Association between postoperative rehabilitation pathway, dose, and three-year mortality in older adults with hip fracture: A nationwide retrospective cohort study.

Background: Osteoporotic fracture is a common public-health problem in ageing societies. Although post-fracture usage of osteoporosis medications may reduce mortality, recent results have been inconsistent. We aimed to examine associations between osteoporosis medication and mortality in older adults, particularly oldest-old adults (>=85 years old).Methods: Participants aged 65 years old and older newly diagnosed with both osteoporosis and hip or vertebral fractures within 2009-2017 were recruited from the records of 23,455,164 people in Taiwan National Health Insurance Research Database (NHIRD). Osteoporosis medication exposure was calculated after the first-time ambulatory visit with newly diagnosed osteoporosis. Mortality and its specific causes were ascertained from Cause of Death Data. Patients were followed until death or censored at the end of 2018.Results: A total of 87,935 participants aged 65 years old and over (73.4% female), with a mean 4.13 follow-up years, were included. Taking medication was associated with significantly lower risk of mortality (hip fracture HR 0.75, vertebral fracture HR 0.74), even in the oldest-old adults (hip fracture HR 0.76, vertebral fracture HR 0.72), where a longer duration of taking osteoporosis medication was associated with lower all-cause mortality. Specific causes of mortality were also significantly lower for participants taking osteoporosis medication (cancer HR 0.84 in hip fracture, 0.75 in vertebral fracture; cardiovascular disease HR 0.85 in hip fracture, 0.91 in vertebral fracture).Conclusions: Osteoporosis medication after hip or vertebral fracture may reduce mortality risk in older adults, notably in oldest-old adults. Encouraging the use of post-fracture osteoporosis medication in healthcare policies is warranted.

BackgroundLow socioeconomic status (SES) is associated with increased mortality after stroke in developed countries. This study was performed to determine whether a similar association also exists in China.MethodsA total of 806 patients with first-ever ischemic stroke were enrolled in our study. From August 1999 to August 2005, the three-year all-cause mortality following the stroke was determined. Level of education, occupation, taxable income and housing space were used as indicators for SES. Stepwise univariate and multivariate COX proportional hazards models were used to study the association between the SES measures and the three-year mortality.ResultsOur analyses confirmed that occupation, taxable income and housing space were significantly associated with three-year mortality after first-ever stroke. Manual workers had a significant hazard ratio of 5.44 (95% CI 2.75 to 10.77) for death within three years when compared with non-manual workers. Those in the zero income group had a significant hazard ratio of 5.35 (95% CI 2.95 to 9.70) and those in the intermediate income group 2.10 (95% CI 1.24 to 3.58) when compared with those in the highest income group. Those in two of the three groups with the smallest housing space also had significant hazard ratios of 2.06 (95% CI 1.16 to 3.65) and 1.68 (95% CI 1.12 to 2.52) when compared with those in group with the largest housing space. These hazard ratios remained largely unchanged after multivariate adjustment for age, gender, baseline cardiovascular disease risk factors, and stroke severity. The analyses did not confirm an association with educational level.ConclusionLower SES has a negative impact on the outcome of first-ever stroke in Nanjing, China. This confirms the need to improve preventive and secondary care for stroke among low SES groups.

Introduction: Habitual physical activity (PA) and less sedentary behavior have been associated with a lower risk of mortality in middle-aged adults. However, little is known about the associations of objectively-assessed PA of varying levels and sedentary time with mortality in community-dwelling older adults. Hypothesis: We hypothesized that higher overall PA and less sedentary time will be associated with a lower risk of all-cause mortality in older adults. Methods: We evaluated 1,262 Framingham Offspring Study participants (mean age 69 yrs, 54% women) with accelerometry-derived PA data (wear time ≥10 hours/day for at least 4 days using an Actical device) at their ninth examination (2011-2014). Multivariable Cox proportional hazards regression models were used to relate PA and sedentary time (separate model for each) with all-cause mortality adjusting for potential confounders. In sensitivity analysis to mitigate the potential impact of frailty on the associations evaluated, we excluded those with frailty at baseline. Results: Overall, 67 participants died during a median follow-up of 4.8 years (25 th -75 th percentiles: 4.3 - 5.3 [years]). Higher total PA, light intensity PA (LIPA), adherence to PA guidelines, and lower sedentary time were associated with a lower risk of all-cause mortality ( Table ). The results remained statistically significant even after excluding those with frailty. Higher LIPA and lower sedentary time were associated with a lower risk of all-cause mortality regardless of MVPA in both models including all participants and excluding those with frailty. Conclusions: In our investigation of a moderate-size sample of community-dwelling older adults, we confirmed that being physically active substantially lowered mortality risk. Additionally, our findings suggest that reducing sedentary time and increasing LIPA (regardless of MVPA) may be sufficient to reduce mortality risk in older adults. Additional studies of larger multi-ethnic samples of older adults are warranted to confirm our findings.

