Adult Health Outcomes Research Articles

What factors attenuate the relationship between childhood neglect and adverse health outcomes? Examining the role of socioeconomic status, health behaviors, and the presence of a protective adult.

The detrimental effects of childhood neglect on adult health outcomes are well-recognized; however, less is known about factors that may attenuate this relationship. (1) To examine the associations between childhood neglect and various physical and mental health outcomes in adulthood among those who had not experienced childhood physical or sexual abuse; and (2) To determine whether adjusting for risk and protective factors, including socioeconomic status, health behaviors, and the presence of a trusted adult, attenuates these relationships. Data came from the 2021 Behavioral Risk Factor Surveillance System (BRFSS), a representative sample of community-dwelling US adults (n=41,322). The relationships between childhood neglect and health outcomes were investigated using logistic regression analyses. Adjustments were made for demographics, socioeconomic status, health behaviors, and the presence of a protective adult. Childhood neglect was significantly associated with adverse health outcomes, including health behaviors (e.g., smoking, low physical activity), physical health indicators (e.g., self-reported fair/poor health, stroke, asthma, COPD), disabilities (e.g., hearing impairment, vision impairment, cognitive impairment, difficulty walking or climbing stairs, difficulty bathing), and mental health indicators (e.g., poor mental health/past month, depression) after controlling for demographics. All significant associations indicated small or very small effect sizes. Associations were substantially attenuated when controlling for adult socioeconomic status, and further attenuated when controlling for the presence of a protective adult, with several outcomes becoming non-significant. Socioeconomic status and the presence of a protective adult in childhood considerably diminishes the association between childhood neglect and health outcomes in adulthood.

Association between possible sarcopenia, all-cause mortality, and adverse health outcomes in community-dwelling older adults in China

The relationship between possible sarcopenia and mortality remains ambiguous within Asian populations. To clarify this, we investigated the association in older adults residing in Chinese communities. Utilizing data from the China Health and Retirement Longitudinal Study, this population-based cohort study included individuals aged ≥ 60 years, followed from 2011 to 2012 through 2020. Possible sarcopenia was defined in accordance with the Asian Working Group on Sarcopenia 2019 criteria, and Cox proportional hazards regression was used to analyze its impact on mortality, while exploratory analyses were conducted to investigate the associations of possible sarcopenia with chronic diseases, functional independence, and hospitalization frequency. The study encompassed 5,160 participants (median age: 66 years), nearly half of whom (48.8%) were identified with possible sarcopenia. Over a 9-year follow-up period, there were 1216 recorded deaths. Analysis indicated that individuals with possible sarcopenia faced a significantly elevated mortality risk compared to their counterparts (HR: 1.79, 95% CI: 1.58–2.03; P < 0.001). Further, subgroup analyses confirmed a strong association between possible sarcopenia and all-cause mortality across various subgroups, including those related to sex, obesity status, and living environment. Additionally, exploratory analyses revealed that possible sarcopenia was significantly associated with an increased likelihood of heart disease (OR = 1.18, 95% CI: 1.03–1.34, P = 0.014) and stroke (OR = 1.41, 95% CI: 1.19–1.68, P < 0.001), as well as reduced functional independence (β = -0.17, 95% CI: -0.24–-0.10, P < 0.001). Possible sarcopenia was also associated with a higher frequency of hospitalizations at baseline (Exp(β) = 1.50, 95% CI: 1.25–1.81, P < 0.001), although this association was no longer significant during the follow-up period. In conclusion, in Chinese community-dwelling older adults, possible sarcopenia was associated with an increased risk of all-cause mortality, several chronic diseases, and functional dependence. Thus, alleviating or preventing possible sarcopenia may improve health outcomes and extend the lifespan of these individuals.

Adult mental health outcomes of adolescent depression and co-occurring alcohol use disorder: a longitudinal cohort study

