The journals of gerontology. Series A, Biological sciences and medical sciences最新文献

Background: The involvement of older adults in research on digital health is uneven with respect to, for example, age, gender, health status, and digital skills. However, little is known regarding the effect of the uneven involvement of older adults in digital health research on researched outcomes. This study helps to fill this knowledge gap, identifies the effects of uneven involvement of older adults in digital health research on researched outcomes, and also develops a correction for this.

Methods: Data are retrieved from a digital health intervention for postoperative monitoring of people who underwent day surgery in Sweden. Based on field information on the recruitment process and researched outcomes for the intervention, this study (i) tested intervention effects by using 2 standard unweighted procedures in a sample of 281 individuals aged 50 years or older, and then (ii) used the information on participants, nonparticipants, and their respective probabilities to be involved in the intervention study to perform a weighting of the intervention effects for each step of selection and for the study group membership.

Results: The intervention effects were found to be overestimated due to overrepresentation of groups that gained from receiving the intervention. No intervention effects were found after adjustment for participation bias.

Conclusions: Selective participation of older adults in digital health research biases research outcomes and can lead to overestimation of intervention effects. Weighting allows researchers to correct and describe the effect of selective participation on researched outcomes.

Background: Mild cognitive impairment (MCI) and parkinsonism affect many older adults. The objective of this study was to determine the sequence of their occurrence and associated risk of death.

Methods: A total of 1255 community-dwelling unimpaired participants from 2 epidemiological cohorts were examined annually. MCI was based on neuropsychological testing and parkinsonism was based on the motor portion of the modified Unified Parkinson's Disease Rating Scale. A multistate Cox proportional hazards model simultaneously examined incidences of MCI, parkinsonism, and death.

Results: The average age at baseline was 76.5 years (standard deviation [SD] = 7.2) and 73% were female. Incident MCI occurred almost as commonly as incident parkinsonism, yet compared with no impairment, the risk of death was higher for MCI (hazard ratio [HR] = 1.82, 95% confidence interval [CI] = 1.34, 2.47), but it was not different for parkinsonism (HR = 1.29; 95% CI =0.95, 1.75). The risk of death for participants with incident MCI who progressed to parkinsonism (40%) was not significantly different from those with MCI alone (HR = 1.25, 95% CI = 0.93, 1.69). However, the risk of death for participants with incident parkinsonism who progressed to MCI (51%) was significantly higher than those who did not progress (HR = 1.67, 95% CI = 1.27, 2.18), indicating that the risk of death is highest with the incidence of MCI.

Conclusions: The varied patterns of sequential occurrence of cognitive and motor impairment and associated risk of death suggest much greater heterogeneity than previously recognized. Further work is needed to determine the biology underlying the temporal evolution of these phenotypes, and if identification of the various subtypes improves risk stratification.

Background: Current multimorbidity measures often oversimplify complex disease interactions by assuming a merely additive impact of diseases on health outcomes. This oversimplification neglects clinical observations that certain disease combinations can exhibit synergistic effects. Thus, we aimed to incorporate simultaneous higher-order disease interactions into the validated ICD-coded multimorbidity-weighted index, to assess for model improvement.

Methods: Health and Retirement Study participants with linked Medicare data contributed ICD-9-CM claims, 1991-2012. Top 20 most prevalent and impactful conditions (based on associations with decline in physical functioning) were assessed through higher-order interactions (2-way, 3-way). We applied the least absolute shrinkage and selection operator and bootstrapping to identify and retain statistically significant disease interactions. We compared model fit in multimorbidity-weighted index with and without disease interactions in linear models.

Results: We analyzed 73 830 observations from 18 212 participants (training set N = 14 570, testing set N = 3 642). Multimorbidity-weighted index without interactions produced an overall R2 = 0.26. Introducing 2-way interactions for the top 10 most prevalent and impactful conditions resulted in a R2 = 0.27, while expanding to top 20 most prevalent and impactful conditions yielded a R2 = 0.26. When adding 3-way interactions, the same top 10 conditions produced a R2 = 0.26, while expanding to top 20 conditions resulted in a R2 = 0.24.

Conclusions: We present novel insights into simultaneous higher-order disease interactions for potential integration into multimorbidity measurement. Incorporating 2-way disease interactions for the top 10 most prevalent and impactful conditions showed a minimal improvement in model fit. A more precise multimorbidity index may incorporate both the main effects of diseases and their significant interactions.