Positive airway pressure (PAP) is the first-line treatment for obstructive sleep apnea (OSA), but evidence on its beneficial effect on major adverse cardiovascular events (MACE) and mortality prevention is limited. To determine whether PAP initiation and utilization are associated with lower mortality and incidence of MACE among older adults with OSA living in the central US. This retrospective clinical cohort study included Medicare beneficiaries with 2 or more distinct OSA claims identified from multistate, statewide, multiyear (2011-2020) Medicare fee-for-service claims data. Individuals were followed up until death or censoring on December 31, 2020. Analyses were performed between December 2021 and December 2023. Evidence of PAP initiation and utilization based on PAP claims after OSA diagnosis. All-cause mortality and MACE, defined as a composite of myocardial infarction, heart failure, stroke, or coronary revascularization. Doubly robust Cox proportional hazards models with inverse probability of treatment weights were used to estimate treatment effect sizes controlling for sociodemographic and clinical factors. Among 888 835 beneficiaries with OSA included in the analyses (median [IQR] age, 73 [69-78] years; 390 598 women [43.9%]; 8115 Asian [0.9%], 47 122 Black [5.3%], and 760 324 White [85.5%] participants; median [IQR] follow-up, 3.1 [1.5-5.1] years), those with evidence of PAP initiation (290 015 [32.6%]) had significantly lower all-cause mortality (hazard ratio [HR], 0.53; 95% CI, 0.52-0.54) and MACE incidence risk (HR, 0.90; 95% CI, 0.89-0.91). Higher quartiles (Q) of annual PAP claims were progressively associated with lower mortality (Q2 HR, 0.84; 95% CI, 0.81-0.87; Q3 HR, 0.76; 95% CI, 0.74-0.79; Q4 HR, 0.74; 95% CI, 0.72-0.77) and MACE incidence risk (Q2 HR, 0.92; 95% CI, 0.89-0.95; Q3 HR, 0.89; 95% CI, 0.86-0.91; Q4 HR, 0.87; 95% CI, 0.85-0.90). In this cohort study of Medicare beneficiaries with OSA, PAP utilization was associated with lower all-cause mortality and MACE incidence. Results might inform trials assessing the importance of OSA therapy toward minimizing cardiovascular risk and mortality in older adults.