AbstractDepression and alcohol use disorder (AUD) are frequently co-occurring in adolescence, which often goes undetected in routine care. While this may potentially compromise treatment effectiveness and lead to a less favourable long-term prognosis, few longitudinal studies have followed this group into adulthood. The aim of this study was to explore the risk for adult depression, anxiety disorders, suicidality, and AUD in adolescents with concurrent depression and AUD. The study was based on the Uppsala Longitudinal Adolescent Depression Study (ULADS), a Swedish prospective cohort study. Diagnostic interviews were conducted in adolescence (age 16-17) and adulthood (around age 30). Adolescents with concurrent depression and AUD (n = 38) were compared with peers having only depression (n = 189) or neither of the conditions (n = 144). Logistic regression was used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Adolescents with concurrent depression and AUD were more likely than their non-affected peers to experience adult depressive episodes (aOR, 5.33; 95% CI, 2.22–12.83), anxiety disorders (4.05; 1.77–9.27), suicidality (5.37; 2.28–12.66), and AUD (7.68; 2.59–22.81). Notably, 34% of adolescents with both depression and AUD subsequently experienced both these conditions as adults, compared to 7% of adolescents with only depression. Adolescents suffering only from depression were less likely than those with both conditions to experience suicidality (0.44; 0.21–0.95) and AUD in adulthood (0.18; 0.07–0.44). These findings underscore the clinical imperative to identify adolescents with this comorbidity. Recognition of the poor long-term prognosis can inform targeted interventions for this vulnerable group, ultimately improving health and well-being throughout the life course.

Burden of systemic inflammation and associated health outcomes in adults with atherosclerotic cardiovascular disease managed in routine care

Abstract Background The burden and outcomes of inflammation in people with atherosclerotic cardiovascular disease (ASCVD) are poorly defined, particularly beyond the controlled settings of trials and research cohorts. Methods We conducted a longitudinal observational study of adults with ASCVD undergoing C-reactive-protein (CRP) testing in routine healthcare in Stockholm, Sweden. After excluding CRP tests associated with acute illness and patients with medications/conditions that bias CRP interpretation, the systemic inflammation of participants was defined over a 3-month ascertainment window. Baseline determinants of CRP≥2 mg/L were explored with logistic regression, and baseline CRP categories were compared via Poisson and Cox regression for subsequent healthcare resource utilization and occurrence of major adverse cardiovascular events (MACE), heart failure hospitalization, and all-cause death. Result After applying inclusion/exclusion criteria, we identified 84,399 adults with ASCVD with a mean age of 71 years and of which 54% were men. In total, 60% had CRP≥2 mg/L. At baseline, female sex, older age, lower kidney function, albuminuria, diabetes, hypertension, and recent anemia, were associated with CRP≥2 mg/L. Conversely, the use of RASi, antiplatelets, and lipid-lowering therapy were associated with lower odds. Over a median follow-up of 6.4 years and compared to people with CRP &amp;lt;2 mg/L, those with CRP≥2 mg/L had a higher rate of hospitalizations, days spent in hospital, outpatient consultations, and dispensed medications during follow-up (P&amp;lt;0.05 for all). They also had a higher rate of MACE [adjusted hazard ratio (HR), 1.30; 95% CI, 1.27–1.33], heart failure hospitalization [1.24; 1.20–1.39], and all-cause death [1.35; 1.20–1.30]. Results were consistent across subgroups and more granular CRP categories, and robust to the exclusion of extreme CRP values or early events. Conclusions Two in three adults with ASCVD have systemic inflammation. A CRP≥2 mg/L is associated with excess healthcare resource utilization as well as increased rates of MACE, heart failure, and death.

The Effect of a Biofeedback-Based Integrated Intervention for Older Adults with Orthostatic Hypotension: A Secondary Analysis on Psychological Health Outcomes in a Non-Randomized Pilot Trial

Background/Objectives: Aging-related physical changes and dysfunctions in the autonomic nervous system (ANS) often lead to orthostatic hypotension (OH) in older adults. OH negatively impacts both the physical and psychological well-being of those affected. Previous studies have demonstrated that the biofeedback-based integrated program (BBIP), a multicomponent intervention focused on heart rate variability biofeedback, effectively improves OH, as well as symptoms related to ANS function. This substudy aims to examine the effects of the BBIP on psychological health outcomes among community-dwelling older adults with OH. Methods: This study employed a non-randomized controlled trial design with a convenience sampling strategy. A total of 51 older adults with OH were recruited from two senior welfare centers and randomly assigned to either the intervention group (n = 27) or the control group (n = 24). The intervention group participated in a 12-week BBIP, which included weekly biofeedback sessions and group education on lifestyle modification to alleviate OH. Telephone counseling was also provided to promote compliance. Results: The intervention group showed significant improvements in health-related quality of life, depression, anxiety, and fall efficacy after the 12-week BBIP, whereas the control group exhibited no significant changes. There was a significant reduction in the percentage of participants in the intervention group reporting problems in all five dimensions of the EQ-5D (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Conclusions: The BBIP was effective in improving the psychological health outcomes of older adults with OH. Future studies should explore the long-term effects of the BBIP using a larger sample size and a randomized controlled trial design.

