Middle-aged Adults Research Articles

How Does Age Matter? Investigating Financial Strain, Health, and Well-Being among Adults Who Need Long-Term Services and Supports.

Being or becoming disabled over the life course can have profound effects on one's financial well-being and health-related quality of life. Adults of different ages and abilities who need long-term services and supports (LTSS) may perceive and experience financial strain and its impact on their health and well-being differently. Yet research on LTSS has typically studied defined age groups separately. This study explores how age may differentiate the associations between disability status, financial strain, and the subjective health and well-being of adults with LTSS needs in California. Using representative population-level data from the 2019-2020 California Long-Term Services and Supports survey, merged with data from the California Health Interview Survey (N = 2,030), descriptive and conditional process analyses were applied to answer the primary research questions. Findings indicate that young and middle-aged adults with LTSS needs struggled more than older adults to make financial ends meet. Middle-aged and older adults reported worse self-rated health, while younger adults were more likely to experience serious psychological distress. The indirect effects of difficulty in performing instrumental activities of daily living and the experience of serious psychological distress through financial strain were significant for young and middle-aged adults but not significant for older adults. These findings suggest the need to calibrate services to be more responsive to diverse experiences of disability, and to reset aging and disability silos to create coordinated LTSS networks for people with disabilities of all ages.

The relationship between activities of daily living and speech impediments based on evidence from statistical and machine learning analyses

IntroductionSpeech impediments (SIs) are increasingly prevalent among middle-aged and older adults, raising concerns within public health. Early detection of potential SI in this demographic is critical. This study investigates the potential of Activities of Daily Living (ADL) as a predictive marker for SI, utilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which includes 10,136 individuals aged 45 and above. The Barthel Index (BI) was used to assess ADL, and the correlation between ADL and SI was examined through statistical analyses. Machine learning algorithms (Support Vector Machine, Decision Tree, and Logistic Regression) were employed to validate the findings and elucidate the underlying relationship between ADL and SI.BackgroundSI poses significant challenges to the health and quality of life of middle-aged and older adults, increasing the demands on community-based and home care services. In the context of global aging, it is crucial to investigate the factors contributing to SI. While the role of ADL as a potential biomarker for SI remains unclear, this study aims to provide new evidence supporting ADL as an early predictor of SI through statistical analysis and machine learning validation.MethodsData were derived from the 2018 CHARLS national baseline survey, comprising 10,136 participants aged 45 and above. ADL was evaluated using the BI, and SI was assessed based on the CHARLS records of “Speech impediments.” Statistical analyses, including independent sample t-tests, chi-square tests, Pearson and Spearman correlation tests, and hierarchical multiple linear regression, were conducted using SPSS 25.0. Machine learning algorithms, specifically Support Vector Machine (SVM), Decision Tree (DT), and Logistic Regression (LR), were implemented in Python 3.10.2.ResultsAnalysis of demographic characteristics revealed that the average BI score in the “With Speech impediments” group was 49.46, significantly lower than the average score of 85.11 in the “Without Speech impediments” group. Pearson correlation analysis indicated a significant negative correlation between ADL and SI (r = −0.205, p < 0.001). Hierarchical multiple linear regression confirmed the robustness of this negative correlation across three models (B = −0.001, β = −0.168, t = −16.16, 95% CI = −0.001 to −0.001, p = 0.000). Machine learning algorithms validated the statistical findings, confirming the predictive accuracy of ADL for SI, with the area under the curve (AUC) scores of SVM-AUC = 0.648, DT-AUC = 0.931, and LR-AUC = 0.666. The inclusion of BI in the models improved the overall predictive performance, highlighting its positive impact on SI prediction.ConclusionThe study employed various statistical methodologies to demonstrate a significant negative correlation between ADL and SI, a finding further corroborated by machine learning algorithms. Impairment in ADL increases the likelihood of SI occurrence, underscoring the importance of maintaining ADL in middle-aged and older populations to mitigate the risk of SI.

