Pub Date : 2025-11-20DOI: 10.1016/j.archger.2025.106087
Ana Rita Capela Oliveira , Carla Maria Pintado Magueja , Armando Manuel Gonçalves de Almeida
Background
Fear of falling in older adults is a multifactorial psychological condition associated with the degree of confidence in performing activities of daily living without falling, leading to reduced physical activity, quality of life, and life satisfaction, and resulting in social isolation.
Purpose
This study aimed to summarize and evaluate effective actions to control fear of falling in older adults.
Method
An umbrella review of interventions that control fear of falling in people aged ≥60 years was conducted, in accordance with JBI and PRISMA guidelines. The search was conducted in six electronic databases: CINAHL, Web of Science, MEDLINE, Scopus, Cochrane Reviews, and JBI Databases, during the period from February to April 2024.
Results
Of a total of 706 references identified, 25 met the eligibility criteria. Of those included, eleven studies are systematic review, three studies are meta-analysis, and eleven studies are systematic review with meta-analysis. Five types of action to control fear of falling with therapeutic potential were identified: Physical and functional therapy; Cognitive Behavioral Therapy; Combined strategies; Multifactorial preventive programs; Technological interventions.
Conclusions
The results of this umbrella review indicate that holistic exercises (Tai Chi, Yoga, Pilates) are the most effective in mitigating fear of falling in older adults. Interventions that incorporate multimodal approaches also appear to be beneficial. The combination of physical and cognitive actions is widely recognized as effective and long-lasting. Longitudinal studies are needed to assess the effectiveness of actions over time.
背景：老年人对跌倒的恐惧是一种多因素的心理状况，与进行日常生活活动而不摔倒的信心程度有关，导致身体活动减少，生活质量下降，生活满意度下降，并导致社会孤立。目的：本研究旨在总结和评估控制老年人跌倒恐惧的有效措施。方法：根据JBI和PRISMA指南，对60岁以上人群中控制跌倒恐惧的干预措施进行综合评价。检索于2024年2月至4月期间在六个电子数据库中进行：CINAHL， Web of Science， MEDLINE, Scopus， Cochrane Reviews和JBI数据库。结果：共纳入706篇文献，其中25篇符合入选标准。其中11项研究为系统评价，3项研究为荟萃分析，11项研究为系统评价加荟萃分析。确定了五种具有治疗潜力的控制跌倒恐惧的行动：物理和功能治疗；认知行为疗法；组合策略;多因素预防方案；技术干预措施。结论：这一综述的结果表明，整体运动（太极、瑜伽、普拉提）在减轻老年人对跌倒的恐惧方面最有效。采用多模式方法的干预措施似乎也是有益的。身体和认知活动的结合被广泛认为是有效和持久的。需要进行纵向研究来评估长期行动的有效性。
{"title":"Actions to control the fear of falling in older people: An umbrella review","authors":"Ana Rita Capela Oliveira , Carla Maria Pintado Magueja , Armando Manuel Gonçalves de Almeida","doi":"10.1016/j.archger.2025.106087","DOIUrl":"10.1016/j.archger.2025.106087","url":null,"abstract":"<div><h3>Background</h3><div>Fear of falling in older adults is a multifactorial psychological condition associated with the degree of confidence in performing activities of daily living without falling, leading to reduced physical activity, quality of life, and life satisfaction, and resulting in social isolation.</div></div><div><h3>Purpose</h3><div>This study aimed to summarize and evaluate effective actions to control fear of falling in older adults.</div></div><div><h3>Method</h3><div>An umbrella review of interventions that control fear of falling in people aged ≥60 years was conducted, in accordance with JBI and PRISMA guidelines. The search was conducted in six electronic databases: CINAHL, Web of Science, MEDLINE, Scopus, Cochrane Reviews, and JBI Databases, during the period from February to April 2024.</div></div><div><h3>Results</h3><div>Of a total of 706 references identified, 25 met the eligibility criteria. Of those included, eleven studies are systematic review, three studies are meta-analysis, and eleven studies are systematic review with meta-analysis. Five types of action to control fear of falling with therapeutic potential were identified: Physical and functional therapy; Cognitive Behavioral Therapy; Combined strategies; Multifactorial preventive programs; Technological interventions.</div></div><div><h3>Conclusions</h3><div>The results of this umbrella review indicate that holistic exercises (Tai Chi, Yoga, Pilates) are the most effective in mitigating fear of falling in older adults. Interventions that incorporate multimodal approaches also appear to be beneficial. The combination of physical and cognitive actions is widely recognized as effective and long-lasting. Longitudinal studies are needed to assess the effectiveness of actions over time.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106087"},"PeriodicalIF":3.8,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-16DOI: 10.1016/j.archger.2025.106086
Xiaoyu Qian , Congdi Wang , Xueman Zhao , Min Jin , Yonghao Xiao , Ziwang Zhou , Feifei Jia
Background
Depression and cognitive decline frequently co-occur in late life, potentially reflecting shared biological, psychological, or social pathways. However, their temporal relationship remains unclear. Understanding how cognitive deterioration and depression unfold over time may inform prevention and intervention strategies.