Loneliness Gets Under the Skin: A Scoping Review Exploring the Link Between Loneliness and Biological Measures of Inflammation.

Research suggests that systemic inflammation may link loneliness to adverse health outcomes, yet there is a gap in comprehensively reviewing recent evidence on the relationship between loneliness and biological measures of inflammation in adults. This scoping review synthesizes current research to address the question: Is there a definitive link between loneliness and biological markers of inflammation in adults? Following the methods outlined by Arksey and O'Malley, we developed a protocol, defined our research question, and systematically searched PubMed, CINAHL, Embase, and Scopus for English-language studies conducted from 2018 to 2023 exploring the relationship between loneliness and biomarkers of inflammation in adults. Twelve studies meeting the inclusion criteria displayed heterogeneity in terms of sample characteristics, loneliness scales, and inflammatory biomarkers. The UCLA Loneliness Scale, in various forms, emerged as the predominant tool for measuring loneliness, while C-reactive protein and interleukin-6 were the most frequently evaluated inflammatory biomarkers. Notably, all 12 studies reported an association between loneliness and at least 1 biological marker of inflammation. Research consistently associates loneliness with poor health outcomes in aging adults, but the underlying mechanisms remain unclear. This scoping review suggests that inflammation may serve as a pathway linking loneliness to adverse health outcomes. However, the variability across studies highlights the need for standardized measurement methods and a consideration of both the duration and extent of loneliness. Enhancing our understanding of how loneliness affects systemic inflammation may help clarify why loneliness is associated with negative health outcomes.

Associations between polygenic scores for cognitive and non-cognitive factors of educational attainment and measures of behavior, psychopathology, and neuroimaging in the adolescent brain cognitive development study.

Educational attainment (EduA) is correlated with life outcomes, and EduA itself is influenced by both cognitive and non-cognitive factors. A recent study performed a 'genome-wide association study (GWAS) by subtraction,' subtracting genetic effects for cognitive performance from an educational attainment GWAS to create orthogonal 'cognitive' and 'non-cognitive' factors. These cognitive and non-cognitive factors showed associations with behavioral health outcomes in adults; however, whether these correlations are present during childhood is unclear. Using data from up to 5517 youth (ages 9-11) of European ancestry from the ongoing Adolescent Brain Cognitive DevelopmentSM Study, we examined associations between polygenic scores (PGS) for cognitive and non-cognitive factors and cognition, risk tolerance, decision-making & personality, substance initiation, psychopathology, and brain structure (e.g. volume, fractional anisotropy [FA]). Within-sibling analyses estimated whether observed genetic associations may be consistent with direct genetic effects. Both PGSs were associated with greater cognition and lower impulsivity, drive, and severity of psychotic-like experiences. The cognitive PGS was also associated with greater risk tolerance, increased odds of choosing delayed reward, and decreased likelihood of ADHD and bipolar disorder; the non-cognitive PGS was associated with lack of perseverance and reward responsiveness. Cognitive PGS were more strongly associated with larger regional cortical volumes; non-cognitive PGS were more strongly associated with higher FA. All associations were characterized by small effects. While the small sizes of these associations suggest that they are not effective for prediction within individuals, cognitive and non-cognitive PGS show unique associations with phenotypes in childhood at the population level.

Swimming Proficiency and Self-reported Mental Health Outcomes in Chinese Individuals

This researh examines the relationship between swimming proficiency and self-reported mental health outcomes in Chinese adults, considering different demographic variables. A descriptive-correlational research technique was used to recruit a varied sample from various areas and backgrounds in China. Systematic surveys evaluated swimming proficiency in multiple aspects, such as water confidence, breath control, body positioning, propulsion, coordination, and safety awareness. Additionally, self-reported mental health outcomes were measured, including emotional well-being, life satisfaction, self-esteem, sense of purpose, resilience, and social connectivity. The findings suggest that respondents usually have high confidence and proficiency in swimming abilities. However, there needs to be more understanding of safety measures, highlighting the need to enhance education on recognizing hazards and following safety procedures. Although respondents were skilled swimmers, they said that participating in swimming activities did not substantially impact their mental well-being, self-esteem, sense of purpose, resilience, or social connectivity. Nevertheless, a significant correlation between swimming proficiency and mental health outcomes was established, indicating that enhancing swimming abilities might benefit mental well-being. The study revealed many primary obstacles to participation in swimming, such as financial limitations, cultural and societal expectations, difficulties in accessing facilities, safety and health worries, and educational and psychological hindrances. The obstacles differ across different demographic groups, emphasizing the need for focused solutions.

