Bidirectional associations between socioeconomic status, physical activity, and depressive symptoms in middle-aged and older adults: A cross-lagged prospective cohort study.

Association between internet exclusion and depressive symptoms among older adults: panel data analysis of five longitudinal cohort studies

BackgroundSocial participation and digital use are associated with reduced depression risk among older adults, but most supporting evidence does not consider both time-invariant and time-varying confounders and is inconsistent. We aimed to evaluate the impact of social participation and digital use on the incidence of depressive symptoms among older adults by a multi-country cohort considering both time-invariant and time-varying counfounders.MethodsWe used data from four nationally representative observational studies across 18 countries (2008–2021): the Health and Retirement Study (HRS), the Survey of Health, Aging and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Aging Study (MHAS). Participants aged 50 years or older without depressive symptoms at baseline and without related behaviors pre-baseline were included. Interested exposure social participation and digital use were measured by specific questions. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the European Depression Scale (EURO-D). Targeted maximum likelihood estimation method was applied to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the long-term impact of exposure on depressive symptoms onset.ResultsA total of 69,186 eligible participants were included. At baseline, 77.0%, 44.0%, 34.2%, and 49.8% of participants were exposed to social participation in HRS, SHARE, CHARLS, and MHAS, respectively, and these proportions were 55.7%, 55.9%, 4.5%, and 69.9% for digital use exposure. During follow-up, a total of 18,245 (26.4%) individuals developed depressive symptoms. The RRs (95% CI) of depression risk under social participation versus no social participation were 0.80 (0.68–0.93) in HRS, 0.80 (0.74–0.87) in SHARE, 0.86 (0.77–0.96) in CHARLS, and 0.93 (0.85–1.02) in MHAS. Compared with no digital use, the RRs (95% CI) of depression risk under digital use were 0.88 (0.72–1.08) in HRS, 0.85 (0.77–0.93) in SHARE, 0.75 (0.60–0.92) in CHARLS, and 0.88 (0.79–0.98) in MHAS.ConclusionsEngagement in social participation and digital use are associated with a reduced incidence of depressive symptoms in older adults. In the digital world, besides social participation, promoting digital use for social connection may be an effective strategy for depression prevention in ageing populations.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-026-04846-4.

BackgroundPatients with Alzheimer's disease or dementia are at increased risk for COVID-19 hospitalization and mortality. However, no study has examined whether memory function is associated with COVID-19 outcomes in general older adults.MethodsData were obtained from SHARE (the Survey of Health, Ageing and Retirement in Europe), HRS (the Health and Retirement Study), and ELSA (the English Longitudinal Study of Ageing), three prospective and representative cohorts of non-institutionalized adults aged 50 years and older in 25 European countries plus Israel, the United States, and the United Kingdom, respectively. Memory function was measured with immediate and delayed 10-words recall tests. Associations of 10-words recall with COVID-19 hospitalization and mortality were assessed using logistic models adjusted for age, sex, race, body mass index, smoking, physical activity, household income, education level, and chronic conditions.Figure 1.Determination of the study sample.COVID-19, coronavirus disease 2019; ELSA, the English Longitudinal Study of Ageing; HRS, the Health and Retirement Study; SHARE, the Survey of Health, Ageing and Retirement in Europe.ResultsA total of 4062 participants with COVID-19 infection from SHARE, 1349 from HRS, and 278 from ELSA were included in the analysis. 610 (15.0%) in SHARE, 142 (10.5%) in HRS, and 39 (14.0%) in ELSA were hospitalized, and 102 (2.5%) died of COVID-19 or related complications in SHARE. The adjusted odds ratios (aORs) for COVID-19 hospitalization were 1.15 (95% CI, 1.09-1.22) in SHARE, 1.07 (95% CI, 0.94-1.21) in HRS, and 1.34 (95% CI, 1.02-1.77) in ELSA, per word decrease in immediate 10-words recall. For delayed 10-words recall, the corresponding aORs were 1.11 (95% CI, 1.06-1.17), 1.12 (95% CI, 1.01-1.24), and 1.25 (95% CI, 1.01-1.55), respectively. The aORs for COVID-19 mortality were 1.07 (95% CI, 0.94-1.21) and 1.14 (95% CI, 1.01-1.28) per word decrease in immediate and delayed 10-words recall in SHARE, respectively. Results were relatively robust to missing data of covariates, exclusion of cases based on symptoms alone, or exclusion of cases with Alzheimer's disease or dementia.ConclusionThis study shows that low memory performance, as measured by 10-words recall, is independently associated with an increased risk of COVID-19 hospitalization and mortality in adults aged 50 years and older.DisclosuresAll Authors: No reported disclosures