Methods
This cohort study analyzed 40,167 older adults without baseline depression from CHARLS, HRS, and SHARE (2010–2021). Depressive symptoms were assessed using validated scales. Cognitive function was assessed across memory, executive function, and orientation, and standardized as z-scores. Linear mixed models estimated cognitive trajectories before, at, and after depression onset.
Results
Across 401,017.8 person-years, 10530 participants developed depression. Compared with non-depressed individuals, those with depression onset showed faster cognitive decline before onset, acute decline at onset, and accelerated decline thereafter across all cognitive domains (P <0.001).
Discussion
Cognitive decline precedes, accompanies, and accelerates after the onset of depression among older adults. These findings suggest that cognitive impairment may be an early signal associated with depression risk, highlighting the importance of routine cognitive monitoring in preventive mental health strategies.
{"title":"Cognitive decline before and after incident depression: Evidence from three international prospective cohorts","authors":"Xiaoyu Qian , Congdi Wang , Xueman Zhao , Min Jin , Yonghao Xiao , Ziwang Zhou , Feifei Jia","doi":"10.1016/j.archger.2025.106086","DOIUrl":"10.1016/j.archger.2025.106086","url":null,"abstract":"<div><h3>Background</h3><div>Depression and cognitive decline frequently co-occur in late life, potentially reflecting shared biological, psychological, or social pathways. However, their temporal relationship remains unclear. Understanding how cognitive deterioration and depression unfold over time may inform prevention and intervention strategies.</div></div><div><h3>Methods</h3><div>This cohort study analyzed 40,167 older adults without baseline depression from CHARLS, HRS, and SHARE (2010–2021). Depressive symptoms were assessed using validated scales. Cognitive function was assessed across memory, executive function, and orientation, and standardized as z-scores. Linear mixed models estimated cognitive trajectories before, at, and after depression onset.</div></div><div><h3>Results</h3><div>Across 401,017.8 person-years, 10530 participants developed depression. Compared with non-depressed individuals, those with depression onset showed faster cognitive decline before onset, acute decline at onset, and accelerated decline thereafter across all cognitive domains (P <0.001).</div></div><div><h3>Discussion</h3><div>Cognitive decline precedes, accompanies, and accelerates after the onset of depression among older adults. These findings suggest that cognitive impairment may be an early signal associated with depression risk, highlighting the importance of routine cognitive monitoring in preventive mental health strategies.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106086"},"PeriodicalIF":3.8,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-15DOI: 10.1016/j.archger.2025.106085
Sutong Wang , Lin Wang , Yongcheng Wang , Xiaoyu Su , Feihu Zhang , Shuli Zong , Lei Qi , Yuehua Jiang , Jifu He , Xiao Li
Objective
We aimed to characterize frailty dynamics in older adults by applying multi-state Markov models (MSMs) to English Longitudinal Study of Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS) data to estimate transition intensities.
Methods
Data from ELSA (2004–2012) and CHARLS (2011–2018) cohorts were analyzed using MSMs. Frailty was assessed using the Frailty Index (FI), and covariates like age, sex, marital status, physical activity, and economic status were included. Transition probabilities between frailty states were estimated, and subgroup analyses were performed to assess the influence of covariates on frailty transitions.
Results
A total of 8 187 participants from ELSA, and 9 171 participants from CHARLS were included in the analysis. In ELSA, the transition intensity from pre-frail to robust (0.226, 95 % CI 0.217–0.234) exceeded that from pre-frail to frail (0.105, 95 % CI 0.099–0.111), whereas in CHARLS a different pattern was observed. In the covariate analysis, we found that age, marital status, loneliness, physical activity, current drinking status, and economic status exerted both common and cohort-specific effects on frailty transitions in ELSA and CHARLS, with age and marital status influencing bidirectional frailty transitions in both cohorts.
Conclusion
Frailty is reversible, especially in the pre-frail stage. Transition intensities and influencing factors vary across older adult cohorts in different countries, and beyond age, marital support, physical activity quality, and economic status significantly shape frailty trajectories and should be incorporated into public health policy design.
