European Journal of Ageing最新文献

Healthy aging requires acquiring new functional skills for adaptation in a dynamic environment. Cognitive interventions with older adults have largely focused on improving broad cognitive abilities, aiming for transfer to functional effects. By contrast, interventions focusing directly on acquiring new functional skills can address current real-world issues, including the need for reskilling and reducing the digital divide, especially for underserved communities. In doing so, we may better understand how aspects of age-related learning and cognitive and functional decline may be due to suboptimal learning circumstances rather than senescence. In this opinion paper, we highlight key aspects for designing long-lasting, real-world interventions to improve functional skills, and potentially transfer to cognitive effects, for older adults. This approach could help build more inclusive theories of cognitive aging, while progressing the field toward developing more effective and useful interventions.

Studies from high-income countries have shown that multimorbidity is associated with increased fall risk among older adults. However, studies specifically on this topic from low- and middle-income counties (LMICs) are lacking. Thus, we aimed to assess this association among adults aged ≥ 50 years from six LMICs.Cross-sectional, community-based data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. Eleven chronic physical conditions were assessed. The presence of past 12-month fall-related injury was ascertained through self-reported information. Multivariable logistic regression and mediation analysis was conducted to assess the association between multimorbidity and fall-related injury.Data on 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; males 48.0%] were analyzed. Overall, compared to having no chronic conditions, having 2, 3, and ≥ 4 chronic conditions were significantly associated with 1.67 (95%CI = 1.21-2.30), 2.64 (95%CI = 1.89-3.68), and 3.67 (95%CI = 2.42-5.57) times higher odds for fall-related injury. The association between multimorbidity (i.e., ≥ 2 chronic conditions) and fall-related injury was mainly explained by pain/discomfort (mediated% 39.7%), mobility (34.1%), sleep/energy (24.2%), and cognition (13.0%).Older adults with multimorbidity in LMICs are at increased odds for fall-related injury. Targeting the identified potential mediators among those with multimorbidity may reduce fall risk in this population.

The household represents a proximal social context whose members can convey various expectations to each other, including expectations for active aging. We used a nationally representative sample (N = 2007, aged 16-94 years) to investigate the household predictors of perceived expectations for active aging (PEAA, i.e., "activation demands" targeting individuals as older adults) in three domains: physical health, mental health, and social engagement. We considered household members' dispositional optimism, conscientiousness, age stereotypes, and the life goal of civic engagement. A set of preregistered multiple regression analyses indicated that, irrespective of age, household members' life goal of civic engagement had a positive effect on individual PEAA in the social engagement domain, which disappeared upon controlling for the respective individual life goal. In middle-aged and older adults, household members' conscientiousness unexpectedly had a significantly negative effect on individual PEAA in the physical health domain. Neither household members' dispositional optimism nor their domain-specific age stereotypes had significant associations with individual PEAA. Our findings suggest that household members' mindsets and attitudes play a limited role in predicting PEAA of individuals from the same household.

To strengthen practice-based evidence, pragmatic, yet rigorous, evaluation of real-world programs is necessary. This study sought to add to the evidence for the effectiveness of physical activity programs for middle-aged and older adults offered by publicly funded local sports partnerships (LSPs) in Ireland. We analysed data from 468 individuals aged 50 + years, who took part in the Move for Life cluster randomised feasibility trial. Outcomes were accelerometer-based moderate-to-vigorous intensity physical activity (MVPA), light intensity physical activity (LiPA), standing time, and sedentary time; self-reported compliance with physical activity guidelines, body composition, physical function, and mental well-being. LSP programs included Women on Wheels/Bike for Life, Go for Life Games, Get Ireland Walking, and Men on the Move. We used a difference-in-differences approach to estimate program effects. We found evidence of positive program effects on accelerometer-derived MVPA (Women on Wheels/Bike for Life, Get Ireland Walking), LiPA (Go for Life Games), and sedentary time (Women on Wheels/Bike for Life, Go for Life Games) (p < .05), plus evidence of positive effects on self-reported physical activity for all LSP programs (p < .05). We did not find evidence of program effects on body composition. Outcomes related to physical function were mixed. Men on the Move was the only program where mental well-being scores increased significantly relative to the control group. Despite sample size limitations, the results support the effectiveness of LSP programs over a 6-month period, notably in terms of energy expenditure outcomes, while identifying areas for improvement regarding outcomes related to body composition, physical function and, particularly, mental well-being.

