Experiences and coping strategies of community-dwelling middle-aged and older adults with physio-cognitive decline syndrome: A qualitative study.

Background: Aging increased the risks of cognitive impairment and depression. Then, these conditions can lead to poor quality of life by reducing one’s ability to perform activities of daily living. Recently, it is established that physical activity can decrease the cognitive decline and the risk of depression in older adults. Moreover, regular physical activity can improve physical and mental functions in populations of all ages. However, level and speed of cognitive decline occurs varies greatly among individual especially the difference between middle-aged and older adults. Objective: This study aimed to focus on the comparison of physical activity, cognitive function and depression between older and middle-aged adults, which has never been done before. Moreover, the associations of physical activity with cognitive impairment and depression were also investigated in older and middle-aged adults. The information in this study will provide an understanding regarding the design of physical activity program for different age groups. Methods: All participants were divided into two groups of 50 middle-aged adults and 50 older adults. The assessments of physical activity, cognitive function, and level of depression were conducted for all participants. Results: The total level of physical activity and cognitive function in older adults was decreased when compared with middle-aged ones. Moreover, each work and transportation domain of physical activity in older adults also was decreased when compared with that in middle-aged ones. However, the leisure domain of physical activity in older adults was increased via a decreasing depression level. In addition, the level of physical activity associated with both cognitive function and depression and depression alone in middle-aged and older adults, respectively. Conclusion: We suggested that total level of physical activity in older adults can increase via stimulating work and transportation activities in physical activity program. Moreover, the level of physical activity associated with both cognitive function and depression and depression alone in middle-aged and older adults, respectively.

BackgroundCognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the older adult population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet use among middle-aged and older adults.ObjectiveThis study aims to explore the association between internet use and age-related cognitive decline among middle-aged and older Chinese adults. To gain a more comprehensive understanding of the effects of internet use, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet use on cognitive function for characteristics significantly linked to cognition in stratified analysis.MethodsWe analyzed data based on 12,770 dementia-free participants aged ≥45 years from the China Health and Retirement Longitudinal Study. We used a fixed effects model to assess the relationship between internet use and cognitive decline and further validated it using multiple linear regression analysis, generalized estimating equations, propensity score matching, inverse probability of treatment weighting, and overlap weighting. We further examined the varying effects of internet device type and frequency on cognitive function using fixed effects models and Spearman rank correlations. The Karlson-Holm-Breen method was used to estimate the mediating role of internet use in the urban-rural cognitive gap.ResultsParticipants using the internet (n=1005) were younger, more likely to be male, more educated, married, retired and living in an urban area and had higher cognitive assessment scores than nonusers (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function (β=0.551, 95% CI 0.391-0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases, at 2.2% (15/671), compared with nonusers, at 5.3% (379/7099; P<.001). The negative impact of aging (>50 years) on cognitive function was consistently less pronounced among internet users than among nonusers. Furthermore, increased frequency of internet use was associated with greater cognitive benefits for middle-aged and older adults (rs=0.378, P<.001). Among digital devices used for internet access, cell phones (β=0.398, 95% CI 0.283-0.495) seemed to have a higher level of cognitive protection than computers (β=0.147, 95% CI 0.091-0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2% of the total effect, P<.001).ConclusionsThis study revealed that the use of internet by individuals aged 45 years and older is associated with a reduced risk of cognitive decline. Internet use has the potential to be a viable, cost-effective, nonpharmacological intervention for cognitive decline among middle-aged and older adults.

The American Geriatrics Society, with support from the National Institute on Aging and the John A. Hartford Foundation, held its seventh Bedside-to-Bench research conference, entitled “Delirium in Older Adults: Finding Order in the Disorder” on February 9–11, 2014, to provide participants with opportunities to learn about cutting-edge research developments, draft recommendations for future research involving translational efforts, and opportunities to network with colleagues and leaders in the field. This meeting was the first of three conferences that will address delirium, sleep disorders, and voiding difficulties and urinary incontinence, emphasizing, whenever possible, the relationships and potentially shared clinical and pathophysiological features between these common geriatric syndromes.

