Adult Age Research Articles

Planning for the Future: Advance Care Planning Knowledge, Discussion and Decision-Making Among Older, Sexual Minority Adults.

Background: Prior research has shown that advance care planning (ACP) knowledge and discussion varies among racial and ethnic groups. However, little is known if similar disparities exist within the sexual minority (SM) population. Objectives: To investigate racial disparities in ACP knowledge, discussion, and decision making within the SM population. Methods: Data from an online survey (N = 281) asked Black and White SM adults ages 50+ about their knowledge and actions about future healthcare wishes and their healthcare experiences. A series of multivariable logistic regressions were conducted to examine the association between ACP knowledge, discussion, and medical decision-making and race, while adjusting for other demographic and health-related variables. Results: On average, respondents were 57 years old (SD = 6.04) and just over half identified as being White (52%) and as men (55%). Most participants had heard of ACP (74%) and had an ACP discussion with someone (65%). Sixty-six percent of participants were very comfortable with medical decision-making. White SM adults had higher odds of having ACP knowledge (aOR = 3.56; 95% CI = 1.78, 7.07) and discussions (aOR = 2.43; 95% CI = 1.28, 4.61). While no racial differences were found in comfort with medical decision-making, other sociodemographics were significantly associated with comfort with medical decision-making. Conclusion: Outcomes from this work indicate persistent racial disparities in ACP within the SM population in addition to highlighting other factors that influence ACP. These findings emphasize the need for resources to address this systemic issues and to ensure that SM adults have access to and engage in ACP.

Potentially traumatic events and the association with hazardous alcohol use in 19,128 middle aged and elderly adults: the Tromsø Study 2015-2016.

The aim was to examine the association between a wide range of potentially traumatic events (PTEs) experienced in childhood, adulthood or both, and hazardous alcohol use, including the relationship between the total sum of PTEs and hazardous alcohol use in middle aged and elderly adults. Previous studies have predominantly focused on childhood PTEs or isolated PTEs and more severe alcohol problems, little focus has been given to middle aged and elderly adults with hazardous alcohol use and PTE experiences. We used logistic regression analysis to study the relation between a broad range of PTEs and hazardous alcohol defined by the alcohol use disorder identification test (AUDIT) in 19,128 women and men aged 40years and above participating in the seventh survey of the Norwegian population-based Tromsø Study in 2015-2016. Alcohol abstainers were excluded from the analyses. Experience of violence, sexual abuse, bullying, painful or frightening medical and dental treatments, and serious illness or accident by a loved one were associated with higher odds for hazardous alcohol use. Further, there were higher odds of hazardous alcohol use per additional experienced PTE (OR = 1.22, 95% CI 1.20-1.25, p ≤ 0.001). PTEs were prevalent among participants who had a hazardous alcohol use. Also, most of the PTEs occurring in childhood, adulthood or both were independently related to hazardous alcohol use. Moreover, the findings indicate an association in the relationship between the number of PTEs and hazardous alcohol use.

Correlations between frailty index and inflammatory markers derived from blood cell count in the United States

BackgroundComplete blood cell count (CBC)-derived inflammatory biomarkers are crucial indicators of adverse outcomes and possess predictive value for a wide range of diseases. The objective of this study was to evaluate the links between CBC-derived inflammatory biomarkers and frailty index.MethodsInformation was gathered from the National Health and Nutrition Examination Survey (NHANES) spanning the years 1999 to 2016. The research investigated the correlation between inflammatory biomarkers derived from CBC, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), systemic inflammatory response index (SIRI), and systemic immune-inflammation index (SII), and Rockwood’s frailty index, using logistic regression analyses.ResultsIn total, the cross-sectional study involved 13,507 U.S. adults aged 50 and older, with 3,729 individuals (24%) meeting the criteria for frailty. After adjusting for confounding factors, elevated levels of logNLR (odds ratio [OR] 3.45, 95% confidence interval [CI] 2.52–4.73), logMLR (OR 3.58, 95% CI 2.44–5.25), logSIRI (OR 2.77, 95% CI 2.17–3.55), and logSII (OR 1.89, 95% CI 1.44–2.48) were significantly associated with an increased frailty index in the entire study population. We also found that frailty index and inflammatory biomarkers derived from CBC have a non-linear relationship by restricted cubic spline.ConclusionsOur findings indicate a correlation between frailty index and NLR, MLR, SIRI, and SII among elderly adults. Considering their wide accessibility in both clinical and laboratory practice, these biomarkers may be recommended as potential indicators for the development of frailty.

