Healthy Longevity Research Articles

Longevity as a Responsibility: Constructing Healthy Aging by Enacting within Contexts over the Entire Lifespan.

Studying aging now requires going beyond the bio-psycho-social model and incorporating a broader multidisciplinary view capable of capturing the ultimate complexity of being human that is expressed as individuals age. Current demographic trends and the lengthening of life expectancies allow the observation of long-lived individuals in full health. These super-agers are no longer an exception. Indeed, individuals can have a good quality of life even over age 70 and living with chronic or neurodegenerative diseases. This change is driven in part by the cohort effect observed in people who are about to age today (e.g., better schooling, more advanced health conditions, and technologization) but more so by the gradual overcoming of ageist views. An aged person is no longer seen as a quitter but rather as one empowered to direct their own trajectory of potentially healthy longevity. According to this vision, this article proposes a situated lifespan perspective for the study of aging that integrates pedagogical models of developmental ecology with psychological theories of optimal experience to understand the individual motivational perspective on aging. At the same time, it does not disregard analyzing the daily and cultural contexts in which everyone situates and that guide aging trajectories. Nor does it forget that aging people are body-mind (embodied) organisms that, with contexts and through motivations, seize opportunities for action (affordances) to evolve in an optimal way during their lifespan. This theoretical reflection sheds new light on the aging process and on future trends in healthy longevity research.

Leisure Activity, Childhood Starvation, and Risk of Incident Diabetes in Older Adults: Evidence from a Chinese Nationwide Cohort Study

ObjectiveThis study explores the impact of leisure activity and the association between childhood starvation and the risk of diabetes in older Chinese adults. DesignProspective cohort study based on the Chinese Longitudinal Healthy Longevity Study (CLHLS), a nationwide cohort study in China. Setting and participantsA total of 4637 older adults aged ≥65 years, all with documented diabetes history, experiences of childhood starvation, and participation in leisure activities were recruited. MethodsChildhood starvation exposure was assessed via self-reported responses from a structured questionnaire. The leisure activities were measured by 9 distinctive components and categorized into 3 distinct categories: productive activity, recreational activity, and sedentary activity. Diabetes status was determined by self-reported, physician-diagnosed cases during the follow-up period. Nonparametric survival models were employed for analysis. ResultsOver an average follow-up period of 4.3 years, 215 of 4637 participants (4.6%) reported a confirmed diagnosis of diabetes. Nonparametric survival models showed that those reporting childhood starvation had a higher risk of late-life diabetes [hazard ratio (HR) 1.72, 95% CI 1.21-2.44]. Engaging in productive activity (HR 0.90, 95% CI 0.83-0.99) and recreational activity (HR 0.88, 95% CI 0.77-1.00) was linked with a reduced risk of late-life diabetes. Sedentary activity did not show a significant effect. Further analysis highlighted the interactions effects of leisure activities on diabetes risk across different demographic and historical exposure subgroups. Conclusions and implicationsEngaging in productive and recreational leisure activities was inversely associated with the risk of diabetes in older adults who experienced childhood starvation. Promoting such activities could be beneficial in mitigating long-term diabetes risk related to early-life nutritional deficiencies.

Associations of body mass index, waist circumference and the weight-adjusted waist index with daily living ability impairment in older Chinese people: A cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey.

To investigate the associations of body mass index (BMI), waist circumference (WC) and the weight-adjusted waist index (WWI) with the impairment of activities of daily living (ADL) in older Chinese people. A total of 13 260 participants aged 65 years and older from the 2018 Chinese Longitudinal Healthy Longevity Survey were included in this cross-sectional study. BMI, WC and the WWI were calculated from measurements of height, weight and WC. Binary logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Non-linear correlations were investigated using restricted cubic spline curves. In multivariate logistic regression fully adjusted for confounding variables, our analyses revealed significant associations between WC and WWI and ADL impairment, with adjusted ORs (95% CI) of 1.01 (1.00, 1.01) and 1.08 (1.03, 1.12), respectively. Meanwhile, participants with a high WWI had a higher risk of ADL impairment compared with those with a low WWI, with an adjusted OR (95% CI) of 1.12 (1.02, 1.23). Subgroup analyses showed that only the association between WWI and ADL impairment did not differ in any of the different populations. In addition, we found that BMI, WC and WWI were non-linearly associated with ADL impairment. There are significant associations between WC and WWI and ADL impairment in older Chinese people. The findings show the ability of the WWI to serve as a comprehensive and effective indicator of obesity in older Chinese people and emphasize the importance of assessing WWI in screening and preventing ADL impairment in older people.

