Age Trends Research Articles

Advanced glycation end products and risk of mortality in patients with cirrhosis: a prospective cohort study

The role of diet in reducing the burden of liver disease and mortality attributed to cirrhosis is very imperative. The present study scrutinized the relationship between dietary advanced glycation end products (AGEs) and mortality in patients with cirrhosis. This research was a prospective cohort study on 166 ambulatory cirrhotic patients who had been diagnosed with cirrhosis for a maximum of six months. Follow-up of patients continued for 5 years until May 2024. To determine the incidence of mortality in the quartiles of dietary AGEs, cox regression models were used with the adjustment of potential confounding variables. Although the first model of the analysis by adjusting the results for age and sex failed to show a significant increase in the risk of mortality in patients (HRQ4 vs. Q1 = 2.64; 95% CI = 0.9–7.5, P trend = 0.075), after adjusting the results for further confounders in the second (HRQ4 vs. Q1 = 3.56; 95% CI = 1.1–11.6, P trend = 0.040) and third (HRQ4 vs. Q1 = 3.3; 95% CI = 1.79–13.7, P trend = 0.048) models, the P trend for the risk of mortality during the quartiles of AGEs became significant. In addition, along with increasing trend of dietary AGEs, the number of deaths increased significantly (P = 0.024). Higher mortality risk was generally attributed to higher dietary AGEs in patients with cirrhosis.

Association of cataract surgery with stroke among older adults in the United States.

Cataract surgery, one of the most frequent conducted surgeries around the world, is associated with cardiovascular diseases. We aim to determine the association of cataract surgery and the risk of stroke. Adults aged over 65 years old in the National Health and Aging Trends Study were followed 7 years annually. There were 6700 stroke-free participants included at baseline survey. These participants were divided into two groups based on past history of cataract surgery. Demographics and multiple comorbidities were compared between the two groups. We identified newly developed cases of stroke over a 7-year period and performed survival analysis. Cox regression was further performed to yield adjusted hazard ratios. Among 6700 elderly participants, 2803 of them had a history of cataract surgery while 3897 of them had not. Over the 7-year follow-up period, the cumulative stroke-free survival rate among the cataract surgery group and the control group were 84.4% versus 88.6% (p < 0.0001, log-rank test). Compared with the control group, elderly with a history of cataract surgery had a higher risk of developing stroke (adjusted HR 1.36, 95% CI 1.03 to 1.79, p = 0.026) after adjusting for multiple covariates. Other significant predictors included age ≥80 years old, having comorbidities with heart disease, lung disease, and dementia. Contrarily, protective factors for further stroke development included higher education and more frequent outdoor activities. Our findings suggest that patients with a history of cataract surgery had a 1.36-fold increased risk of future stroke development.

Global, regional, and national disease burden attributable to high systolic blood pressure in youth and young adults: 2021 Global Burden of Disease Study analysis