Beyond the underlying cause of death: an algorithm to study multi-morbidity at death

BackgroundIn countries with high life expectancy, a growing share of the population is living with several diseases, a situation referred to as multi-morbidity. In addition to health data, cause-of-death data, based on the information reported on death certificates, can help monitor and characterize this situation. This requires going beyond the underlying cause of death and accounting for all causes on the death certificates which may have played various roles in the morbid process, depending on how they relate to each other.MethodsApart from the underlying cause, the cause-of death data available in vital registration systems do not differentiate all other causes. We developed an algorithm based on the WHO rules that assigns a “role” to each entry on the death certificate. We distinguish between the following roles: originating (o), when the condition has initiated a sequence of events leading directly to death; precipitating (p), when it was caused by an originating condition or one of its consequences; associated (a), when it contributed to death but was not part of the direct sequence leading to death; ill-defined (i), i.e., conditions such as symptoms or signs or poorly informative causes. We applied this algorithm to all death records in four countries (Italy, France, Spain and the US) in 2017.ResultsThe average number of originating causes is similar in the four countries. The proportion of death certificates with more than one originating cause—a situation typical of multi-morbidity—ranges from 10% in the US to 18% in Spain. All ages combined, the proportion of deaths with at least one associated cause is higher in Italy (41%) and in the US (42%) than in France (29%) and in Spain (27%). It is especially high in the US at all adult ages. Variations in the average number of causes between the four countries are mainly due to precipitating and ill-defined causes.ConclusionsThe output of our algorithm sheds light on cross-country differences in the average number of causes on death certificates. It also opens the door for improvements in the methods used for multiple cause-of-death analysis.

Grid-based analysis of three-dimensional choroidal Sattler’s and Haller’s layer vascularity volume index and its relation to age and axial length in adults by ultra-widefield swept-source optical coherence tomography angiography

BackgroundThis study was to evaluate the features of choroidal Sattler’s and Haller’s layer (CSHL) vessels in adults and explore its relationship with factors such as age, axial length (AL) and body mass index (BMI) by using ultra-widefield swept-source optical coherence tomography angiography (ultra-widefield SS-OCTA).Methods24mm × 20mm fovea centered rectangular SS-OCTA scans were acquired. They were divided into 9 identical grids, with each equal size of 8 mm × 6.7 mm. OCTA artifacts were evaluated. Three-dimensional choroidal vascularity volume index (CVI) and choroidal vascular volume per unit area (CVV/a or CVV) of CSHL were calculated. The correlations of CVI and CVV with age, AL, and BMI were analyzed.ResultsArtifacts account for 19.30%, 18.60%, 30.23% of three inferior grids, respectively. CVI and CVV of left eyes were 30.82 ± 0.28% and 76.76 ± 2.19μm, respectively. Similary, CVI and CVV of right eyes were 31.16 ± 0.34% and 80.49 ± 3.10μm. Strong relationships of CVI (0.877, P = 0.000) and CVV (0.866, P = 0.000) were found between the two eyes in the same individual. The covariance of CVI is lower than that of CVV. Higher CVI was associated with younger age and shorter AL. Neither CVI nor CVV has association with BMI.ConclusionsCVI can be a more stable parameter for describing choroidal medium and large-sized vessels compared to CVV. Aging and longer AL were associated with attenuated CSHL’s vascularity. Taken together, these findings may provide helpful and referential CSHL vascular parameters for retinal specialists to reveal risk factors of choroidal diseases.