Integrating antiretroviral therapy into HIV care dramatically extended the lifespan for people living with HIV. Improving the health span requires understanding aging, HIV, associated comorbid conditions, and concurrent treatments. The 14th annual International Workshop on HIV and Aging on October 26-27, 2023 included podium presentations on: Sarcopenia: Biology, Pathophysiology, Prevention and Treatment; Long-acting ART; Central Nervous System (CNS) complications; Asymptomatic Neurocognitive Impairment (ANI); Mental Health; Loneliness; and Resilience. Presentations highlighted persistent concerns for people living with HIV including sarcopenia and frailty, mental health, loneliness, and cognition. Presenters encouraged prioritizing mental health treatment, reducing social isolation, and research on resiliency.

Background: Denture use may contribute to maintaining cognitive function by addressing the masticatory difficulties caused by tooth loss. However, reports on the association between tooth loss and cognitive impairment have been inconsistent. The impact of changes in tooth number and denture use on the development of cognitive impairment in older adults remains unclear. This study aimed to evaluate these impacts among community-dwelling older adults.

Methods: This 7-year longitudinal prospective cohort study included 64 520 community-dwelling Taiwanese older adults aged ≥65 years without cognitive impairment at baseline. The primary outcome was cognitive impairment assessed using the Short Portable Mental Status Questionnaire.

Results: Older adults with 10-19, 1-9, and 0 teeth, including natural teeth and dentures, had higher risks of developing cognitive impairment than those with ≥20 teeth, with adjusted odds ratios (ORs) of 1.40 (95% confidence intervals [CIs], 1.14-1.71), 1.85 (95% CI, 1.40-2.43), and 2.56 (95% CI, 1.74-3.76), respectively. Furthermore, among those with 10-19 teeth (OR, 0.71; 95% CI, 0.52-0.98) or 1-9 teeth (OR, 0.43, 95% CI, 0.27-0.68) at baseline, an increase of more than 1 level in tooth number during follow-up (eg, from 10-19 to ≥ 20 teeth and dentures through the acquisition of dental prosthetics such as dentures, bridges, or implants) was associated with a lower risk of developing cognitive impairment compared with those with a stable tooth number.

Conclusions: Our findings suggest that prompt denture use and maintaining >20 teeth (including natural teeth and dentures) mitigate the risk of cognitive impairment associated with tooth loss among community-dwelling older adults.

Vascular aging, a common pathogenesis of senile chronic diseases, significantly increases morbidity and mortality in older adults; its intricate cellular and molecular mechanisms necessitate further investigation. Lumican (LUM) and integrin α2β1 are profibrotic extracellular matrix proteins and vital cell regulatory receptors, respectively. However, their roles in vascular aging remain unclear. This study sought to elucidate the connection between LUM and vascular aging as well as the biological mechanism of LUM/integrin α2β1 in this process. Using an enzyme-linked immunosorbent assay, we discovered that plasma LUM was elevated in vascular aging individuals and was positively correlated with brachial-ankle pulse wave velocity. Additionally, immunohistochemical and Western blot analyses confirmed LUM upregulation in arteries of older adults and aged mice, as well as in senescent vascular smooth cells (VSMCs). Wild-type and LUM semiknockout (Lum-/+) mice, along with primary VSMCs extracted from these mice, were exposed to angiotensin II to induce a stress-induced senescence model. LUM semiknockout mitigated angiotensin II-induced arteriosclerosis, hypertension, vascular aging, and remodeling in mice. Both in vitro and in vivo studies revealed that LUM deficiency suppressed p53, p21, collagen 1, and collagen 3 upregulation and synthetic phenotype formation in VSMCs stimulated by angiotensin II. Treating VSMCs with an integrin α2β1 antagonist reversed the aforementioned changes triggered by LUM proteins. Briefly, LUM functions as a potential marker and risk factor for vascular aging and promotes pathological changes by affecting integrin α2β1 in VSMCs. This study introduces a novel molecular target for the early diagnosis and treatment of vascular aging and age-related vascular diseases.

Background: Physiological networks are highly complex, integrating connections among multiple organ systems and their dynamic changes underlying human aging. It is unknown whether individual-level network could serve as robust biomarkers for health and aging.