To the Editor: Older adults have a 5- to 8 times greater risk of all-cause mortality during the first 3 months after hip fracture, with almost half of the mortality risk during the first year attributed to in-hospital deaths.1, 2Although hip fracture rates have decreased in older adults in the United States since the mid-1990s,3 there is little information about nationwide trends in in-hospital hip fracture mortality in older adults. A recent hip fracture–related mortality study in Texas demonstrated that in-hospital hip fracture–related deaths decreased 1.8% per year, from 75.4% in 1990 to 60.1% in 2007.4 The aim of the current study was to examine nationwide trends in in-hospital hip fracture mortality in older adults between 1988 and 2007. The National Hospital Discharge Survey (NHDS) database was used to generate unbiased national estimates of hip fracture hospitalizations. Only general hospitals and hospitals with an average length of stay of fewer than 30 days for all patients are included in the survey.5 Hospitalizations for hip fractures as the primary diagnosis were defined according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 820.xx to 820.9. The in-hospital case-fatality rate was calculated as the proportion of hospital deaths that occurred within 30 days of hip fracture hospitalization. Trends in in-hospital hip fracture mortality according to selected characteristics were examined across 5-year periods using the Cochrane-Armitage test. The Charlson Comorbidity Index (CCI) was used to evaluate trends in in-hospital hip fracture mortality according to comorbidities.6 For an estimated 5.3 million hip fracture hospitalizations in the United States between 1988 and 2007, in-hospital hip fracture mortality was 4.9% (95% confidence interval (CI) = 4.2–5.7) in men and 2.6% (95% CI = 2.3–2.9) in women. In individuals with hip fracture who died in the hospital, cardiac arrhythmia, congestive heart failure (CHF), acute myocardial infarction (MI), chronic obstructive pulmonary disease (COPD), and electrolyte disorders were the leading listed secondary diagnoses. In general, in-hospital hip fracture mortality was higher in men and increased gradually with advancing age and higher comorbidity scores. As shown in Table 1, in-hospital hip fracture mortality decreased significantly over time in men, those aged 85 and older, blacks, older adults hospitalized in the northeastern and southern regions of the country, and those with a CCI score of 2 or greater. In-hospital mortality in women remained steady over the study period. The results of this study indicate that in-hospital hip fracture mortality decreased in older adults in the United States between 1988 and 2007. The downward trend in in-hospital hip fracture mortality was predominantly attributed to a decrease in deaths of the oldest old, men, blacks, and those with higher CCI scores. The present findings are similar to those of a hip fracture–related mortality study in Texas reporting downward trends in the proportion of hip fracture deaths that occurred in the hospital, in men, and in those aged 85 and older between 1990 and 2007.4 Likewise, nationwide studies from France and England have described a decrease in in-hospital hip fracture mortality for both sexes between 2002 and 2008 and between 1998 and 2009, respectively.7, 8 Older age, male sex, and comorbidities are factors reported to be associated with greater risk of in-hospital hip fracture mortality, which are consistent with the present findings.9 The marked sex differences in mortality in individuals with hip fracture have been observed during the first weeks and persist for at least 2 years after the fracture event.10 Moreover, men with hip fracture seem to be prone to acute postoperative complications, which may increase the risk of mortality.10 A previous study also demonstrated that, in 3,981 individuals with hip fracture, the prevalence of postoperative pneumonia, ischemic heart disease, cardiac arrhythmias, and sepsis was significantly higher in men than in women.9 Several limitations must be mentioned in interpreting these results. First, in-hospital hip fracture mortality may be underestimated because the NHDS does not include federal, military, or Veteran Affairs hospitals. Second, the NHDS does not collect data about other reported risk factors associated with in-hospital hip fracture mortality such as delay in surgery, early mobilization, place of residence, and dependency in activities of daily living. Third, the NHDS staff did not clinically verify the discharge ICD-9-CM codes. Despite these limitations, the present study found nationwide temporal trends in in-hospital hip fracture mortality in older adults. The downward trend in in-hospital hip fracture mortality seen during the study period was predominantly attributed to better survival among the oldest old, men, and those with a high comorbidity burden. Conflict of Interest: The author reports no conflict of interest. Author Contribution: Carlos H. Orces is responsible for the entire letter. Sponsor's Role: None.

Osteoporosis increases fracture risk, particularly in older adults. Spinal and hip fractures are common and costly complications. To examine the effectiveness of parenteral antiresorptive medications-denosumab and zoledronate-in reducing refracture rates among older adults with prior spinal or hip fractures. A nationwide retrospective cohort study was conducted using data from Taiwan's National Health Insurance Research Database (2011-2020). Patients aged 50 and older with spinal or hip fractures were divided into a treatment group (received zoledronate or denosumab) and a control group (no osteoporosis treatment). A 1:1 matching based on age, sex, and Charlson Comorbidity Index was performed. Kaplan-Meier method and Cox proportional hazards regression were used for analysis. Out of 23,331 eligible patients, 582 were in the treatment group and 17,281 in the control group. After matching, 211 patients received zoledronate and 367 received denosumab. The treatment group showed a trend toward lower refracture risk compared to the control group, though not statistically significant. Hazard ratios were 0.63 for zoledronate and 0.80 for denosumab, indicating potential benefits. There was no substantial difference between the two medications. This is the first real-world study to assess the effectiveness of complete adherence to parenteral antiresorptive medications in reducing the risk of refractures among older adults with prior spinal or hip fractures. However, further research is needed to confirm these findings and investigate long-term effects.