Goals for, insecurity in, and self-perceptions of peer status: short term longitudinal associations with relational aggression and prosocial behaviors in emerging adults

Research on relational aggression in adolescents suggests it is in part driven by the desire to attain and maintain enhanced status among peers, and recent work also suggests certain forms of prosocial behaviors are similarly status-motivated. However, these associations are not well understood in young adults. In this short-term longitudinal study across 8 months (N = 215), we examined whether relational aggression and two forms of prosocial behaviors (altruistic and public) are related to social goals for popularity and preference, social status insecurity, and self-perceptions of status (in terms of dominance and prestige) concurrently and over time in emerging adults (age 18–25). Social goals for popularity predicted increases in relational aggression and public prosociality and were negatively related to and predicted decreases in altruistic prosociality. Preference goals were concurrently negatively related to relational aggression and to public prosociality and were positively related to and predicted increases in altruistic prosociality over time. Social status insecurity moderated links between self-perceptions of status and aggressive/prosocial behaviors, which were largely non-significant without considering status insecurity. Finally, tests of indirect effects suggest that aggression and prosociality mediate associations between popularity goals and self-perceptions of dominance. Findings suggest that strategic use of aggression and prosociality may not be developmentally limited to adolescence.

Rural Out of Hospital Cardiac Arrest Patients More Likely to Receive Bystander CPR: A Retrospective Cohort Study

ABSTRACT OBJECTIVES Survival from out-of-hospital cardiac arrests (OHCA) remains lower in rural areas. Longer Emergency Medical Services (EMS) response times suggests that rural OHCA survival may need to rely more on early bystander intervention. This study compares the rates of bystander Cardiopulmonary Resuscitation (CPR) between rural and urban areas and examines societal factors associated with bystander CPR. METHODS This study was a retrospective cohort study using merged county-level data from the National Emergency Medical Services Information System (NEMSIS) sample from 2019 and 2020, the 2019 American Community Survey, and the Bureau of Health Care Workforce data. We included all adults (age ≥ 18) with OHCA who were treated by an EMS clinician reporting data to NEMSIS, with the primary exposure of OHCA rurality, and the primary outcome of bystander CPR by a member of the public. Rurality was assigned using the Rural Urban Commuting Area code associated with the OHCA location. Cases were excluded if there was an indication for witnesses identified as health care personnel, the incident occurred at a health care site, or geographical data were not available. The association between patient- and community-level covariates and bystander CPR were measured using generalized estimating equations to model the adjusted odds ratios (aOR) and 95% confidence intervals (CI), clustering on county. RESULTS A total of 99,171 OHCA patients were identified and 60.9% (n = 60,380) received bystander CPR. Patients with OHCA living in isolated small rural towns (aOR: 1.57, 95%CI: 1.28-1.91) were more likely to have bystander CPR when compared to those living in urban cities. The odds of bystander CPR was lower in counties with larger populations of those without high school diplomas (e.g., >15% vs ≤6%, aOR: 0.56; 95%CI: 0.51-0.61), non-Caucasian populations (e.g., >40% vs ≤10%, aOR: 0.83; 95%CI: 0.76-0.91), and older populations (e.g., >14% vs ≤9%, aOR: 0.82; 95%CI: 0.74-0.91). CONCLUSIONS We observed lower rates of bystander CPR in communities with lower education, higher rates of non-Caucasian populations, and older populations. Our findings emphasize the need for public interventions in bystander CPR training to meet the needs of diverse community characteristics, and particularly in areas where EMS response times may be longer.

Interpretable multimodal machine learning (IMML) framework reveals pathological signatures of distal sensorimotor polyneuropathy

BackgroundDistal sensorimotor polyneuropathy (DSPN) is a common neurological disorder in elderly adults and people with obesity, prediabetes and diabetes and is associated with high morbidity and premature mortality. DSPN is a multifactorial disease and not fully understood yet.MethodsHere, we developed the Interpretable Multimodal Machine Learning (IMML) framework for predicting DSPN prevalence and incidence based on sparse multimodal data. Exploiting IMMLs interpretability further empowered biomarker identification. We leveraged the population-based KORA F4/FF4 cohort including 1091 participants and their deep multimodal characterisation, i.e. clinical data, genomics, methylomics, transcriptomics, proteomics, inflammatory proteins and metabolomics.ResultsClinical data alone is sufficient to stratify individuals with and without DSPN (AUROC = 0.752), whilst predicting DSPN incidence 6.5 ± 0.2 years later strongly benefits from clinical data complemented with two or more molecular modalities (improved ΔAUROC > 0.1, achieved AUROC of 0.714). Important and interpretable features of incident DSPN prediction include up-regulation of proinflammatory cytokines, down-regulation of SUMOylation pathway and essential fatty acids, thus yielding novel insights in the disease pathophysiology.ConclusionsThese may become biomarkers for incident DSPN, guide prevention strategies and serve as proof of concept for the utility of IMML in studying complex diseases.