BackgroundHigh systolic blood pressure (HSBP) can cause adverse cardiovascular events and is therefore associated with a heavy global disease burden. However, this disease burden is poorly understood in youth and young adults. We aimed to explore this population to better understand the evolving trends in HSBP-related disease burden, which is crucial for effectively controlling and mitigating harmful effects.MethodsThis systematic analysis used data from the 2021 Global Burden of Disease Study, spanning 1990–2021. Participants were aged 15–39 years from 204 countries/territories. We analysed HSBP-related disease burden by region, sex, age, and temporal trends. The primary outcomes were disability-adjusted life years (DALYs), mortality rates, and estimated annual percentage change.ResultsGlobally, the number of HSBP-related deaths among youth and young adults has increased by 36.11% (95% uncertainty interval [95% UI], 20.96–52.37%), whereas the number of DALYs has increased by 37.68% (95% UI, 22.69–53.65%); however, global mortality and DALY rates have remained relatively stable. In 2021, the mortality and DALY rates were 4.29 (95% UI, 3.29–5.28) and 263.37 (95% UI, 201.40–324.46) per 100,000 population, respectively. The overall HSBP-related burden was higher in males than in females, with increasing and decreasing trends for males and females, respectively. Regionally, significant improvements in HSBP-related burden were observed in most high-sociodemographic index (SDI) regions, including high-income Asia Pacific (deaths: percentage change, − 72.65%; DALYs: percentage change, − 69.30%) and Western Europe (deaths: percentage change, − 72.89%; DALYs: percentage change, − 67.48%). In contrast, middle-SDI regions had the highest number of deaths and DALYs in 2021, whereas low-middle-SDI regions had the highest mortality and DALY rates. Furthermore, low-SDI regions experienced the largest increase in the number of deaths and DALYs. The HSBP-related burden increased with age; in addition, the proportion of deaths or DALYs due to ischaemic heart disease and stroke increased with age, reaching > 75% for those > 25 years of age.ConclusionsThe increase in global HSBP-related burden among youth and young adults indicates that current preventative efforts are insufficient. Therefore, targeted measures are needed to counter the trends in HSBP-related diseases and reduce disparities across regions and sexes.

Associations of Accelerometer-Measured Physical Activity With Dementia, Anxiety, and Depression Among Older Adults.

Higher physical activity (PA) is associated with better neuropsychiatric health, but prior studies have been limited by cross-sectional designs, self-reported PA measures, and small numbers of older individuals. We examined associations between baseline and changes in accelerometer-measured moderate-vigorous PA (MVPA) with neuropsychiatric health among individuals aged ≥ 70 years in the National Health and Aging Trends Study. We used the average daily minutes of accelerometer-measured MVPA above a validated threshold of 2184 counts per minute as a continuous measure at baseline for the exposure variable. For longitudinal analyses, we categorized change in MVPA as follows: an increase of > 20 min/day over 1 year, a decrease of > 20 min/day over 1 year, and staying within 20 min/day over 1 year. Our outcomes were possible/probable dementia and anxiety or depression. Associations were estimated using confounder-adjusted logistic regressions. In our survey-weighted analytic sample of 639 individuals aged ≥ 70 years, 56% were ≥ 75 years, and 53% were female. After adjusting for confounders, a 20-min/day higher baseline MVPA was significantly associated with lower odds of possible/probable dementia 1 year later (odds ratio [OR] = 0.89, 95% confidence interval [CI] = 0.83-0.96) but not with depression and anxiety symptoms. Compared to no change in PA over 1 year, an increase in MVPA by > 20 min/day was associated with decreased odds of depression and anxiety symptoms (OR = 0.06, 95% CI = 0.03-0.14) but not with possible/probable dementia. Compared to no change in MVPA over 1 year, a decrease in MVPA by > 20 min/day was associated with higher odds of possible/probable dementia (OR = 3.82, 95% CI = 1.34-10.87) but not with depression and anxiety symptoms. Higher and increasing MVPA over time is associated with better neuropsychiatric health in individuals aged ≥ 70 years. Future studies should prioritize evaluating detailed PA trajectories to better understand how different doses, intensities, and modalities of PA impact neuropsychiatric decline in older adults.

Mechanism for meeting the care of older adults in rural China—relying on spouse, offspring or community?