ObjectivesThe burden of pain in middle‐aged and older adults is considerable and significantly increases healthcare expenditures. We aimed to investigate the roles of handgrip strength (HGS) weakness and asymmetry in predicting pain across four nationally representative cohorts.MethodsThis longitudinal study utilized data from four major surveys: the Health and Retirement Study (HRS); the English Longitudinal Study of Ageing (ELSA); the Survey of Health, Ageing and Retirement in Europe (SHARE); and the China Health and Retirement Longitudinal Study (CHARLS). Multivariable cubic regression splines were employed to visually explore the nonlinear associations between HGS and pain in each cohort. The Cox proportional hazard model was applied to analyze the independent and combined relationship between HGS weakness and asymmetry and pain risk.ResultsWe included 41,171 participants in the final analysis, with a mean follow‐up period of 4.68 ± 2.61 years (50.7% female, mean age 64.3 ± 9.3 years). No nonlinear relationship was found between HGS and pain incidence (nonlinear p < 0.05 in ELSA and SHARE; >0.05 in CHARLS and HRS). After adjustment, the highest quartile groups had a significantly reduced risk of pain compared to the lowest quartile groups across all cohorts, with hazard ratios of 0.81 (0.74, 0.89) in CHARLS, 0.86 (0.77, 0.97) in HRS, 0.88 (0.77, 0.98) in ELSA, and 0.78 (0.73, 0.84) in SHARE. Participants with normal HGS had approximately 20% lower risk of pain compared to those with weak HGS. Each 5 kg increase in HGS was associated with decreased hazard ratios for pain: 0.95 (0.93, 0.97) in CHARLS, 0.97 (0.94, 0.99) in HRS, 0.96 (0.94, 0.99) in ELSA, and 0.94 (0.92, 0.95) in SHARE. The association between HGS asymmetry and pain risk was significant only in a few cohorts (HRS at 10%, 1.10 (1.03, 1.18); SHARE at 30%, 1.12 (1.05, 1.21)). No interaction effect between HGS weakness and asymmetry on pain risk was observed (all p‐values for interaction >0.05).ConclusionsOur findings suggest that HGS can be used as an independent predictor of pain in middle‐aged and older European, American, and Chinese populations. However, our results do not support the use of HGS asymmetry as an independent predictor of pain risk. It is necessary to establish appropriate criteria for HGS asymmetry across different populations. The use of both weak HGS and asymmetry as predictors of health outcomes requires further validation in more diverse populations.

