Pub Date : 2025-08-01DOI: 10.1016/j.lanhl.2025.100734
Nicholas R Jones DPhil , Margaret Smith PhD , Yaling Yang PhD , Prof F D Richard Hobbs FMedSci , Prof Clare J Taylor PhD
Background
Atrial fibrillation and heart failure frequently coexist but the relative effect of atrial fibrillation on survival in people with heart failure, and vice versa, remains uncertain. We aimed to report contemporary estimates of mortality among people with atrial fibrillation and heart failure and analyse trends in mortality over time.
Methods
We did a retrospective cohort study of adults aged 45 years or older in England, using primary care data from the Clinical Practice Research Datalink GOLD dataset and linked secondary care data (Hospital Episode Statistics and Office for National Statistics datasets), for a total follow-up period from Jan 1, 2000, to Dec 31, 2018. We recorded incident cases of heart failure and atrial fibrillation in primary or secondary care during the study period, as well as pre-existing cases at the study index date. Individuals were categorised as having both heart failure and atrial fibrillation, atrial fibrillation only, heart failure only, or neither condition, with heart failure and atrial fibrillation included in analyses as time-varying covariates. The primary outcome was all-cause mortality, as recorded in primary or secondary care. We report the incidence and hazard ratios for all-cause mortality by diagnosis status, median overall survival following diagnosis, and the cumulative probability of all-cause mortality from 3 months to 10 years of follow-up and by year of diagnosis to assess trends over time. Estimates of median survival and the cumulative probability of overall mortality were restricted to incident diagnoses during the study period, and calculated overall as well as by sex, age, and Index of Multiple Deprivation quintile.
Findings
The cohort consisted of 2 381 941 people, including 100 132 initially diagnosed with heart failure only and 155 061 initially diagnosed with atrial fibrillation only by the study index date or during follow-up. By the end of follow-up, 74 470 people had been diagnosed with both conditions. 314 042 people died during follow-up, including 42 427 (57·0%) of those diagnosed with both heart failure and atrial fibrillation. In people diagnosed with both conditions during the study period (n=43 714), median overall survival was 3·15 years (95% CI 3·08–3·21), and the cumulative probability of mortality was 31·8% (95% CI 30·2–33·6) at 1 year, 61·4% (59·4–63·3) at 5 years, and 80·2% (78·3–82·1) at 10 years after both conditions had been diagnosed, representing significantly worse rates than for an initial diagnosis of either condition alone. Similarly, the risk-adjusted hazard of all-cause mortality was highest among people with both heart failure and atrial fibrillation. For the overall population, cumulative mortality probability estimates were unchanged over successive years of diagnosis for people with both heart failure and atrial fibrillation, while showing small improvements for people initia
背景：心房颤动和心力衰竭经常共存，但心房颤动对心力衰竭患者生存的相对影响，反之亦然，仍不确定。我们的目的是报告心房颤动和心力衰竭患者的当代死亡率估计，并分析死亡率随时间的趋势。方法：我们对英国45岁及以上的成年人进行了回顾性队列研究，使用临床实践研究数据链GOLD数据集的初级保健数据和相关的二级保健数据（医院事件统计和国家统计局数据集），总随访期为2000年1月1日至2018年12月31日。我们记录了在研究期间在初级或二级护理中发生的心力衰竭和心房颤动的病例，以及在研究索引日期已存在的病例。个体被归类为既有心力衰竭又有心房颤动，只有心房颤动，只有心力衰竭，或两者都没有，心力衰竭和心房颤动作为时变协变量包括在分析中。主要结局是记录在初级或二级保健中的全因死亡率。我们报告了全因死亡率的发生率和风险比，包括诊断状态、诊断后的中位总生存率，以及随访3个月至10年的全因死亡率累积概率和诊断年份，以评估随时间推移的趋势。中位生存期和总死亡率累积概率的估计仅限于研究期间的事件诊断，并根据总体以及性别、年龄和多重剥夺指数五分位数进行计算。研究结果：该队列包括2 381 941人，其中100132人最初诊断为心力衰竭，155 061人最初诊断为心房颤动，仅在研究索引日期或随访期间。到随访结束时，有74 470人被诊断出患有这两种疾病。随访期间死亡314042人，其中42427人（57.0%）同时诊断为心力衰竭和心房颤动。在研究期间（n=43 714）诊断为这两种疾病的患者中，中位总生存期为3.15年（95% CI 3.08 - 3.21），两种疾病诊断后1年的累积死亡率为31.8% (95% CI 30.2 - 33.6)， 5年的累积死亡率为64.1%(59.4 - 63.3)，10年的累积死亡率为80.2%(78.3 - 82.1)，明显低于单独诊断任何一种疾病的患者。同样，经风险调整后的全因死亡率在心力衰竭和心房颤动患者中最高。对于总体人群来说，对于心力衰竭和心房颤动患者的累积死亡率估计在连续几年的诊断中没有变化，而对于最初诊断为心力衰竭的患者（2000年至2008年诊断年期间10年累积概率中位数降低3.8% [95% CI 1.4 - 6.1]）或仅心房颤动（2000年至2017年诊断年期间1年累积死亡率中位数降低2.4%[0.5 - 4.2]），以及65岁之前诊断为两种疾病的患者的长期改善（10年累积死亡率中位数降低）2000年和2008年诊断年份之间的概率为14.5% [95% CI 3.8 - 25.2])。对于两种情况的患者，最贫困五分位数的中位总生存期明显更长(3.46年[95% CI 3.31 - 3.59]；N =9275)比最贫困五分位数（2.67岁[2.51 ~ 2.81]）多；n = 6302)。在年龄分层后，每个暴露组的中位总生存率在性别之间相似。解释：合并症心衰和房颤很常见，预后很差，随着时间的推移，诊断的死亡率估计没有改善，社会剥夺群体的生存率最差。资助：惠康信托基金会和国家健康与护理研究合作研究所，领导牛津大学的应用健康研究和护理。