BackgroundWithin the population aging and the trend of aging in place on the rise, it is crucial to explore how care needs are being met for this demographic within the community.MethodsThis study utilizes data from the 2019–2021 survey on 1,126 rural older adults aged 60 years and above across 11 provinces and 31 villages in China. This study aims to examine the influence of spouse, offspring, and community status on the extent to which the care needs of rural older adults are met. Furthermore, it seeks to clarify the underlying mechanism of influence, as well as the change that occurs throughout the life cycle, using a multiple linear regression analysis.ResultsThis study demonstrates that the health status of spouses, the education level of offspring, the relationship with offspring, and the living with offspring significantly and positively influence the meeting of care needs among rural older adults. Notably, older adults with healthier spouses experience a 14.5% greater fulfillment of care needs compared to those without partners. Furthermore, those living with their offspring experience a 10.6% higher degree of care met. Additionally, the construction and operation of community senior care facilities, indicative of community quality, significantly enhance the meeting of care needs among rural older adults, with a 16.0% increase in met needs for those residing in communities equipped with such facilities compared to those without. From a life cycle perspective, the aforementioned significant effects are only observed among rural older adults aged 60–74 years or those in better health.ConclusionOur results indicate the meeting of the care needs among rural older adults is influenced by the quality of their spouse, offspring, and community, with these effects diminishing later in the life cycle.

Integrated Geriatric Healthcare and Related Innovative Models

The intensifying trend of population aging has made geriatric healthcare a key concern for countries worldwide. According to the United Nations, the global elderly population is projected to increase to 1.6 billion by 2050 at which time persons above 65 years old are expected to account for 16% of the world's population (United Nations, 2023). To address this challenge, proactive and systematic approaches as well as innovative models are needed to implement practices, education, research, and policy measures (Mohd Tohit & Haque, 2024). Innovative healthcare models and policies are being continuously developed that address aspects such as interdisciplinary collaboration, diverse gender needs, talent cultivation, community assessment and management, and home-based emergency care. For the column in this issue, we invited experts from various fields of geriatric healthcare to share their significant developments and application experiences. Their articles highlight several key related points.

Aging Disparities in Ostomy Surgery.

Little is known about the association between age and fecal ostomy surgery trends over time. We aim to 1) determine the rate of fecal ostomy operations over time and 2) compare rates of colostomy formation between patients older and younger than 65y. Retrospective multi-institutional cohort study of patients ≥18y who underwent colorectal resection between 2003 and 2014 using the Nationwide Inpatient Sample database. Patients were identified using International Classification of Diseases, 9th edition Procedural Codes. A difference-in-difference analysis was performed to evaluate the differences in colostomy formation between age groups. Out of 819,441 adult patients who underwent major colorectal resection, 136,840 (16.6%) required ostomy formation. Median age was 63y (interquartile range 51-74), 50% were female. Overall,82,606 (10.0%) patients underwent a colostomy formation and 54,234 (6.6%) an ileostomy formation. Rates of colostomy formation decreased (13.2%-7.1% in <65 and 14.0%-7.2% in ≥65). Incidence of ileostomy formation increased for both age groups (6.1%-9.9% in <65 and 3.8%-6.3% in ≥65). The difference-in-difference analysis showed that the decline in colostomy formation was less pronounced among the older adult cohort (odds ratio 0.49, 95% confidence interval 0.47-0.50) than those <65 (odds ratio 0.42, 95% confidence interval 0.41-0.44). Incidence of colostomy formation decreased in both groups over the study period. In contrast, the decline in colostomy formation was slower among older adults. This highlights a significant change in surgical trends across the United States with increasing rates of ileostomy use. Appropriate resource allocation and support are vital to the recovery of this growing surgical patient population.

Higher education expansion, economic reform, and the change of college wage premium in urban China (1986-2019): An age-period-cohort analysis.

This study utilizes three large-scale survey datasets and multiple APC models to analyze the trends of the college wage premium in urban China across different temporal dimensions. The findings reveal that the economic returns to higher education increase continuously with age. In addition, the period effect also demonstrates an upward trend, which is attributed to the rapid economic modernization and market-oriented economic reform in urban China. Furthermore, the cohort effect declines significantly in cohorts born after 1980, primarily due to the rapid increase in higher education enrollments after the massive university expansion policy in 1999. It is suggested that scholars should focus on age, period, and cohort trends simultaneously and explore their driving forces when studying countries where economic reform and higher education expansion concurrently exert significant effects on the change of economic returns to higher education.