Depression in middle-aged and older adults is increasingly recognized as being influenced by spousal health conditions, yet the specific impact of spousal chronic diseases and sensory impairments remains underexplored. This study aimed to investigate the independent and combined effects of spousal cardio-pulmo-metabo-disease (CPMD) and sensory impairments on (1) incident depression, (2) age at onset of depression, and (3) changes in these conditions with depression onset. This pooled multi-cohort study utilized data from four nationally representative longitudinal cohort studies: the Health and Retirement Study (HRS), the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Study of Ageing (ELSA), and the Korean Longitudinal Study of Ageing (KLoSA). Spousal CPMD was defined as the self-reported presence of cardiovascular disease, chronic lung disease, and diabetes, and categorized as none, single, or multimorbidity. Spousal sensory impairments were defined based on self-rated hearing and vision, harmonized into "optimal," "adequate," or "impaired," and further classified as none, single (hearing or vision), or dual impairments (both hearing and vision). We excluded participants with depressive symptoms at baseline. Incident depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) or EURO-D. Cox proportional hazard models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) after adjusting for potential confounders. After adjusting for covariates, spousal CPMD was progressively associated with higher depression risk (HR per one disease increment: 1.10, 95% CI: 1.06-1.14). Similarly, graded increases in risk were observed for spousal sensory impairments (HR per one impairment increment: 1.18, 95% CI: 1.14-1.22). Their combined effects were significantly associated with age at onset of depression across all age groups. Participants whose spouses had persistent CPMD or sensory impairments had a significantly higher risk of depression compared to those whose spouses remained free of these conditions. Holistically addressing spousal CPMD and sensory impairments can reduce depression risk and improve quality of life in aging populations.

Patients with Alzheimer's disease or dementia are at increased risk for COVID-19 hospitalization and mortality. However, no study has examined whether memory function is associated with COVID-19 outcomes in general older adults. Data were obtained from SHARE (the Survey of Health, Ageing and Retirement in Europe), HRS (the Health and Retirement Study), and ELSA (the English Longitudinal Study of Ageing), three prospective and representative cohorts of non-institutionalized adults aged 50 years and older in 25 European countries plus Israel, the United States, and the United Kingdom, respectively. Memory function was measured with immediate and delayed 10-words recall tests. Associations of 10-words recall with COVID-19 hospitalization and mortality were assessed using logistic models adjusted for age, sex, race, body mass index, smoking, physical activity, household income, education level, and chronic conditions. A total of 4,062 participants with COVID-19 infection from SHARE, 1349 from HRS, and 278 from ELSA were included in the analysis. 610 (15.0%) in SHARE, 142 (10.5%) in HRS, and 39 (14.0%) in ELSA were hospitalized, and 102 (2.5%) died of COVID-19 or related complications in SHARE. The adjusted odds ratios (aORs) for COVID-19 hospitalization were 1.15 (95% CI, 1.09-1.22) in SHARE, 1.07 (95% CI, 0.94-1.21) in HRS, and 1.34 (95% CI, 1.02-1.77) in ELSA, per word decrease in immediate 10-words recall. For delayed 10-words recall, the corresponding aORs were 1.11 (95% CI, 1.06-1.17), 1.12 (95% CI, 1.01-1.24), and 1.25 (95% CI, 1.01-1.55), respectively. The aORs for COVID-19 mortality were 1.06 (95% CI, 0.93-1.20) and 1.14 (95% CI, 1.01-1.28) per word decrease in immediate and delayed 10-words recall in SHARE, respectively. Results were relatively robust to missing data of covariates, exclusion of cases based on symptoms alone, or exclusion of cases with Alzheimer's disease or dementia. This study shows that low memory performance, as measured by 10-words recall, is independently associated with an increased risk of COVID-19 hospitalization and mortality in adults aged 50 years and older.