目的：通过将多状态马尔可夫模型（msm）应用于英国老龄化纵向研究（ELSA）和中国健康与退休纵向研究（CHARLS）数据来估计过渡强度，以表征老年人的衰弱动态。方法：采用MSMs对ELSA（2004-2012）和CHARLS（2011-2018）队列的数据进行分析。使用虚弱指数（FI）评估虚弱程度，协变量包括年龄、性别、婚姻状况、身体活动和经济状况。估计脆弱状态之间的过渡概率，并进行亚组分析以评估协变量对脆弱状态过渡的影响。结果：ELSA共纳入受试者8 187人，CHARLS共纳入受试者9 171人。在ELSA中，从虚弱前期到强壮的过渡强度（0.226,95% CI 0.217-0.234）超过了从虚弱前期到虚弱的过渡强度（0.105,95% CI 0.099-0.111），而在CHARLS中观察到不同的模式。在协变量分析中，我们发现年龄、婚姻状况、孤独、身体活动、当前饮酒状况和经济状况对ELSA和CHARLS的虚弱转变既有共同的影响，也有特定队列的影响，年龄和婚姻状况影响两个队列的双向虚弱转变。结论：虚弱是可逆的，尤其是在虚弱前期。不同国家老年人群体的过渡强度和影响因素各不相同，年龄之外，婚姻支持、身体活动质量和经济状况在很大程度上决定了脆弱性轨迹，应纳入公共卫生政策设计。
{"title":"Bidirectional transitions of frailty states in middle-aged and older adults: Findings from two longitudinal cohorts studies","authors":"Sutong Wang , Lin Wang , Yongcheng Wang , Xiaoyu Su , Feihu Zhang , Shuli Zong , Lei Qi , Yuehua Jiang , Jifu He , Xiao Li","doi":"10.1016/j.archger.2025.106085","DOIUrl":"10.1016/j.archger.2025.106085","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to characterize frailty dynamics in older adults by applying multi-state Markov models (MSMs) to English Longitudinal Study of Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS) data to estimate transition intensities.</div></div><div><h3>Methods</h3><div>Data from ELSA (2004–2012) and CHARLS (2011–2018) cohorts were analyzed using MSMs. Frailty was assessed using the Frailty Index (FI), and covariates like age, sex, marital status, physical activity, and economic status were included. Transition probabilities between frailty states were estimated, and subgroup analyses were performed to assess the influence of covariates on frailty transitions.</div></div><div><h3>Results</h3><div>A total of 8 187 participants from ELSA, and 9 171 participants from CHARLS were included in the analysis. In ELSA, the transition intensity from pre-frail to robust (0.226, 95 % CI 0.217–0.234) exceeded that from pre-frail to frail (0.105, 95 % CI 0.099–0.111), whereas in CHARLS a different pattern was observed. In the covariate analysis, we found that age, marital status, loneliness, physical activity, current drinking status, and economic status exerted both common and cohort-specific effects on frailty transitions in ELSA and CHARLS, with age and marital status influencing bidirectional frailty transitions in both cohorts.</div></div><div><h3>Conclusion</h3><div>Frailty is reversible, especially in the pre-frail stage. Transition intensities and influencing factors vary across older adult cohorts in different countries, and beyond age, marital support, physical activity quality, and economic status significantly shape frailty trajectories and should be incorporated into public health policy design.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106085"},"PeriodicalIF":3.8,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-14DOI: 10.1016/j.archger.2025.106084
Juan Robles Costa , Angélica Quintero-Flórez , Emilio García-Cabrera , Julia Romero-Barranca , Ángel Vilches-Arenas
Background
Increases in life expectancy and declining birth rates have intensified the demographic weight of older adults, particularly women. This population frequently faces intersecting age and gender-based discrimination, resulting in greater health burdens and lower quality of life compared to men.
Objective
To examine gender-based disparities affecting older adults, particularly older women, intending to uncover underlying mechanisms and contribute to the formulation of more equitable, gender-responsive, and age-sensitive public health policies.
Study design
This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420251104219).
Methods
Six databases were searched (2014–2024) for studies in English or Spanish on gender- and age-based health inequalities in older adults. Eligible systematic reviews, observational, and experimental studies were quality-assessed (PRISMA, STROBE, CONSORT), and findings were synthesized qualitatively.
Results
Fourteen studies met the inclusion criteria. Across contexts, older women consistently exhibited higher prevalence of disability, frailty, depression, and poorer self-rated health, frequently linked to lower educational attainment and income. In contrast, older men showed lower prevalence of these conditions but faced higher mortality risks from frailty and suicide. Men also tended to report better subjective quality of life.
Conclusions
While women live longer, they often experience greater illness and functional limitations. Socioeconomic disadvantages explain part of these gaps, but a considerable proportion remains unexplained. These findings highlight the urgent need for gender- and age-sensitive public health strategies to reduce inequities in later life.