Association of Longitudinal Trajectories of Physical Frailty With Dementia Status in Older Adults: A National Cohort Study.

The longitudinal patterns of change in physical frailty and their associations with the subsequent dementia risk remain unclear. This study aimed to (1) explore the long-term trajectories of physical frailty over a 6-year period in older adults without dementia at baseline; (2) identify the socio-demographic and health-related factors associated with different physical frailty trajectories; and (3) examine the longitudinal relationships between different physical frailty trajectories and subsequent risk of dementia. This national cohort study used data from the National Health and Aging Trends Study (NHATS) conducted in the United States from 2015 to 2021 and included adults aged ≥65 without dementia (n=2245) at baseline in 2015. Group-based trajectory modeling was used to describe the longitudinal changes. Socio-demographic and health-related characteristics were compared across the identified physical frailty trajectories using bivariate analyses, employing Rao-Scott chi-square tests for categorical variables and design-based F-tests for continuous variables. Multinomial logistic regression analyses were conducted to examine the relationships between different frailty trajectories and subsequent dementia status. Three frailty trajectories were identified: low-stable (74.00%), low-increasing (21.14%), and high-level (4.86%). Participants in the low-increasing and high-level groups were predominantly older, female, minorities, unmarried, and less educated and had a lower income, more comorbidities, and greater anxiety and depression symptoms (p<0.001). Compared with the low-stable group, older adults in the low-increasing group had higher risk of possible dementia (RRR: 2.37, 95% CI: 1.41-3.97, p<0.001) and probable dementia (RRR: 1.71, 95% CI: 1.08-2.73, p=0.02); similarly, older adults in the high-level group had higher risks of possible dementia (RRR: 4.24, 95% CI: 1.74-10.36, p<0.001) and probable dementia (RRR: 2.99, 95% CI: 1.32-6.76, p=0.01). No significant differences were found in the risk of dementia between the high-level frailty group and the low-increasing frailty group (p>0.05). This study highlighted the importance of regular frailty monitoring for early detection and informed future interventions that could delay frailty progression and potentially reduce dementia risk.

Food insufficiency, SNAP status, and variability in weight and body composition: Longitudinal analysis of the National Health and Aging Trends Study Cohort 2012 - 2021

The impact of food insecurity and food assistance programs on long-term body weight and composition is unclear. The aim of the study was to investigate the associations between baseline and duration of food insufficiency (FI), the Supplemental Nutrition Assistance Program (SNAP) status, and variability in weight, BMI, and waist circumference (WC). Data from 3897 eligible Medicare beneficiaries aged ≥ 65 y recruited in the National Health and Aging Trends Study (2012-2021) were analyzed. At baseline, SNAP status was assessed. With repeated measurements over follow-up, baseline FI status, years with FI experience (nFI), 3 variability metrics for weight, BMI, and WC [i.e. SD, coefficient of variation (CV), root mean squared error (RMSE)] and 4 patterns (stable, loss, gain and cycling) were defined. Partial proportional-odds generalized ordered logit models and multinomial logistic regression models were fit to investigate the association between FI status, nFI, and SNAP status and quartiles of variability metrics and patterns, respectively. The median (IQR) follow-up years was 8 (4, 9). Per 1-unit increase in the nFI, older adults had significantly higher variability in BMI (OR: 1.08-1.10), weight (OR: 1.14-1.15), and waist circumference (OR: 1.11-1.27) by SD, CV, and RMSE. SNAP participants did not differ from eligible nonparticipants in any variability metrics. Older adults with FI at baseline were 2.72 times (95% CI: 1.32, 5.58) more likely to gain weight. Relative risk of weight loss (RRR: 1.29; 95% CI: 1.06, 1.56), gain (RRR: 1.34; 95% CI: 1.09, 1.65), or cycling (RRR: 1.27; 95% CI: 1.04, 1.21) increased per 1-unit increase in nFI. SNAP participants did not differ in BMI, weight, or WC patterns from eligible nonparticipants. Recurring food insecurity is associated with variability in older adults' weight and body composition. Additional interventions beyond SNAP are needed to prevent food insecurity and instability in body weight and composition.

