Age and ageing最新文献

Background: Neurocognitive disorders (i.e. dementia) are a leading cause of cognitive decline and loss of independence among older adults. While reported rates are higher among autistic adults, it is unclear whether this disparity persists after accounting for known risk factors.

Objective: We compared neurocognitive disorder risk between autistic and non-autistic older adults after adjusting for known risk factors and evaluated whether risk factors moderated this disparity. We replicated our analyses among subsets of autistic older adults with and without co-occurring intellectual disability (ID).

Design: Retrospective longitudinal cohort study.

Setting: National Medicare Standard Analytical Files (2013-21).

Participants: The sample included 9201 autistic and 18 356 non-autistic older adults aged 65 or older, who were matched on demographic and clinical characteristics.

Methods: Our dependent variable was time to neurocognitive disorder, defined as years between age 65 or older and the date of first diagnosis.

Results: Autistic older adults had a 20% higher adjusted risk of neurocognitive disorders than non-autistic older adults (95% CI = 14%-25%; P < .001). Risk was highest among autistic adults with co-occurring ID [adjusted subhazard ratio (SHR) = 1.46; 95% CI = 1.36-1.57]. The disparity between cohorts was amplified in the presence of most known risk factors, notably hypertension (SHR = 2.04; 95% CI = 1.79-2.32), high cholesterol (SHR = 1.60; 95% CI = 1.46-1.75), depression (SHR = 1.52; 95% CI = 1.42-1.62), and type 2 diabetes (SHR = 1.45; 95% CI = 1.36-1.55).

Conclusions: Autistic older adults, particularly those with ID, face significantly higher risk of neurocognitive disorders even after adjusting for known risk factors. These findings emphasise that risk factors may impact the autistic population differently and highlight the need for early screening and tailored prevention strategies.

Introduction: Nature experienced with peers may mitigate the harmful outcomes of loneliness on health and wellbeing. The H2020 RECETAS 'Friends in Nature (FiN)-Helsinki' group intervention for lonely older adults in Helsinki assisted living facilities (ALFs) aimed to investigate the effects on participants' loneliness and health-related quality of life (HRQoL). We also examined factors influencing effects between the intervention and the outcomes.

Methods: Lonely participants were recruited from 22 ALFs in Helsinki area, Finland and randomised into two groups: (i) nature-based group intervention once a week for 9 weeks (n = 162) and (ii) usual care (n = 157). Loneliness (modified De Jong Gierveld Loneliness Scale = mDJGLS) and HRQoL (15D) were assessed as the primary outcomes at baseline, 3, 6 and 12 months.

Results: Most participants (mean age 83 years, 73% women) were living with frailty (66%) and had dementia (55%). Whilst loneliness was reduced in the intervention group at three months (mean change -2.2 points [95% confidence interval (CI) -3.5 to -0.9] in mDJGLS, it remained at baseline level amongst controls (mean change -0.1 (95% CI -1.4 to 0.9); P = .025 between groups). During the 6- and 12-month follow-ups the difference was reduced. No difference emerged between groups in changes of HRQoL according to the 15D. However, the 'sleep' dimension in 15D improved in the intervention relative to controls during the 12-month follow-up. Frequent attendance in group sessions and extended time spent outdoors affected effects on both HRQoL and loneliness. High self-efficacy at baseline influenced effect on both HRQoL and mDJGLS. Being male, <85 years old, non-frail, having Mini-Mental-State Examination >20 and exhibiting a high Nature Connection Index at baseline influenced the magnitude of effect in reducing loneliness.

Conclusions: Group intervention with nature contacts had favourable effects on loneliness and sleep amongst physically and cognitively frail, lonely older adults in ALFs.

Trial registration: ClinicalTrials.gov, ID: NCT05507684. Registration 19/08/2022.

Background: Consistent antihypertensive treatment reduces cardiovascular risk, but older adults requiring long-term care (LTC) due to functional impairment may have a diminished ability to adhere to treatment.

Objective: To examine antihypertensive medication adherence among older adults requiring LTC in Japan and to identify its associated factors.

Design: Retrospective cohort study.

Setting: 11 municipalities.

Participants: Individuals aged ≥65 years requiring LTC and diagnosed with hypertension between April 2016 and March 2020.

Methods: Medical claims data, LTC claims data and LTC certification data were analysed. The study outcome was antihypertensive medication adherence (proportion of days covered >0.8) over 1 year. Using logistic regression analysis, we assessed the associations between adherence and the following factors: care needs levels, paralysis, visual function, hearing function, swallowing function, cognitive function and need for medication intake assistance.