{"title":"Trends in mortality in people with heart failure and atrial fibrillation: a population-based cohort study","authors":"Nicholas R Jones DPhil , Margaret Smith PhD , Yaling Yang PhD , Prof F D Richard Hobbs FMedSci , Prof Clare J Taylor PhD","doi":"10.1016/j.lanhl.2025.100734","DOIUrl":"10.1016/j.lanhl.2025.100734","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation and heart failure frequently coexist but the relative effect of atrial fibrillation on survival in people with heart failure, and vice versa, remains uncertain. We aimed to report contemporary estimates of mortality among people with atrial fibrillation and heart failure and analyse trends in mortality over time.</div></div><div><h3>Methods</h3><div>We did a retrospective cohort study of adults aged 45 years or older in England, using primary care data from the Clinical Practice Research Datalink GOLD dataset and linked secondary care data (Hospital Episode Statistics and Office for National Statistics datasets), for a total follow-up period from Jan 1, 2000, to Dec 31, 2018. We recorded incident cases of heart failure and atrial fibrillation in primary or secondary care during the study period, as well as pre-existing cases at the study index date. Individuals were categorised as having both heart failure and atrial fibrillation, atrial fibrillation only, heart failure only, or neither condition, with heart failure and atrial fibrillation included in analyses as time-varying covariates. The primary outcome was all-cause mortality, as recorded in primary or secondary care. We report the incidence and hazard ratios for all-cause mortality by diagnosis status, median overall survival following diagnosis, and the cumulative probability of all-cause mortality from 3 months to 10 years of follow-up and by year of diagnosis to assess trends over time. Estimates of median survival and the cumulative probability of overall mortality were restricted to incident diagnoses during the study period, and calculated overall as well as by sex, age, and Index of Multiple Deprivation quintile.</div></div><div><h3>Findings</h3><div>The cohort consisted of 2 381 941 people, including 100 132 initially diagnosed with heart failure only and 155 061 initially diagnosed with atrial fibrillation only by the study index date or during follow-up. By the end of follow-up, 74 470 people had been diagnosed with both conditions. 314 042 people died during follow-up, including 42 427 (57·0%) of those diagnosed with both heart failure and atrial fibrillation. In people diagnosed with both conditions during the study period (n=43 714), median overall survival was 3·15 years (95% CI 3·08–3·21), and the cumulative probability of mortality was 31·8% (95% CI 30·2–33·6) at 1 year, 61·4% (59·4–63·3) at 5 years, and 80·2% (78·3–82·1) at 10 years after both conditions had been diagnosed, representing significantly worse rates than for an initial diagnosis of either condition alone. Similarly, the risk-adjusted hazard of all-cause mortality was highest among people with both heart failure and atrial fibrillation. For the overall population, cumulative mortality probability estimates were unchanged over successive years of diagnosis for people with both heart failure and atrial fibrillation, while showing small improvements for people initia","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 8","pages":"Article 100734"},"PeriodicalIF":14.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862525","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 : 2025-08-01DOI: 10.1016/j.lanhl.2025.100745
Jo Dawes MPhil , Emmanouil Bagkeris PhD , Kate Walters PhD , Alexandra Burton PhD , Debra Hertzberg MSc , Rachael Frost PhD , Natasha Palipane MSc , Andrew Hayward MD
Background
Frailty is a complex health state affecting multiple body systems, resulting in increased vulnerability to health stressors. People experiencing homelessness (PEH) have poorer health, including higher prevalence of frailty, than the general population. This study aimed to calculate prevalence of frailty in PEH in England and explore associated sociodemographic characteristics.