Inverse association between dietary flavonoid intake and nocturia in middle-aged and older adults from NHANES 2007–2010

Nocturia is an increasingly prevalent chronic disease that affects the quality of an individual’s life. The prevalence of nocturia exceeds 50% among older adults in the U.S. Inflammation and oxidative stress are considered potential factors affecting nocturia, according to prior research. Flavonoids have attracted considerable interest due to their anti-inflammatory, antioxidant, and anti-aging properties. The association between flavonoid consumption and nocturia has been rarely investigated. For this cross-sectional study, we selected 5926 middle-aged and older adults over 40 from the 2007–2010 National Health and Nutrition Examination Survey (NHANES). Daily dietary flavonoid consumption was assessed through two 24-hour dietary recall interviews and the principal outcome was assessed based on a standardized questionnaire administered by trained interviewers. Weighted multivariate logistic regression and stratified analysis were employed to evaluate the impact of dietary total flavonoid consumption on nocturia. Restricted cubic spline (RCS) was utilized to explore whether there is a non-linear association between total flavonoid intake and nocturia. In addition, we performed weighted logistic regression and weighted quantile sum (WQS) regression by six flavonoid species (isoflavones, anthocyanins, flavan-3-ols, flavanones, flavonoids and flavonols) to estimate a combined mixture sum effect as well as the contribution of each mixture component. Subgroup analysis help us identify heterogeneity in these relationships and enhances the applicability of the research findings across different groups. After fully adjusting for confounders, weighted logistic regression models indicated that dietary flavonoid intake was significantly associated with a decreased prevalence of nocturia (OR: 0.93; 95% CI: 0.88-1.00, P-value = 0.036). This trend remained significant in the analysis stratified by quartile level of flavonoid intake. RCS analysis demonstrated an inverse linear correlation between total flavonoid consumption and nocturia. Analysis conducted through quartile stratification of six flavonoid species and WQS regressions showed that anthocyanins, flavan-3-ols, and flavonols were crucial elements. Within these subclasses, Peonidin in anthocyanins, Catechin and Theaflavin-3,3’-digallate in flavan-3-ols, and Isorhamnetin, Kaempferol, and Quercetin in flavonols were also investigated and may have contributed significantly. Our study revealed an inverse association between dietary flavonoid intake and nocturia in middle-aged and older adults, and anthocyanins, flavan-3-ols and flavonols were protectively associated with nocturia.

Sex-specific associations between estimated glucose disposal rate and cognitive decline in middle-aged and older adults in China: a longitudinal cohort study

BackgroundInsulin resistance (IR) is recognized as a potential modifiable risk factor for cognitive decline, but findings within Asian populations have been inconsistent. Given the high prevalence of dementia and its substantial economic burden in China, large-scale longitudinal studies are essential to elucidate the complex relationship between IR and cognitive function.MethodsThis longitudinal cohort study included 8,734 middle-aged and older adults (median age: 58 years; 53.6% females) from the China Health and Retirement Longitudinal Study (CHARLS), followed from 2011 to 2018. Estimated glucose disposal rate (eGDR) was used to assess IR and was calculated using waist circumference, hypertension status, and HbA1c levels. Participants were categorized into tertiles based on eGDR levels (Tertile 1: lowest; Tertile 3: highest). Cognitive function was calculated as the sum of episodic memory and executive function scores, which was then standardized to a Z-score. Linear mixed-effects models and dose-response analyses were performed to evaluate the association between baseline eGDR and cognitive changes in the total population and stratified by sex.ResultsHigher eGDR levels were significantly associated with slower global cognitive decline (Tertile 3 vs. Tertile 1: β = 0.007; 95% CI: 0.000–0.014; P = 0.047). This association was stronger in females (Tertile 3 vs. Tertile 1: β = 0.011; 95% CI: 0.002–0.021; P = 0.021), while no significant association was observed in males. Dose-response analyses indicated a linear positive relationship between baseline eGDR and global cognitive function in the total population and in females, but not in males. Similar patterns were found for episodic memory and executive function, with significant associations predominantly in females.ConclusionHigher eGDR was significantly associated with slower cognitive decline, particularly among women. These findings underscore the potential of eGDR as a marker for identifying and mitigating cognitive decline and highlight the importance of sex-specific strategies to address insulin resistance and promote cognitive health.