SEROCONVERSION CAN PRECEDE CULTURE CONFIRMED DIAGNOSIS OF MYCOBACTERIUM TUBERCULOSIS INFECTION IN ASIAN ELEPHANTS (ELEPHAS MAXIMUS) BY DECADES.

Mycobacterium tuberculosis (M. tb) infection was diagnosed in 16 human-managed Asian elephants (Elephas maximus) at four different US facilities. A retrospective review was performed to collate information on serological test results and describe the timelines from exposure to an elephant known to be positive for M. tb, detection of antimycobacterial antibodies in the exposed elephant, and M. tb isolation from the exposed elephant to confirm diagnosis. Seroconversion was defined by a positive test result using ElephantTB STAT-PAK, multiantigen print immunoassay, or DPP VetTB assay for elephants (Chembio Diagnostic Systems, Inc). Fifteen elephants were adults (age ≥24 yr) at first seroconversion and 26 yr or older when confirmed by a positive M. tb culture. Six animals were diagnosed postmortem, and 10 were diagnosed antemortem by positive trunk wash (TW) culture. The interval between last known exposure to an M. tb-positive elephant and serological conversion was 8.5 yr (median; range 0-18 yr) in the eight animals that had not already seroconverted. The median time from seroconversion to isolation of M. tb was 2.8 yr in elephants diagnosed by TW culture (antemortem) compared with those diagnosed postmortem (median 1.2 yr). Of the 10 elephants diagnosed antemortem, four were seropositive for 14 or more yr (range 0-33 yr) prior to the M. tb-positive culture. The median number of negative TW samples submitted between seroconversion and diagnosis by culture was 16 (range 0-151 samples). In contrast, a median of 48 negative TW cultures and 10 yr elapsed (range 0-41 yr) between exposure and culture diagnosis. Although this descriptive report has limitations, these findings are useful for veterinarians faced with an M. tb-seropositive elephant. This report supports the recommendation of increasing TW surveillance if an elephant has a history of exposure to an M. tb-positive elephant and has multiple seropositive results.

Infrastructure Analysis of Long-term Care for Elderly Adults in Iran: A Qualitative Study

Objectives: To analyze the challenges and dimensions of long-term care (LTC) infrastructure in Iran’s health system. Design: Exploratory qualitative content analysis. Setting(s): Iran’s health system. Participants: Individuals with a minimum of five years of experience in geriatric care, LTC, and health systems, as well as at least a master’s degree in health system management. Outcome Measures: The data on challenges and dimensions related to the LTC infrastructure in Iran’s health system were gathered through 15 semi-structured interviews. Results: The challenges of LTC infrastructure in the health system of Iran were divided into two main themes (physical and human resources) and four sub-themes (lack of skilled and trained human resources, lack of attention to older adults in the training of specialists, the inappropriateness of LTC facilities, and weakness of LTC infrastructure). In addition, the planning and development of human resources, use of human resources, and development of specialized facilities and community-based care were identified as the sub-themes of the components. Conclusions: The training of specialized human resources, the updating of medical science curricula according to demographic changes, and the formation of multidisciplinary specialized teams to assess care needs and provide services are among the most important measures to provide human resource infrastructure. Moreover, designing LTC facilities at different levels and using the capacity of primary healthcare centers are among the most important measures to provide physical infrastructure that should be prioritized.

