods
The Lifestyle Intervention to Improve Bone Quality (LIMB-Q) study was a randomised controlled trial conducted at Baylor College of Medicine and the Michael E DeBakey VA Medical Center (Houston, TX, USA) including older adults (aged 65–85 years) with obesity (BMI ≥30 kg/m2). Participants were randomly assigned to receive either an intensive lifestyle intervention (intensive lifestyle group, consisting of weight management plus exercise training) or healthy lifestyle (healthy lifestyle group, consisting of educational sessions on healthy diets). The co-primary outcomes were 12-month changes in (1) distal tibia cortical thickness, measured using high-resolution peripheral quantitative CT, and (2) hip bone strength (failure load), assessed via finite element analysis of CT scans. The primary endpoint was analysed by intention to treat (all randomly assigned patients). This trial is registered with ClinicalTrials.gov, NCT03329963 (completed).
Findings
Of 138 participants assessed for eligibility in person between Nov 9, 2017, and Nov 8, 2021, 120 were included in this study (mean age 71·4 years [SD 4·6]; 63 [53%] male and 57 [47%] female). At 12 months, weight loss was greater in the intensive lifestyle group than in the healthy lifestyle group (–11·6 kg [SE 0·5] vs –1·2 kg [0·5]). No group differences were noted in the change in distal tibia cortical thickness between the intensive lifestyle group (–0·013 mm [SE 0·026]) and the healthy lifestyle group (–0·002 mm [0·025]; between-group difference 0·027 [95% CI –0·066 to 0·120], p=0·40). The change in hip failure load at 12 months did not differ between the intensive lifestyle group (13 N [SE 25]) and the healthy lifestyle group (3 N [26]; between-group difference –6.9 N [95% CI –108 to 95], p=0·89). Exercise-related adverse events in the intensive lifestyle group included a small number of musculoskeletal events (falls [one participant], neck pain [two], and foot, shoulder, back, and leg pain [one each]).
Interpretation
Lifestyle intervention preserved bone quality in older adults with obesity during weight loss. Further research is needed to determine whether lifestyle interventions can reduce fracture risk in older adults with obesity.
Funding
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and US Department of Veterans Affairs.
背景：生活方式干预减肥可能加剧年龄相关性骨质流失和骨质疏松症。然而，关于它们对骨质量的影响的知识有限。我们研究了生活方式干预是否可以在骨密度降低的情况下保持或提高骨质量。方法：生活方式干预改善骨质量（LIMB-Q）研究是在贝勒医学院和Michael E DeBakey VA医学中心（Houston， TX， USA）进行的一项随机对照试验，研究对象为年龄在65-85岁之间的肥胖老年人（BMI≥30 kg/m2）。参与者被随机分配接受强化生活方式干预组（强化生活方式组，包括体重管理和运动训练）或健康生活方式组（健康生活方式组，包括健康饮食教育课程）。共同主要结果是12个月的变化(1)胫骨远端皮质厚度，使用高分辨率外围定量CT测量；(2)髋骨强度（失效载荷），通过CT扫描的有限元分析评估。主要终点通过治疗意向进行分析（所有随机分配的患者）。该试验已在ClinicalTrials.gov注册，编号NCT03329963（已完成）。研究结果：在2017年11月9日至2021年11月8日期间亲自评估资格的138名参与者中，120名参与者被纳入本研究（平均年龄71.4岁[SD 4.6]； 63名[53%]男性，57名[47%]女性）。12个月时，强化生活方式组的体重减轻幅度大于健康生活方式组（- 11.6 kg [SE 0.5] vs -1·2 kg [SE 0.5]）。强化生活方式组（- 0.013 mm [SE 0.026]）与健康生活方式组（- 0.002 mm[0.025]）胫骨远端皮质厚度变化无组间差异，组间差异0.027 [95% CI - 0.066 ~ 0.120], p= 0.40]。12个月时，强化生活方式组（13 N [SE 25]）和健康生活方式组（3 N[26]）髋关节衰竭负荷变化无差异，组间差异为-6.9 N [95% CI -108 ~ 95], p= 0.89)。强化生活方式组的运动相关不良事件包括少量肌肉骨骼事件（跌倒[1名参与者]，颈部疼痛[2名]，足部、肩部、背部和腿部疼痛[各1名]）。解释：生活方式干预在减肥期间保持了老年肥胖患者的骨质量。需要进一步的研究来确定生活方式干预是否可以降低老年肥胖患者的骨折风险。资助：国家糖尿病、消化和肾脏疾病研究所（NIDDK）和美国退伍军人事务部。
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