{"title":"Ageism and the feminization of old age: A Systematic review","authors":"Juan Robles Costa , Angélica Quintero-Flórez , Emilio García-Cabrera , Julia Romero-Barranca , Ángel Vilches-Arenas","doi":"10.1016/j.archger.2025.106084","DOIUrl":"10.1016/j.archger.2025.106084","url":null,"abstract":"<div><h3>Background</h3><div>Increases in life expectancy and declining birth rates have intensified the demographic weight of older adults, particularly women. This population frequently faces intersecting age and gender-based discrimination, resulting in greater health burdens and lower quality of life compared to men.</div></div><div><h3>Objective</h3><div>To examine gender-based disparities affecting older adults, particularly older women, intending to uncover underlying mechanisms and contribute to the formulation of more equitable, gender-responsive, and age-sensitive public health policies.</div></div><div><h3>Study design</h3><div>This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD420251104219).</div></div><div><h3>Methods</h3><div>Six databases were searched (2014–2024) for studies in English or Spanish on gender- and age-based health inequalities in older adults. Eligible systematic reviews, observational, and experimental studies were quality-assessed (PRISMA, STROBE, CONSORT), and findings were synthesized qualitatively.</div></div><div><h3>Results</h3><div>Fourteen studies met the inclusion criteria. Across contexts, older women consistently exhibited higher prevalence of disability, frailty, depression, and poorer self-rated health, frequently linked to lower educational attainment and income. In contrast, older men showed lower prevalence of these conditions but faced higher mortality risks from frailty and suicide. Men also tended to report better subjective quality of life.</div></div><div><h3>Conclusions</h3><div>While women live longer, they often experience greater illness and functional limitations. Socioeconomic disadvantages explain part of these gaps, but a considerable proportion remains unexplained. These findings highlight the urgent need for gender- and age-sensitive public health strategies to reduce inequities in later life.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106084"},"PeriodicalIF":3.8,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Among traumatic-fracture patients admitted to intensive care units (ICUs), those with substantial chronic comorbidities recover more slowly and die more often than their counterparts without such conditions. The age-adjusted Charlson Comorbidity Index (aCCI) quantifies this burden, yet clinicians still lack a tool that can identify—at the point of ICU admission—which fracture patients are likely to have a high aCCI. To fill this gap, we used a large electronic health-record repository to develop and externally validate an interpretable machine-learning model that predicts severe comorbidity burden in this population.
Methods
We extracted 3 763 adult fracture cases from MIMIC-IV (2008–2019) and split them 3:1 into training and internal validation sets. High comorbidity (aCCI ≥ 7) was defined as the optimal cut-off derived from one-year survival analysis. Nine key predictors emerged from the intersection of LASSO, SVM-RFE, and random-forest importance. Eleven candidate algorithms underwent grid-search hyperparameter tuning with 10-fold cross-validation, and their performance was compared to identify the optimal model, while SHAP clarified model logic. External validation in two Chinese tertiary centres (n = 558) confirmed generalisability, and the final model was deployed as a bedside Shiny calculator.
Results
XGBoost achieved the best internal discrimination (AUROC = 0.84; AUPRC = 0.76) and exhibited excellent calibration and net benefit across clinically relevant thresholds. In external validation, AUROC values were 0.88 (Hainan) and 0.83 (Guangdong). The interactive calculator delivers patient-specific risk explanations in real time.
Conclusions
An XGBoost-based, SHAP-interpretable model accurately predicts high aCCI in ICU fracture patients and generalises across institutions. The readily accessible web tool can help clinicians identify high-risk individuals early, personalise management, and allocate resources more efficiently.