Effect of a Two-Week Diet without Meat and Poultry on Serum Coenzyme Q10 Levels

Coenzyme Q10 (CoQ10) is an essential compound for energy production in the mitochondria and the antioxidation of lipid-soluble substances in cells. As it can be biosynthesized in cells, CoQ10 is not an essential nutrient. However, its intake through meals contributes to the maintenance of CoQ10 levels in the body. Therefore, understanding the effects of daily diet on serum CoQ10 levels is crucial. This study investigated the effect of a two-week diet without meat or poultry, which are rich in CoQ10 content, on serum CoQ10 levels of 22 young women aged 20–21 years. Upon restricting the intake of meat and poultry, the participants’ average daily intake of CoQ10 from meals decreased from 2.1 ± 0.6 to 1.1 ± 0.5 mg/day. Simultaneously, the average serum reduced, oxidized, and total CoQ10 levels decreased by 14%, 31%, and 16%, respectively, after the two-week dietary intervention, whereas the reduced serum CoQ10 ratio increased significantly. These results suggest that meat and poultry are significant sources of CoQ10 in the diet. Dietary habits affect serum CoQ10 levels; however, further research is required to determine whether people who follow long-term diets with lower serum CoQ10 levels, such as a healthy reference diet proposed by the EAT-Lancet Commission in addition to vegetarian and vegan diets, need CoQ10 supplementation to maintain health and achieve healthy longevity.

Mitochondrial Quality Control Processes at the Crossroads of Cell Death and Survival: Mechanisms and Signaling Pathways.

Biological aging results from an accumulation of damage in the face of reduced resilience. One major driver of aging is cell senescence, a state in which cells remain viable but lose their proliferative capacity, undergo metabolic alterations, and become resistant to apoptosis. This is accompanied by complex cellular changes that enable the development of a senescence-associated secretory phenotype (SASP). Mitochondria, organelles involved in energy provision and activities essential for regulating cell survival and death, are negatively impacted by aging. The age-associated decline in mitochondrial function is also accompanied by the development of chronic low-grade sterile inflammation. The latter shares some features and mediators with the SASP. Indeed, the unloading of damage-associated molecular patterns (DAMPs) at the extracellular level can trigger sterile inflammatory responses and mitochondria can contribute to the generation of DAMPs with pro-inflammatory properties. The extrusion of mitochondrial DNA (mtDNA) via mitochondrial outer membrane permeabilization under an apoptotic stress triggers senescence programs. Additional pathways can contribute to sterile inflammation. For instance, pyroptosis is a caspase-dependent inducer of systemic inflammation, which is also elicited by mtDNA release and contributes to aging. Herein, we overview the molecular mechanisms that may link mitochondrial dyshomeostasis, pyroptosis, sterile inflammation, and senescence and discuss how these contribute to aging and could be exploited as molecular targets for alleviating the cell damage burden and achieving healthy longevity.

Healthy Dietary Patterns, Longevity Genes, and Life Expectancy: A Prospective Cohort Study

Healthy Dietary Patterns, Longevity Genes, and Life Expectancy: A Prospective Cohort Study

Analysis of changes in social isolation, loneliness, or both, and subsequent cognitive function among older adults: Findings from a nationwide cohort study.