Associations of four obesity indices with diabetes mellitus in Korean middle-aged and older adults using the Korean Genome and Epidemiology Study (KoGES)

BackgroundObesity is associated with a high risk of diabetes mellitus (DM); therefore, obesity-related indices are strongly associated with DM. This study evaluated the association of obesity indices, including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and a body shape index (ABSI), with DM in Korean middle-aged and older adults.MethodsData from three population-based cohorts (Ansan and Ansung, Health Examinee, and Cardiovascular Disease Association Study, derived from the Korean Genome and Epidemiology Study) were analyzed. Logistic analysis was used to evaluate the association of BMI, WC, WHR, and ABSI with DM, after adjusting for covariates according to sex and age. The integrated discrimination index (IDI) and category-free net reclassification improvement (cfNRI) and area under the curve (AUC) of the receiver operating characteristic (ROC) curve were analyzed by age group to investigate index-specific model performance.ResultsAmong the 160,585 participants, 13,846 had DM (6,837; men [11.86%] and 7,009 women [6.81%]). Age increase was associated with an increased prevalence of DM: 2,339 (4.01%), 5,313 (8.74%), and 6,194 (14.93%) in the 40–49, 50–59, and ≥ 60 years age groups. After adjusting for covariates, the odds ratios (OR) for DM of WHR and WC were higher than those of the other indices in every age group. However, the OR for WHR, WC, and BMI decreased with age in both sexes. ABSI showed steady and slightly increasing ORs with increasing age although the ORs in both sexes were generally low for DM. For IDI and cfNRI, WHR had the highest values among all age groups. The AUC of the ROC curve showed that the WHR had the highest value in all age groups.ConclusionThe WHR had the strongest association with DM, but was not a good DM index in older people. Therefore, age-related index criteria for DM, especially in women, were needed for the effective prevention and management of DM.

A cohort study reveals shared and distinct serum metabolic biomarkers for major adverse cardiovascular events in middle-aged and older adults.

We assessed the association of serum metabolites with the occurrence of major adverse cardiovascular events (MACE) in middle-aged and elderly individuals, explored the value of metabolomics in predicting MACE, and compared the distinctions in MACE risk-related metabolic biomarkers between middle-aged and elderly groups. Among the participants of the UK Biobank who underwent baseline assessment through nuclear magnetic resonance (NMR)-based metabolomic profiling of 168 serum metabolites and had complete covariates and clinical lipid parameters, we included those without a previous diagnosis of ischemic heart disease, cerebrovascular disease, heart failure, or cardiac arrest and not on lipid-lowering medications. Relevant covariates included sociodemographic characteristics, lifestyle factors, clinical information, and fasting time. Cox regression gave adjusted hazard ratios for metabolites, including the concentrations of various lipoprotein particles, compositional profiles of different lipoproteins, ketone bodies, amino acids, fatty acids, and additional low-molecular-weight metabolic biomarkers. The least absolute shrinkage and selection operator (LASSO) regression was applied to these metabolites to screen characteristic metabolic variables. Selected feature metabolic biomarkers were added to the established model for predicting MACE risk; risk differentiation (C-statistic) and reclassification (continuous net reclassification improvement [NRI], integrated differentiation index [IDI]) were evaluated. This study included 54,561 UK Biobank participants (34,797 middle-aged adults and 19,764 elderly adults) and was followed for a median of more than 12 years. Of these, there are 1799 middle-aged individuals and 2527 elderly individuals incident of MACE (ischemic heart disease, stroke, and cardiovascular deaths). After adjusting for relevant covariates, Cox regression yielded metabolic biomarkers associated with the occurrence of MACE in the population (false discovery rate controlled P < 0.05). In the elderly, the metabolites associated with increased MACE risk were notably diminished compared to the middle-aged; and the elderly group underscored the protective function of medium and small HDL and their constituents, docosahexaenoic acid, and glycine. The more comprehensive model, which additionally includes the feature metabolic biomarkers, demonstrated enhanced discriminatory power and predictive accuracy for MACE occurrence among middle-aged individuals, evidenced by improved C-statistics (from 0.711 [95% CI 0.699-0.722] to 0.723 [0.711-0.734]), a continuous NRI of 0.247 [0.207-0.315], and an absolute IDI of 0.005 [0.004-0.008]. Its evaluation value is superior to that in the elderly. Our study explored the association of circulating metabolites with MACE risk in middle-aged and elderly adults and made comparisons. Metabolomic insights have revealed biomarkers associated with new-onset MACE in different age populations, highlighting the value of protective metabolites in the elderly. This provides instrumental information to possibly implement precision medicine for preventing MACE.