Results: The study cohort comprised 69 200 participants (nonadherent: 17 523; 25.3%). At LTC certification application, most participants lived at home (78.3% adherent vs. 64.1% nonadherent). Adherence was negatively associated with high care needs levels (odds ratio: 0.241, 95% confidence interval: 0.222-0.263), bilateral upper limb paralysis (0.605, 0.565-0.648), bilateral lower limb paralysis (0.837, 0.803-0.873), left upper limb paralysis (0.820, 0.746-0.921), moderate visual impairment (0.738, 0.675-0.808), severe hearing impairment (0.683, 0.549-0.853), severe swallowing impairment (0.199, 0.169-0.234), severe cognitive impairment (0.652, 0.621-0.684) and need for full medication intake assistance (0.296, 0.279-0.315).

Conclusions: Over 25% of older adults requiring LTC were nonadherent to antihypertensive treatment. These findings may help to identify high-risk individuals who could benefit from targeted interventions to support medication management.

Introduction: Various methodological approaches exist to estimate physical resilience in older adults (phenotype, expected recovery, adapted ageing), but their comparative performance remains unclear. This study evaluated their agreement and predictive performance across two clinical contexts.

Methods: We applied three methodological approaches in two cohorts: older adults receiving chemotherapy (TENT) and those presenting with acute illness at the emergency department (APOP). Physical functioning was assessed using Katz Activities of Daily Living and Lawton Instrumental Activities of Daily Living scales. The phenotype approach measured functional change after the health stressor; the expected recovery approach compared actual to predicted recovery based on clinical characteristics; and the adapted ageing approach assessed baseline function relative to expected levels given clinical risk profile. Outcomes at 12 months included mortality and a composite endpoint of functional decline, quality of life decline or mortality. Agreement was assessed using Cohen's kappa and predictive performance using area under the curve (AUC).

Results: The TENT cohort included 330 patients (median age 75 years; 43% female) and APOP included 2111 patients (median age 78 years; 54% female). Agreement between approaches was poor to moderate (κ = -0.10 to 0.64). All approaches showed only moderate discriminative ability for 12-month mortality (AUC 0.55-0.69) and composite outcomes (AUC 0.52-0.66). The physical resilience approaches provided limited added discrimination beyond simple predictors: functional score at follow-up (AUC 0.65-0.69) and age (AUC 0.48-0.67).

Conclusion: Various physical resilience approaches identified different patient groups as resilient and demonstrated limited prognostic value. Current approaches may inadequately capture the dynamic construct of physical resilience; higher-frequency longitudinal measures may better quantify physical resilience for clinical practice.

Background: Antibiotics are commonly prescribed in older community-dwelling adults, contributing to adverse effects, antimicrobial resistance and increased healthcare costs. Prescribing patterns in dementia are unclear, although healthcare use and goals of care change around diagnosis.

Objective: To describe trends in antibiotic dispensing and prevalence amongst Australians aged ≥70 years, compare dispensing between those with and without dementia and identify factors associated with dispensing.

Methods: We analysed data from 13 659 ASPREE and ASPREE-XT participants (2010-20). Antibiotic dispensing was assessed using Pharmaceutical Benefits Scheme records, with rates stratified by age group. Interrupted time-series analysis compared dispensing rates and the proportion of broad- versus narrow-spectrum antibiotics dementia case and matched controls (matched on time since randomisation, age and sex). Negative binomial regression identified factors associated with dispensing.

Results: Dispensing rates increased to 1651 per 1000 person-years (95% CI: 1604-99) by year 9. Annual prevalence averaged 47%. Broad-spectrum antibiotics were dispensed twice as often as narrow-spectrum. Individuals with dementia had higher dispensing both before and after diagnosis, but dementia was not independently associated with dispensing (IRR 1.06, 95% CI: 0.95-1.18). Female sex, polypharmacy, pre-frailty and higher depressive symptom scores were linked to higher dispensing, whilst hypertension, dyslipidaemia and alcohol use were linked to lower dispensing.

Conclusions: Antibiotic dispensing in older adults remains high, dominated by broad-spectrum agents. Dementia was not independently associated with increased dispensing. Female sex, polypharmacy, pre-frailty and depressive symptoms identified groups who may benefit most from targeted antimicrobial stewardship interventions.

Background: Age-associated loss of skeletal muscle mass impairs metabolic health, increases disease risk and diminishes response to therapeutic interventions. Optimising dietary protein intake combined with resistance training has been proposed as an effective strategy to preserve muscle mass in older adults. While the clinical benefits of such lifestyle interventions are known, the long-term metabolic safety and precise systemic changes at the metabolome level in older adults remain uncharacterised.

Methods: In the NutriAging Protein study, 136 men and women aged 65-85 years were randomised into three groups: control, recommended-protein and high-protein groups. Participants underwent a 17-week intervention, combining a 6-week dietary intervention followed by 8 weeks of supervised resistance training in the high-protein and recommended-protein groups. Plasma samples were collected at baseline, Week 8 and Week 17. An untargeted metabolomics approach based on ultra-high-performance liquid chromatography-mass spectrometry was employed to characterise systemic metabolic alterations across interventions.