Methods
This cross-sectional, secondary analysis study of health needs data collected from PEH in England created a frailty index by seeking expert input using a modified Delphi method and following published guidance for frailty index construction. Data were collected by Homeless Link in primarily urban areas through in-person, interviewer-administered surveys between 2012 and 2021 in three waves. Participants with data for at least 80% of frailty index variables were included. Descriptive statistics summarised the population. Among participants with sufficient frailty index data, the prevalence of frailty (frailty index scores of 0·25 or more) and pre-frailty (scores between 0·08 and 0·25) was calculated. Associations between frailty and sociodemographic characteristics were explored using multinomial logistic regression (adjusted for age; gender; accommodation at time of survey; engagement in employment, volunteering, and education; and immigration status).
Findings
The study sample included 2288 PEH (2156 [94·2%] aged 18–59 years). Frailty was prevalent in 949 (41·5%) of the study population and pre-frailty in 1001 (43·8%). Frailty was identified in 210 of 789 (26·6%) PEH aged 18–29 years. PEH aged 50–59 years had over eight times higher risk of frailty compared with PEH aged 18–29 years (adjusted risk ratio 8·30, 95% CI 4·86–14·16). Women experiencing homelessness (2·30, 1·57–3·37), and PEH who were not engaged in employment, volunteering, and education (3·05, 1·97–4·71) also had higher risk of frailty than men experiencing homelessness and PEH who were engaged in these activities, respectively. PEH who were not UK nationals had lower risk of frailty than those who were UK nationals (0·20, 0·12–0·33). Sleeping outside conferred a lower likelihood of frailty compared with people who were previously homeless but now housed (0·36, 0·17–0·76). Similar patterns were observed with pre-frailty.
Interpretation
To our knowledge, this is the largest study of frailty in PEH, offering valuable insights into the high levels of non-geriatric frailty in this vulnerable group, and can act as a starting point to guide service development and policy for this population.
{"title":"Prevalence of frailty and associated socioeconomic factors in people experiencing homelessness in England: cross-sectional secondary analysis of health needs survey data","authors":"Jo Dawes MPhil , Emmanouil Bagkeris PhD , Kate Walters PhD , Alexandra Burton PhD , Debra Hertzberg MSc , Rachael Frost PhD , Natasha Palipane MSc , Andrew Hayward MD","doi":"10.1016/j.lanhl.2025.100745","DOIUrl":"10.1016/j.lanhl.2025.100745","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is a complex health state affecting multiple body systems, resulting in increased vulnerability to health stressors. People experiencing homelessness (PEH) have poorer health, including higher prevalence of frailty, than the general population. This study aimed to calculate prevalence of frailty in PEH in England and explore associated sociodemographic characteristics.</div></div><div><h3>Methods</h3><div>This cross-sectional, secondary analysis study of health needs data collected from PEH in England created a frailty index by seeking expert input using a modified Delphi method and following published guidance for frailty index construction. Data were collected by Homeless Link in primarily urban areas through in-person, interviewer-administered surveys between 2012 and 2021 in three waves. Participants with data for at least 80% of frailty index variables were included. Descriptive statistics summarised the population. Among participants with sufficient frailty index data, the prevalence of frailty (frailty index scores of 0·25 or more) and pre-frailty (scores between 0·08 and 0·25) was calculated. Associations between frailty and sociodemographic characteristics were explored using multinomial logistic regression (adjusted for age; gender; accommodation at time of survey; engagement in employment, volunteering, and education; and immigration status).</div></div><div><h3>Findings</h3><div>The study sample included 2288 PEH (2156 [94·2%] aged 18–59 years). Frailty was prevalent in 949 (41·5%) of the study population and pre-frailty in 1001 (43·8%). Frailty was identified in 210 of 789 (26·6%) PEH aged 18–29 years. PEH aged 50–59 years had over eight times higher risk of frailty compared with PEH aged 18–29 years (adjusted risk ratio 8·30, 95% CI 4·86–14·16). Women experiencing homelessness (2·30, 1·57–3·37), and PEH who were not engaged in employment, volunteering, and education (3·05, 1·97–4·71) also had higher risk of frailty than men experiencing homelessness and PEH who were engaged in these activities, respectively. PEH who were not UK nationals had lower risk of frailty than those who were UK nationals (0·20, 0·12–0·33). Sleeping outside conferred a lower likelihood of frailty compared with people who were previously homeless but now housed (0·36, 0·17–0·76). Similar patterns were observed with pre-frailty.</div></div><div><h3>Interpretation</h3><div>To our knowledge, this is the largest study of frailty in PEH, offering valuable insights into the high levels of non-geriatric frailty in this vulnerable group, and can act as a starting point to guide service development and policy for this population.</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 8","pages":"Article 100745"},"PeriodicalIF":14.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972265","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 : 2025-08-01DOI: 10.1016/j.lanhl.2025.100756
Hélio José Coelho-Júnior PhD , Emanuele Marzetti MD PhD
Sarcopenia was originally conceptualised to describe a neuromuscular condition that could help to explain, at least partly, the effect of unsuccessful ageing on the ability of older adults (ie, those aged 60 years and older) to maintain independent mobility. Over time, international committees have standardised the definition and operationalisation of sarcopenia. However, a key issue in diagnosing sarcopenia remains as the current definitions are primarily based on expert opinion, with no clear explanation or description of the method used to prioritise the diagnostic criteria for sarcopenia, rather than on the integration of subjective methods (eg, expert opinion) with hierarchical evidence and advanced statistical methodologies. This issue has led to considerable variability in the reported prevalence rates of sarcopenia, inconsistent findings regarding sarcopenia as a predictor of adverse outcomes, and major challenges in the development of effective non-pharmacological (eg, physical exercise, nutrition), pharmacological therapies, or reliable biomarkers of disease status. The ambiguity on what is being measured under the present definitions of sarcopenia raises the fundamental question of whether these models truly represent the most accurate and clinically useful constructs of age-related muscle failure. In this Personal View, we critically examine the current state of sarcopenia research and highlight the need for a revised approach that integrates physiological face validity and clinical applicability.