Background: Digital exclusion is a global issue that disproportionately affects older individuals especially in low- and middle-income nations. However, there is a wide gap in current research regarding the impact of digital exclusion on the mental health of older adults in both high-income and low- and middle-income countries. Methods: We analyzed data from 5 longitudinal cohorts: the Health and Retirement Study (HRS), the English Longitudinal Study of Aging (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Aging Study (MHAS). These cohorts consisted of nationwide samples from 24 countries. Digital exclusion was defined as the self-reported lack of access to the internet. Depressive symptoms were assessed using comparable scales across all cohorts. We used generalized estimating equation models, fitting a Poisson model, to investigate the association between the digital exclusion and depressive symptoms. We adjusted for the causal directed acyclic graph (DAG) minimal sufficient adjustment set (MSAS), which includes gender, age, retirement status, education, household wealth, social activities, and weekly contact with their children. Results: During the study period (2010-2018), 122,242 participants underwent up to 5 rounds of follow-up. Digital exclusion varied greatly across countries, ranging from 21.1% in Denmark to 96.9% in China. The crude model revealed a significant association between digital exclusion and depressive symptoms. This association remained statistically significant in the MSAS-adjusted model across all cohorts: HRS [incidence rate ratio (IRR), 1.37; 95% confidence interval (CI), 1.28 to 1.47], ELSA (IRR, 1.32; 95% CI, 1.23 to 1.41), SHARE (IRR, 1.30; 95% CI, 1.27 to 1.33), CHARLS (IRR, 1.62; 95% CI, 1.38 to 1.91), and MHAS (IRR, 1.31; 95% CI, 1.26 to 1.37); all Ps < 0.001. Notably, this association was consistently stronger in individuals living in lower wealth quintile households across all 5 cohorts and among those who do not regularly interact with their children, except for ELSA. Conclusions: Digital exclusion is globally widespread among older adults. Older individuals who are digitally excluded are at a higher risk of developing depressive symptoms, particularly those with limited communication with their offspring and individuals living in lower wealth quintile households. Prioritizing the provision of internet access to older populations may help reduce the risks of depression symptoms, especially among vulnerable groups with limited familial support and with lower income.

BackgroundPatients with Alzheimer’s disease or dementia are at increased risk for COVID-19 hospitalization and mortality. However, no study has examined whether memory function is associated with COVID-19 outcomes in general older adults.MethodsData were obtained from SHARE (the Survey of Health, Ageing and Retirement in Europe), HRS (the Health and Retirement Study), and ELSA (the English Longitudinal Study of Ageing), three prospective and representative cohorts of non-institutionalized adults aged 50 years and older in 25 European countries plus Israel, the United States, and the United Kingdom, respectively. Memory function was measured with immediate and delayed 10-words recall tests. Associations of 10-words recall with COVID-19 hospitalization and mortality were assessed using logistic models adjusted for age, sex, race, body mass index, smoking, physical activity, household income, education level, and chronic conditions.ResultsA total of 4062 participants with COVID-19 infection from SHARE, 1349 from HRS, and 278 from ELSA were included in the analysis. 610 (15.0%) in SHARE, 142 (10.5%) in HRS, and 39 (14.0%) in ELSA were hospitalized, and 102 (2.5%) died of COVID-19 or related complications in SHARE. The adjusted odds ratios (aORs) for COVID-19 hospitalization were 1.15 (95% CI, 1.09–1.22) in SHARE, 1.07 (95% CI, 0.94–1.21) in HRS, and 1.34 (95% CI, 1.02–1.77) in ELSA, per word decrease in immediate 10-words recall. For delayed 10-words recall, the corresponding aORs were 1.11 (95% CI, 1.06–1.17), 1.12 (95% CI, 1.01–1.24), and 1.25 (95% CI, 1.01–1.55), respectively. The aORs for COVID-19 mortality were 1.07 (95% CI, 0.94–1.21) and 1.14 (95% CI, 1.01–1.28) per word decrease in immediate and delayed 10-words recall in SHARE, respectively. Results were relatively robust to missing data of covariates, exclusion of cases based on symptoms alone, or exclusion of cases with Alzheimer’s disease or dementia.ConclusionsThis study shows that low memory performance, as measured by 10-words recall, is independently associated with an increased risk of COVID-19 hospitalization and mortality in adults aged 50 years and older.