The study aimed to investigate the associations of changes in social isolation, loneliness, or both, with cognitive function. Data were from 7299 older adults in the Chinese Longitudinal Healthy Longevity Survey. We defined four change patterns (no, incident, transient, and persistent) for social isolation and loneliness, and created nine-category variable to represent the joint changes. Tobit regression models and Cox models were performed. Incident, transient, and persistent social isolation or loneliness may accelerate cognitive decline (p<0.05). Incident, transient, and persistent social isolation wereassociated with higher cognitive impairment risk, while only persistent loneliness was associated with higher cognitive impairment risk (p<0.001). Notably, short-term or persistent social isolation was associated with accelerated cognitive decline and incident cognitive impairment, regardless of different loneliness change status (p<0.05). Short-term or persistent social isolation and persistent loneliness may be a salient risk factor for cognitive decline and cognitive impairment. Incident, transient, and persistent social isolation were associated with accelerated cognitive decline and higher cognitive impairment risk. Persistent loneliness was associated with accelerated cognitive decline and higher cognitive impairment risk. Short-term or persistent social isolation with concurrent different loneliness change status accelerated cognitive decline and higher cognitive impairment risk.

The potential of public organizations in creating conditions of healthy aging for sustainable demographic development of the Russian regions

The article considers issues of potential of public organizations to develop conditions for healthy aging in order to ensure sustainable development of Russian regions differing in their socio-economic, socio-cultural and demographic characteristics. It is established that individual approach is to be applied in developing and implementing measures, since elderly Russians constitute very heterogeneous social demographic group, characterizing by differences in age, health condition, social, economic and professional status, life motivation, family/single/nursing type of residence, etc. It is indicated that work will require time, financial expenses and labor costs. The achievement of sustainable development of Russian regions depends on ability and readiness of regional and municipal authorities, public and commercial organizations and entire population. It is determined that age-related stigmatization and ageism can not be overcame through decisions made by persons of power. No less significant is public opinion, determining position of employers, physicians, teachers and other specialists on whom healthy longevity of population depends. The conclusion is made that present demographic changes are a predictor of development of position of state authorities and public opinion that needed attention is to be paid to promoting of healthy aging, to expending necessary financial, infrastructural, informational and human resources. Only in this case Russian regions can count on social dividends that will follow preliminary comprehensive investments into developing conditions for healthy aging of local residents.

Trends and patterns of the healthy life expectancy of the elderly in China

This study analyzes the healthy life expectancy (HLE) of older adults in China since the 1990s, utilizing data from China's sixth (2010) and seventh (2020) National Population Censuses and the Chinese Longitudinal Healthy Longevity Survey (CLHLS), conducted from 1998 to 2018. By applying the Sullivan method for estimating HLE, the study examines trends in HLE and assesses the impacts of mortality and morbidity rates on HLE through counterfactual analysis. It differentiates measurements of health status: the census uses self-reported ability of living independently, while CLHLS uses the activities of daily living (ADL) scale. The results from both data sources indicate an increase in HLE as a proportion of overall life expectancy for the elderly in China since the 1990s, which suggests a “compression of morbidity”. The CLHLS findings align with those based on the census data. Monitoring HLE is crucial for tracking the health status of the elderly in China and can offer valuable insights for policymakers and healthcare providers in enacting strategies that enhance the health and overall well-being of the senior population.

Активное долголетие: дефиниция понятия, основные детерминанты и противоречия

Introduction. With the increasing share of elderly people in the population, shifting the focus of attention towards solving the problems of healthy longevity is one of the conditions for ensuring social, economic and geopolitical sustainability of modern society. However, despite the relevance of the issue, we can talk about the existence of a number of problems that reduce the effectiveness of the implementation of the active longevity policy and dictate the need for further theoretical and empirical research.The purpose of the article is to elaborate the definition of active longevity, analyze and systematize the main determinants affecting the increase in life expectancy and quality of life, and identify the key contradictions demonstrating the vulnerable nature of the concept of active longevity as a political, economic and social construct.Methodology. The methodology of the study is based on the concepts of active longevity, demographic, epidemiological and reverse epidemiological transitions, approaches considering active longevity specifics in male and female populations, the theory of demographic security and demographic well-being. To confirm the theoretical conclusions, a secondary analysis of the results of sociological research on this issue was used. The information base of the article was compiled by the official statistics of the United Nations and the Federal State Statistics Service.Results. To study the phenomenon of active longevity, the scientific literature uses concepts that affect various aspects of the well-being of elderly people and best meet the needs and/or challenges of a modern “aging" society.The whole set of factors of active longevity can be conditionally combined into three groups: macro-, meso- and micro-level factors. In the case of a society in a state of permanent transformation, socio-economic, political, cultural and historical factors, the state of ecology, the specifics of social structure and stratification, working and living conditions, and the development of social networks are decisive.An analysis of strategic regulatory documents at the international and Russian levels, adopted as part of the implementation of the active longevity strategy has demonstrated a shift in emphasis to considering the problems of population aging not as a demographic threat, but as a global process that provides new opportunities for realizing the potential of the population of older age groups and society as a whole.Conclusions. A conceptual understanding of the phenomenon of population aging in scientific and political discourse, including a shift in focus towards active longevity, opens up great prospects both for the elderly themselves and for the state interested in realizing the potential of older people, including for ensuring socio-economic, political and demographic security and sustainability.The classification of determinants of active longevity proposed in this article covers the entire set of macro-, meso- and micro-level factors and can be used to adjust active longevity strategies at the federal and regional levels.It is also important to take into account and resolve the contradictions that demonstrate the vulnerability of the concept of active longevity and require close attention from authorities, public structures and the scientific community.

