JAR life最新文献

Background: Healthy ageing relies on preserving intrinsic capacity (IC), the combination of an individual's physical and mental capacities. The World Health Organization (WHO) developed the Integrated Care for Older People (ICOPE) framework as a person-centred care pathway to identify declines in IC and link older adults to appropriate interventions. The ICOPE model outlines a four-step approach involving basic community-based assessment, in-depth clinical evaluation, personalized care planning, and regular monitoring. However, evidence on large-scale implementation of this framework remains limited.

Objective: To assess the feasibility and diagnostic accuracy of Step 1 screening across all seven municipalities of Andorra, and to link individuals to tailored interventions.

Methods: From 2020 to 2025, 874 community-dwelling adults ≥ 60 years underwent Step 1 screening followed by full Step 2 assessment, using instruments from the WHO ICOPE Handbook.Local adaptations included a clock-drawing test, the Montreal Cognitive Assessment (MoCA), Body Mass Index (BMI), and frequency-based scoring of the Patient Health Questionnaire-9 (PHQ-9). Diagnostic metrics (sensitivity, specificity, and Cohen's kappa [κ]) were calculated for each domain. Referrals and interventions were tracked.

Results: Of 857 participants analysed, Step 2 showed the highest prevalence of impairment in hearing (55 %) and cognition (39 %). Step 1 sensitivity improved notably after adaptations: cognition (+12 percentage points), mood (+30 percentage points), and nutrition (+6 percentage points), with vision specificity rising from 17 % to 99.5 %. Overall, 1 182 referrals were generated; 8 % joined a 12-week multicomponent programme including physical activity, nutrition and psychosocial support.

Conclusion: The ICOPE model is feasible at national scale. Local adaptations significantly enhanced screening accuracy without added burden. The Andorran experience offers a scalable and replicable model for other countries or regions and highlights the value of embedding healthy ageing in community care.

Introduction: The Integrated Care for Older People (ICOPE) care model is being actively implemented worldwide, including in low-resource countries like Nepal. We aimed to conduct a survey to understand the major barriers and facilitators of implementing ICOPE in Nepal from a clinical perspective.

Methods: A survey questionnaire was developed to assess the barriers and facilitators of implementing ICOPE at the micro, meso, and macro levels and the recommended four steps of ICOPE. Relevant suggestions for improving ICOPE were also collected from the implementors.

Results: Among the 11 (ICOPE implementors) respondents, four were geriatricians and seven were non-geriatric clinicians. Lack of suitable infrastructure, shortage of trained workforce, comparatively low priority for geriatric health and geriatrics, lack of national guidelines and funding were considered the major barriers for implementing ICOPE in Nepal. Major facilitators for implementing ICOPE in Nepal were motivated healthcare workers, continuous support from the WHO, and government ICOPE training programs. Lack of a systematic referral framework with no provision of electronic health records and a dedicated team were considered as major barriers in completing the recommended four steps of ICOPE. The respondents thought the ICOPE application was feasible in Nepal, which could also serve as a tool to share health records digitally. Additionally, localisation of the ICOPE pathway was suggested.

Conclusion: The ICOPE care pathway was considered quite feasible in Nepal by the implementors, although more work is needed to remove the current barriers and embed ICOPE in the existing healthcare system.

Background: Korea is projected to become a super-aged society by 2025, prompting the World Health Organization (WHO) to develop the Integrated Care for Older People (ICOPE) framework for person-centered, community-based care. Despite Korea's efforts in translating ICOPE materials and launching pilot projects, evidence on their national policy alignment and feasibility for scale-up remains limited.

Objective: This study assesses the policy relevance and feasibility of implementing the ICOPE framework in Korea through expert consensus and structural comparison with ongoing national and local initiatives.

Methods: A three-round Delphi survey involved 31 experts in geriatrics, public health, and aging policy. Thirty-two ICOPE implementation items were evaluated across micro, meso, and macro levels using interquartile range (IQR) and content validity ratio (CVR). Results were compared with key Korean programs, including the Seoul Health Companion Center and Ministry of Health and Welfare's Integrated Care Pilot Project.

Results: Most ICOPE elements, particularly at the micro level (e.g., frailty screening in primary care: IQR = 0.93, CVR = 0.72), were deemed relevant and feasible. However, macro-level components like digital infrastructure and financing showed limited readiness.

Conclusion: The ICOPE framework is broadly compatible with Korea's integrated care strategies, especially at the micro level. Macro-level implementation gaps persist. This study's findings, particularly identified consensus priorities and policy-practice gaps, aim to directly inform future policy design and scale-up strategies for integrated care in Korea, guiding efforts in governance integration, ICT infrastructure development, and indicator standardization.