BACKGROUNDDepression is a significant risk factor for diabetes, particularly type 2 diabetes. However, depressive symptoms differ from clinical depression. Previous research has not fully considered the relationship between the trajectory of depressive symptoms and the risk of developing diabetes over time.AIMTo investigate the association between depressive symptoms, their trajectories, and the risk of developing diabetes in two prospective cohort studies.METHODSIn the first phase we analyzed the association between depressive symptoms and the risk of developing diabetes separately using the Health and Retirement Study (HRS). Depressive symptom trajectories were assessed by examining changes in depressive symptoms at baseline and again 8 years later. We then identified specific depressive symptom trajectories that increased the risk of diabetes in the second phase. Finally, we confirmed the association between depressive symptoms and their trajectories with diabetes risk using the English Longitudinal Study of Ageing (ELSA) as a validation study. Depressive symptom trajectories were categorized into five states based on changes in the modified 8-item Center for Epidemiological Studies-Depression scores: Persistently high; increasing; fluctuating; decreasing; and persistently low. Diabetes mellitus was defined as self-reported, physician-diagnosed diabetes. Cox proportional hazards models were used to assess hazard ratios (HR) and 95% confidence intervals (CI), adjusting for potential confounders.RESULTSIn the first phase a total of 27658 participants were included (HRS: 18633, ELSA: 9025), among whom 6582 had depressive symptoms (HRS: 4547, ELSA: 2035), 6407 had somatic depressive symptoms (HRS: 4414, ELSA: 1993), and 26415 had cognitive-affective depressive symptoms (HRS: 17755, ELSA: 8660). We found that overall depressive symptoms (HRS: HR = 1.14, 95%CI: 1.07-1.22; ELSA: HR = 1.18, 95%CI: 1.03-1.34) and somatic depressive symptoms (HRS: HR = 1.14, 95%CI: 1.07-1.22; ELSA: HR = 1.25, 95%CI: 1.10-1.42) increased the risk of diabetes, while cognitive depressive symptoms were not associated with diabetes risk. Over an 8-year follow-up we identified 19729 trajectories of overall, somatic, and cognitive-affective depressive symptoms (HRS: 13918, ELSA: 5811). In the second phase we found that persistently high (HRS: HR = 1.22, 95%CI: 1.06-1.40, ELSA: HR = 1.54, 95%CI: 1.16-2.05 in total and HRS: HR = 1.24, 95%CI: 1.07-1.43, ELSA: HR = 1.79, 95%CI: 1.36-2.35 in somatic) and fluctuating (HRS: HR = 1.09, 95%CI: 1.01-1.17, ELSA: HR = 1.33, 95%CI: 1.14-1.55 in total and HRS: HR = 1.10, 95%CI: 1.02-1.18, ELSA: HR = 1.31, 95%CI: 1.13-1.53 in somatic) trajectories of overall and somatic depressive symptoms increased the risk of diabetes, while increasing trajectories may also raise diabetes risk. However, decreasing trajectories were not associated with diabetes risk. Cognitive-affective depressive symptoms showed no association with diabetes risk regardless of trajectory changes. Sensitivity analyses confirmed the reliability of the findings.CONCLUSIONPersistently high and fluctuating trajectories of overall and somatic depressive symptoms increased the risk of diabetes, while decreasing trajectories were not associated with diabetes risk. In contrast trajectories of cognitive-affective depressive symptoms show no relationship with diabetes risk. Focusing on depressive symptom trajectories, particularly those of somatic depressive symptoms, represented a viable strategy for future diabetes prevention.

ObjectiveOur study prospectively assessed the relationship between cumulative handgrip strength and temporal changes in depressive symptoms among adults aged 50 years and over.MethodsThis study was conducted based on two longitudinal cohort studies: the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Cumulative handgrip strength was derived from three repeated measurements taken over eight years (ELSA) or six years (SHARE). The mixed linear regression models and Cox regression models were employed to assess the associations between cumulative handgrip strength and temporal changes in depressive symptoms, as well as incident depression risk.ResultsParticipants in the lowest quartile of cumulative handgrip strength had higher depressive symptom scores compared to those in the highest quartile in ELSA (β: 0.191; 95% CI: 0.035, 0.348) and SHARE (β: 0.391; 95% CI: 0.267, 0.514), and experienced an accelerated increase in depressive symptoms of 0.040 point/y (95% CI: 0.009, 0.070) in ELSA, and 0.067 point/y (95% CI: 0.045, 0.089) in SHARE during follow-up. Regarding incident depression, the lowest quartile group faced a 55% (HR: 1.55; 95% CI: 1.13, 2.12) and 62% (HR: 1.62; 95% CI: 1.38, 1.90) increased risk of developing depression in ELSA and SHARE, relative to the highest quartile.ConclusionsReduced cumulative handgrip strength correlated with accelerated depressive symptom progression and increased depression incidence. Future interventional studies should further investigate if strength/muscular fitness can improve mental health, particularly in older adults.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24223-9.