Nutritional Risks of Heavy Metals in the Human Diet—Multi-Elemental Analysis of Energy Drinks

Background: In recent years, the consumption of energy drinks (EDs) by adolescents and young adults has increased significantly, so concerns have been raised about the potential health risks associated with excessive ED consumption. Most analyses on EDs focus on the caffeine content. Research on the content of minerals (essential and toxic) in energy drinks can be considered scarce. Therefore, there is a need for research stating the actual status of heavy metal content in commercially available energy drinks. Methods: This research presents the determination of the total concentrations of macro-elements and trace elements (TEs), such as Na, K, Mg, Ca, Al, Cr, Co, Cu, Fe, Mn, Ni, B, Zn, V, Sr, Ba, Pb, Cd, and As in nine samples of energy drinks using inductively coupled plasma optical emission spectrometry (ICP-OES) and inductively coupled plasma mass spectrometry (ICP-MS) techniques. Results: The order in the content of macro-minerals in the EDs was as follows: Na > K > Mg > Ca. The results showed that ED 1, ED 3, and ED 7 samples had the highest micro-mineral concentrations. All the samples had a hazard quotient and hazard index < 1, indicating no non-carcinogenic risk from exposure to single or multiple heavy metals in both the adolescent and adult age groups. Some samples exceeded the threshold limit of acceptable cancer risk for As, Ni, and Cr in both adolescents and adults. Conclusions: This assessment showed that in addition to health implications based on the caffeine content of EDs, there might be a carcinogenic risk associated with the toxic element content of these beverages. This research also highlights notable differences in the TE levels among various ED brands, which may have important implications for consumer well-being and health.

Game on or game over? A cross-sectional study of factors impacting sport-active and sport-inactive Australian adults

Sport provides immense physical, psychological, and social benefits. However, participation rates in Australia are declining across the lifespan. Adults (25–64 years) are particularly vulnerable to inactivity due to the significant life events and transitions that occur throughout this population. This study examined the multi-level factors impacting sport participation among sport-active and sport-inactive working age adults. A cross-sectional survey of 744 Australians (M age = 45.2 years, 76.6% female) was conducted to determine potential predictors of sport participation and to compare the factors impacting sport-active (n = 470) and sport-inactive (n = 274) groups. Individual-level facilitators (e.g., enjoyment, being active) were associated with an increased likelihood of sport engagement, and various constraints (e.g., individual, partner, interest, time) were associated with decreased likelihood of participation. The outcomes from this study have the potential to guide the development of future initiatives to encourage and sustain adults’ sport participation, and to provide direction for future research.

Variant of uncertain significance (VUS) patterns among patients with early-onset colorectal cancer.

The increasing burden of colorectal cancer among adults age<50 (early-onset CRC) and new National Comprehensive Cancer Network guidelines recommending universal genetic testing in early-onset CRC emphasize the need for accurate/timely variant classification in clinical care. Here, we investigated germline variant of uncertain significance (VUS) patterns among diverse individuals with early-onset CRC. A total of 3,980 individuals age 15-49 when diagnosed with a first primary CRC-including 1,001 cases identifying as non-White, who underwent genetic testing for 14 CRC susceptibility genes performed by a clinical testing laboratory were included. A five-tier classification system was applied to all alterations to classify VUSs and was updated in March 2024. Disparities in variant reclassification rates emerged by self-identified race/ethnicity (P<0.0001). A total of 4.8% of Ashkenazim, 18.2% of Asian, 12.2% of Black, 7.6% of Hispanic and 6.7% of White individuals had at least 1 reclassified VUS. After reclassification, 356 individuals (8.9%) presented with 1+ VUSs. VUSs significantly varied by self-identified race/ethnicity (P=0.008). Young individuals identifying as Black and Hispanic had significantly higher odds of presenting with a VUS versus Whites in multivariable logistic regression models. Individuals who identified as Black and Asian were significantly more likely to present with a VUS in PMS2 (OR=3.59,95%CI=1.73-7.48;P=0.0006) and MSH2 (OR=3.14,95%CI=1.17-8.45;P=0.02), respectively, versus Whites. These findings define distinct VUS patterns in early-onset CRC by race and ethnicity, pointing to distinct germline variant spectra and to the potential for discovery of novel ancestry-specific variants associated with early-onset CRC that will guide efforts to reduce clinical uncertainty and improve equitable care.