{"title":"An explainable machine learning model for comorbidity risk stratification in patients with fractures admitted to the intensive care unit: a multicenter study","authors":"Xuelong Liang , Weijie Zhao , Weigui Liufu , Jiale Qian , Nantian Xiang , Xinzhe Zhang , Jihui Zhou , Hongwang Cui","doi":"10.1016/j.archger.2025.106082","DOIUrl":"10.1016/j.archger.2025.106082","url":null,"abstract":"<div><h3>Background</h3><div>Among traumatic-fracture patients admitted to intensive care units (ICUs), those with substantial chronic comorbidities recover more slowly and die more often than their counterparts without such conditions. The age-adjusted Charlson Comorbidity Index (aCCI) quantifies this burden, yet clinicians still lack a tool that can identify—at the point of ICU admission—which fracture patients are likely to have a high aCCI. To fill this gap, we used a large electronic health-record repository to develop and externally validate an interpretable machine-learning model that predicts severe comorbidity burden in this population.</div></div><div><h3>Methods</h3><div>We extracted 3 763 adult fracture cases from MIMIC-IV (2008–2019) and split them 3:1 into training and internal validation sets. High comorbidity (aCCI ≥ 7) was defined as the optimal cut-off derived from one-year survival analysis. Nine key predictors emerged from the intersection of LASSO, SVM-RFE, and random-forest importance. Eleven candidate algorithms underwent grid-search hyperparameter tuning with 10-fold cross-validation, and their performance was compared to identify the optimal model, while SHAP clarified model logic. External validation in two Chinese tertiary centres (<em>n</em> = 558) confirmed generalisability, and the final model was deployed as a bedside Shiny calculator.</div></div><div><h3>Results</h3><div>XGBoost achieved the best internal discrimination (AUROC = 0.84; AUPRC = 0.76) and exhibited excellent calibration and net benefit across clinically relevant thresholds. In external validation, AUROC values were 0.88 (Hainan) and 0.83 (Guangdong). The interactive calculator delivers patient-specific risk explanations in real time.</div></div><div><h3>Conclusions</h3><div>An XGBoost-based, SHAP-interpretable model accurately predicts high aCCI in ICU fracture patients and generalises across institutions. The readily accessible web tool can help clinicians identify high-risk individuals early, personalise management, and allocate resources more efficiently.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106082"},"PeriodicalIF":3.8,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145552264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-10DOI: 10.1016/j.archger.2025.106083
Gengxin Yao , Fei Li , Xuehan Ma , Xinyu Wan , Yali Yang , Yiran Xu , Lishuang Zheng , Guichen Li , Li Chen
Aim
To systematically summarise the characteristics and effectiveness of home-based interventions on health outcomes in older adults with frailty or pre-frailty.
Design
Systematic review and meta-analysis.
Methods
Seven databases were searched from their inception through 31st October 2024. Two reviewers independently performed study screening, selection, data extraction, and quality appraisal. Pooled effects were quantified using standardised mean differences (SMDs) with 95 % confidence intervals (CIs). Risk of bias and evidence certainty were assessed using RoB2 and GRADE, respectively.
Results
Twenty-four studies (20 RCTs; n = 3, 826 participants) were included. The meta-analysis demonstrated that home-based interventions significantly reduced frailty phenotype scores (SMD = -0.27, 95 % CI:0.39 to -0.15) and depressive symptoms (SMD = -0.11, 95 % CI:0.20 to -0.01), alongside marked increases in grip strength (MD = 0.84, 95 % CI: 0.26 to 1.42) and mental health-related quality of life (SMD = 0.17, 95 % CI: 0.04 to 0.30). Subgroup analyses indicated that significant improvements in physical function were observed only in supervised subgroup. No significant changes were observed for overall quality of life, or physical health-related quality of life.
Conclusions
Home-based interventions are a valuable strategy for improving frailty, grip strength, and mental health outcomes in older adults with frailty or pre-frailty. Improvements in physical function appear to depend on home-based interventions delivered under professional supervision, while the unsupervised mode may pose the risk of potential iatrogenic harm and therefore necessitates caution alongside safety monitoring.
Reporting Method
This review followed PRISMA guidelines (PROSPERO: CRD42024604527).
{"title":"Effectiveness of Home-Based interventions for older adults with frailty or pre-frailty: a systematic review and meta-analysis","authors":"Gengxin Yao , Fei Li , Xuehan Ma , Xinyu Wan , Yali Yang , Yiran Xu , Lishuang Zheng , Guichen Li , Li Chen","doi":"10.1016/j.archger.2025.106083","DOIUrl":"10.1016/j.archger.2025.106083","url":null,"abstract":"<div><h3>Aim</h3><div>To systematically summarise the characteristics and effectiveness of home-based interventions on health outcomes in older adults with frailty or pre-frailty.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>Seven databases were searched from their inception through 31st October 2024. Two reviewers independently performed study screening, selection, data extraction, and quality appraisal. Pooled effects were quantified using standardised mean differences (SMDs) with 95 % confidence intervals (CIs). Risk of bias and evidence certainty were assessed using RoB2 and GRADE, respectively.</div></div><div><h3>Results</h3><div>Twenty-four studies (20 RCTs; <em>n</em> = 3, 826 participants) were included. The meta-analysis demonstrated that home-based interventions significantly reduced frailty phenotype scores (SMD = -0.27, 95 % CI:0.39 to -0.15) and depressive symptoms (SMD = -0.11, 95 % CI:0.20 to -0.01), alongside marked increases in grip strength (MD = 0.84, 95 % CI: 0.26 to 1.42) and mental health-related quality of life (SMD = 0.17, 95 % CI: 0.04 to 0.30). Subgroup analyses indicated that significant improvements in physical function were observed only in supervised subgroup. No significant changes were observed for overall quality of life, or physical health-related quality of life.</div></div><div><h3>Conclusions</h3><div>Home-based interventions are a valuable strategy for improving frailty, grip strength, and mental health outcomes in older adults with frailty or pre-frailty. Improvements in physical function appear to depend on home-based interventions delivered under professional supervision, while the unsupervised mode may pose the risk of potential iatrogenic harm and therefore necessitates caution alongside safety monitoring.</div></div><div><h3>Reporting Method</h3><div>This review followed PRISMA guidelines (PROSPERO: CRD42024604527).</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106083"},"PeriodicalIF":3.8,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-07DOI: 10.1016/j.archger.2025.106081