Testing the amount of nicotinamide mononucleotide and urolithin A as compared to the label claim

Healthy Longevity Medicine aims to optimize health by targeting aging processes across the lifespan. Addressing accelerated aging involves adaptation of lifestyle and the use of geroprotective drugs and supplements, including nutritional supplements and bioactive compounds. The Food and Drug Administration, under the Dietary Supplement Health and Education Act, categorizes bioactive compounds and medicinal products as dietary supplements. While numerous companies sell ingredients that can be deemed geroprotectors, there's limited oversight in their quality control. Governmental safety authorities only verify the presence of prohibited compounds, not the accuracy of ingredients listed on labels.Here, Nicotinamide mononucleotide and Urolithin A supplements, easily accessible online or in pharmacies, were tested for their active ingredient content. Results showed a significant deviation from the labeled amounts, ranging from + 28.6% to -100%. This indicates a considerable disparity in the quality of geroprotective supplements.To address this variability, collaboration between and within societies representing healthcare professionals, industry and regulatory bodies is imperative to ensure the quality of geroprotective supplements.

Association between possible sarcopenia and domain-specific cognitive impairment in middle-aged and older adults: Insights from the Gan-Dau Healthy Longevity Plan

BackgroundGiven the established association between sarcopenia and cognitive impairment was mainly in the older and oldest-old population or people with relatively limited education, this study extends the investigation to community-dwelling middle-to-old age adults in urban communities, emphasizing the need for preventive intervention for muscle health and healthy longevity. MethodsData of 712 participants from the Gan-Dau Healthy Longevity Plan were retrieved for analysis, and all participants were stratified by age (50–64, 65–74 and 75+ years old). Possible sarcopenia was defined by 2019 consensus report of the Asian Working Group for Sarcopenia (AWGS). This study used four neuropsychological tests for analysis, i.e., Mini-Mental Status Examination (MMSE), California Verbal Learning Test II (CVLT-SF), Digital Symbol Substitution Test (DSST) and Verbal fluency (VF) for global and domain-specific cognitive function. Multivariate generalized linear models (GLMs) were employed to investigate the associations between possible sarcopenia and cognitive function in each age-specific groups. ResultsThe prevalence of possible sarcopenia increased with age, with 31.8 %, 37.7 %, and 55.6 % in participants aged 5064, 65–74 and, 75+ years, respectively. On the other hand, cognitive performance declined with age. In particular, among participants aged 75+ years with possible sarcopenia, their cognitive performance were poorer than robust counterparts, including MMSE (26.6 [3.4] vs. 27.4 [2.6]), CVTL-SF (total score: 21.5 [5.4] vs. 23.8 [5.5]; 30-second delayed recall: 6.0 [1.7] vs. 6.5 [1.6]), DSST (32.8 [14.3] vs. 41.3 [18.7]), and VF (12.8 [5.1] vs. 14.8 [4.9]). Multivariate generalized linear model indicated that possible sarcopenia was associated with lower MMSE (β: −0.70, p = 0.014) and lower DSST (β: −7.00, p = 0.010) in those aged 50–64 years. Moreover, possible sarcopenia was associated with lower CVLT-SF (total score β:-1.90, p = 0.028), lower DSST (β: −6.45, p < 0.001), and lower VF (β: −1.64, p=0.026) in 75+ years group. ConclusionsAn association exists between possible sarcopenia and cognitive impairment, encompassing global cognition, delayed memory, verbal fluency, and executive function, among community-dwelling adults of mid-to-old age. Future research is warranted to explore the temporal alterations in this association and the potential effects of interventions aimed at fostering healthy longevity.