Cognitive Risk Stratification Score in Middle-aged and Older Adults with Type 2 Diabetes: a Cross-Sectional Study.

Cognitive impairment (CI) affects approximately 45% of middle-aged and older adults with Type 2 Diabetes Mellitus (T2DM) globally. Although formal comprehensive neuropsychological tests are the gold standard for diagnosing CI, they are often time-intensive and may not be feasible in primary care. This study aimed to develop and validate a novel Risk Stratification Score (RSS) to rapidly and comprehensively predict CI risk among middle-aged and older adults with T2DM, offering a streamlined alternative in clinical practice. A cross-sectional study was conducted from July 2023 to February 2024 in a primary care polyclinic in Singapore's western region. Participants aged between 40 and 85 diagnosed with T2DM (n=150) were included in a convenience sampling. The primary outcome was CI status and assessed using formal neuropsychological tests, which including Montreal Cognitive Assessment (MoCA). CI was identified in 49.3% of participants (n=74). The RSS, incorporating the MoCA, Diastolic Blood Pressure (DBP), and Short Physical Performance Battery (SPPB), demonstrated excellent discrimination, achieving an area under the ROC curve of 0.802 (p < 0.001). With an optimal cutoff of 0.3, the model showed a sensitivity of 63.5% and specificity of 86.8%, effectively differentiating high- and low-risk CI groups. RSS in clinical practice, exemplified by the Integrated Metabolic Cognitive Risk Stratification Pathway (imCRSP), is a promising tool for rapid CI risk assessment in primary care. Its robust predictive accuracy and ease of use support its application for early intervention in middle-aged and older adults with T2DM. Future studies should validate its use longitudinally and across diverse populations to enhance generalizability.

Physical Activity Reduces the Incidence of Sarcopenia in Middle-Aged Adults

Purpose of the ResearchThe aim of this study was to investigate associations between physical activity and risk of sarcopenia in middle-aged adults.MethodsThis was a longitudinal study based on a subset of UK Biobank data consisting of 1,918 participants (902 men and 1,016 women, mean age 56 years) who had no sarcopenia at baseline based on the criteria of European Working Group on Sarcopenia in Older People (EWGSOP2). The participants were assessed again after 6 years at follow-up, and were categorized into no sarcopenia, probable sarcopenia, or sarcopenia using EWGSOP2. Physical activity was assessed at baseline using 7-day acceleration data that were analysed to obtain physical activity dose at different intensities. Multinominal logistic regression was employed to examine the association between the incidence of sarcopenia and physical activity dose, between baseline and follow up, controlled for other factors at baseline including age, sex, BMI, smoking status, intake of alcohol, vitamin D and calcium, history of rheumatoid arthritis, osteoarthritis, secondary osteoporosis, and type 2 diabetes.ResultsAmong the 1918 participants with no sarcopenia at baseline, 230 (69 men and 161 women) developed probable sarcopenia and 37 (14 men and 23 women) developed sarcopenia at follow-up. Logistic regression models showed that increase in physical activity dose at moderate-to-vigorous intensity significantly reduced the risk of sarcopenia (odds ratio=0.368, p<0.05), but not probable sarcopenia (odds ratio=0.974, p>0.05), while physical activity dose at light or very light activity intensity were not associated with the risk of sarcopenia or probable sarcopenia (p>0.05).ConclusionsPhysical activity at moderate-to-vigorous intensity could reduce risk of sarcopenia in middle-aged adults.

Survey among adult users of semaglutide for weight loss in Denmark: User characteristics, treatment expectations and experienced effects.