BackgroundFrailty is a multidimensional geriatric syndrome characterized by cumulative physiological decline. While associated with various adverse outcomes, the longitudinal relationship between frailty and new-onset depression across diverse national populations remains insufficiently explored. This study investigated the association between the Frailty Index (FI) and new-onset depression in three large aging cohorts.MethodsThis multinational longitudinal cohort study included community-dwelling adults aged ≥50 years from three nationally representative aging cohorts: the Health and Retirement Study (HRS), the English Longitudinal Study of Aging (ELSA), and the Survey of Health, Aging and Retirement in Europe (SHARE). Frailty was assessed using a deficit accumulation–based frailty index (FI). New-onset depression was defined by validated CES-D 8 or EURO-D scores among participants free of depression at baseline. Associations were estimated using Cox proportional hazards, Fine–Gray competing risk, and discrete-time logistic regression models. Dose–response patterns were examined using restricted cubic splines, and mediation analysis evaluated the role of grip strength.ResultsOver median follow-ups of 8 (HRS), 2 (ELSA), and 4 (SHARE) years, 749, 973, and 7,821 participants developed new-onset depression, respectively. Cohort-specific incidence rates were 34.5% in HRS (749/2, 171), 18.6% in ELSA (973/5, 223), and 30.4% in SHARE (7, 821/25, 721). Adjusted analyses showed the FI was consistently associated with depression risk across all cohorts. Each one-unit FI increase was associated with an approximately 4% higher risk (HR = 1.04, p < 0.001 for all cohorts). Participants in the highest FI quartile had significantly elevated risk compared to the lowest. Results were robust across all statistical models. Restricted cubic splines indicated a nonlinear association, which was partially mediated by grip strength.ConclusionFrailty is an independent predictor of new-onset depression in older adults across diverse international populations. Early frailty identification and targeted multidimensional interventions—including grip strength enhancement, structured physical activity, nutritional optimization, and psychosocial support—may help reduce depression incidence and promote healthy aging.

highly prevalagent hearing and vision sensory impairments among older people may contribute to the risk of cognitive decline and pathological impairments including dementia.This study aims to determine whether single and dual sensory impairment (hearing and/or vision) are independently associated with cognitive decline among older adults and to describe cognitive trajectories according to their impairment pattern. we used data from totals of 13,123, 11,417 and 21,265 respondents aged 50+ at baseline from the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE), respectively. We performed growth curve analysis to identify cognitive trajectories, and a joint model was used to deal with attrition problems in longitudinal ageing surveys. respondents with a single sensory impairment had lower episodic memory score than those without sensory impairment in HRS (β = -0.15, P < 0.001), ELSA (β = -0.14, P < 0.001) and SHARE (β = -0.26, P < 0.001). The analysis further shows that older adults with dual sensory impairment in HRS (β = -0.25, P < 0.001), ELSA (β = -0.35, P < 0.001) and SHARE (β = -0.68, P < 0.001) remembered fewer words compared with those with no sensory impairment. The stronger associations between sensory impairment and lower episodic memory levels were found in the joint model which accounted for attrition. hearing and/or vision impairments are a marker for the risk of cognitive decline that could inform preventative interventions to maximise cognitive health and longevity. Further studies are needed to investigate how sensory markers could inform strategies to improve cognitive ageing.