BackgroundThe systemic immune-inflammation index (SII), based on peripheral platelet, neutrophil and lymphocyte counts, has been proven to be a promising prognostic indicator in various diseases. Hip fracture is a common injury among the older adults, and has become a global public health problem with high mortality and disability rates. However, the relationship between SII and the prognosis of hip fracture is not yet well-known. The aim of the this study was to explore the predictive value of SII in older adults with hip fracture undergoing surgery.MethodsThis was a prospective cohort study performed from January 2014 to December 2018 at a orthopaedic center, China. The SII was calculated as platelet×neutrophil/lymphocyte counts. Univariable and multivariable Cox proportional hazard models were used to assess the association between SII and all-cause mortality.ResultsA total of 290 older adults with hip fracture were included, and the mean (SD) age was 77.6 (8.6) years, and 189 (65.2%) were female. The median (IQR) SII was 759.4 (519.0–1128.7) × 109/L. After a median follow-up time of 33.4 months, 13 (4.5%), 26 (9.0%) and 54 (18.6%) patients died within the 30-day, 1-year and last follow-up, respectively. Multivariable Cox analysis revealed that each increase of 100 units of SII was associated with a 8% increased hazard of death at 1-year follow-up (HR = 1.08, 95% CI: 1.01–1.17, p = 0.033), and 9% increased hazard of death at last follow-up (HR = 1.09, 95% CI: 1.03–1.15, p = 0.003).ConclusionsSII is associated with poor all-cause mortality in older adults with hip fracture undergoing surgery, and deserves further investigation and application in clinical practice.

Introduction: The association patterns of hemoglobin (HB) concentrations with mortality among the longevity older adults are unclear. We aimed to evaluate the relationship among older adults form Chinese longevity regions.Methods: We included 1,785 older adults aged ≥65 years (mean age, 86.7 years; 1,002 women, 783 men) from the community-based Chinese Longitudinal Healthy Longevity Survey. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality using multivariable Cox proportional hazards models and Cox models with restricted cubic spline.Results: In total, 999 deaths occurred during a median follow-up of 5.4 years from 2011 to 2017. Restricted cubic spline analysis found no non-linear association between HB concentrations and all-cause mortality after a full adjustment for covariates among the older adults form longevity regions (p > 0.05 for non-linearity). The risk for all-cause mortality was significantly higher in the groups with HB concentration of <11.0 g/dL (HR: 1.37, 95% CI: 1.10–1.70) and 11.0–12.0 g/dL (HR: 1.25, 95% CI: 1.01–1.54); the risk of all-cause mortality was significantly lower in the groups with HB concentration ≥14.0 g/dL (HR: 0.76, 95% CI: 0.60–0.97) compared with the reference group (13.0–13.9 g/dL).Conclusions: Among older adults form Chinese longevity regions, HB concentrations were found to be inversely and linearly associated with all-cause mortality. Further prospective intervention trials are needed to confirm whether higher HB concentrations had a lower risk of mortality in these older adults.

Obesity paradox of cardiovascular mortality in older adults in the United States: A cohort study using 1997–2018 National Health Interview Survey data linked with the National Death Index

Background and Aim:Worldwide, heart-related conditions, including myocardial infarction (MI), persist as the leading cause of morbidity and mortality. The aim is to compare three-year mortality outcomes and identify causes of death among post-MI patients who received either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).Methods:This registry-based retrospective cohort with follow-up study analyzed data from 3,542 PCI and 3,244 CABG patients treated post-MI between 2020 and 2024 in two hospitals in Baghdad. Kaplan–Meier curves (log-rank test) were used for unadjusted comparison. Cox proportional hazards regression was employed to compare three-year all-cause mortality, adjusting for baseline demographic and clinical covariates.Results:Baseline characteristics differed significantly, with CABG patients being older and having a higher prevalence of certain risk factors. Crude observed mortality during available follow-up was 7.99% for PCI and 11.19% for CABG; Kaplan–Meier analysis showed significantly different unadjusted survival distributions by log-rank test. However, after adjusting for baseline covariates, there was no significant difference in the hazard of three-year all-cause mortality between patients undergoing CABG and PCI (adjusted hazard ratio [aHR] = 1.12, 95% CI = 0.93–1.35, p = 0.280). Significant independent predictors of mortality included age (aHR = 1.04 per year), diabetes mellitus (aHR = 1.45), and renal complications (aHR = 1.70). Non-cardiovascular causes accounted for the majority of deaths in both groups (56.06% post-PCI, 50.11% post-CABG).Conclusion:In this observational cohort, adjusted three-year mortality was not significantly different between PCI and CABG, with non-cardiac causes accounting for the largest proportion of deaths. Due to potential confounding by indication, these findings represent observational associations rather than clinical equivalence. Both remain vital revascularization strategies, with selection guided by individualized heart-team assessment.