Since the launch of semaglutide for weight loss (Wegovy®, SEMA-WL) in late 2022, there has been a huge increase in new users of SEMA-WL. We explored characteristics, treatment expectations and experienced effectiveness and side effects among Danish adults using SEMA-WL. A questionnaire-based survey was conducted from September to December 2023 across 29 Danish community pharmacies. During a 10-day period, pharmacies invited consecutive individuals aged ≥18 years redeeming a prescription on SEMA-WL to complete an electronic questionnaire. A total of 1013 individuals were invited to study participation of which 55% (n = 559) accepted. Users of SEMA-WL were primarily female (78%, n = 434) and middle-aged adults (36-65 years; 76%, n = 423), with a median body mass index of 36 (interquartile range [IQR] 32-40) at treatment initiation. Two in three users had personally asked their general practitioner to initiate treatment (70%, n = 393). Four in ten users had not discussed expected treatment duration with their general practitioner (42%, n = 237), almost half (46%, n = 258) expected treatment for a limited time period, while only 11% (n = 64) expected lifelong treatment. Self-reported median weight loss was 5.3% (IQR 3.2-8.5) for users treated for <3 months, 10% (IQR 8.2-14) for 3-5 months of treatment and 17% (IQR 13-21) for those treated for >5 months. More than half of users (59%, n = 330) had experienced side effects, most commonly nausea (35%, n = 193) and constipation (29%, n = 160). This study provides valuable insights into the characteristics, treatment expectations and effects experienced by Danish adult users of SEMA-WL.

Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018

Abstract Background It is unclear how the estimated glucose disposal rate (eGDR) index relates to osteoarthritis (OA). The goal of this research is to explore the possible link between the eGDR index and the likelihood of OA development. Methods The study encompassed 9,051 individuals from the National Health and Nutrition Examination Survey (2011–2018). Participants were divided into quartiles according to their eGDR, calculated with the equation: eGDR (mg/kg/min) = 21.158 − (0.09 × waist circumference) − (3.407 × hypertension) − (0.551 × glycosylated hemoglobin). We assessed the independent correlation between the eGDR metric and the incidence of OA through weighted multivariate regression, stratified analysis, and threshold effect evaluation. Results The study encompassed 9,051 participants, who had an average eGDR of 7.09. Participants with OA had lower eGDR levels compared to those without OA (6.27 ± 0.09 vs 7.31 ± 0.06, P &lt; 0.001). The odds ratios (ORs) for OA associated with the eGDR index in the logistic regression models were 0.87 (95% confidence interval [CI]: 0.84, 0.89) in the unadjusted model I and 0.87 (95% CI: 0.84, 0.91) in model II (adjusted for all covariates). Higher eGDR index was associated with a reduced risk of OA when compared to the lowest quartile (Q1). A restricted cubic spline analysis indicated a linear negative relationship between eGDR and OA risk. Conclusion An increased eGDR index is inversely related to the risk of OA. The eGDR may serve as a valuable biomarker for the detection of OA and offers a new perspective for the assessment and management of the condition.

Association of lung health and cardiovascular health (Life’s Essential 8)

BackgroundCardiorespiratory health issues often intersect. This study explored the relationship between lung health and the recently updated Cardiovascular Health Measure (Life’s Essential 8).MethodsData from the 2007–2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. Three cohorts were included: lung disease in the Main cohort (N = 9,772), lung function in the Spirometry sub-cohort (N = 3,896), and respiratory symptoms in the Respiratory Symptoms sub-cohort (Age &amp;gt; 40) (N = 3,449). LE8 scores were used as both continuous and categorical variables (0–49, 50–79, 80–100). Weighted multivariate regression analyses examined the correlations between LE8 and lung health, and weighted restricted cubic spline (RCS) regression analyzed potential non-linear relationships. Subgroup analysis was conducted to verify stability.ResultsOverall lung health was better in the high LE8 group than in the low LE8 group. In the fully adjusted model, the high LE8 group had significantly lower odds of asthma (OR = 0.42; 95% CI = 0.29, 0.59) and chronic bronchitis (OR = 0.27; 95% CI = 0.15, 0.49) compared to the low LE8 group. Regarding lung function, each 10-point increase in LE8 was associated with an increase of 50 ml in FEV1 (Beta = 50; 95% CI = 32, 67) and 56 ml in FVC (Beta = 56; 95% CI = 32, 79). Among middle-aged and older adults (age &amp;gt; 40), the high LE8 group had significantly lower odds of respiratory symptoms, including cough (OR = 0.23; 95% CI = 0.12, 0.46), phlegm (OR = 0.42; 95% CI = 0.19, 0.90), and wheezing (OR = 0.29; 95% CI = 0.15, 0.54). RCS analyses demonstrated a non-linear negative correlation between LE8 and cough, sputum, and wheeze. Subgroup and sensitivity analysis suggested stability.ConclusionLife’s Essential 8 (LE8) scores are positively associated with lung health in the US population. These findings provide a valuable reference for maintaining overall cardiorespiratory health.