Liang-Kung Chen
{"title":"Reframing sarcopenia: the AWGS 2025 paradigm shift from disease to muscle health","authors":"Liang-Kung Chen","doi":"10.1016/j.archger.2025.106081","DOIUrl":"10.1016/j.archger.2025.106081","url":null,"abstract":"","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106081"},"PeriodicalIF":3.8,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-06DOI: 10.1016/j.archger.2025.106079
Camille Ouvrard , Ivane Koumetio Jiatsa , Antoine Gbessemehlan , Yvanna Simon , Luc Letenneur , Jean-François Dartigues , Melissa K Andrew , Hélène Amieva , Karine Pérès
Background and objectives
Social vulnerability (SV) is a multidimensional construct associated with adverse health outcomes, including mortality. However, little is known about how SV differentially affects older men and women.
Research design and methods
We analyzed data from 3695 community-dwelling older adults from the Paquid cohort, followed for 15 years. SV was assessed using a 26-item SV Index (SVI), categorized into low, moderate, and high levels. Delayed-entry Cox models stratified by gender were used to estimate mortality risk, adjusting for disability, history of ischemic heart disease, dyspnea, diabetes, and cognitive impairment. Associations between SV subdimensions and mortality were also examined separately by gender.
Results
Women accumulated more social deficits than men (40 % vs. 21 % with high SV). High SV was associated with a 21–25 % increased mortality risk in both genders. However, moderate SV is significantly associated with an increased mortality risk only in men (adjusted Hazard Ratio = 1.25, 95 % CI: 1.09–1.44 vs. aHR = 0.96, 95 % CI: 0.81–1.13 in women). Among subdimensions, low socioeconomic status and poor leisure activity engagement were the strongest mortality predictors in men–even at moderate levels (result marginally significant for leisure activities, p = 0.073). In women, poor engagement in leisure activities and negative psychological experience were the main predictors of mortality; low socioeconomic status (SES) showed a trend-level association (p = 0.045).
Discussion and implications
Despite greater SV, women seem to withstand moderate social deficits better than men. These findings highlight the need for further studies to explain gender differences and develop gender-sensitive public health interventions.
{"title":"Social vulnerability increases the risk of death differently in men and women: longitudinal analysis over 15 years in the Paquid Study","authors":"Camille Ouvrard , Ivane Koumetio Jiatsa , Antoine Gbessemehlan , Yvanna Simon , Luc Letenneur , Jean-François Dartigues , Melissa K Andrew , Hélène Amieva , Karine Pérès","doi":"10.1016/j.archger.2025.106079","DOIUrl":"10.1016/j.archger.2025.106079","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Social vulnerability (SV) is a multidimensional construct associated with adverse health outcomes, including mortality. However, little is known about how SV differentially affects older men and women.</div></div><div><h3>Research design and methods</h3><div>We analyzed data from 3695 community-dwelling older adults from the Paquid cohort, followed for 15 years. SV was assessed using a 26-item SV Index (SVI), categorized into low, moderate, and high levels. Delayed-entry Cox models stratified by gender were used to estimate mortality risk, adjusting for disability, history of ischemic heart disease, dyspnea, diabetes, and cognitive impairment. Associations between SV subdimensions and mortality were also examined separately by gender.</div></div><div><h3>Results</h3><div>Women accumulated more social deficits than men (40 % vs. 21 % with high SV). High SV was associated with a 21–25 % increased mortality risk in both genders. However, moderate SV is significantly associated with an increased mortality risk only in men (adjusted Hazard Ratio = 1.25, 95 % CI: 1.09–1.44 vs. aHR = 0.96, 95 % CI: 0.81–1.13 in women). Among subdimensions, low socioeconomic status and poor leisure activity engagement were the strongest mortality predictors in men–even at moderate levels (result marginally significant for leisure activities, <em>p</em> = 0.073). In women, poor engagement in leisure activities and negative psychological experience were the main predictors of mortality; low socioeconomic status (SES) showed a trend-level association (<em>p</em> = 0.045).</div></div><div><h3>Discussion and implications</h3><div>Despite greater SV, women seem to withstand moderate social deficits better than men. These findings highlight the need for further studies to explain gender differences and develop gender-sensitive public health interventions.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106079"},"PeriodicalIF":3.8,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145518340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.archger.2025.106080
Cho Rong Kim , Jisu Ko , Min Jin Ha , Kui Son Choi , Eun-Cheol Park
Introduction
Considering social isolation in approaches to frailty is important for the early detection of health problems in older adults and the development of appropriate intervention strategies. This study aims to investigate the relationship between changes in social isolation and frailty using the data the Korea Longitudinal Study of Aging (2006–2022).