{"title":"Capturing what counts in muscle failure: a critical appraisal of the current operational models of sarcopenia","authors":"Hélio José Coelho-Júnior PhD , Emanuele Marzetti MD PhD","doi":"10.1016/j.lanhl.2025.100756","DOIUrl":"10.1016/j.lanhl.2025.100756","url":null,"abstract":"<div><div>Sarcopenia was originally conceptualised to describe a neuromuscular condition that could help to explain, at least partly, the effect of unsuccessful ageing on the ability of older adults (ie, those aged 60 years and older) to maintain independent mobility. Over time, international committees have standardised the definition and operationalisation of sarcopenia. However, a key issue in diagnosing sarcopenia remains as the current definitions are primarily based on expert opinion, with no clear explanation or description of the method used to prioritise the diagnostic criteria for sarcopenia, rather than on the integration of subjective methods (eg, expert opinion) with hierarchical evidence and advanced statistical methodologies. This issue has led to considerable variability in the reported prevalence rates of sarcopenia, inconsistent findings regarding sarcopenia as a predictor of adverse outcomes, and major challenges in the development of effective non-pharmacological (eg, physical exercise, nutrition), pharmacological therapies, or reliable biomarkers of disease status. The ambiguity on what is being measured under the present definitions of sarcopenia raises the fundamental question of whether these models truly represent the most accurate and clinically useful constructs of age-related muscle failure. In this Personal View, we critically examine the current state of sarcopenia research and highlight the need for a revised approach that integrates physiological face validity and clinical applicability.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 8","pages":"Article 100756"},"PeriodicalIF":14.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972182","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 : 2025-08-01DOI: 10.1016/j.lanhl.2025.100741
Amy J Morgan PhD , Anna M Ross PhD , Sanne Oostermeijer PhD , Claire M Kelly PhD , Angela Nicholas PhD , Prof Jane Pirkis PhD , Prof Nicola J Reavley PhD
Background
Older men (aged ≥65 years) have high suicide rates relative to other ages and there are major gaps in understanding how to improve suicide prevention knowledge and skills as a potential pathway to reduce suicide risk in this group. This study aimed to evaluate the effectiveness of a suicide prevention training course in a community sample of older men.
Methods
We conducted a cluster randomised controlled trial evaluating the Mental Health First Aid Conversations about Suicide course, which teaches community members to recognise when someone is experiencing suicidal thoughts and how to provide appropriate support. Australian Men’s Sheds(ie, community organisations that provide communal spaces for men to meet, socialise, learn new skills, and work on meaningful projects with other men) in the state of Victoria (from study onset) and additionally in New South Wales, Queensland, and Western Australia (from Oct 31 2022) were randomised (1:1) in clusters (single sheds or groups of sheds, if fewer than eight men per shed)with minimisation to the course or a waitlist control and all shed members who were men were eligible to participate. The primary outcome was participant intended actions (recommended or not recommended) towards a suicidal person, measured at baseline, 1-month follow-up and 7-month follow-up (primary timepoint), analysed by intention to treat. This trial is registered with ANZCTR, ACTRN12621000756820.