Methods: We used personalized network analysis to construct a single-sample network and examine the associations between network properties and functional disability in the Rugao Longevity and Aging Study (RuLAS), the China Health and Retirement Longitudinal Study (CHARLS), the Chinese Longitudinal Healthy Longevity Survey (CLHLS), and the National Health and Nutrition Examination Survey (NHANES).

Results: We observed impairments in interconnected physiological systems among long-lived adults in RuLAS. Single-sample network analysis was applied to reflect the co-occurrence of these multisystem impairments at the individual level. The activities of daily living (ADL)-disabled individuals' networks exhibited notably increased connectivity among various biomarkers. Significant associations were found between network topology and functional disability across RuLAS, CHARLS, CLHLS, and NHANES. Additionally, network topology served as a novel biomarker to capture risks of incident ADL disability in CHARLS. Furthermore, these metrics of physiological network topology predicted mortality across 4 cohorts. Sensitivity analysis demonstrated that the prediction performance of network topology remained robust, regardless of the chosen biomarkers and parameters.

Conclusions: These findings showed that metrics of network topology were sensitive and robust biomarkers to capture risks of functional disability and mortality, highlighting the role of single-sample physiological networks as novel biomarkers for health and aging.

Background: We assessed the association of adherence to the guidelines and subsequent changes over time in adherence with all-cause mortality.

Methods: We used data from 3518 and 3273 older adults, aged 60-96 years at baseline, from Seniors-ENRICA-1 and 2 cohorts, respectively. Adherence to 24-hour movement guidelines was defined as ≥150 minutes/week of moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB) ≤8 hours/day (including ≤3 hours/day of recreational screen time), and 7-9 hours/day of sleep if aged 18-64y or 7-8 hours/day if aged ≥65y. All-cause mortality was ascertained up to January 31, 2024. Analyses were performed using Cox regression adjusted for the main confounders.

Results: Of the 6613 participants with complete data, 1353 died during a mean follow-up of 10.1 (SD = 4.0) years. Meeting MVPA (hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.65-0.82), SB (HR 0.89; 95% CI 0.80-0.99), and sleep (HR 0.89; 95% CI 0.80-0.99) recommendations were associated with lower mortality. Also, we noticed a reduction in mortality in meeting MVPA combined with both SB (34%) and sleep (12%), sleep and SB combined (23%), and meeting all 24-hour movement guidelines (40%). Changes in meeting 24-hour movement guidelines occurred between a mean follow-up of 2.8 (0.6) years. Meeting 24-hour movement guidelines at baseline and follow-up is associated with lower mortality (HR 0.69; 95% CI 0.47-0.99), compared to not meet them at both examinations.

Conclusions: This prospective cohort study underscores the critical impact of adhering to and maintaining adherence to the 24-hour movement guidelines in reducing mortality risk among older adults.

Background: Social risk factors are linked to adverse health outcomes, but their total impact on long-term quality of life is obscure. We hypothesized that a higher burden of social risk factors is associated with greater decline in quality of life over 10 years.

Methods: We examined associations between social risk factors count and decline >5 points in (i) physical component summary, and (ii) mental component summary scores from the Short Form-12 among Black and White participants in the Reasons for Geographic and Racial Differences in Stroke study (n = 14 401).

Results: For physical component summary, White participants with 1 social risk factor had relative risk (RR) for decline of 1.14 [95% confidence intervals (CI): 1.07-1.12]. Those with ≥2 social risk factors had RR of 1.26 [95% CI: 1.17-1.35], after adjusting for baseline demographics, health behaviors, medical conditions, medications, and physiological variables. Black participants with 1 social risk factor had RR of 1.03 [95% CI: 0.93-1.15]. Those with ≥2 social risk factors had RR of 1.24 [95% CI: 1.13-1.36]. For mental component summary, White participants with 1 social risk factor had RR for decline of 1.19 [95% CI: 1.04-1.37]. Those with ≥2 social risk factors had RR of 1.47 [95% CI: 1.28-1.68]. Black participants with 1 social risk factor had RR of 1.18 [95% CI: 0.96-1.45]. Those with ≥2 social risk factors had RR of 1.38 [95% CI: 1.14-1.66].

Conclusions: More social risk factors increased the risk of decline of quality of life for Black and White individuals, especially impacting mental health.