Factors Associated With Outdoor Frequency Among U.S. Community-Dwelling Medicare Beneficiaries: A Cross-Sectional Study.

Despite the benefits of outdoor activity in older adults, a paucity of research explores factors associated with the frequency of older adults going outdoors. The aim of the current study was to investigate if factors of cognitive status, physical performance, and neighborhood characteristics were associated with outdoor frequency among older adults. This cross-sectional study used National Health and Aging Trends Study data to characterize outdoor frequency among Medicare beneficiaries by participant demographics, health, and neighborhood characteristics, and estimated relationships between participant factors and outdoor frequency. The sample included 3,368 participants. The majority (51.6%) were aged 75 to 84 years and female (57.2%). Most (60.4%) participants went outside daily. Probable dementia, physical limitations, and presence of street disorder and sidewalk continuity were associated with decreased outdoor frequency. Research is needed to develop interventions addressing neighborhood conditions and promoting outdoor activity among older adults living with dementia and physical limitations. [Research in Gerontological Nursing, 18(1), 40-52.].

Academic Achievement of Children With Neurofibromatosis Type 1.

Learning difficulties are frequently reported in children with neurofibromatosis type 1 (NF1), yet little is known about the extent and predictors of their academic functions across ages. We aimed to examine the developmental patterns of academic achievement in these children from childhood to adolescence and how these patterns differ across demographic and NF1-related disease factors. This cross-sectional study integrated data of 1512 children with NF1 (mean age, 11.2years, SD, 3.62, range, 3-18, 46.5% female patients) from 8 institutions. Academic functioning was assessed with Woodcock-Johnson Tests of Achievement or the Wechsler Individual Achievement Test. Data were analyzed primarily using time-varying effect modeling. Participants' academic achievement was significantly lower than the normative means across ages, and the gap widened from middle childhood to midadolescence. Academic age trends varied across academic domains and demographic and disease factors. Male patients demonstrated larger deviations in math at midchildhood and in reading and writing between midchildhood and midadolescence. Children with lower parental education demonstrated larger deviations in math, reading, and writing between midchildhood and midadolescence. Children with familial NF1 demonstrated larger deviations in math at midchildhood and mid-to-late-adolescence, and in reading and writing between midchildhood and midadolescence. Academic difficulties in children with NF1 emerge early and worsen with age. The findings also highlight the variability within this population across demographic and disease factors. The age-specific estimates of academic functions can serve as the first NF1-specific academic norms, providing useful insights for future research and practice.

The Number Of Family Caregivers Helping Older US Adults Increased From 18Million To 24Million, 2011-22.

The evolving composition and experiences of the family caregiver workforce have profound ramifications for public policy but are not well understood. Drawing on the linked National Health and Aging Trends Study and National Study of Caregiving, we found that the numbers of family caregivers providing help to older adults increased by nearly six million between 2011 and 2022, rising from 18.2million to 24.1million. Among older adults receiving care, network size was stable, at about two caregivers per older adult at both points in time. However, in 2022, family caregivers were assisting older adults who were younger, more likely to be male and better educated, and less likely to have dementia. We found few changes in competing work and child care responsibilities, weekly care hours, and caregiving-related difficulty. A smaller number of family caregivers were assisting fewer older adults with dementia, but in this group, co-residence increased by 25percent, average care hours increased by 50percent, and employment decreased. For family caregivers as a whole, challenges persist, and for those assisting people with dementia, tailored surveillance and effective support programs are needed.