BackgroundEarly surgery within 24–48 h is recommended for hip fractures; however, the majority of older adults experience delays due to medical instability. Evidence is limited on interventions during this waiting period. In cardiovascular and acute care, rehabilitation initiated immediately after admission has been shown to improve outcomes. Whether similar early inpatient rehabilitation strategies could benefit orthopedic patients has not been well explored. We aimed to assess whether preoperative rehabilitation may reduce in-hospital mortality in patients undergoing delayed hip fracture surgery, and whether this association varies by kidney function.MethodsIn this nationwide retrospective cohort study using the JMDC hospital database (Tokyo, Japan), we identified patients aged ≥ 65 years who underwent delayed hip fracture surgery (≥ 3 days after admission) between 2014 and 2023. Patients were grouped by receipt of preoperative rehabilitation. We applied overlap weighting based on propensity scores to compare in-hospital mortality. A marginal standardization approach was used to assess effect modification by estimated glomerular filtration rate. Sensitivity analyses included multiple imputation, exclusion of patients with no rehabilitation during hospitalization, and instrumental variable analysis using day of admission.ResultsOf 21,450 eligible patients, 9,486 received preoperative rehabilitation and 11,964 did not. After overlap weighting, in-hospital mortality was significantly lower in the rehabilitation group (1.51%) than in the non-rehabilitation group (2.19%) with an adjusted odds ratio of 0.68 (95% CI: 0.55–0.85). The marginal effects analysis showed a stronger protective association of preoperative rehabilitation in patients with lower kidney function (P for trend = 0.004). Sensitivity analyses yielded consistent results across all models, including the instrumental variable approach, supporting the robustness of the findings.ConclusionsPreoperative rehabilitation was associated with lower in-hospital mortality in older adults undergoing delayed hip fracture surgery. This association was particularly pronounced in patients with impaired kidney function. These findings may help guide perioperative care strategies in frail older adults for whom early surgery is not immediately possible.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-025-06415-5.

People with intellectual disabilities (ID) have a lower life expectancy than their peers without ID. A contributing factor to the lower life expectancy and early mortality could be sarcopenia: low muscle mass and low muscle function. In the general population, sarcopenia strongly predicts early mortality, but this association is unknown in people with ID. Therefore, this study aims to explore the association between sarcopenia and 5-year mortality in older adults with ID. In the Healthy Ageing and Intellectual Disabilities (HA-ID) study, the prevalence of sarcopenia was measured at baseline among 884 older adults (≥50years) with ID. All-cause mortality was measured over a 5-year follow-up period. Univariable and multivariable Cox proportional hazard models were applied to determine the association between sarcopenia (no sarcopenia, pre-sarcopenia, sarcopenia, severe sarcopenia) and early mortality, adjusted for age, sex, level of ID, presence of Down syndrome, and co-morbidity (chronic obstructive pulmonary disease, diabetes type 2 and metabolic syndrome). The unadjusted hazard ratio (HR) for sarcopenia was 2.28 [95% confidence interval (CI) 1.48-3.42], P<0.001), and 2.40 (95% CI 1.40-4.10, P=0.001) for severe sarcopenia. When adjusted for age, sex, level of ID, and Down syndrome, sarcopenia (HR=1.72, 95% CI 1.08-2.75, P=0.022) and severe sarcopenia (HR=1.86, 95% CI 1.07-3.23, P=0.028) were significantly associated with early mortality. When additionally adjusted for co-morbidity, the adjusted HR decreased to 1.62 (95% CI 1.02-2.59, P=0.043) and 1.81 (95% CI 1.04-3.15, P=0.035) for sarcopenia and severe sarcopenia, respectively. Sarcopenia is an independent risk factor for early mortality in older adults with ID over a 5-year follow-up period. Our results stress the need to delay the incidence and development of sarcopenia in older adults with ID.