Results: The high-protein group increased their daily protein intake to 1.6 g/kg body weight and exhibited significantly increased concentrations of two metabolites and reduced concentrations of 98 metabolites compared to baseline. Most metabolite shifts occurred during the dietary intervention phase, with minimal additional changes after resistance training. Affected metabolites belonged primarily to lipid subclasses, energy and amino acid metabolism intermediates, and pathways linked to heme degradation and the urea cycle.

Conclusion: A high-protein diet, alone or combined with resistance training, induces modest but measurable metabolic shifts without disrupting global metabolic homeostasis. These findings suggest that older adults can adapt to elevated protein intake while maintaining metabolic stability, supporting the metabolic safety of a high-protein diet in combination with resistance exercise. https://clinicaltrials.gov (NCT04023513).

Background: Dementia care is a health and social care priority, with rising prevalence driven by ageing populations worldwide. Timely and accurate diagnosis improves quality of life, enables access to support and is becoming even more critical due to the emergence of disease-modifying therapies for Alzheimer's disease. Complex referral pathways can contribute to diagnostic delays and under-diagnosis. A structured, evidence-based referral template could enhance diagnostic efficiency and care quality.

Methods: This study was conducted in two phases. First, a two-round e-Delphi survey was used to achieve consensus on items for inclusion in a dementia referral template. In the second phase, a modified Nominal Group Technique was employed with a multidisciplinary panel and Public and Patient Involvement (PPI) contributors to discuss, refine and prioritise items, ensuring clinical relevance and practical applicability.

Results: The consensus process refined and prioritised 76 potential referral items into a final set of 11 essential components. The resulting concise template balances clinical relevance with usability, potentially supporting more efficient referral and triage. Items achieving the highest consensus included cognitive screening scores, rapid deterioration, problems with daily activities and patient safety concerns.

Conclusion: The findings demonstrate the value of structured consensus methods in developing a practical, evidence-based referral template, tailored to optimise dementia diagnostic pathways. This is particularly important in the current evolving therapeutic landscape, to ensure that people with suspected dementia receive timely diagnosis and access to appropriate care and treatment options.

Objective: Population ageing has increased the need for solutions that support independent living, with medication management being a major challenge. We assessed the effects of reminder technologies among home-dwelling older citizens on outcomes within the Quintuple Aim domains: user experiences, care professional experiences, health/wellbeing, health and social service utilisation/costs and equity.

Methods: We searched databases (Scopus, CENTRAL, PubMed, Web of Science, CINAHL, PsycINFO and Cochrane Reviews) from 1.1.2017 to 29.9.2025. Two authors extracted relevant data and assessed the quality of the included studies. We assessed the evidence using a four-level quality rating scale: strong, moderate, limited or no evidence.

Results: Twenty-three original studies and nine systematic reviews were included, resulting in 43 original studies. Significant beneficial effects on health outcomes were observed in 20 out of 40 studies, and on service utilisation in one out of four studies. Significant effects on patient/carer experiences and cost-effectiveness were not found, whereas no study assessed effects on professional experiences or equity. Only for clinical health outcomes, in particular systolic blood pressure and physical symptoms, the effectiveness of reminders reached moderate evidence.

Conclusion: While clinical health benefits have been observed, more high-quality research is needed to determine whether medication reminder technologies can help more broadly to respond to the challenges of population ageing, including the high pressure on health services and related expenditures.

Background: Health recommender systems offer new opportunities to meet the personalized needs of people with dementia and their caregivers, but evidence on their effectiveness remains limited.

Objective: This study aimed to evaluate the effectiveness of a mobile application-based dementia care intelligent recommender system (DCIRS) among caregivers of people with dementia.

Methods: We conducted a RCT among family caregivers of people with dementia in China. Participants were randomly assigned to either the intervention group or a waitlist control group (n = 125 per group). Caregivers in the control group received no intervention during the study period, whereas those in the intervention group received access to a remote, mobile application-based DCIRS. Outcomes were assessed at baseline (T0), week 6 (T1), and week 12 (T2). The outcomes included distress related to care problems, caregiver burden, depressive symptoms, and the occurrence of safety-related events. Generalized estimating equations were used for analysis.

Results: The caregivers in intervention group showed significant reductions in distress scores for dressing, personal hygiene, communication, and behavioural and psychological care problems at both the 6th and 12th week assessments. Caregiver burden scores in the intervention group showed a continuous decline from baseline to week 6 (MD = -1.61) and further to week 12 (MD = -3.43) (P < .05). Within-group analyses showed that depressive symptom scores remained largely stable from baseline to week 6 and week 12 in both the intervention and control groups, with no significant pre-post changes detected. A significant between-group difference was found in the total number of safety-related events (P = .037).

Conclusion: In summary, this RCT showed that the DCIRS may reduce caregivers' distress related to care problems and lessen caregiver burden. Although depressive symptoms did not improve significantly, further research is needed to assess long-term effects and clarify the mechanisms underlying remote, personalized interventions such as the DCIRS.

Registration: The trial was registered at the Chinese Clinical Trials Registry (ChiCTR2200066087).