Findings
Between July 14, 2021 and Sept 27, 2023, ten clusters were allocated to the intervention and ten to the control, with 19 clusters analysed as one intervention cluster withdrew before baseline. Following exclusion of participants who did not provide data or withdrew consent, 261 participants were included: 92 in the intervention group and 169 in the control group. The mean age of participants was 71·6 years (SD 8·8). For the primary outcome of intended actions to support a suicidal person, the intervention group showed a larger improvement than the control group on recommended actions at 1-month follow-up (mean difference 4·42, 95% CI 3·19 to 5·64, p<0·0001) and 7-month follow-up (3·31, 2·06–4·57, p<0·0001). For non-recommended actions, the intervention group showed small, non-significant reductions at both timepoints relative to the control group (1-month follow-up: –0·48, –1·20 to 0·24, p<0·19; 7-month follow-up: –0·58, –1·32 to 0·16, p<0·12).
Interpretation
Delivering the Conversations about Suicide course in Men’s Sheds could improve the suicide prevention skills of older men in the community.
Funding
Australian Medical Research Future Fund.
背景：老年男性（≥65岁）相对于其他年龄段有较高的自杀率，在了解如何提高自杀预防知识和技能作为降低该群体自杀风险的潜在途径方面存在重大差距。本研究旨在评估自杀预防培训课程在社区老年男性样本中的有效性。方法：我们进行了一项随机对照试验，评估关于自杀的心理健康急救对话课程，该课程教导社区成员识别某人何时有自杀念头以及如何提供适当的支持。在维多利亚州（从研究开始）以及新南威尔士州、昆士兰州和西澳大利亚州（从2022年10月31日起）的澳大利亚男性棚屋（即为男性提供公共空间的社区组织，用于会面、社交、学习新技能和与其他男性一起从事有意义的项目）被随机分组（1:1）（单个棚屋或棚屋组），如果每个棚少于8人)，最小化课程或候补名单控制，所有棚成员都是男性，有资格参加。主要结局是参与者对自杀者的预期行动（推荐或不推荐），在基线、1个月随访和7个月随访（主要时间点）测量，并通过治疗意向进行分析。本试验已在ANZCTR注册，ACTRN12621000756820。研究结果：在2021年7月14日至2023年9月27日期间，10个组被分配到干预组，10个组被分配到对照组，其中19个组被分析为一个干预组在基线前退出。排除未提供数据或撤回同意的参与者后，共纳入261名参与者：干预组92名，对照组169名。参与者的平均年龄为71.6岁（标准差为8.8）。对于支持自杀者的预期行动的主要结果，干预组在1个月的随访中比对照组在推荐的行动方面显示出更大的改善（平均差4.42,95% CI 3.19至5.64）。解释：在男性棚里提供关于自杀的对话课程可以提高社区中老年男性的自杀预防技能。资助：澳大利亚医学研究未来基金。
{"title":"Suicide prevention training in older men: a cluster randomised controlled trial of the Conversations about Suicide course in Australian Men’s Sheds","authors":"Amy J Morgan PhD , Anna M Ross PhD , Sanne Oostermeijer PhD , Claire M Kelly PhD , Angela Nicholas PhD , Prof Jane Pirkis PhD , Prof Nicola J Reavley PhD","doi":"10.1016/j.lanhl.2025.100741","DOIUrl":"10.1016/j.lanhl.2025.100741","url":null,"abstract":"<div><h3>Background</h3><div>Older men (aged ≥65 years) have high suicide rates relative to other ages and there are major gaps in understanding how to improve suicide prevention knowledge and skills as a potential pathway to reduce suicide risk in this group. This study aimed to evaluate the effectiveness of a suicide prevention training course in a community sample of older men.</div></div><div><h3>Methods</h3><div>We conducted a cluster randomised controlled trial evaluating the Mental Health First Aid Conversations about Suicide course, which teaches community members to recognise when someone is experiencing suicidal thoughts and how to provide appropriate support. Australian Men’s Sheds(ie, community organisations that provide communal spaces for men to meet, socialise, learn new skills, and work on meaningful projects with other men) in the state of Victoria (from study onset) and additionally in New South Wales, Queensland, and Western Australia (from Oct 31 2022) were randomised (1:1) in clusters (single sheds or groups of sheds, if fewer than eight men per shed)with minimisation to the course or a waitlist control and all shed members who were men were eligible to participate. The primary outcome was participant intended actions (recommended or not recommended) towards a suicidal person, measured at baseline, 1-month follow-up and 7-month follow-up (primary timepoint), analysed by intention to treat. This trial is registered with ANZCTR, ACTRN12621000756820.</div></div><div><h3>Findings</h3><div>Between July 14, 2021 and Sept 27, 2023, ten clusters were allocated to the intervention and ten to the control, with 19 clusters analysed as one intervention cluster withdrew before baseline. Following exclusion of participants who did not provide data or withdrew consent, 261 participants were included: 92 in the intervention group and 169 in the control group. The mean age of participants was 71·6 years (SD 8·8). For the primary outcome of intended actions to support a suicidal person, the intervention group showed a larger improvement than the control group on recommended actions at 1-month follow-up (mean difference 4·42, 95% CI 3·19 to 5·64, p<0·0001) and 7-month follow-up (3·31, 2·06–4·57, p<0·0001). For non-recommended actions, the intervention group showed small, non-significant reductions at both timepoints relative to the control group (1-month follow-up: –0·48, –1·20 to 0·24, p<0·19; 7-month follow-up: –0·58, –1·32 to 0·16, p<0·12).</div></div><div><h3>Interpretation</h3><div>Delivering the Conversations about Suicide course in Men’s Sheds could improve the suicide prevention skills of older men in the community.</div></div><div><h3>Funding</h3><div>Australian Medical Research Future Fund.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 8","pages":"Article 100741"},"PeriodicalIF":14.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972309","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 : 2025-07-01DOI: 10.1016/j.lanhl.2025.100728