This article's objective was to compare demographic/medical history and multidomain clinical assessment outcomes between older and middle-aged adults following concussion. Seventy-six patients aged 50-80 years within 12 months of a concussion from a specialty clinic between October 2021 and August 2023 participated in the study. Participants were grouped into older (≥60 years) and middle-aged (50-59 years) adults. At their first clinic visit, participants completed multidomain clinical assessments comprising symptoms, cognitive, vestibular/ocular motor, psychological health, and quality of life domains. Older adults (n = 35) had less females (40.0% vs. 68.3%, p = .01), anxiety history (17.1% vs. 39.0%, p = .036), and employed individuals (57.1% vs. 82.9%, p = .002) than middle-aged adults (n = 41). Older adults had better Neuro-Quality of Life, F(1, 71) = 6.8, p = .01, ηp² = 0.09; Repeatable Battery for the Assessment of Neuropsychological Status recall, F(1, 71) = 12.6, p < .001, ηp² = 0.15; fluency, F(1, 71) = 5.7, p = .02, ηp² = 0.08; list recall, F(1, 69) = 5.2, p = .03, ηp² = 0.07; and list recognition, F(1, 69) = 5.3, p = .03, ηp² = 0.07, when controlling for sex, anxiety history, and employment status. Older adults also had lower odds of being impaired to borderline on Immediate Post-Concussion Assessment and Cognitive Testing verbal memory (OR = 0.05, 95% CI [0.01, 0.56], p = .01), visual motor speed (OR = 0.08, 95% CI [0.01, 0.73], p = .03), and reaction time (OR = 0.21, 95% CI [0.05, 0.89], p = .03), and lower odds of having moderate to severe impairment on Neuro-Quality of Life (OR = 0.32, 95% CI [0.11, 0.97], p = .04) than middle-aged adults. Older adults (≥60 years) exhibited fewer subjective cognitive difficulties and objective cognitive impairments compared to middle-aged adults (50-59 years) following concussion. There were no differences between groups in symptoms, vestibular/ocular motor functioning, or psychological health. Clinicians should consider these findings when evaluating and interpreting outcomes from older and middle-aged adults following concussion. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This study aimed to examine older adults' physical activity intentions and preferred implementation intentions, and how intentions and preferred implementation intentions differ between older, middle aged and younger adults. A cross-sectional Australian wide telephone survey of 1217 respondents was conducted in 2016. Multiple and ordinal regression analyses were conducted to compare intentions and preferred implementation intentions between older (65+), middle aged (45-64) and younger adults (<45). A higher percentage of older adults had no intentions to engage in regular physical activity within the next 6months (60%) compared to younger adults (25%). Older adults' most popular preferences included being active at least once a day and for 30min or less and were more likely to prefer more frequent and shorter sessions compared to younger adults. Both older and middle aged adults were more likely to prefer slower paced physical activity compared to younger adults who preferred fast paced physical activity. Physical activity interventions for older adults should address the high percentage of older adults with no intentions and public health campaigns for older adults should promote 30min daily sessions of slow paced activity.

The relationship between atherosclerosis and cognitive function is less well studied in Chinese populations. In addition, the results among middle-aged adults have been mixed. We aimed to investigate the association of atherosclerosis measured by carotid intima-media thickness (CIMT) and cognitive function in middle-aged and older adults from a Chinese community. Participants in the Asymptomatic Polyvascular Abnormalities in Community study (APAC) who had completed the CIMT detection and cognitive function measurements in 2012/2013 were included. Cognitive function was measured using the Mini-Mental State Examination (MMSE). Multivariate linear regression analysis was used to analyze the association between CIMT and MMSE. Then, a stratified analysis was performed separately in middle-aged and older adults. A total of 3227 participants were included in this study (mean age 57.9years, range 43-93years); 56.6% of them were men, 66.0% were middle-aged adults. After adjusting for potential confounders, larger CIMT was associated with lower MMSE scores, with a 0.75-point decrease in MMSE score for every 1-mm increase in CIMT (β=-0.75, P=0.0020). The association remained statistically significant in middle-aged adults (β=-0.57, P=0.0390), and was stronger in older adults and adults with low education levels. There is a significant association between CIMT and cognitive function among middle-aged and older adults sampled from a Chinese population. This association was stronger in older adults and adults with low education levels.