Association of increased participation in social activity in later life with risk of all-cause mortality and heart diseases in older people: results from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

Previous studies have shown social activity is associated with reduced risk of health outcomes. However, among older people (≥65 years) who were socially inactive at baseline, limited study explored whether increased participation in social activity in later life was associated with reduced risk of health outcomes; therefore, using the data from the Chinese Longitudinal Healthy Longevity Survey, the study was performed. The study outcomes were 10-year all-cause mortality (sample number = 9,984) and 10-year heart diseases (sample number = 7,496). The exposure was the change of social activity frequency. Cox regression analysis was used for data analysis. During the follow-up, there were 6,407 all-cause mortalities and 1,035 heart diseases, respectively. Kaplan-Meier analysis demonstrated that cumulative incidences of all-cause mortality were significantly lower in participants with changes into more frequent social activity (log-rank p < 0.001), while no significant difference was observed for heart diseases (log-rank p = 0.330). Compared with the subgroup who never participated in social activity at baseline, adjusted HRs of all-cause mortality were 0.79 (95% CI: 0.70-0.90, p < 0.001), 0.78 (95% CI: 0.63-0.96, p = 0.019), 0.74 (0.59-0.92, p = 0.006), and 0.70 (95% CI: 0.56-0.88, p = 0.002) for the subgroup of switching to sometimes, the subgroup of switching to once a month, the subgroup of switching to once a week, and the subgroup of switching to everyday, respectively. The corresponding HRs of heart diseases were 0.83 (95% CI: 0.65-1.08, p = 0.170), 0.82 (95% CI: 0.51-1.31, p = 0.412), 0.91 (0.58-1.42, p = 0.675) and 0.75 (95% CI: 0.47-1.20, p = 0.227), respectively. Stratified and sensitivity analyses revealed similar results. Among older people who never participated in social activity, increased participation in social activity in later life was associated with reduced risk of all-cause mortality, but was not associated with reduced risk of heart diseases.

Towards Healthy Longevity: Comprehensive Insights from Molecular Targets and Biomarkers to Biological Clocks.

Aging is a complex and time-dependent decline in physiological function that affects most organisms, leading to increased risk of age-related diseases. Investigating the molecular underpinnings of aging is crucial to identify geroprotectors, precisely quantify biological age, and propose healthy longevity approaches. This review explores pathways that are currently being investigated as intervention targets and aging biomarkers spanning molecular, cellular, and systemic dimensions. Interventions that target these hallmarks may ameliorate the aging process, with some progressing to clinical trials. Biomarkers of these hallmarks are used to estimate biological aging and risk of aging-associated disease. Utilizing aging biomarkers, biological aging clocks can be constructed that predict a state of abnormal aging, age-related diseases, and increased mortality. Biological age estimation can therefore provide the basis for a fine-grained risk stratification by predicting all-cause mortality well ahead of the onset of specific diseases, thus offering a window for intervention. Yet, despite technological advancements, challenges persist due to individual variability and the dynamic nature of these biomarkers. Addressing this requires longitudinal studies for robust biomarker identification. Overall, utilizing the hallmarks of aging to discover new drug targets and develop new biomarkers opens new frontiers in medicine. Prospects involve multi-omics integration, machine learning, and personalized approaches for targeted interventions, promising a healthier aging population.

Effects of Qigong Therapy on the Psychological Well-Being, Physical Health State, Sleep State, and Life Satisfaction of Older Adults Living in Community.