A multi-stage feature selection method to improve classification of potential super-agers and cognitive decliners using structural brain MRI data-a UK biobank study.

Cognitive aging is described as the age-related decline in areas such as memory, executive function, reasoning, and processing speed. Super-Agers, adults over 80 years old, have cognitive function performance comparable to middle-aged adults. To improve cognitive reserve and potentially decrease Alzheimer's disease (AD) risk, it is essential to contrast changes in regional brain volumes between "Positive-Agers" who have superior cognitive performance compared to their age peers but are not 80 years old yet and aging adults who show cognitive decline (i.e., "Cognitive Decliners"). Using longitudinal cognitive tests over 7-9 years in UK Biobank, principal component analysis (PCA) was first applied to four cognitive domains to create a general cognition (GC) composite score. The GC score was then used to identify latent cognitive groups. Given cognitive groups as the target variable and structural magnetic resonance imaging (sMRI) data and demographics as predictors, we developed a multi-stage feature selection algorithm to identify the most important features. We then trained a Random Forest (RF) classifier on the final set of 54 selected sMRI and covariate predictors to distinguish between Positive-Agers and Cognitive Decliners. The RF model achieved an AUC of 73%. The top 6 features were age, education, brain total surface area, the area of pars orbitalis, mean intensity of the thalamus, and superior frontal gyrus surface area. Prediction of cognitive trajectory types using sMRI may improve our understanding of successful cognitive aging.

Comparative analysis of cancer statistics in China and the United States in 2024.

Cancer patterns in China are becoming similar to those in the United States (US). Comparing the recent cancer profiles, trends, and determinants in China and the US can provide useful reference data. This study used open-source data. We used GLOBOCAN 2022 cancer estimates and United Nations population estimates to calculate cancer cases and deaths in both countries during 2024. Data on cancer incidence and mortality trends were obtained from the Surveillance, Epidemiology, and End Results (SEER) program and National Centre for Health Statistics in the US and cancer registry reports of the National Cancer Center (NCC) of China. Data from the Global Burden of Disease study (GBD) and a decomposition approach were used to estimate the contributions of four determinants to the change in cancer deaths. In 2024, there are an estimated 3,246,625 and 2,510,597 new cancer cases and 1,699,066 and 640,038 cancer deaths in China and the US, respectively. The highest estimated cancer cases are lung cancer in China and breast cancer in the US. The age-standardized incidence rates of lung and colorectal cancer in the US, and stomach, liver, and esophageal cancer in China have decreased, but the incidence rates of liver cancer in the US and colorectal cancer, prostate cancer in men, and cervical cancer in women in China have increased. Increases in the adult population size and population aging are main reasons for the increase in cancer deaths; case fatality rates are a main reason for the decrease in cancer deaths in both countries. China has made progress in cancer control but lags the US. Considering the transformation in China's pattern of cancers epidemiology, it is imperative to develop stronger policies by adopting the cancer prevention and control strategies used in the US to address population aging and curb growing cancer trends.

The Assessment of Muscle Strength and Cardiorespiratory Parameters Using Simple Tests in Older Adults With Recovery From Mild COVID-19.