Fridolin Haugg MS , Grace Lee MD , John He BS , Justin Johnson MS , Anna Zapaishchykova MS , Danielle S Bitterman MD , Benjamin H Kann MD , Prof Hugo J W L Aerts PhD , Raymond H Mak MD
Chronological age, although commonly used in clinical practice, fails to capture individual variations in rates of ageing and physiological decline. Recent advances in artificial intelligence (AI) have transformed the estimation of biological age using various imaging techniques. This Review consolidates AI developments in age prediction across brain, chest, abdominal, bone, and facial imaging using diverse methods, including MRI, CT, x-ray, and photographs. The difference between predicted and chronological age—often referred to as age deviation—is a promising biomarker for assessing health status and predicting disease risk. In this Review, we highlight consistent associations between age deviation and various health outcomes, including mortality risk, cognitive decline, and cardiovascular prognosis. We also discuss the technical challenges in developing unbiased models and ethical considerations for clinical application. This Review highlights the potential of AI-based age estimation in personalised medicine as it offers a non-invasive, interpretable biomarker that could transform health risk assessment and guide preventive interventions.
{"title":"Imaging biomarkers of ageing: a review of artificial intelligence-based approaches for age estimation","authors":"Fridolin Haugg MS , Grace Lee MD , John He BS , Justin Johnson MS , Anna Zapaishchykova MS , Danielle S Bitterman MD , Benjamin H Kann MD , Prof Hugo J W L Aerts PhD , Raymond H Mak MD","doi":"10.1016/j.lanhl.2025.100728","DOIUrl":"10.1016/j.lanhl.2025.100728","url":null,"abstract":"<div><div>Chronological age, although commonly used in clinical practice, fails to capture individual variations in rates of ageing and physiological decline. Recent advances in artificial intelligence (AI) have transformed the estimation of biological age using various imaging techniques. This Review consolidates AI developments in age prediction across brain, chest, abdominal, bone, and facial imaging using diverse methods, including MRI, CT, x-ray, and photographs. The difference between predicted and chronological age—often referred to as age deviation—is a promising biomarker for assessing health status and predicting disease risk. In this Review, we highlight consistent associations between age deviation and various health outcomes, including mortality risk, cognitive decline, and cardiovascular prognosis. We also discuss the technical challenges in developing unbiased models and ethical considerations for clinical application. This Review highlights the potential of AI-based age estimation in personalised medicine as it offers a non-invasive, interpretable biomarker that could transform health risk assessment and guide preventive interventions.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 7","pages":"Article 100728"},"PeriodicalIF":14.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683303","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 : 2025-07-01DOI: 10.1016/j.lanhl.2025.100731
Jasmine Ming Gan MBBS , Emily Louise Boucher BHSc , Nicola Georgia Lovett MD , Sophie Roche BM BCh , Sarah Catherine Smith MBBS , Sarah Tamsin Pendlebury DPhil
Background
Reliable estimates of delirium occurrence and outcomes are necessary to inform hospital services, research, and policy, but inclusive cohorts with long-term follow-up are scarce. We aimed to assess the age-specific occurrence of delirium in acute general (internal) medicine, associated factors, and 10-year outcomes stratified by age and comorbid dementia status.
Methods
This longitudinal, observational study was done at the John Radcliffe Hospital (Oxford, UK). We included consecutive adult patients aged 16 years and older in an acute general (internal) medicine service over six 8-week periods (between Sept 4, 2010, and Nov 15, 2018). Delirium was diagnosed prospectively using the Confusion Assessment Method and Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria and subcategorised as prevalent (≤48 h of admission) or incident (>48 h postadmission). Odds ratios adjusted (adjORs) for demographics, comorbidity, frailty, and illness severity were calculated for binarised outcomes and adjusted hazard ratios (adjHRs) were calculated for time to death.