Association of a novel nutritional index with cognitive impairment in middle-aged and elderly Chinese adults: a cross-sectional analysis from the China Health and Retirement Longitudinal Study

PurposeThe triglyceride-cholesterol-body weight index (TCBI), a novel and easily computable nutritional index, incorporates serum triglyceride (TG), total cholesterol (TC), and body weight (BW). This study explored the association between TCBI and cognitive impairment in middle-aged and elderly Chinese populations.Patients and methodsThis cross-sectional study employed data from the China Health and Retirement Longitudinal Study (CHARLS) baseline survey, including 7,145 participants. TCBI was calculated as TG (mg/dL) × TC (mg/dL) × BW (kg)/1,000. Cognitive function was assessed based on mental status and episodic memory, with a total score below 11 indicating cognitive impairment. The relationship between TCBI and cognitive impairment was examined using multiple logistic regression, smooth curve fitting, and subgroup analyses.ResultsAfter full adjustment, each 1-unit increase in log-transformed TCBI (Lg TCBI) was associated with a 29.7% reduction in cognitive impairment risk [odds ratio (OR) = 0.703, 95% confidence interval (CI): 0.529–0.933; p = 0.015]. When Lg TCBI was categorized into quartiles, the Q2, Q3, and Q4 groups exhibited a reduced risk of cognitive impairment by 19.9, 16.3, and 22.9%, respectively (p for trend = 0.043), compared to the Q1 group. Smooth curve fitting revealed a consistent decrease in cognitive impairment risk with higher Lg TCBI levels. Subgroup analysis indicated that the association was stronger among participants aged ≥60 years (OR = 0.655, 95% CI: 0.438–0.979), non-current drinkers (OR = 0.643, 95% CI: 0.451–0.917), and those who engaged in socializing (OR = 0.568, 95% CI: 0.371–0.871).ConclusionTCBI was significantly and negatively associated with cognitive impairment in Chinese middle-aged and elderly individuals, with the effect more pronounced in those aged ≥60 years, non-current drinkers, and socially active participants.

Association between remnant cholesterol and depression in middle-aged and older Chinese adults: a population-based cohort study

BackgroundThe focus on remnant cholesterol (RC) has intensified because of its association with various diseases. In this study, we investigated the association between RC and depression in middle-aged and older adults.MethodsThe study involved 7,305 participants from the 2015 and 2018 waves of the China Health and Retirement Longitudinal Study. Based on the 10-item Center for Epidemiological Studies Depression Scale (CESD-10), depression was indicated by scores ≥ 12. To assess the correlation between RC levels and depression, a logistic regression model that incorporated restricted cubic spline techniques was used.ResultsOf the study population, (mean age: 60.0 ± 9.5 years), 50.3% were female. From 2015 to 2018, the mean CESD-10 score increased from 6.31 ± 3.56 to 7.85 ± 5.23. Following adjustment for confounding factors, individuals in the higher RC level quartile exhibited a higher depression risk (Q3: odds ratio [OR]: 1.75, 95% confidence intervals [CI]: 1.29–2.39; Q4: OR: 2.68, 95% CI: 1.96–3.68, P for trend &amp;lt; 0.001), with a linear correlation between RC levels and depression (P for nonlinearity = 0.108). And the subgroup analysis yielded results consistent with the primary findings.ConclusionThis study revealed that in China, in middle-aged and older individuals, elevated RC levels were associated with a higher depression risk, suggesting RC is a promising target for depression prevention and treatment.