More middle-aged and older adults are often encouraged to volunteer (Gray et al., 2012). However, the effects of various volunteering activities on physical, psychological and cognitive health remain unknown. This study thereby aims to investigate such effects and the moderating effect of age in such associations. Data of 501 middle-aged and older Hong Kong Chinese adults (Mage = 53.06, SD = 4.55; and Mage = 70.46, SD = 7.34, respectively; range = 45 – 96) from a survey on Adult Development and Aging were analysed. Engagements in instrumental (e.g., food preparation, fundraising) and cognitively demanding volunteering (e.g., counselling, mentoring), hand-grip strength, life satisfaction, depressive symptoms, and cognitive functioning were measured. Factorial ANOVA revealed significant main effects of age group and volunteering type (F = 29.71, and F = 3.96, respectively, ps < .001), and an interaction effect of age and volunteering type (F =1.80, p = .03) on health outcomes. Comparisons among the four volunteering types (no volunteering, instrumental volunteering, cognitively demanding volunteering, and both types) revealed that individuals engaging in cognitively demanding volunteering had better hand-grip strength, life satisfaction, and cognitive functioning, and lower depressive symptoms than those who engaged in instrumental volunteering (all ps < .05). The health outcomes of instrumental volunteering were even worse than those who did not volunteer at all. These patterns were more prevalent in the middle-aged adults than in the older adults. Findings of this study indicated the beneficial effects of cognitively demanding volunteering, providing valuable directions for future programs on volunteering.

Older adults who smoke: Do they engage with and benefit from web-based smoking cessation interventions?

Walking while listening or talking is a functionally relevant cognitive-motor dual-task (DT) activity that may challenge attentional capacity. DT activity alters gait and increases falls risk. The aging process may magnify challenges in DT performance. This study compared cognitive-motor interference (CMI) and DT performance across younger, middle-aged, and older adults during walking under varying memory task types. A cross-sectional sample of 32 younger (mean age=25),18 middle-aged (mean age=56), and 19 older (mean age=73.6) healthy adults completed walking trials under single-task (ST) and four DT conditions with different memory-based tasks, two auditory encoding (story memory and list encoding), and two verbal retrieval (verbal fluency and list retrieval). Participants wore sensors that transmitted spatiotemporal walking data to a mobile iOS device. Gait parameters (speed (m/s), stride time (s), stride time variability (%CoV)) and memory performances were measured under ST and DT conditions. DT effects (DTE) were calculated for all measures to quantify CMI, the percent change in performance under DT relative to ST. Statistical analyses included ANOVAs with post hoc tests and correlations with age. We found a decreasing trend in DTgait performance and worsening CMI across conditions with advancing age (for example, DT verbal fluency gait speed: younger= 1.10m/s DTE= -15%; middle-aged= 0.98m/s DTE= -18%, older= 0.82m/s DTE= -24%). ANOVA showed differences between the 3 age groups in the DTE of all memory tasks on the gait measures (p<0.05), with the DTE being consistently higher (worse) in older than younger adults. Middle-aged and older adults did not differ in DTE on speed or stride variability under memory retrieval tasks, but the latter had greater DTE on speed under memory encoding tasks. Middle-aged adults had similar DTE on gait measures to younger adults under encoding tasks, but greater on stride time and variability under retrieval tasks. Groups had similar DTE on memory tasks. Age-related differences in CMI were more prominent for gait than for memory tasks. Findings support that DT performance incrementally declines with age. Middle-aged and older adults had similar gait destabilization in different DT walking demands, but older adults had higher interference with DT walking of auditory processing demands. Retrieval tasks during walking expose early deficits in middle-aged adults that differentiate them from younger adults. Results further suggest assessing DT walking of different demands and beginning from middle age to reduce fall risk and enhance DT ability early in life via education or cognitive-motor training.