Loneliness has consistently been found to be associated with an increased probability of depressive symptoms among older adults. Yet, the relationship is complex, and it remains unclear whether loneliness is a cause of depressive symptomatology. The aim of this study is to investigate the possible causal effect of loneliness on subsequent depressive symptoms among older adults (65+) in Europe. We analyzed two waves of observational data (2015-2017) from the Study of Health, Aging, and Retirement in Europe (SHARE) (n = 6808) and attempted to identify a causal effect of loneliness on depressive symptomatology by accounting for confounding by potential unmeasured factors using an endogenous treatment-effect model. The results showed a substantial positive association between loneliness in 2015 and depressive symptoms in 2017 in the sample. However, there was no support for the hypothesis that loneliness in 2015 was a cause of depressive symptoms in 2017. Additionally, there was no evidence of unmeasured factors confounding the relationship. Thus, loneliness may not be a cause of depressive symptoms among older adults in the short term. These findings suggest that there might be other reasons why lonely individuals are at an increased risk of depressive symptoms. Therefore, a shift in focus when aiming to reduce depressive symptoms among lonely older adults may be warranted.

Previous research reveals that older adults have relatively intact well-being when excluded by others as compared to young adults. This observation can be attributed to two plausible explanations: Either older adults are unaware of their exclusion, thereby shielding their well-being from its impact, or they recognize the exclusion but respond to it rationally. We carried out two studies to compare young and older adults' awareness of and response to exclusion, and explored its potential mechanisms by assessing the explanatory roles of loneliness, general cognition, and rejection sensitivity. Study 1 measured young and older adults' loneliness, awareness of exclusion, and needs satisfaction after playing the Cyberball game, and Study 2 further examined other potential correlates including processing speed, working memory, and rejection sensitivity. Over the two studies, older adults were not worse at recognizing exclusion, and sometimes better than young adults. Older adults' awareness of exclusion predicted their responses to exclusion, whereas the same link was absent in younger adults. Despite older adults' relatively good performance, there were individual differences in recognizing exclusion; older adults with better general cognition and lower rejection sensitivity were particularly adept. In sum, older adults can be as aware of exclusion as young adults, but rather than reacting in an emotional way that is detached from reality, older adults are more likely to respond to it rationally based on the severity of exclusion they have perceived.

Depressive symptoms are common in mild cognitive impairment (MCI), dementia caused by Alzheimer's disease (AD dementia) and in cognitively unimpaired older adults. However, it is unclear whether they could contribute to the identification of cognitive impairment in ageing. To assess the potential utility of depressive symptoms to distinguish between healthy cognitive ageing and MCI and AD dementia. The diagnostic workup of the cognitive function of 1737 older cognitively unimpaired individuals, 334 people with MCI and 142 individuals with AD dementia relied on a comprehensive neuropsychiatric assessment, including the Mini Mental State Examination (MMSE). Depressive symptoms were tapped with the 15-item Geriatric Depression Scale (GDS). Proportional odds logistic regression (POLR) models and the machine learning technique Adaptive Boosting algorithm (AdaBoost) were employed. Stratified repeated random subsampling (stratified bootstrap resampling) was used to recursive partitioning to training- and validation set (70/30 ratio). The average accuracy of the POLR models for the GDS total score in distinguishing between cognitive impairment and healthy cognitive ageing exceeded 78% and was inferior to that of MMSE. Of note, the sensitivity of GDS total score was very low. By employing the AdaBoost algorithm and considering GDS items separately, the average accuracy was higher than 0.72 and comparable to that of the MMSE, while sensitivity- and specificity values were more balanced. The findings of the study provide initial evidence that depressive symptoms may contribute to distinguishing between cognitive impairment and cognitively healthy ageing.