Age trend in risks for the chronic diseases in miners and metallurgists of the Kola Arctic

Introduction. With the combined and complex action of harmful occupation factors, traditional methods fail to allow an objective assessing of age-related changes in health. The purpose of the work. To analyze and give a hygienic assessment of the age trend in prevalence in miners and metallurgists of the Kola Arctic. Materials and methods. There were examined three groups of workers of the Kola Arctic region including 1758 workers from the mining complex with harmful working conditions (degree of harm 3.1.–3.3); 2181 workers of the metallurgical enterprise (degree of harm 3.1.–3.3); 242 engineering and technical staff (hazard classes 2 and 3.1). There were investigated 12 classes of diseases, established according to the data of periodic medical examinations. The average values of morbidity indices and linear regression indice were calculated as “disease risk = annual gain in risk (AGR) · age + const”. The relative assessment of the AGR was carried out in relation to the actual value to the control, background value. Results. For each class of diseases in four age groups of employees (20–29; 30–39; 40–49; 50–59 years). These linear regressions were calculated. The obtained AGR values were compared with the control values and the values in the report. The obtained values ​​of the AGR were compared with the control values ​​and literature data. The highest AGR for diseases of the circulatory system, musculoskeletal system, and chronic diseases was found in workers in the mining complex. The highest annual increase in the risk of diseases of the respiratory, genitourinary and endocrine systems was observed in workers in metallurgical production. The annual rise in the risk of diseases of the organs of vision was the highest in the group of specialists. The differences in the prevalence in the examined groups of workers are due to the differences in the annual increases. Limitations. The limitation of the study may be the insufficient amount of data to calculate the AGR in women due to the legislative prohibition of the use of female labour in underground work and in some types of metallurgical industries. Conclusion. The workers at the mining complex have the highest annual gain in the risk for diseases of the circulatory system, musculoskeletal system, and in the number of chronic diseases. Metallurgical workers have the highest annual increase in the risk of diseases of the respiratory system, genitourinary, and endocrine systems. The annual increase in the risk of diseases of the visual organs is of the greatest importance in the group of specialists. The differences in the disease levels of the surveyed groups of workers are due to differences in their annual increases.

Stressors and Resources Among Adult Child Caregivers in the Presence or Absence of Siblings.

Recent attention has focused on understanding later-life caregiving networks, emphasizing how multiple adult children within the same family navigate parental care. However, families with one child are increasingly common, and we know little about how adult only children experience caregiving and whether their experiences differ from those with siblings. Therefore, this study assessed differences in caregiving experiences between adult child caregivers with and without siblings and whether associations between caregiving experiences and mental health (i.e., psychological well-being and distress) vary by sibling presence. We used cross-sectional data from 1,773 adult child caregivers (12% without siblings; Mage = 56.75 [9.23]) in the National Health and Aging Trends Study and National Study of Caregiving. We conducted t-tests and a series of multivariate regressions with interactions to test hypotheses. Adult only child caregivers reported more financial difficulty with care than respondents with siblings. The negative association between emotional difficulty of care and psychological well-being was stronger among adult children without siblings. Informal support was positively associated with psychological well-being only for adult children with siblings, although this may be accounted for by race and ethnicity. Findings suggest that adult only children may be at elevated risks of the financial difficulties and the emotional consequences of parental care provision. Further, informal support may be less protective for adult only children's well-being. Given the increasing prevalence of single-child families, more research is needed to better understand and support adult only children caring for parents.

Examining Valued Social Participation of Disabled Older adults Through the Frameworks of Critical Gerontology and Critical Disability Studies.