When someone says, “I can't hear myself think,” it usually means that background noise is making it difficult to concentrate. But another meaning of this expression has emerged from recent research examining the relationship between hearing and cognition in aging. Several studies have demonstrated the association between aspects of auditory abilities and cognitive function in older adults (Laryngoscope Investig Otolaryngol. 2017;2[2]:69). It has long been understood that the perception of complex everyday sounds, such as music and speech, involves much more than auditory detection and discrimination. However, the relationship between hearing and cognition has only recently become the focus of intensive scientific inquiry (Ear Hear. 2016; 37 Suppl 1:5S).hearing loss, ethnicity, race, health careFigure: Kaplan–Meier failure curve showing the cumulative incidence of dementia according to observed hearing loss status (unadjusted for covariates) (N = 1,881). (Republished with permission from J Am Geriatr Soc. 2017;65:1691).One striking finding of this work is that the rate of age-related cognitive decline is significantly greater in older adults with a hearing loss than among their normal-hearing peers, even when controlling for other known risks (Laryngoscope Investig Otolaryngol. 2017). While the presence and magnitude of this effect vary across studies, overall results demonstrate that the negative impact of hearing loss extends well beyond quality of life issues. Understanding the nature of the relationship between hearing loss and cognition can potentially lead to the design of effective interventions to benefit an individual's well-being and reduce the disease burden on society. Several general mechanisms have been proposed to account for a relationship between hearing and cognition (JAMA Intern Med. 2013;173[4]:293). First, the basis could arise from a common cause, such as the general neural degeneration associated with aging that affects both hearing and cognitive function. Second, cascading consequences of the chronic sensory deprivation due to hearing loss may prevent the appropriate stimulation of higher central auditory processing structures, leading to a subsequent decline in cognitive status. The increased listening effort used to compensate for sensory deprivation may itself affect cognitive processing, resulting in suboptimal allocation of limited cognitive resources and reduced performance on other tasks. Finally, hearing loss may indirectly affect cognitive status through a concomitant reduction in the extent of social interaction and an increase in clinical depression. ETHNICITY AND RACE FACTORS A recent study by Golub and colleagues highlighted an important but less-explored aspect of the relationship between hearing loss and cognition in aging–the influence of ethnicity and race (J Am Geriatr Soc. 2017;65[8]:1691). The researchers examined the prevalence of incident dementia and hearing loss in a large longitudinal sample of aging adults from an ethnically diverse neighborhood of New York City. Among 1,881 baseline participants (40% Hispanic, 31% black, and 29% white), 377 developed incident dementia during the average of 7.4 (+/- 4.6) years of follow-up visits. Overall, there was a 1.69 greater risk of incident dementia among participants with hearing loss than normal-hearing participants, even when controlling for other potential contributors such as cardiovascular risk and stroke. When the sample was stratified by ethnicity and race, however, hearing impairment increased the risk of incident dementia only for black participants (2.62, P <.01). The risk of dementia among Hispanics and whites with hearing loss was also greater than that for those with normal hearing (1.43 and 1.61, respectively), though this trend was not statistically significant. Differences among the three groups persisted even when factors such as education and income were considered in statistical modeling. Golub, et al., observed that the specific reasons for the greater risk of dementia in older black adults with hearing loss are not known. The findings are generally consistent with previous research that demonstrated how ethnicity and race can be significant predictors of cognitive status in older adults (J Int Neuropsychol Soc. 2016;22[1]:66). In our previous work, tests of spectral-temporal processing in which listeners were asked to discriminate changes in the phase of a spectral-ripple and compare brief (0.5 sec) spectro-temporal frequency patterns showed reduced performance among black participants compared with white participants (PLoS One. 2015;10[8]:e0134330). Performance on these tests was significantly correlated with global cognition assessed using a battery of 12 neuropsychological tests, more specifically with scores on working memory tests. The authors suggested that differences in the response strategies used by white and black participants in tasks with a high degree of uncertainty may have contributed to the performance differences between the groups. Another study, however, found that black adults demonstrate a greater resilience to age-related hearing loss (J Gerontol A Biol Sci Med Sci. 2011; 66[5]:582). Therefore, the relationship between hearing and cognition in black adults is more complex than a simple group-wise association. Interpretation of the findings of Golub, et al., on racial and ethnic differences requires further caution for several reasons. First, the criterion used to determine the presence of hearing loss in the study was quite lax. The determination was based on the examiner's observations of a participant's hearing status, including whether the examiner needed to speak loudly or if the participant wore a hearing aid. As the authors acknowledged, this assessment approach may potentially confound the effects of hearing loss and dementia because the ability to repeat and follow the experimenter's instruction—part of the basis for hearing loss determination—also involves cognitive processing of linguistic information. In addition, the performance of participants with hearing loss on cognitive tests may in part reflect their inability to hear instructions well. HEARING AIDS AND COGNITIVE DECLINE The reliability of hearing assessment becomes a critical question as an increasing number of studies use examiner observations and patient reports to evaluate the relationship between hearing and cognition. For example, a study by Amieva and colleagues reported that older adults with self-reported hearing loss and who used hearing aids had the same rate of cognitive decline as their normal-hearing peers, while those who had hearing loss but did not use a hearing aid showed a significantly steeper rate of cognitive decline (J Am Geriatr Soc. 2015;63[10]:2099). This finding, based on the analysis of 3,414 participants in a 25-year longitudinal study, is encouraging because it suggests that the negative impact of hearing loss on cognition may be a modifiable risk factor that can be effectively addressed through hearing aid use. On the other hand, the determination of hearing loss in that study was made based on a single question (“Do you have hearing trouble?”) that was asked only once at the baseline assessment. Participants who were either unaware of their hearing loss or felt uncomfortable admitting it, would not be correctly categorized. Similarly, hearing aid use was also assessed only at baseline, thus reflecting neither the frequency nor consistency of hearing aid use over time. Notably, the study findings revealed that the steeper rate of cognitive decline among participants with hearing loss was no longer different from normal-hearing participants after controlling for psychosocial variables. Amieva, the lead author of the study, later observed that “it is highly unlikely that hearing aids have a direct effect on cognition,” and hypothesized that depression and social isolation associated with hearing loss may mediate the relationship (J Am Geriatr Soc. 2015). IMPACT OF HEARING LOSS Indeed, hearing loss affects many aspects of a person's life. In a recent study, Vas and colleagues examined the complaints of those affected by hearing loss and their communication partners (Trends Hear. 2017). Their analysis documented that in addition to complaints directly related to auditory function such as listening and communication, both hearing-impaired individuals and their communication partners presented with a large range of complaints related to social interactions and individual well-being. Given that social engagement and self-appraisal are known factors in the cognitive decline of older adults, it is likely that these may also play a mediating role between hearing and cognition in older adults. Although there is yet a full understanding of the relationship between hearing and cognition, our current knowledge of the mediating factors can already inform the development of a wide range of effective interventions. Among these, hearing instruments as well as cognitively-focused and healthy lifestyle interventions may serve as effective tools to improve the social circumstances and overall well-being of people with hearing loss and those of their families. Journal Club Highlight Observed Hearing Loss and Incident Dementia in a Multiethnic Cohort Golub, JS, et al. J Am Geriatr Soc. 2017; 65:1691.Valeriy Shafiro, PhDStanley Sheft, PhD