Methods
A longitudinal study was conducted with 17,932 adults aged ≥65 years. Frailty was assessed using the frailty index, changes in social isolation were categorized into four groups. Associations between changes in social isolation and frailty were examined using generalized estimating equations with logistic regression to account for repeated measures and within-subject correlations.
Results
Compared to participants who remained non-isolated, those whose social isolation status changed from a non-isolated to isolated state had 3.47 times higher odds of frailty (95 % confidence interval [CI]: 3.03–3.96), and those in a consistently isolated state had 3.18 times higher odds (95 % CI: 2.80–3.62). Analysis by frailty type indicated that the transition from non-isolated to isolated status exhibited a stronger association with psychological frailty (odds ratio [OR] 4.38, 95 % CI 4.36–4.39) than physical frailty, and the highest increase was observed in the likelihood of exhibiting both physical and psychological frailty (OR 6.81, 95 % CI 6.77–6.84).
Conclusions
The transition to an isolated state was associated with frailty among older adults. These findings emphasize the need for early identification and active interventions to address social isolation to prevent frailty among older adults.
导言：在处理衰弱问题时考虑到社会孤立对于早期发现老年人的健康问题和制定适当的干预策略很重要。本研究旨在利用韩国老龄化纵向研究（2006-2022）的数据，探讨社会孤立的变化与脆弱性之间的关系。方法：对17932名年龄≥65岁的成年人进行纵向研究。脆弱性是用脆弱性指数来评估的，社会孤立的变化被分为四组。使用广义估计方程和逻辑回归来检验社会隔离变化与脆弱性之间的关联，以解释重复测量和受试者内部相关性。结果：与未隔离的参与者相比，社会隔离状态从非隔离状态变为隔离状态的参与者虚弱的几率高3.47倍（95%置信区间[CI]: 3.03-3.96），持续隔离状态的参与者虚弱的几率高3.18倍（95% CI: 2.80-3.62）。虚弱类型分析表明，与身体虚弱相比，从非孤立状态到孤立状态的转变与心理虚弱的关联更强（比值比[OR] 4.38, 95% CI 4.36-4.39），并且观察到表现出身体和心理虚弱的可能性的最高增加（比值比[OR] 6.81, 95% CI 6.77-6.84）。结论：老年人向孤立状态的转变与虚弱有关。这些发现强调需要及早发现并采取积极干预措施，解决社会孤立问题，以防止老年人虚弱。
{"title":"Association between changes in social isolation status and frailty among older adults","authors":"Cho Rong Kim , Jisu Ko , Min Jin Ha , Kui Son Choi , Eun-Cheol Park","doi":"10.1016/j.archger.2025.106080","DOIUrl":"10.1016/j.archger.2025.106080","url":null,"abstract":"<div><h3>Introduction</h3><div>Considering social isolation in approaches to frailty is important for the early detection of health problems in older adults and the development of appropriate intervention strategies. This study aims to investigate the relationship between changes in social isolation and frailty using the data the Korea Longitudinal Study of Aging (2006–2022).</div></div><div><h3>Methods</h3><div>A longitudinal study was conducted with 17,932 adults aged ≥65 years. Frailty was assessed using the frailty index, changes in social isolation were categorized into four groups. Associations between changes in social isolation and frailty were examined using generalized estimating equations with logistic regression to account for repeated measures and within-subject correlations.</div></div><div><h3>Results</h3><div>Compared to participants who remained non-isolated, those whose social isolation status changed from a non-isolated to isolated state had 3.47 times higher odds of frailty (95 % confidence interval [CI]: 3.03–3.96), and those in a consistently isolated state had 3.18 times higher odds (95 % CI: 2.80–3.62). Analysis by frailty type indicated that the transition from non-isolated to isolated status exhibited a stronger association with psychological frailty (odds ratio [OR] 4.38, 95 % CI 4.36–4.39) than physical frailty, and the highest increase was observed in the likelihood of exhibiting both physical and psychological frailty (OR 6.81, 95 % CI 6.77–6.84).</div></div><div><h3>Conclusions</h3><div>The transition to an isolated state was associated with frailty among older adults. These findings emphasize the need for early identification and active interventions to address social isolation to prevent frailty among older adults.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106080"},"PeriodicalIF":3.8,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145484023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-03DOI: 10.1016/j.archger.2025.106076
Andrea Fuente-Vidal , Erika Karkauskiene , Javier Jerez-Roig , Ricard Castro-Prat , Eduard Minobes-Molina , Damaso Sanchez , Nadine Barth , Dhayana Dallmeier , Dolores Forgione , Paolo Caserotti , Mathias Skjødt , Guillaume Lefebvre , Charlotte Bascompte-Soler , Aimar Intxaurrondo-Gonzalez , Sergi Blancafort-Alias , Ainhoa Nieto-Guisado , José Luis Socorro-Cumplido , Maria Giné-Garriga , Laura Coll-Planas