To evaluate muscle strength and cardiorespiratory parameters, this study uses simple tests in older adults, including those who have and have not recovered from mild coronavirus disease 2019 (COVID-19). Eighty older adults (age≥60 years old) were divided into two groups: those without previous COVID-19 (control group, n=40) and those with recovery from mild COVID-19 (recovered group, n=40). Muscle strength was assessed using a handgrip strength test and the sit-to-stand test (STS10). Cardiorespiratory parameters were evaluated with a 1-minute sitto- stand (1-min STS) test and a 6-minute walk test (6MWT). Both groups had normal values for body mass index, blood pressure, heart rate, and pulse oxygen saturation. The recovered group showed significant differences in handgrip strength test (24.73±6.99 vs. 22.03±4.36, p=0.041) and duration for the STS10 (25.15±6.11 vs. 33.40±7.56, p<0.001) when compared to the control group. Furthermore, the recovered group had significantly decreased repetitions of a 1-min STS (31.38±4.89 vs. 21.25±3.64, p<0.001) and increased the rate of perceived exertion (RPE) (7.43±1.20 vs. 8.95±1.01, p=0.01) and leg fatigue (1.49±1.13 vs. 3.00±1.04, p=0.03) after performing a 1-min STS when compared with the control group. Moreover, the recovered group had also significantly decreased distances for the 6MWT (421.68±8.28 vs. 384.35±6.17, p<0.001) and increased the post-test RPE (7.63±1.37 vs. 12.05±1.63, p<0.001) and the post-test leg fatigue (1.71±0.88 vs. 5.28±0.91, p<0.001) compared with the control group. Older adults with recovery from mild COVID-19 reported reduced muscle strength and exercise tolerance when compared with older adults without COVID-19.

Association between cumulative body mass index exposure and cognitive function among elderly people aged 60 years and older in China

Objective: To analyze the relationship between cumulative body mass index (BMI) and cognitive score or cognitive impairment at different age groups among elderly adults aged≥60 years old. Methods: Participants were recruited from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR). A total of 27 227 participants aged≥60 years old, who completed at least 2 physical examinations between 1992-1994 and 2018-2021, and completed cognitive function tests from 2018 to 2021, were included in the final analysis. Cognitive score was assessed using the Minimum Mental State Examination (MMSE). Cognitive impairment was defined based on education level: illiterate individuals with MMSE≤17, primary school graduates with MMSE≤20, and secondary school graduates with MMSE≤24. Multivariate linear regression or multivariate logistic regression models were used to analyze the association between 10-year weighted cumulative BMI and cognitive score or cognitive impairment in the general population, as well as in specific age groups (including 60-64 years, 65-69 years, 70-74 years, and≥75 years). Restricted cubic spline was adopted to explore the dose-response relationship. Results: The age of enrolled participants was (72.3±5.8) years, and 10 639 (39.1%) were males. The mean MMSE score was (24.9±6.8), and 4 171 (15.4%) participants had cognitive impairment. In the general population, the MMSE score increased and the risk of cognitive impairment decreased with the increase in cumulative BMI when cumulative BMI was280 kg/m2 (β=0.095, 95%CI: 0.060-0.130; OR=0.962, 95%CI: 0.946-0.978). When cumulative BMI≥280 kg/m2, the associations between cumulative BMI level and MMSE score and cognitive impairment risk were not statistically significant (β=-0.105, 95%CI:-0.212-0.001; OR=1.047, 95%CI: 0.992-1.102). Subgroup analysis according to age groups revealed a potential"U-shaped"correlation between cumulative BMI and MMSE score or cognitive impairment risk in participants aged75 years old. For cumulative BMI levels280 kg/m2, the OR and 95%CI for cognitive impairment were 0.983 (0.904-1.069), 0.953 (0.919-0.987), and 0.951 (0.922-0.982) for each 10 kg/m2 increment in cumulative BMI in the 60-64, 65-69, and 70-74 years old groups, respectively. For cumulative BMI≥280 kg/m2, the OR and 95%CI were 1.548 (1.134-2.186), 1.037 (0.938-1.139), and 1.109 (1.014-1.208) in the 60-64, 65-69, and 70-74 age groups. Among those aged≥75 years old, the cumulative BMI level was statistically associated with the increased MMSE score and decreased cognitive impairment (β=0.132, 95%CI: 0.074-0.190; OR=0.961, 95%CI: 0.944-0.979). Conclusions: Overall, when cumulative BMI is280 kg/m2, an increase in cumulative BMI is associated with a reduced risk of cognitive impairment in the general population. However, the association varies among individuals aged75 years old and those≥75 years old when cumulative BMI is≥280 kg/m2. The findings highlight the necessity of personalized weight management strategies for elderly individuals across different age groups.

Advance care planning in adults ages 80 years and older with impaired cognition: Using actual conversations to examine best practices.