Frailty and sarcopenia represent harm to good longevity and are often related to inadequate dietary intake and to a decrease in appetite over the years, which are characteristics of a complex process also known as anorexia in aging. Understanding the factors leading to anorexia in aging is crucial for enabling the adequate development of public policies and clinical strategies to prevent and treat this condition and to help older adults to pursue healthy aging pathways. In the present article, a brief overview on the factors contributing to appetite loss and malnutrition among older adults is presented, and challenges to timely identifying and treating anorexia in aging are discussed. Major factors known to affect appetite and favor lower food intake in older people include physiological, pathological or social conditions. Trials testing treatments for anorexia in aging have focused on education, exercise, meal adjustments, nutritional supplementation and medications, but results are variable, partly due to the multitude of etiological factors and determinants of appetite loss in older adults, demanding further research. Routine screening in primary care with simple tools, as the Integrated Care for Older People (ICOPE) program, might important contribute for preserving intrinsic capacity and nutritional status, as also to early identifying the need for treating anorexia in aging.

Aim: Handgrip strength (HGS) is a simple, noninvasive measure that may help with the early detection and risk assessment of cognitive decline in middle-aged and older adults. This study aimed to explore the relationship between both absolute and relative measures of HGS and cognitive impairment in a nationally representative sample of Mexican adults aged 55 and older.

Methods: This secondary cross-sectional study included 1870 participants (58.4% women; mean age = 68.1 ± 8.7 years) from the Mexican Cognitive Aging Study (Mex-Cog). Data from individuals aged ≥ 55 years included socioeconomic, lifestyle, anthropometric, and biomarker information. HGS was assessed using a dynamometer in absolute values (kg) and relative indices (HGS/height, HGS/height², HGS/weight, and HGS/BMI). Quartiles (Q) were created, with Q4 representing the highest performance. Cognitive impairment was defined as an MMSE score of < 24 points. Associations were examined using sex-stratified binary logistic regression adjusted for age, education level, and population density.

Results: Women in the lowest quartile of absolute handgrip strength had significantly higher odds of cognitive impairment than those in the highest quartile (odds ratio [OR] = 2.24, 95% CI 1.04-4.80, p = 0.039). In men, significant associations were found for the second quartile of HGS normalised by height and height². Overall, absolute HGS and HGS/height² showed the strongest and most consistent significant association with cognitive impairment.

Conclusions: Lower absolute and relative HGS values were strongly associated with a higher likelihood of cognitive impairment in Mexican adults. Due to its low cost, accessibility, and reproducibility, HGS may represent a practical biomarker for the early detection and tracking of cognitive decline, particularly in low-resource settings.

Oral health is a critical determinant of overall well-being and healthy aging, especially in countries with growing older populations and health disparities. Maintaining healthy teeth, gums, and orofacial structures improves the quality of life (QoL) while simultaneously reducing the risk associated with several non-communicable diseases through modifying shared risk factors and controlling inflammation. Oral diseases, such as dental caries and periodontal issues, affect nearly 903 million people in Southeast Asia (SEA), with a 61.4% increase in their prevalence from 1990 to 2019. Poor oral health, especially in older individuals, is associated with functional impairments, nutritional deficiencies, psychosocial challenges, and systemic health issues such as diabetes and cardiovascular diseases. Shared risk factors, including dietary habits, stress, and socioeconomic inequalities, compound these challenges. Functional limitations due to oral health inadequacies, such as edentulism, difficulty chewing, pain during eating, and speech impairments, negatively impact nutritional intake and social participation. The impact of oral diseases on QoL and their association with systemic health emphasize the need for preventive strategies and early interventions. Enhancing oral health can bridge the gap between lifespan and healthspan, thereby improving an individual's QoL, reducing healthcare costs, easing the burden on the healthcare system, and alleviating societal burdens for future generations. Most oral health issues can be managed and mitigated through integrated healthcare strategies, preventive interventions, and public education campaigns. This review emphasizes the need for awareness and a collaborative, interprofessional approach within the healthcare system to ensure equitable access to oral care and support healthy aging across SEA.

Objectives: This study explored the feasibility of agricultural activities for older adults with type 2 diabetes and the psychological and nutritional effects of the activities.

Methods: Nine adults over 65 years of age, capable of performing agricultural activities without assistance were randomly assigned to two groups in a crossover design. Participants engaged in one-hour morning agricultural activities at the Kyoto University farm once a week for 15 weeks (July-November). The Wilcoxon rank-sum test compared Δ values, representing changes from baseline to follow-up, between control and intervention years.

Results: Six participants (three each group) completed the protocol. After the assignment of nine, one participant withdrew, and two others were unable to participate in any agricultural activities due to busy schedules. The procedures were performed safely and no adverse events were reported. Vigor/Activity scores of the Profile of Mood States (POMS-VA) indicated significantly maintained vigor in the intervention year; the median Δ POMS-VA was -13 in the control year and 2 in the intervention year (P = 0.01). The Brief-type Self-administered Diet History Questionnaire (BDHQ) suggested that plant-based protein intake was better maintained in the intervention year compared with the control year.