Father-child attachment on children’s screen time: mediating role of ego resilience

BackgroundChildren spend a significant amount of time engaging in sedentary behaviors, defined as activities that do not increase energy expenditure significantly above resting levels, such as watching TV and playing PC/video games. Increased screen time is a significant public health concern because children are in a developmental stage where lifestyle behaviors predict various health outcomes in adulthood and beyond. This study explores the links between parent-child attachment, ego resilience, and children’s screen time.MethodsThis cross-sectional correlation study uses 1,163 parents and their children data from the 12th Panel Survey of Korean Children. The study instruments were a modified Armsden and Greenberg scale of parent-child attachment and modified the children’s ego resilience scale of the Block and Kremen. Children’s screen time was classified as more than 2 h per day spent watching television, playing on computers, or playing video games in their leisure time.ResultsStudy results show a negative association between father-child attachment and children’s screen time (ß = -0.43, p < .001) and a positive association between father-child attachment and ego resilience (ß = 0.24, p < .001). Ego resilience showed a negative link to children’s screen time after adjusting for parental attachment (ß =- 0.03, p = .009). Father-child attachment link to children’s screen time (ß = -0.36, p < .001) continued even though the association was slightly reduced in magnitude after adjusting for ego resilience.ConclusionsOur findings show the mediating role of ego resilience on a negative path of father-child attachment to children’s screen time. This finding emphasizes the importance of fostering solid father-child relationships and enhancing children’s psychological resilience as critical strategies for reducing excessive screen time. By addressing emotional support and resilience-building, interventions can more effectively promote healthier behavioral outcomes in children.

A comparative retrospective longitudinal study of arthritis risk and cognitive decline in older adults

Arthritis often results in unmet healthcare needs for older adults with cognitive decline, who may struggle to communicate pain or recall symptoms. However, the risk factors for arthritis in this group remain underexplored. We addressed this gap by identifying and comparing arthritis risk factors among older adults with varying cognitive statuses. Data from 334 participants with cognitive decline and 808 participants with normal cognition were analysed using the Korean Longitudinal Study of Aging, tracking arthritis diagnoses over 12 years with Kaplan–Meier curves and Cox proportional hazards regression. Results showed 47.6% of older adults with cognitive decline developed arthritis, compared with 30.1% with normal cognition. Key risk factors for the cognitive decline group included depressive symptoms (hazard ratio [HR]: 1.87), living alone (HR: 1.66), infrequent social interactions (HR: 1.42), and greater dependency in daily activities (HR: 1.41). In the normal cognition group, additional chronic illnesses (HR: 1.41) and higher body mass index (HR: 1.09) were significant risk factors. Understanding these distinct risk factors is crucial for preventing and managing arthritis among at risk groups. Moreover, these findings can assist in developing comprehensive public health strategies integrating mental health and social support to improve health outcomes for older adults with cognitive decline.

Meta-analysis reveals low language capacity in childhood is associated with mental health problems in adulthood.

Children and adolescents with language problems have poorer mental health compared with their non-language impaired peers. Less is known about mental health in adults with a history of language problems. This paper presents a systematic review and meta-analysis that addresses this gap in the literature. Specifically, it summarisesthe results from studies examining anxiety and depression in adults (aged 18 years and over) who were identified with language impairments or problems earlier in development. Five electronic databases (PsycINFO, ERIC, CINAHL, EMBASE and PubMed) were searched for studies comparing anxiety and/or depression in a sample of adults with and without a history of language problems. Nine studies were found that met the inclusion criteria. From each, an odds ratio (OR) was computed measuring the relationship between childhood language problems and anxiety or depression in adulthood. The OR was computed so values > 1 which indicated anxiety/depression were associated with a history of language problems. ORs were averaged using multilevel random effects meta-analysis. Averaging the study's findings across both anxiety and depression outcomes, we found that a history of childhood language problems was associated with poorer mental health in adulthood (OR = 1.79, p = 0.004). The association for anxiety was also significant (OR = 1.80, p = 0.012) and close to statistical significance for depression (OR = 1.60, p = 0.054). This review reveals that adults with a history of language problems are more likely to experience poorer mental health outcomes compared with controls. These findings demonstrate childhood language problems affect not only communication but also mental health and well-being in the long term. What is already known on the subject Prior research examining mental health in children and adolescents with language problems reveals a twofold increased risk of internalisingproblems, including anxiety and depression. However, little is known about mental health outcomes in adults with a history of language problems. What this paper adds to the existing knowledge The main finding was that childhood language problems are associated with increased risk of anxiety and depression in adulthood. What are the practical and clinical implications of this work? First, the study demonstrates childhood language problems increase the risk of poor mental health in adulthood. Second, in adult mental health settings there is a need to screen for language problems and, where applicable, adjust interventions to accommodate communicative needs for patients/clients. Solving these issues requires integration and recognition of the importance of speech-language therapy in the adult mental health system.