The current study examined potential mediators of the association between physical disability and depressive symptoms, along with positive mental health variables, including meaning in life and positive affect, within the framework of an empirically supported model of depression---the behavioral model of depression (Lewinsohn, 1985). The behavioral model of depression posits that reduced contact with positive reinforcement in the environment (i.e., engagement in pleasant events) precipitates and maintains depressive symptoms (Lewinsohn et al., 1985). Treatment studies have demonstrated the efficacy of interventions based on the behavioral model of depression in older adults (Cuijpers et al., 2007; Dimidjian et al., 2006; Hopko et al., 2003). The application of the behavioral model of depression to understanding the link between physical disability and depressive symptoms fits well with previous conceptualizations specifying the ways in which disability may affect mood (Bruce, 2001). First, consistent with role of life events in the behavioral model of depression (Lewinsohn et al., 1985), onset of disability can function as a discrete life event with the potential to create initial dysregulation in mood and disruption in schedules of reinforcement (Bruce, 2001; Dunne et al., 2011; Heckhausen et al., 2010), conditions that serve as catalysts for reduction in positive reinforcement over time (Lewinsohn, 1985). Second, physical disability is often chronic in nature and requires goal-adjustment and various forms of coping for successful adaption over time (Boerner, 2004; Hall et al., 2010). Failure to successfully adjust goals and coping strategies in response to physical disability may lead to reduced positive reinforcement if older adults do not replace lost activities with new ones, thereby increasing risk for depression over time (Duke et al., 2002). The current study was designed to examine whether the frequency of pleasant events, as well as frequency by pleasantness of events product (i.e., frequency of pleasant events and frequency x pleasantness of events), mediated the association between physical disability and affective outcomes (depressive symptoms, positive affect, meaning in life), after controlling potential confounds (age, gender, education, cognitive functioning, and perceived social support; Blazer, 2003). Participants were (N = 82) adults 65 years and older recruited from Morgantown, WV and surrounding towns/cities, Mage = 77.6 (SD = 8.0), 64.6% female, 97.6% White. Questionnaires measured physical disability (ADLS/IADLS), affective outcomes (GDS, GSIS-MIL, PANAS-PA), pleasant events (OPPES), and covariates (MoCA, DSSI, demographics). Simple mediation analyses with each proposed mediator (frequency of pleasant events and frequency x pleasantness of events) predicting affective outcomes