Findings
1846 patients were admitted to acute general (internal) medicine (mean age 68·2 years [SD 20·0], age range 16–102 years), 426 (23% [95% CI 21–25]) of whom had delirium (prevalent n=290 [68%], incident n=73 [17%], both prevalent and incident n=63 [15%]), of whom 134 (31·5%) had dementia. 950 (51·5%) patients were female, 895 (48·5%) were male, and sex data were missing for one patient. Delirium increased with age, from six (2% [95% CI 1–4]) of 340 patients younger than 50 years and 31 (9% [6–13]) of 333 patients at age 50–64 years to 57 (20% [16–25]) of 281 at age 65–74 years, 245 (35% [31–38]) of 704 at age 75–89 years, and 87 (46% [39–54]) of 188 at age 90 years and older. Of the 37 patients younger than 65 years who had delirium, 28 (76%) had an underlying neurological or neuropsychiatric disorder. In those aged 65 years or older, delirium was overall associated (all p<0·001, age and sex adjusted) with dementia (adjOR 3·63 [95% CI 2·65–4·98]), pre-admission dependency (2·63 [2·02–3·43]), comorbidity burden (1·04 [1·02–1·05]), and frailty (moderate vs low risk 3·62 [2·70–4·85] and high vs low risk 11·85 [7·24–19·42]), with stronger associations in patients without comorbid dementia than in those with comorbid dementia. Delirium predicted inpatient stay longer than 7 days (adjOR 2·48 [1·84–3·35]), discharge care needs (2·41 [1·70–3·40]), and mortality during admission (2·45 [1·52–3·94]). The increased risk of death in the delirium group was highest in the immediate postadmission period and attenuated thereafter, but was maintained for up to 10 years of follow-up (adjHR 2·03 [95% CI 1·40–2·97] for 30-day mortality vs 1·52 [1·30–1·77] for 10-year mortality). Excess inpatient mortality was highest i
{"title":"Occurrence, associated factors, and outcomes of delirium in patients in an adult acute general medicine service in England: a 10-year longitudinal, observational study","authors":"Jasmine Ming Gan MBBS , Emily Louise Boucher BHSc , Nicola Georgia Lovett MD , Sophie Roche BM BCh , Sarah Catherine Smith MBBS , Sarah Tamsin Pendlebury DPhil","doi":"10.1016/j.lanhl.2025.100731","DOIUrl":"10.1016/j.lanhl.2025.100731","url":null,"abstract":"<div><h3>Background</h3><div>Reliable estimates of delirium occurrence and outcomes are necessary to inform hospital services, research, and policy, but inclusive cohorts with long-term follow-up are scarce. We aimed to assess the age-specific occurrence of delirium in acute general (internal) medicine, associated factors, and 10-year outcomes stratified by age and comorbid dementia status.</div></div><div><h3>Methods</h3><div>This longitudinal, observational study was done at the John Radcliffe Hospital (Oxford, UK). We included consecutive adult patients aged 16 years and older in an acute general (internal) medicine service over six 8-week periods (between Sept 4, 2010, and Nov 15, 2018). Delirium was diagnosed prospectively using the Confusion Assessment Method and Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria and subcategorised as prevalent (≤48 h of admission) or incident (>48 h postadmission). Odds ratios adjusted (<sub>adj</sub>ORs) for demographics, comorbidity, frailty, and illness severity were calculated for binarised outcomes and adjusted hazard ratios (<sub>adj</sub>HRs) were calculated for time to death.</div></div><div><h3>Findings</h3><div>1846 patients were admitted to acute general (internal) medicine (mean age 68·2 years [SD 20·0], age range 16–102 years), 426 (23% [95% CI 21–25]) of whom had delirium (prevalent n=290 [68%], incident n=73 [17%], both prevalent and incident n=63 [15%]), of whom 134 (31·5%) had dementia. 950 (51·5%) patients were female, 895 (48·5%) were male, and sex data were missing for one patient. Delirium increased with age, from six (2% [95% CI 1–4]) of 340 patients younger than 50 years and 31 (9% [6–13]) of 333 patients at age 50–64 years to 57 (20% [16–25]) of 281 at age 65–74 years, 245 (35% [31–38]) of 704 at age 75–89 years, and 87 (46% [39–54]) of 188 at age 90 years and older. Of the 37 patients younger than 65 years who had delirium, 28 (76%) had an underlying neurological or neuropsychiatric disorder. In those aged 65 years or older, delirium was overall associated (all p<0·001, age and sex adjusted) with dementia (<sub>adj</sub>OR 3·63 [95% CI 2·65–4·98]), pre-admission dependency (2·63 [2·02–3·43]), comorbidity burden (1·04 [1·02–1·05]), and frailty (moderate <em>vs</em> low risk 3·62 [2·70–4·85] and high <em>vs</em> low risk 11·85 [7·24–19·42]), with stronger associations in patients without comorbid dementia than in those with comorbid dementia. Delirium predicted inpatient stay longer than 7 days (<sub>adj</sub>OR 2·48 [1·84–3·35]), discharge care needs (2·41 [1·70–3·40]), and mortality during admission (2·45 [1·52–3·94]). The increased risk of death in the delirium group was highest in the immediate postadmission period and attenuated thereafter, but was maintained for up to 10 years of follow-up (<sub>adj</sub>HR 2·03 [95% CI 1·40–2·97] for 30-day mortality <em>vs</em> 1·52 [1·30–1·77] for 10-year mortality). Excess inpatient mortality was highest i","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 7","pages":"Article 100731"},"PeriodicalIF":14.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757865","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}
Evidence shows that violence in childhood affects health in adulthood, and violence in adulthood is associated with worse health. However, the extent to which violence-related health disparities persist into later life and whether the gap between victims and non-victims narrows, remains stable, or widens over time are unclear. This study aimed to examine the long-term effects of childhood and lifetime violence on health trajectories in older age.