The Impact of Closing Medicare Part D Coverage Gap on Mental Health of Adults Over Age 65.

Using Medical Expenditure Panel Survey data from 2006 to 2019, this study assessed the effect of closing Medicare Part D coverage gap on mental health of older adults. We employed difference-in-differences and compared mental health outcomes of older adults on Medicare with those on private insurance before and after the 2011 policy change. Findings showed a 0.447-point reduction in the Kessler Index 6 (K-6) score after closure. These findings were mainly attributable to women, Hispanics, individuals with multiple chronic conditions, and those in Traditional Medicare. A reduction in out-of-pocket (OOP) expenditures appeared to be the primary mechanism for this finding. Our analysis was robust to several specifications, including using different measures of mental health and alternate constructions of treatment and control groups. The closure of the Medicare Part D coverage gap improved mental health among beneficiaries, potentially by reducing financial strain associated with high OOP expenditures.

Handgrip Strength and Cognitive Recovery in Older Stroke Survivors: A Prospective Study

Background and Objectives: Handgrip strength (HGS) is an important indicator of overall physical capability and is linked to various health outcomes in older adults. Despite extensive research on the relationship between HGS and cognitive decline, longitudinal studies on poststroke cognitive changes in relation to HGS are scarce. This study aimed to observe whether HGS at discharge from acute stroke rehabilitation affects cognitive function 6–12 months after stroke onset and to compare cognitive outcomes between patients with normal and low HGS at discharge. Materials and Methods: This prospective cohort study was conducted in the Department of Rehabilitation Medicine at a tertiary care hospital. In agreement with the Asian Working Group for Sarcopenia 2019 criteria, low muscle strength was defined as an HGS of less than 28 kg for men and less than 18 kg for women, and participants were categorized into normal and low HGS groups. Neuropsychological evaluations were conducted before discharge (approximately one month after stroke onset) and between 6 and 12 months after stroke onset. Results: The low HGS group was older and had lower Montreal Cognitive Assessment scores. However, after adjusting for covariates, the linear mixed model analysis showed no significant differences between the groups in global cognition or specific cognitive domains, except for psychomotor speed during the subacute phase. Notable improvements in language ability were observed in both groups over time, while significant improvements in executive function were observed exclusively in the low HGS group. Conclusions: This longitudinal study is the first to explore the relationship between HGS and changes in cognitive function in older adults with stroke, providing insights into physical strength and cognitive recovery during stroke rehabilitation.

Long Term Physical and Mental Health Outcomes of Older Adults Following a Major Burn Injury: A Burn Model System Investigation.

Older adults are at a higher risk of complications after burn injuries since many physical and mental changes are compounded by increasing age. Few studies have targeted the long-term effects of burns on older adults. Therefore, this study will investigate the long-term physical and mental health outcomes in older adults. 3129 participants from the Burn Model System Database were divided into 3 cohorts based on their age at injury (18-54, 55-64, and 65+). Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were derived from the 12-item Short Form (SF-12) and the Veterans RAND 12-item (VR-12) health surveys and analyzed to measure recovery at preinjury, discharge, 2-year follow-up, and 5-year follow-up. ANOVA, T-score analysis, and linear mixed-effects models were utilized to assess for significant differences in outcome scores. PCS scores were significantly different between the 18-54 cohort and 65+ cohorts at the preinjury and 2-year time intervals (p<0.001 and p<0.001, respectively), but not at the 5-year follow up (P=0.28). MCS scores were significantly different between the 18-54 cohort and 65+ cohorts at all time intervals measured (p=0.001, p<0.001, P<0.001, and p=0.005 respectively), though the change in MCS scores over time were not significantly different between age cohorts across time (p=0.088). This supports that patients 65 years and older have a different physical function recovery trajectory when compared to patients under 64 years. These findings underscore the belief that for physical recovery after a burn injury, individualized physical rehabilitation plans will provide the most benefit for patients across all ages.