BACKGROUNDDepressive symptoms differ from clinical depression. However, the relationship between depressive symptom trajectories and stroke risk across diverse geographic regions remains unclear.AIMTo address the gap in the existing understanding of the relationship between depressive symptom trajectories and stroke risk, the current study utilized three representative cohorts.METHODSIn this study, we used three representative cohorts from Asia, Europe, and the Americas: China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), and Health and Retirement Study (HRS). Depressive symptoms were assessed using the 8-item Center for Epidemiological Studies Depression scale and categorized into somatic and cognitive-affective subtypes. The trajectories of depressive symptoms were monitored over four surveys starting from baseline and classified into five distinct states: persistently low, decreasing, fluctuating, increasing, and consistently high. Self-reported physician diagnoses were used to evaluate the subsequent stroke events. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) were computed using Cox proportional-risk models adjusted for potential confounding factors.RESULTSA total of 7990 participants from CHARLS (females: 52.3%, mean age: 63.4 years), 5642 participants from ELSA (females: 56.2%, mean age: 63.7 years), and 12260 participants from HRS (females: 61.4%, mean age: 64.7 years) participated in this study. The median follow-up periods were 5 years for CHARLS, 8 years for ELSA, and 10 years for HRS. In comparison with the persistently low trajectory, consistently high and fluctuating trajectories of total depressive symptoms increased the risk of stroke in all three cohorts (CHARLS: HR = 1.80, 95%CI: 1.36-2.38; ELSA: HR = 1.50, 95%CI: 1.02-2.21; HRS: HR = 1.45, 95%CI: 1.29-1.62 for consistently high; CHARLS: HR = 1.47, 95%CI: 1.14-1.90; ELSA: HR = 1.44, 95%CI: 1.17-1.77; HRS: HR = 1.26, 95%CI: 1.13-1.41 for fluctuating). Increasing trajectories enhanced the risk in the European cohort (ELSA: HR = 1.71, 95%CI: 1.06-2.74), while decreasing trajectories did not increase stroke risk in any cohort. For somatic depressive symptoms, consistently high and fluctuating trajectories increased the risk of stroke across all cohorts (CHARLS: HR = 2.16, 95%CI: 1.67-2.79; ELSA: HR = 1.94, 95%CI: 1.34-2.81; HRS: HR = 1.79, 95%CI: 1.49-2.15 for consistently high; CHARLS: HR = 1.35, 95%CI: 1.20-1.62; ELSA: HR = 1.56, 95%CI: 1.27-1.92; HRS: HR = 1.33, 95%CI: 1.20-1.46 for fluctuating). Increasing trajectories only increased the risk in the European cohort (ELSA: HR = 1.95, 95%CI: 1.11-3.43), while decreasing trajectories did not increase stroke risk in the European and American cohorts. For cognitive-affective depressive symptoms, consistently high and fluctuating trajectories increased the risk in the Asian and European cohorts (CHARLS: HR = 2.06, 95%CI: 1.52-2.81; ELSA: HR = 1.25, 95%CI: 1.02-1.54 for consistently high; CHARLS: HR = 1.63, 95%CI: 1.23-2.16; ELSA: HR = 1.58, 95%CI: 1.11-2.24 for fluctuating). Increasing trajectories increased the risk only in the American cohort (HRS: HR = 14.67, 95%CI: 1.87-114.91).CONCLUSIONConsistently high and fluctuating trajectories of total and somatic depressive symptoms were associated with an increased risk for stroke across all populations. Consistently high, fluctuating, and increasing trajectories of cognitive-affective symptoms pose a risk for certain populations. These findings highlight the importance of targeted interventions for managing depressive symptoms as potential strategies for stroke prevention, particularly in regions where specific symptom trajectories are prevalent.