Hip fracture is becoming a major health problem with high mortality and morbidity in older adults. However, whether specific fall patterns could act as independent risk factors for predicting mortality after hip fracture remains unknown. We aimed to investigate whether fall patterns can serve as an independent risk factor for mortality after hip fracture. Electronic medical records (EMR) of individuals who visited emergency room or admitted to the Severance hospital, Seoul, Korea, between January 2005 to December 2019 were reviewed to categorize fall patterns. Fall patterns were categorized upon review of explanatory description in EMR, using modified classification based on motion analysis of video-captured falls in a prior study. Among 1,991 study subjects (mean age 77 years, 71% women), 211 patients died (10.6%; median survival 296 days). Fall location was divided into home (67.4%) and outdoor (32.6%) with mortality rate of 11.9% and 8.0% (p=0.009), respectively. Fall patterns were specified by “cause of fall” (6 categories; slip [29.6%], trip or stumble [17.5%], etc.) and by “activity at time of fall” (6 categories; walking [54.8%], getting up or rising [14.1%], etc). Among the combinations of both causes and activities, individuals who sustained hip fracture during “incorrect weight shift while sitting down or lowering”(hazard ratio [HR] 3.35, p=0.003), “collapsed during unclassified activity”(HR 2.37, p=0.006), “incorrect weight shift while getting up or rising”(HR 2.13, p=0.003), and “slipped while walking”(HR 1.83, p=0.004) had increased mortality after hip fracture compared to those with outdoor falls, after adjustment for age, sex, and Charlson comorbidity index. Specific fall patterns in individuals who sustained hip fracture predicted excess mortality in older adults, independent of age, sex, and comorbidities. Acknowledgement: We thank Doori Cho of the the SENTINEL (Severance ENdocrinology daTa scIeNcE pLatform) team (4-2018-1215) for the data acquisition process. Conflict of Interest: SB, NH, and YR have nothing to declare.

To assess the role of sex-based influence on cognitive impairment and 1-year mortality in older adults with hip fractures. In this retrospective cohort study, we included older patients who experienced a hip fracture between 1 January 2015 and 30 September 2019. Demographic and clinical data of patients were obtained from original medical records. We contacted the patient’s family members by telephone to record data on survival. The endpoint was all-cause mortality. Univariate and multivariate binary logistic regression models were used to build relationships between cognitive impairment and 1-year mortality. Overall, 2589 patients were included in this study, containing 835 males and 1754 females. One hundred five patients had cognitive impairment. The mean age was 79.60 (6.78) and 81.26 (5.84) years in the no cognitive and cognitive impairment groups. There were 286 (11.0%) patients who died after 1 year. Multivariate binary logistic regression showed that cognitive impairment was associated with increased 1-year mortality in hip fracture patients after correction for confounders (OR = 2.14, 95% CI: 1.2–3.82, P < 0.001). Also, the study found that cognitive impairment in male patients have an even higher 1-year mortality following hip fracture (OR = 5.96, 95% CI: 2.40–14.78, P < 0.0001). The interaction between males and females was P = 0.0171. The 1-year mortality was higher in older male patients with hip fractures and cognitive impairment. Cognitive impairment was associated with increased mortality in older adults with hip fractures. Notably, sex was a factor modifying this association, and male patients with cognitive impairment have an even higher 1-year mortality. Registration: ChiCTR2200057323.

The aging of populations is accelerating globally, posing scientific and societal challenges. Beyond physical health factors, there is a need to map the psychosocial determinants of mortality in older adults. This study examines the impact of life satisfaction (LS), positive attitudes toward aging (PA), and negative emotionality (NE) on 10-year mortality risk. A total of 2,271 community-dwelling older adults from the Neurological Disorders in Central Spain population-based cohort were included in the study. Participants were comprehensively assessed, including an examination of diverse chronic conditions, health habits, and psychological well-being (i.e., the Philadelphia Geriatric Center Morale Scale). Associations between psychological well-being factors (LS, PA, and NE) were examined using adjusted Cox regression models. Two-way interaction analyses were also performed to test moderator effects of main covariates (age, sex, diabetes, alcohol, and functional status) on the association between PA and mortality. Only PA, but not LS or NE, was associated with lower 10-year mortality risk in the fully adjusted Cox model (hazard ratio = 0.89, 95% confidence interval [0.83, 0.94], p < .001). The PA effect was robust even when neurological conditions were excluded in the sensitivity analysis. Age reached a statistical tendency as a moderator (hazard ratio = 1.01, 95% confidence interval [1.00, 1.02], p = .03), indicating that the PA effect is slightly higher at younger ages. PA is associated with a lower mortality risk over a 10-year follow-up. Our findings suggest a complex interplay of physical and psychosocial factors in explaining mortality risk in older adults. Health-related policies targeting older adults should consider PA as a key factor in reducing mortality. (PsycInfo Database Record (c) 2026 APA, all rights reserved).