Study protocol of the safe driving program for the prevention of car accidents: A randomized controlled trial protocol.

Driving cessation is strongly associated with adverse health outcomes in older adults. Although numerous studies have focused on driving skill interventions for safe driving, the effects of interventions on car accidents remain unclear. We designed a randomized controlled trial to examine the effects of driving skill training on the prevention of car accidents among community-dwelling older adults using on-road training. A total of 1408 community-dwelling older drivers aged ≥65 years participated in the randomized controlled trial with blinded endpoint assessment. Participants randomized to the intervention group (n = 697) underwent four sessions, with 200 min re-training focused on the problem of driving in the older people. Controls (n = 697) received one classroom education session. On-road driving performance was assessed by certified driving school instructors in a driving school. The primary endpoint is an incident car accident, which will be detected based on the Japanese national car accident report data, after 24 months. This study has the potential to provide the first evidence of the effectiveness of on-road driving skill training regarding the prevention of car accidents. If our trial results show a lower number of car accidents due to driving skill training, this kind of intervention will provide an effective method for maintaining safe driving. These results will be disseminated to the appropriate national transportation agencies to improve or modify safe driving policies and possibly extend the validity of driver's licenses for older adults. UMIN-CTR (identification number: UMIN000034709). Registered 31 October 2018. Geriatr Gerontol Int 2024; ••: ••-••.

Loneliness Trajectories in U.S. Military Veterans: A 3-Year Longitudinal Study of Risk and Protective Factors.

Loneliness is a significant public health concern associated with adverse mental and physical health outcomes in older adults. This study examined the nature and correlates of predominant loneliness trajectories in a nationally representative sample of older U.S. military veterans. Participants included 2,441 veterans (mean age = 63, 8% female, 80% white) from the National Health and Resilience in Veterans Study, a 3-year longitudinal cohort study. Growth mixture modeling (GMM) was used to identify distinct trajectory classes of loneliness based on self-reported ratings. Multinomial logistic three-step regression analyses examined potential psychosocial risk and protective factors associated with loneliness trajectories. GMM revealed three distinct loneliness trajectories: Low-decreasing loneliness (61.2%), moderate-increasing loneliness (31.6%), and high-increasing loneliness (7.2%). Being married/partnered and perceiving greater purpose in life emerged as protective factors against elevated levels of loneliness. Worse cognitive functioning was a risk factor for the moderate-increasing loneliness trajectory, while greater psychological distress and more adverse childhood experiences were risk factors for the high-increasing loneliness trajectory. Nearly 40% of older U.S. veterans exhibited trajectories characterized by moderate to high levels of loneliness, with both groups showing increases over time. Targeted interventions that promote social connectedness, enhance purpose in life, and address mental health concerns and early life adversities may help mitigate the negative health consequences associated with chronic loneliness in this vulnerable population.

Plant protein, fibre and physical activity solutions to address poor appetite and prevent undernutrition in older adults: study protocol for the APPETITE randomised controlled trial.

Reduced appetite with ageing is a key factor that may increase risk of undernutrition. The objective of this study is to determine the impact of innovative plant protein fibre (PPF) products within a personalised optimised diet (PD), a physical activity (PA) programme, and their combination on appetite, and other nutritional, functional and clinical outcomes in community-dwelling older adults in a multi-country randomised controlled intervention trial. One hundred and eighty community-dwelling adults (approximately sixty per trial centre in Germany, Ireland and Italy) aged 65 years and over will be recruited to participate in a 12-week, parallel-group, controlled trial. Participants will be randomised into one of four groups: 1, PD (incorporating two PPF products): 2, PA; 3, PD + PA; and 4, no intervention (control). The primary outcome is appetite measured by visual analogue scales and energy intake from an ad libitum test meal. Secondary outcomes include fasting and postprandial appetite-related gut hormones, Simplified Nutritional Appetite Questionnaire score, body composition, cardiorespiratory fitness, muscle strength, physical function and PA. In addition, self-efficacy, cognitive status, dietary restraint, depressive symptoms and compliance and acceptability of the intervention will be assessed. Metabolomic profiles, RMR, muscle motor unit properties and gut microbiome will also be assessed to explore potential underlying mechanisms. This multi-centre randomised controlled trial will advance knowledge on how PD (incorporating PPF products), PA and their combination influence appetite, nutritional status and related health outcomes in community-dwelling older adults and contribute to the prevention of undernutrition. Trial registration: Clinical Trials.gov Registry NCT05608707 (registered on 2 November 2022). Protocol Version: NCT05608707 Version 4 (registered on 29 September 2023).