Older adults living in a community are looking for alternative and complementary methods to improve their healthy longevity and quality of life. This study aimed to examine the effects of the Qigong therapy on psychological well-being, physical health state, sleep state, and life satisfaction of older adults living in community. This study used a quasi-experimental pretest-posttest control group design. The study samples were 69 older adults (intervention, n =34; control, n =35) over 65years old in community in South Korea. Qigong therapy was performed 50 minutes per session, twice a week for a total of 20 times over a 10-week period in a comfortable and quiet environment without external noise. Measures were the study participant's general characteristics survey, psychological well-being scale, Cornell Medical Index-Korean version, sleep scale, and life satisfaction scale standardized for the elderly. Effects of Qigong therapy according to interaction effect over time and the group showed statistically significant differences in psychological well-being, physical health state, sleep state, and life satisfaction. This study suggests that Qigong therapy was an effective nursing intervention for improving the psychological well-being, physical health state, sleep state, and life satisfaction of older adults living in community.

Science of Cognitive Brain and Quantum Biophysics Homo sapiens 21st Century: hybrid Neuroimaging and Nuclear medicine, 5P Medicine and 5G Technology, Neurobiology and Neurophysiology of Quantum Brains, Psychoanalysis, Art-Medicine, Bioelementology and Nutriciology

New discoveries in the field of genetics and epigenetics, the scientific union of neurobiology and neurophysiology of the quantum brain Homo sapiens of the 21st century, the achievements of biophysics, hybrid neuroimaging and nuclear medicine, the introduction of nutritionology and bioelementology technologies, the 5P of Medicine and 5G Technology, the replication of compliance of art medicine and modern psychoanalysis made it possible to manage 21st century Human cognitive brain. Scientific progress and 33 years of experimental experience of biophysics in the field of neurogeriatrics and neurocardiology, neuroendocrinology and psychoneuroimmunology made it possible to argue that “nerve cells are restored”, the quantum human brain is Controlled, high-quality and healthy longevity Homo sapiens of the 21st century is achievable. Humankind needs to know (discover, prove) in the near future the existence of more than 450 trillion neurosynaptic and neurocosmic interactions between the cognitive mind and the universe.

The Relationship Between Alcohol Consumption and Frailty Among Older Adults in China: Results From the Chinese Longitudinal Healthy Longevity Survey.

Alcohol consumption has an impact on the frailty, but current research in China lacks a detailed classification of alcohol use. This study aimed to explore the relationship between different drinking patterns and frailty in older adults. The data came from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) study, which included older adults (aged ≧ 60). Their demographic data, drinking status, and frailty index were collected in CLHLS. Through logistic regression models to analyze the correlation between alcohol consumption and frailty. A total of 14,931 participants were included in the analysis. The prevalence of frailty was 29.1%, 35.2%, and 14.9% among risk-free, past risky, and now risky drinkers, respectively. After adjusting for covariates, past risky drinking was a risk factor for frailty (p = .003). High-risk alcohol consumption is positively correlated with frailty. Prevention and reduction of risky drinking in older adults may help protect them from developing frailty.

Effects of spatial accessibility of community health services on the activities of daily living among older adults in China: a propensity score matching study.

The Chinese government proposes to establish a hierarchical diagnosis and treatment system, and attaches great importance to community health services. Under the background of population aging and the increase of older adults with disability, this study aimed to analyze the effect of spatial accessibility of community health services on the activities of daily living (ADL) among older adults in China. A research sample of 7,922 older adults from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2018 was adopted. There were 2,806 participants in the treatment group and 5,116 participants in the control group. The propensity score matching method was adopted to match the treatment and control groups to calculate the values of average treatment effects on treated (ATT). The results of kernel density matching method showed that the factual ADL score of the treatment group was 10.912, the counterfactual ADL score of the control group was 10.694, and the ATT value was 0.218 (p < 0.01). The spatial accessibility of community health services could significantly improve the activities of daily living among older adults in China. Meanwhile, there was urban-rural heterogeneity in the impact of spatial accessibility of community health services on the activities of daily living of older adults in China. The effect value in urban samples (ATT = 0.371, p < 0.01) was higher than that in rural samples (ATT = 0.180, p < 0.01). Spatial accessibility of community health services could improve the activities of daily living among older adults in China. The Chinese government should take actions to improve the distribution of community health service resources.