The association between changes in frailty status and the prevalence of chronic lung diseases (CLD) is critical. This study aims to explore the relationship between variations in frailty status and incidence of CLD. This study utilized data from four national prospective cohorts: China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS) and Survey of Health, Ageing and Retirement in Europe (SHARE). Changes in frailty status were assessed using the Rockwood Frailty Index. CLD was defined as self-reported physician-diagnosed chronic lung diseases, including chronic bronchitis, emphysema, cor pulmonale. Cox proportional hazards model was employed to examine the relationship between changes in frailty status and the incidence of CLD. The analysis included 38,122 participants from four cohorts. Participants who progressed to prefrail or frail status had a significantly higher risk of developing CLD compared to those who remained robust (CHARLS, HR: 1.85, 95% CI: 1.47–2.32; HRS, HR: 1.84, 95% CI: 1.34–2.51; ELSA, HR: 1.58, 95% CI: 1.08–2.31; SHARE, HR: 1.70, 95% CI: 1.40–2.07). Conversely, individuals who transitioned to robust status demonstrated a lower risk of incident CLD compared to those who remained in prefrail or frail status (CHARLS, HR: 0.59, 95% CI: 0.48–0.73; HRS, HR: 0.71, 95% CI: 0.49–1.01; ELSA, HR: 0.57, 95% CI: 0.36–0.89; SHARE, HR: 0.71, 95% CI: 0.55–0.92). Different changes in frailty status are associated with varying risks of developing CLD. Progression of frailty status is associated with the increasing risk of CLD, whereas recovery from frailty is associated with the decreased risk of CLD. The findings suggest that changes in frailty status can serve as important indicators for predicting the risk of developing CLD, where frailty progression elevates risk while recovery from frailty mitigates it. Question What are the associations of changes in frailty status with risks of incident chronic lung disease (CLD)? Finding Progression from robust to pre-frail or frail status increased risks of incident CLD, while recovery from pre-frail or frail statust to robust status, and decreased risks of incident CLD. Conclusions Changes in frailty status affect incident CLD risk. Abbreviations：CHARLS, China Health and Retirement Longitudinal Study ; HRS, Health and Retirement Study; ELSA, English Longitudinal Study of Ageing.; SHARE, Survey of Health, Ageing and Retirement in Europe

The Survey of Health, Ageing and Retirement in Europe (SHARE) is a unique multidisciplinary and cross-national panel database of ex ante harmonized microdata on health, socioeconomic status, and social and family networks covering most of the European Union and Israel. To date, SHARE has collected five waves of data in 2-year intervals since 2004, including current living circumstances and retrospective life histories. A sixth wave is currently (2015) in the field. Four additional waves are planned until 2024. More than 230,000 interviews conducted so far give a broad picture of life after age 50, measuring physical and mental health, both objectively and subjectively; economic and noneconomic activities, income, and wealth by sources; intergenerational transfers of time and money within and outside of the family; as well as life satisfaction and well-being. The data are available to the scientific community free of charge at www.share-project.org after registration. SHARE is harmonized with the US Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) and has become a role model for several aging surveys worldwide. SHARE’s scientific power is based on its panel design that grasps the dynamic character of the aging process, its multidisciplinary approach that delivers the full picture of the individual and societal aging, and its cross-nationally ex ante harmonized design that permits international comparisons of health, economic, and social outcomes in Europe and the USA. Due to their harmonization, the SHARE data and their international sisters encompass a worldwide “historical laboratory” to assess the effects of different policies on health, socioeconomic status, and well-being after age 50. To date (May 2015), more than 1,200 SHARE-based publications assess the chances and challenges of individual and societal aging by exploiting the links between health, economic, and social conditions over the life course observable in SHARE. Among the key findings is a European North–South gradient in many more dimensions than previously documented. In addition to the well-known income gradient, the health and wellbeing differences between North and South contradict mortality data and folklore about healthy Mediterranean lifestyle. SHARE has sparked an entire new area of research by revealing a strong correlation between early retirement and the loss of cognitive abilities, social contacts, and well-