Latent classes of adverse childhood experiences and adult health and behavioural outcomes in Haiti’s Cité Soleil

Exposure to adverse childhood experiences (ACEs) is associated with harmful biopsychosocial and behavioral outcomes in adulthood and with reduced community capacity. We investigated the prevalence of ACEs and differential risk of adverse adult outcomes based on latent class assignment in a resource- limited, high violence, and understudied setting of urban Haiti, i.e., Cité Soleil. 100% (N = 673; 41.4% men, 58.6% women, mean age 28.5) reported at minimum one ACE; 70% reported physical and emotional abuse as ACEs, and 47% reported experience of child sexual abuse (CSA). We identified 3 distinct latent classes and evaluated associations between class membership and correlates (e.g., experience of non-partner sexual violence as adults [NPSV], suicidal ideation [SI], substance use to manage stress). Family dysfunction (domestic violence, substance abuse, mental illness, divorce, or incarceration of caregivers) existed across all three classes. Patterns of ACEs reported by members of Class 2 support their identification as a distinct class that is at greatest risk for adverse adult outcomes. Specifically, the increased odds of exposure to CSA distinguished members of Class 2 from Classes 1 and 3. Members of Class 2 also had increased odds of substance use, SI, fear of going outside, NPSV experience, and hypervigilance. Class 2 members further showed reduced odds of education, access to health care, and being men survivors of NPSV. The prevalence of ACEs in this sample is unprecedented. Haiti needs ACE prevention and compassionate trauma-informed care at the population level.

Examining the Relationship Between Internet Use and Depressive Symptoms Among Older Adults: Analyses of Mediators and Moderators

ABSTRACT Objectives The study aimed to investigate the influence mechanism underlying the relationship between Internet use and depressive symptoms in Chinese older adults. Methods Data were derived from the 2018 wave of China Longitudinal Aging Social Survey. Mediation and moderation analyses were conducted using Ordinary list squares (OLS) regression analysis. To address potential endogenous issues, we employed the Propensity Score Matching (PSM) method to explore the association between Internet use and depressive symptoms. Results Our findings indicate that Internet use can significantly reduce depressive symptoms and enhance mental health of older adults. Loneliness mediated the relationship between Internet use and depressive symptoms among older adults, while socioeconomic status (SES) moderated this relationship. Furthermore, the four purposes of Internet use, namely online chatting, information searching, recreational activities, consumption and investment, were negatively associated with loneliness and depressive symptoms among older adults. Conclusions The findings emphasize the positive effects of Internet use on the mental health outcomes of older adults. Clinical Implications The proper use of the Internet possesses considerable promise for clinical rehabilitation, targeting the enhancement of the mental health outcomes of older adults during their later life.

The Effect of Tai Chi (Bafa Wubu) Training and Artificial Intelligence-Based Movement-Precision Feedback on the Mental and Physical Outcomes of Elderly.

(1) Background: This study aims to compare the effects of AI-based exercise feedback and standard training on the physical and mental health outcomes of older adults participating in a 4-week tai chi training program. (2) Methods: Participants were divided into three groups: an AI feedback group received real-time movement accuracy feedback based on AI and inertial measurement units (IMUs), a conventional feedback group received verbal feedback from supervisors, and a control group received no feedback. All groups trained three times per week for 8 weeks. Outcome measures, including movement accuracy, balance, grip strength, quality of life, and depression, were assessed before and after the training period. (3) Results: Compared to pre-training, all three groups showed significant improvements in movement accuracy, grip strength, quality of life, and depression. Only the AI feedback group showed significant improvements in balance. In terms of movement accuracy and balance, the AI feedback group showed significantly greater improvement compared to the conventional feedback group and the control group. (4) Conclusions: Providing real-time AI-based movement feedback during tai chi training offers greater health benefits for older adults compared to standard training without feedback.