The global ageing population faces significant health challenges linked to insufficient physical activity (PA). Although PA offers emotional, cognitive, and physical benefits, long-term participation among older adults remains low. Enhancing enjoyment may boost their motivation and sustain engagement, while improving inclusivity is essential to reach underserved groups. This study describes the process of co-designing strategies to enhance enjoyment and social inclusion in PA interventions for community-dwellers and nursing home residents, guided by the Octalysis gamification framework. Using a qualitative phenomenological approach, we conducted 13 focus groups and 3 online individual interviews, with 98 participants in total, including 51 older adults, 29 formal caregivers, 5 family members, 10 policymakers, and 3 students, from Spain, Denmark, France, Germany, and Italy. Analysis revealed barriers such as fatigue, fear of injury, and social isolation, as well as facilitators including enjoyment, adaptability, and community support. Participants emphasized tailoring interventions to individual abilities and cultural contexts, integrating social connection, and fostering supportive environments. Stakeholders proposed innovative strategies to improve accessibility and enjoyment of PA. The findings underscore the value of co-design in meeting the needs of older adults and fostering a sense of ownership and commitment to PA programmes. Group-based initiatives will be able to benefit from the Join4Joy approach, which promotes enjoyment, improves movement behaviour, and mitigates social isolation. Following the co-design process, practical strategies are presented to increase PA and reduce sedentary behaviour, offering a pathway to more impactful, inclusive, and sustainable interventions for older adults.
{"title":"Co-designing the Join4Joy approach to boost enjoyment and social inclusion for the increase of physical activity among older people in nursing homes and community settings: a qualitative study in Spain, Denmark, Germany, Italy and France","authors":"Andrea Fuente-Vidal , Erika Karkauskiene , Javier Jerez-Roig , Ricard Castro-Prat , Eduard Minobes-Molina , Damaso Sanchez , Nadine Barth , Dhayana Dallmeier , Dolores Forgione , Paolo Caserotti , Mathias Skjødt , Guillaume Lefebvre , Charlotte Bascompte-Soler , Aimar Intxaurrondo-Gonzalez , Sergi Blancafort-Alias , Ainhoa Nieto-Guisado , José Luis Socorro-Cumplido , Maria Giné-Garriga , Laura Coll-Planas","doi":"10.1016/j.archger.2025.106076","DOIUrl":"10.1016/j.archger.2025.106076","url":null,"abstract":"<div><div>The global ageing population faces significant health challenges linked to insufficient physical activity (PA). Although PA offers emotional, cognitive, and physical benefits, long-term participation among older adults remains low. Enhancing enjoyment may boost their motivation and sustain engagement, while improving inclusivity is essential to reach underserved groups. This study describes the process of co-designing strategies to enhance enjoyment and social inclusion in PA interventions for community-dwellers and nursing home residents, guided by the Octalysis gamification framework. Using a qualitative phenomenological approach, we conducted 13 focus groups and 3 online individual interviews, with 98 participants in total, including 51 older adults, 29 formal caregivers, 5 family members, 10 policymakers, and 3 students, from Spain, Denmark, France, Germany, and Italy. Analysis revealed barriers such as fatigue, fear of injury, and social isolation, as well as facilitators including enjoyment, adaptability, and community support. Participants emphasized tailoring interventions to individual abilities and cultural contexts, integrating social connection, and fostering supportive environments. Stakeholders proposed innovative strategies to improve accessibility and enjoyment of PA. The findings underscore the value of co-design in meeting the needs of older adults and fostering a sense of ownership and commitment to PA programmes. Group-based initiatives will be able to benefit from the Join4Joy approach, which promotes enjoyment, improves movement behaviour, and mitigates social isolation. Following the co-design process, practical strategies are presented to increase PA and reduce sedentary behaviour, offering a pathway to more impactful, inclusive, and sustainable interventions for older adults.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106076"},"PeriodicalIF":3.8,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145518341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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