The importance of social participation for older adults has been well articulated. Missing from this discourse is a critical consideration of how social participation is shaped by political, economic, and social contexts that marginalize aging and disabled bodies. We bridge this gap by applying critical gerontology and critical disability frameworks to our analysis of how access to health and social services and individual and environmental factors, are associated with engagement in valued social activities among disabled older adults. Using the National Health and Aging Trends Study (NHATS) Round 12 (n = 4,562) we conducted a series of generalized linear regression models evaluating the association between disability, access to health and social services, and participation in valued social activities. Increased limitation with Activities of Daily Living and Instrumental Activities of Daily Living, and presence of dementia were significantly associated with decreased valued social participation. Receiving unpaid support, social network size, transportation access, having a regular doctor, and employment were positively associated with valued social participation, while neighborhood disorder, low neighborhood cohesion, difficulty paying for medications, and Medicaid beneficiary status were negatively associated. Findings indicate disabled older adults face challenges engaging in valued social activities. Applying critical gerontology and disability perspectives, calls us to reexamine the ways social participation, accessibility, and full inclusion of disabled older adults are considered. We urge gerontologists to use these findings to reimagine the structures of aging services and community to achieve social change.

Global burden of burns among children and adolescents: a trend analysis from the global burden of disease study 2019

PreciseThis study investigates global trends in burns among children and adolescents using data from the Global Burden of Disease Study 2019. Analyzing incidence and YLD rates across 204 countries from 1990 to 2019 reveals a general decline in burn-related injuries, with age and sex influencing trends. Notably, in high-SDI regions, incidence rates initially increased before reversing. These findings highlight the need for targeted public health policies and resource allocation to reduce burn-related risks in vulnerable populations.BackgroundGiven the lack of long-term trend studies on global burns among children and adolescents, this study examined trends in the global burden of burns among children and adolescents.MethodsThe Global Burden of Disease (GBD) Study 2019 provided the statistical data. Sex, age, region, and SDI were used as stratification variables in the study to evaluate the prevalence of burns injuries among kids and teenagers across 204 nations and territories between 1990 and 2019. YLD rates per 100,000 people and incidence rates together with their respective average annual percentage changes (AAPC) were computed to evaluate burden trends. Furthermore, AAPC in YLD rates and incidence rates spanning various age cohorts were analyzed using the Joinpoint software.ResultsThe worldwide burns incidence and YLD rates of burns among kids and teenagers exhibited a general declining trend between 1990 and 2019. Concerning the general trend in new cases, incidence rates, and YLD rates, age was positively associated. In 2019, the incidence rate for females surpassed that of males, while YLD rates for females were consistently higher than those of males. New Zealand, Czechia, and Australia rank as the top three among the 204 countries studied. Interestingly, in the high SDI range, the expected values based on incidence rates reversed after first rising with the SDI.ConclusionOverall, the incidence and YLD rates of burns among children and adolescents have declined globally, though significant disparities exist across age groups, sexes, regions, and countries. These findings could help guide the development of more targeted strategies to reduce the burn burden in this population.

Care Recipients' Cognitive Trajectories and Caregivers' Depressive Symptoms: The Mediating Role of Caregiving Burden.

The heterogeneity of population-based trajectories of care recipients' (CRs) cognitive functioning and how they are associated with their caregivers' mental health is less studied in the United States. Informed by the stress process model, this study examines the relationship between care recipients' cognitive trajectories and caregivers' depressive symptoms, and the mediating role of caregiving burden. Data were from the National Health and Aging Trends Study (2011-2020) for 1,086 care recipients and their 1,675 caregivers from the 2021 National Study of Caregiving. We applied Bayesian group-based trajectory modeling to identify distinct cognitive trajectory groups among care recipients. Hierarchical linear models were then used to examine the associations between these trajectory group memberships and caregivers' depressive symptoms. Finally, Gelbach decomposition analysis was conducted to investigate the mediating role of physical, emotional, and financial caregiving burden. Five cognitive trajectories were identified among care recipients: "high start, stable" (11.81%), "medium-high start, slight decline" (31.83%), "medium start, slight decline" (27.72%), "medium-low start, sharp decline" (20.60%), and "low start, sharp decline" (8.04%). Worse cognitive trajectories (e.g., lower baselines and steeper slopes) were associated with increasing caregivers' depressive symptoms; financial, emotional, and physical caregiving burdens jointly explained 63.5% of this association. Emotional caregiving difficulty is the most important contributing caregiving burden, explaining 49.6% of the observed association. When understanding caregiving experiences, it is critical to consider longitudinal cognitive course among care recipients. Interventions targeting multiple aspects of caregiving burden, especially emotional burden, should be prioritized.