This study aimed to investigate bilateral motor control and connectivity between supplementary motor area (SMA) and primary motor cortex (M1) in younger, middle-aged, and older healthy adults. 32 younger (mean age 22.8 ± 5.3years), 18 middle-aged (47.6 ± 6.5years), and 23 older (75.8 ± 6.7years) adults were tested. Bilateral motor control was assessed using the Purdue pegboard. Dual-site transcranial magnetic stimulation (TMS) was used to measure SMA-M1 connectivity at different conditioning stimulation intensities. Older adults had significantly poorer motor performance than younger and middle-aged in all pegboard subtests. Notably, there were no conclusive differences in motor performance between younger and middle-aged adults. There was no conclusive evidence supporting age-related and intensity-related differences in SMA-M1 connectivity between younger, middle-aged, and older adults. There was also no conclusive evidence to support clear associations between SMA-M1 connectivity and bilateral motor control. Age-related declines in bilateral motor functioning was found in older, but not middle-aged adults. The bilateral motor functioning of middle-aged adults is more young-like than old-like. The lack of conclusive age- and intensity-related differences in SMA-M1 connectivity, and lack of conclusive association with bilateral motor performance, might be due to high inter-individual variability in SMA-M1 connectivity. Potential factors contributing to this variability include SMA and M1 morphometry, the structural connectivity between these regions, and the localisation of SMA.