Recommendations for advance care planning (ACP) in persons with cognitive impairment are based on expert input without insight from actual ACP conversations. We used thematic analysis to analyze transcripts of ACP conversations for 88 older adults with normal cognition (n=15), mild cognitive impairment (n=13), and scores consistent with dementia (n=60). Patients with dementia were least verbally active; however, some shared values and identified surrogates. We identified three themes: (1) cognitive impairment inhibits participation in ACP, but individuals with dementia are able to contribute; (2) care partners have a key role in supporting ACP across the spectrum of cognitive impairment; and (3) structured questions about values and tailored communication strategies can facilitate engagement of older adults with dementia. Our findings reinforce best practice recommendations for early ACP and identify strategies to increase patient engagement among older adults with cognitive impairment with support of care partners. Data from actual ACP conversations involving older adults with a range of cognitive function and their care partners reinforce best practice recommendations and suggest practical implications for education and training. Family involvement in ACP was valued by older adults and improved engagement. ACP initiatives should prioritize eliciting values of older adults with dementia and improving skills for communication to increase engagement.

Socioeconomic Position and Oral Health in Chinese Older Adults: A Life Course Approach.

We investigated associations between socioeconomic position (SEP) across childhood, adulthood, and older age and number of teeth among Chinese older adults. Data came from 15,136 participants aged 65 to 105 y in the Chinese Longitudinal Healthy Longevity Survey (2018 wave). The outcome was number of teeth. Pathways and sensitive period models were tested simultaneously via structural equation modeling. Ordinal logistic regression assessed the accumulation of risk and social mobility models. Differences were examined across 4 birth cohorts. Adult and older age SEP had direct effects on number of teeth in older age (adulthood, direct β = 0.182, P < 0.001; older age, direct β = 0.093, P = 0.005), supporting the sensitive period model. Childhood SEP had an indirect effect on number of teeth (indirect β = 0.130, P < 0.001) through adult and older age SEP, supporting the pathway/accumulation of risk and social mobility models. Effects of SEP on number of teeth were more pronounced in younger cohorts. Graded associations in the expected directions were found between the number of periods in which participants experienced disadvantaged SEP and number of teeth, as well as social mobility trajectories and number of teeth. Among Chinese older adults, the number of remaining teeth is subject to marked social inequalities. Our findings document the simultaneous applicability of life course models and a widening of oral health inequalities in China across generations. Interventions earlier in child and adult life are needed to address this problem and reduce oral health inequalities. The findings of this study suggest marked socioeconomic inequalities in oral health among Chinese older adults. These inequalities are generated throughout the life course and appear to have widened across cohorts. This study emphasizes that interventions are needed to address the social determinants of oral health at all life stages.

Trends in sepsis-associated cardiovascular disease mortality in the United States, 1999 to 2022

PurposeCardiovascular disease (CVD) is the leading cause of death in the United States, and sepsis significantly contributes to hospitalization and mortality. This study aims to assess the trends of sepsis-associated CVD mortality rates and variations in mortality based on demographics and regions in the US.MethodsThe Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database was used to identify CVD and sepsis-related deaths from 1999 to 2022. Data on gender, race and ethnicity, age groups, region, and state classification were statistically analyzed to obtain crude and age-adjusted mortality rates (AAMR). The Joinpoint Regression Program was used to determine trends in mortality within the study period.ResultsDuring the study period, there were a total of 1,842,641 deaths with both CVD and sepsis listed as a cause of death. Sepsis-associated CVD mortality decreased between 1999 and 2013, from AAMR of 65.7 in 1999 to 58.8 in 2013 (APC −1.06*%, 95% CI: −2.12% to −0.26%), then rose to 74.3 in 2022 (APC 3.23*%, 95% CI: 2.18%–5.40%). Throughout the study period, mortality rates were highest in men, NH Black adults, and elderly adults (65+ years old). The Northeast region, which had the highest mortality rate in the initial part of the study period, was the only region to see a decline in mortality, while the Northwest, Midwest, and Southern regions experienced significant increases in mortality rates.ConclusionSepsis-associated CVD mortality has increased in the US over the past decade, and both this general trend and the demographic disparities have worsened since the onset of the COVID-19 pandemic.