Conclusions: Weekly agricultural activities for older adults with type 2 diabetes showed potential as a therapeutic option, warranting further investigation in a larger and more diverse populations of older patients.

Human movement directly supports physical, emotional, and mental health and well-being-how people think, feel, and function. The neurons that spark creative ideas, the circuits that support memory and focus, and the neurotransmitters that regulate mood all improve function when the body moves and rests when needed. Unfortunately, the modern work setting-including in-person, remote, or hybrid options-has quietly engineered human movement out of the day. As cognitive demands on knowledge workers rise, their opportunities for movement decline. And as their movement declines, their cognitive abilities are under increased stress. This phenomenon may be referred to as the sedentary - cognitive paradox. Companies can leverage the work environment, corporate polices, and culture to position movement as cognitive infrastructure. In the context of a work environment where attention, creativity, and adaptability may be challenged resources, movement is a strategic imperative that can effectively address the sedentary - cognitive paradox.

Purpose: We constructed and validated a frailty-intrinsic capacity (FR-IC) index for predicting disability in community-dwelling older Japanese adults.

Methods: This longitudinal cohort study included 1179 participants aged ≥60 years (mean age: 71.3 ± 7.4 years, 51 % men). A multidisciplinary geriatric team constructed a 35-item FR-IC index (score range: 0: robust to 1: severe frailty, accumulation model) comprising 15 domains incorporating the intrinsic capacity concept (IC-Vision, IC-Hearing, IC-Locomotor capacity, IC-Cognition, IC-Vitality, and IC-Psychological capacity) based on questionnaires widely used in Japan. To test predictive validity, age- and sex-adjusted Cox proportional hazard models estimated hazard ratios (HRs) for incident disability (care need levels ≥1) by FR-IC index quartiles using the cohort study's existing data.

Results: The mean FR-IC index score (32 items, three missing) was 0.08±0.05 (range: 0.00-0.31). During a mean follow-up of 9.0 ± 2.8 years, 284 (24 %) adults developed a disability. Compared with the lowest quartile, the adjusted HRs for developing an incident disability in the second to fourth quartiles were 2.32 (95 % confidence interval: 1.15-5.33), 3.18 (1.64-7.15), and 4.15 (2.14-9.32), respectively. The area under the curve of the FR-IC index for incident disability was 0.86. Among healthy participants, defined as robust by the baseline phenotypic physical frailty assessment (n = 437), sex- and age-adjusted HRs for incident support care through the second to third tertiles were 1.72 (0.79-4.30) and 2.51(1.17-6.22), respectively (trend P = 0.028).

Conclusions: The novel FR-IC index can predict future disability among community-dwelling older Japanese adults. Integrating IC into frailty assessments provides a more comprehensive measure of aging.

Objectives: Adherence to the Mediterranean diet (MedDiet) and engagement in physical activity (PA) are associated with a lower risk of chronic disease, yet their relationship with medication use in older adults is less clear. This study examined cross-sectional associations between MedDiet adherence, PA levels, and medication use, including polypharmacy, in independently living older Australians.

Design: A cross-sectional observational study.

Setting and participants: Baseline data were drawn from the MedWalk trial, including 161 participants (119 females, 42 males; aged 60-90 years) residing in independent living facilities in Adelaide and Melbourne, and the wider Melbourne community.

Measurements: Adherence to the MedDiet was assessed using the 14-item Mediterranean Diet Adherence Screener (MEDAS). PA was objectively measured via accelerometry and categorized as low (<150 min/week), moderate (150-<300 min/week), or high (≥300 min/week) of moderate-to-vigorous PA. Medication use was self-reported and coded using Anatomical Therapeutic Chemical (ATC) classifications. Polypharmacy was defined as use of ≥5 medications. Logistic and negative binomial regression analyses were adjusted for age, sex, education, and BMI.

Results: Moderate and high PA were associated with significantly lower odds of polypharmacy compared with low PA (AOR=0.37, p = 0.047; AOR=0.08, p = 0.022, respectively). High PA was also associated with a reduced total number of medications (exp(B)=0.44, p = 0.018) and fewer cardiovascular medications (AOR=0.29, p = 0.042). Each additional point in MedDiet adherence was associated with reduced use of alimentary tract and metabolism medications (AOR=0.78, p = 0.016), though no association was found with total medication use or polypharmacy.

Conclusion: In this cross-sectional study, higher PA was consistently associated with reduced polypharmacy and fewer medications, while greater MedDiet adherence was linked to reduced use of metabolic medications. Lifestyle practices may influence medication use patterns in later life. Larger longitudinal studies are needed to clarify causality and inform strategies to reduce polypharmacy through promotion of healthy lifestyle behaviors.