Volunteering is a popular activity among middle-aged and older adults as means to contribute to the society and to maintain personal health and wellbeing. While the benefits of volunteering have been well-documented in the current literature, it does not tend to distinguish between various types of volunteering activities. This cross-sectional study aims to compare the effects of instrumental (e.g. food preparation, fundraising) and cognitively demanding volunteering activities (e.g. befriending, mentoring) in a sample of 487 middle-aged and older Hong Kong Chinese adults. Participation in instrumental and cognitively demanding volunteering, life satisfaction, depressive symptoms, cognitive functioning and hand-grip strength were measured. The results of two-way between-subject robust analyses of variance demonstrated significant main effects of volunteering type and their interaction effect with age on life satisfaction and depressive symptoms. Comparisons among four volunteering groups (no volunteering, instrumental volunteering, cognitively demanding volunteering and both types) revealed that individuals engaging in instrumental volunteering exhibited lower life satisfaction and more depressive symptoms compared to those who engaged in cognitively demanding volunteering and those who did not volunteer at all. This detrimental pattern of instrumental volunteering was only seen in middle-aged adults, but not in older adults. Findings of this study revealed distinctive effects of two volunteering types, and provide valuable directions for designing future volunteering programmes.

This study explored factors of formal care service usage, dividing service users between middle-aged (50-64) and older adults&#x0D; (65+). Despite of upsurging care needs of middle-aged adults, previous studies have not studied on their care needs. Therefore, we focused&#x0D; on examining the factors of service uses for understanding their needs for public care services. We used the second data from Care SOS&#x0D; Center in Seoul, South Korea and selected 31,265 people who used the services in 2021. Independent variables were organized into four&#x0D; categories - predisposing, enabling, need, and health care system factors - based on Andersen's theory of service uses, for which many&#x0D; previous studies have adopted. After conducting multiple regression analysis using SPSS 25.0, the results were as follows: First, regarding&#x0D; the predisposing factors, middle-aged adults who have many family members were more likely to use care services, while older adults’&#x0D; family members were not statistically significant. Second, need factors such as the discharged patients were pivotal in care service uses&#x0D; of both middle-aged and older adults. Third, older adults who had used other social care services before were less likely to use this short-term&#x0D; care SOS services, but the result was not statistically significant for middle-aged adults. Based on the results, we suggested social welfare&#x0D; interventions such as developing intensive care services for the discharged based on community care, interlocking and connecting social&#x0D; care services, making interventions for the excluded who needs imminent services as well as pointed out the importance of universal care services for both older and middle-aged adults.

Unhealthy alcohol consumption such as binge drinking and depression are common problems among adults. The combined effect of binge drinking and depression might contribute to negative health outcomes, such as accidents, addiction, or sleep problems. Previous evidence has indicated that alcohol consumption differs by age. However, little is known about the association between binge drinking, depression, and sleep health, and how age might play a role in this association. This study aimed to examine the association between binge drinking, depressive symptoms, and sleep health in middle-aged and older adults and characterize any age differences. A total of 5191 middle-aged and older adults from the 2014 Core Survey of the Health and Retirement Survey (HRS) data aged 50 to 80 were included for this study. Binge drinking was defined as the consumption of 5 or more drinks (men) and 4 or more drinks (women) per drinking day. Depressive symptoms were measured using a validated 8-item Center for Epidemiologic Studies Depression Scale. Sleep health was assessed using a composite measure. Age was grouped into middle-aged (50-64.9 years) and older (65-79.9 years) adults. Multiple linear regression analysis was used to examine the associations between variables of interest. Our findings indicated that binge drinking and depressive symptoms negatively influenced sleep health among middle-aged adults, however this relationship was not found in older adults. Clinicians should simultaneously assess problematic alcohol consumption, depressive symptoms, and sleep health. Future research can develop and test age-specific interventions to reduce unhealthy drinking behaviors in middle-aged adults.