Methods
The English Longitudinal Study of Ageing is one of the only cohort studies to cover violence across the lifespan alongside health trajectories in later life. Data were collected every 2 years between 2006 and 2019 and experiences of violence and limiting long-standing illness or disability (LLSID) were self-reported. We used logistic multilevel regressions and growth curve modelling to examine associations between parental physical abuse in childhood, lifetime physical or sexual violence, and any violence across the life course, with subsequent change in LLSID and depressive symptoms in later life, adjusted for demographic (age, gender, marital status, and region), socioeconomic (education, occupational class, tenure, and financial hardship), and social (household size and caregiving) attributes. Depressive symptoms were measured with the Centre for Epidemiological Studies Depression scale.
Findings
Of the 9771 participants who responded to the questionnaire, 6171 answered all three questions about experiences of violence and were included in this cohort. Any experience of violence was consistently associated with worse health in older age, including depression scale score of at least 4 (men: adjusted odds ratio 1·99, 95% CI 1·34–2·94; women: 1·38, 1·02–1·86) and LLSID (men: 1·74, 1·08–2·81; women: 2·15, 1·45–3·17). The patterns were evident in men and women.
Interpretation
Physical and mental health disadvantages associated with experiencing violence in childhood and adulthood are sustained throughout later life. There was little evidence that health disparities between victims and non-victims reduce over time. Preventing violence in both childhood and adulthood could promote healthy ageing.
{"title":"Violence across the life course and physical and mental health trajectories in later life: a 13-year population-based cohort study in England","authors":"Anastasia Fadeeva PhD , Polina Obolenskaya PhD , Estela Capelas Barbosa PhD , Prof Gene Feder MD , Prof Sally McManus MSc","doi":"10.1016/j.lanhl.2025.100738","DOIUrl":"10.1016/j.lanhl.2025.100738","url":null,"abstract":"<div><h3>Background</h3><div>Evidence shows that violence in childhood affects health in adulthood, and violence in adulthood is associated with worse health. However, the extent to which violence-related health disparities persist into later life and whether the gap between victims and non-victims narrows, remains stable, or widens over time are unclear. This study aimed to examine the long-term effects of childhood and lifetime violence on health trajectories in older age.</div></div><div><h3>Methods</h3><div>The English Longitudinal Study of Ageing is one of the only cohort studies to cover violence across the lifespan alongside health trajectories in later life. Data were collected every 2 years between 2006 and 2019 and experiences of violence and limiting long-standing illness or disability (LLSID) were self-reported. We used logistic multilevel regressions and growth curve modelling to examine associations between parental physical abuse in childhood, lifetime physical or sexual violence, and any violence across the life course, with subsequent change in LLSID and depressive symptoms in later life, adjusted for demographic (age, gender, marital status, and region), socioeconomic (education, occupational class, tenure, and financial hardship), and social (household size and caregiving) attributes. Depressive symptoms were measured with the Centre for Epidemiological Studies Depression scale.</div></div><div><h3>Findings</h3><div>Of the 9771 participants who responded to the questionnaire, 6171 answered all three questions about experiences of violence and were included in this cohort. Any experience of violence was consistently associated with worse health in older age, including depression scale score of at least 4 (men: adjusted odds ratio 1·99, 95% CI 1·34–2·94; women: 1·38, 1·02–1·86) and LLSID (men: 1·74, 1·08–2·81; women: 2·15, 1·45–3·17). The patterns were evident in men and women.</div></div><div><h3>Interpretation</h3><div>Physical and mental health disadvantages associated with experiencing violence in childhood and adulthood are sustained throughout later life. There was little evidence that health disparities between victims and non-victims reduce over time. Preventing violence in both childhood and adulthood could promote healthy ageing.</div></div><div><h3>Funding</h3><div>UK Prevention Research Partnership.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 7","pages":"Article 100738"},"PeriodicalIF":14.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757866","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号