Long-term care trajectories typically vary in care types, transitions and durations. Understanding these patterns can help optimize care provision. This study aimed at (1) identifying formal long-term care trajectories of severely disabled older individuals, and (2) assessing the relationships between individual characteristics and these trajectories.Nationwide administrative data from the Centre for Care Needs Assessment were used. The sample included all 140,973 individuals older than 65 and with institutional care entitlements for somatic or psychogeriatric problems on July 1, 2015. The study period was from January 2010 to June 2019. Latent class growth analysis was performed to derive distinct care trajectories. Multinomial logistic regression analysis was used to examine the relationships between individual characteristics and these trajectories.Five trajectories were identified, varying in complexity and duration of needs in long-term care. Two were characterized by mostly mild (somatic) institutional care and three by (psychogeriatric) institutional care with increasing duration and intensity. Men and younger individuals were more likely to require intensive (psychogeriatric) institutional care.This study highlighted clear divergences among formal long-term care trajectories of severely disabled older individuals. Though less generous entitlement criteria may result in relatively lower expenditures in formal (institutional) care, they also imply increased use of alternatives, such as informal and community care. These insights can be used to tailor the provision of long-term care services in the future, and inform policy related to the financial sustainability of long-term care systems.

Research findings on the relationship between caring and health are mixed and call for a more nuanced analysis of the care situation. This study investigates cross-sectional and longitudinal associations between caring and depressive symptoms, considering location and type of care. Data come from the Survey of Health Ageing and Retirement in Europe (SHARE), collected in wave 6 (from 2015 to 2016) and wave 8 (from 2019 to 2020). Cross-sectional data were available for 52.186 respondents in 18 countries. Of these, 18.659 were free of elevated depressive symptoms in wave 6 and were used to investigate incident depression in the longitudinal analyses. We distinguished between personal care, practical help, and paperwork, and were able to compare in-home and outside-home personal care. For both men and women, findings indicate that in-home personal care is associated with an increased risk of reporting and developing depressive symptoms (after controlling for age, country affiliation, education, wealth, employment situation, and functional limitations). Cross-sectional, but not longitudinal, associations were also found for outside-home care in terms of personal care or paperwork, but not for practical help. Additionally, women and disadvantaged population groups were more likely to provide in-home care, but less likely to provide outside care (regardless of the type). Overall, the results highlight that different locations and types of care are associated differently with mental health. Findings also underscore the need for interventions specifically tailored to support disadvantaged populations who provide in-home care, addressing the unique challenges they face.

Early life stress has far-reaching effects on various aspects of well-being in later life, but whether it impacts resilience, i.e., the ability to tolerate hardship, in old age remains unclear. We investigated whether childhood adversities and childhood home atmosphere are associated with resilience in old age directly or indirectly through poorer physical and psychological functioning in late middle age. The data comprised 1176 persons born in 1934-1944 and were collected over a 17-year follow-up in 2001-2018. Childhood adversities (greater score indicates more adversities) and home atmosphere (greater score indicates better atmosphere) were assessed retrospectively. Resilience in old age was measured with the Hardy-Gill Resilience Scale, depressive symptoms in late middle age with the Beck Depression Inventory, and hand grip strength in late middle age with a dynamometer. Data were analyzed with path modeling with depressive symptoms and grip strength set as mediators. We found that a greater number of childhood adversities and a poorer home atmosphere were associated with poorer resilience in old age (β =  - .13; p < .001 and β = .11, p < .001, respectively). These associations were fully mediated by depressive symptoms, but not hand grip strength, in late middle age. The findings indicate that adverse childhood exposures may decrease psychological functioning in middle age, and subsequently, lessen resilience in old age. Future studies should assess whether this pathway can be intervened.