Prediction model related to 6-year risk of frailty in older adults aged 65 years or above in China

Objective: To develop a prediction tool for 6-year incident risk of frailty among Chinese older adults aged 65 years or above. Methods: Data from the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2018 was used, including 13 676 older adults aged 65 years or above who were free of frailty at baseline. Key predictors of frailty were identified via the least absolute shrinkage and selection operator (LASSO) method, and were thereafter used to predict the incident frailty based on the Cox proportional hazards regression model. The model was internally validated by 2 000 Bootstrap resamples and evaluated for the performance of discrimination and calibration using the area under the receiver operating characteristic curve (AUC) and calibration curve, respectively. The net benefit of the developed prediction tool was evaluated by decision-curve analysis. Results: The M(Q1, Q3) age and follow-up time of the participants were 81.0 (71.0, 90.0) years and 6.0 (4.1, 9.2) years, respectively. A total of 4 126 older persons (30.2%) were recorded with frailty incidents during the follow-up, with the corresponding incidence density of 41.8/1 000 person-years. A total of 15 key predictors of frailty were selected by LASSO, namely, age, sex, race, education years, meat consumption, tea drinking, performing housework, raising domestic animals, playing cards or mahjong, and baseline status of visual function, activities of the daily living score, instrumental activities of the daily living score, hypertension, heart disease, and self-rated health. The prediction model was internally validated with an AUC of 0.802, with the max Youden's index of 0.467 at a risk threshold of 19.0%. The calibration curve showed high consistency between predicted probabilities and observed proportions of frailty events. The decision curve indicated that higher net benefits could be obtained via the prediction model than did strategies based on intervention in all or none participants for any risk threshold less than 59%, and the model-based net benefit was estimated to be 0.10 at a risk threshold of 19.0%. Conclusions: The herein developed 6-year incident risk prediction model of frailty, based on easily accessible questionnaires and physical examination variables, has good predictive performance. It has application potential in identifying populations at high risk of incident frailty.

Associations and attributable burdens in late-life exposure to PM2.5 and its major components and depressive symptoms in middle-aged and older adults: A nationwide cohort study

BackgroundDepression in late life has been associated with reduced quality of life and increased mortality. Whether the chronic fine particular matter (PM2.5) and its components exposure are contributed to the older depression symptoms remains unclear. MethodMiddle-aged and older adults (>45 years) were selected from the China Health and Retirement Longitudinal Study during the four waves of interviews. The concentrations of PM2.5 and its major constituents were calculated using near real-time data at a spatial resolution of 10 km during the study period. The depressive symptom was evaluated by the Depression Center for Epidemiologic Studies Depression (CES-D)-10 score. The fix-effect model was applied to evaluate the association between PM2.5 and its major constituents with depressive symptoms. Three three-step methods were used to explore the modification role of sleep duration against the depressive symptoms caused by PM2.5 exposure. ResultsIn our study, a total of 52,683 observations of 16,681 middle-aged and older adults were assessed. Each interquartile range (IQR) level of PM2.5 concentration exposure was longitudinally associated with a 2.6 % (95 % confidence interval [CI]: 1.3 %, 4.0 %) increase in the depression CES-D-10 score. Regarding the major components of PM2.5, OM, NO3-, and NH4+ showed the leading toxicity effects, which could increase the depression CES-D-10 score by 2.2 % (95 %CI: 1.0 %, 3.4 %), 2.2 % (0.6 %, 3.9 %), and 2.0 % (95 %CI: 0.6 %, 3.4 %) correspondingly. Besides, males were more susceptible to the worse depressive symptoms caused by PM2.5 and its major components exposure than female subpopulations. Shortened sleep duration might be the mediator of PM2.5-associated depressive symptoms. ConclusionOur results suggest that long-term exposure to PM2.5 and its major components were associated with an increased risk for depressive symptoms in middle-aged and older adults. Reducing the leading components of PM2.5 may cost-effectively alleviate the disease burden of depression and promote healthy longevity in heavy pollutant countries.