Trends in age and antithrombotic therapy in patients who underwent transurethral resection of bladder tumor and perioperative complications.

We investigated the subsequent trends in age and antithrombotic therapy in patients who underwent transurethral resection of bladder tumor (TURBT) and examined the rate of perioperative complications. Medical records of patients who underwent TURBT were retrospectively analyzed. We arbitrarily divided the observation years into three periods (I: 2007-2013, II: 2014-2018, and III: 2019-2023) to compare the trends in age and frequency of perioperative complications after TURBT between patients taking and those not taking antithrombotic drugs. The number of patients who underwent TURBT was 173, 224, and 224 in periods I, II, and III, respectively. The proportion of patients receiving antithrombotic drugs was similar among the three periods (34.1%, 29.9%, and 37.5% in periods I, II, and III, respectively). The percentage of patients taking antithrombotic medications who were aged ≥80 was gradually increasing. The usage of warfarin (25.4%, 13%, and 4.2% in periods I, II, and III, respectively) and aspirin (65.1%, 40.3%, and 32.3% in periods I, II, and III, respectively) was decreased, whereas direct oral anticoagulant (1.6%, 18.2%, and 35.4% in periods I, II, and III, respectively) and clopidogrel (4.8%, 15.6%, and 16.7% in periods I, II, and III, respectively) administrations was increased. The rate of hemorrhagic and cardiocirculatory complications was higher in patients receiving antithrombotic drugs than in patients not receiving them. Of the patients receiving antithrombotic therapy, two patients with a history of cardiac infarction and deep vein thrombosis passed away after TURBT due to ischemic heart disease. The age of patients receiving antithrombotic drugs has increased, and antithrombotic drug types have changed among those who underwent TURBT. Further attention to hemorrhagic and lethal cardiocirculatory complications after TURBT will be required in a super-aged society.

Association of Self-Recognition of Hearing Loss With Hospitalizations in Older Adults in the United States.

Hearing loss is highly prevalent and associated with increased health care utilization. Recognition of hearing loss may play an important role in self-advocacy in difficult communication situations and prevent negative outcomes. To investigate the associations between self-recognition of hearing loss and hospitalization outcomes. This is a cross-sectional analysis of 1766 participants from the National Health and Aging Trends Study. The exposure, recognition of hearing loss, was constructed using participants' self-reported functional hearing difficulty, audiometric hearing loss, and self-reported hearing aid use. Primary outcomes included self-reported hospital stay occurrence and number of hospital stays within the last year. Regression models were adjusted for demographic, socioeconomic, and health characteristics and further stratified by severity of hearing loss. Among 1766 participants with hearing loss, those with unrecognized hearing loss [60.1% (n=1062)] had higher but statistically insignificant odds of any hospitalization [odds ratio (OR)=1.32; 95% CI: 0.96, 1.81] or higher count of hospitalizations [incident rate ratio (IRR)=1.13; 95% CI: 0.85, 1.51] compared with those with recognized hearing loss (39.9%, n=704). Among participants with mild hearing loss, those with unrecognized hearing loss demonstrated significantly higher odds of any hospitalization occurrence (OR=2.50; 95% CI: 1.26-4.97) and a higher count of hospitalizations (IRR=2.00, 95% CI: 1.00-4.01) than those with recognized hearing loss. There were no significant differences in hospitalization outcomes among participants with moderate or greater hearing loss. In a nationally representative sample of older adults, individuals with unrecognized hearing loss compared with those with self-recognized hearing loss may be at increased odds of adverse hospitalization outcomes.