Spousal Caregiving Types and Cognitive Trajectories Among Middle-Aged and Older Adults in China.

Objectives: This study investigates the longitudinal association between spousal caregiving types and cognitive trajectories among middle-aged and older Chinese adults, with a focus on gender differences. Method: Data from the China Health and Retirement Longitudinal Study (CHARLS) (2011-2018) were analyzed, covering 4568 couples aged 45 and above. Caregiving types were Activities of Daily Living (ADLs) caregiving, Instrumental Activities of Daily Living (IADLs) caregiving, and both ADLs/IADLs caregiving. Cognitive function was assessed using tests of memory, orientation, numeric ability, and visuospatial ability. Latent growth curve modeling was used to examine associations between caregiving types and cognitive trajectories. Results: Spouses who only provided IADLs caregiving had slower cognitive decline compared to those who did not provide caregiving, regardless of gender. However, those who provided ADLs caregiving had faster cognitive decline compared to non-caregivers, especially in women. Discussion: These findings highlight the importance of caregiving types as well as the gendered effects of caregiving on cognitive trajectories.

Using routine health care data to develop and validate a system dynamics simulation model of frailty trajectories in an ageing population

ABSTRACT Frailty is common in older adults and has a substantial impact on patient outcomes and service use. Information to support service planning, including prevalence in middle-aged adults and patterns of frailty progression at population level, is scarce. This paper presents a system dynamics model describing the dynamics of frailty and ageing within a population of patients aged ≥50, based on linked data for 2.2 million patients from primary care practices in England. The purpose of the model is to estimate the incidence and prevalence of frailty in an ageing population over time. The model was developed in consultation with stakeholders (patients, carers, clinicians, and commissioners) and validated against another large dataset (1.38 million patients) from Wales. It was then scaled up to the population of England, using Office for National Statistics projections (to 2027). The baseline results, subject to the assumption that the frailty transition parameters remain constant over this period, suggest that the number of people living with frailty will increase as the population ages, and that those with mild-moderate frailty are likely to have the greatest impact on demand. This paper focuses on model development and validation, highlighting the benefits and challenges of using large routine health datasets.

Exploring the link between serum betaine levels and hyperuricemia risk in middle-aged and older adults: insights from a prospective cohort study.

Betaine is connected to various cardio-metabolic outcomes, yet its relationship with hyperuricemia remains uncertain. We aimed to longitudinally investigate the association between serum betaine levels and the risk of hyperuricemia in middle-aged and older adults. This study utilized data from the Guangzhou Nutrition and Health Study (GNHS). Participants were enrolled between 2008 and 2010, with follow-ups conducted every three years, comprised an analysis sample of 2204 adults aged 40-75. Baseline serum betaine levels were assessed using high-performance liquid chromatography-tandem mass spectrometry. Serum uric acid (SUA) levels were measured at baseline and every three years thereafter. Linear mixed-effects models (LMEMs) and generalized estimating equations (GEEs) were employed to examine the longitudinal association between serum betaine levels and SUA levels, as well as hyperuricemia risk, respectively. LMEMs indicated that compared to individuals in the lowest quartile (Q1) of serum betaine levels, those in the highest quartile (Q4) exhibited the lowest SUA levels (Q4 vs. Q1: β -8.19, 95% CI -16.32 to -0.06, P-trend = 0.023). Each standard deviation increase in betaine (16.5 µmol/L) was associated to SUA levels decrease of -3.28 (-6.10, -0.45). Results from the GEE model suggested a 19% reduction in the odds of hyperuricemia (OR = 0.81; 95% CI: 0.68, 0.95, P-trend = 0.051) in the Q4 group compared to the Q1 category. Our findings highlight a negative association between serum betaine levels and SUA levels, as well as the risk of hyperuricemia in middle-aged and older adults, which is more pronounced in individuals with better dietary quality. This trial was registered at clinicaltrials.gov as NCT03179657. Website: https://clinicaltrials.gov/ct2/show/NCT03179657.

Effects of Exergame Training on Executive Function and Heart Rate Variability in Middle-Aged and Older Adults: ARandomized Controlled Study.

Exergame has become widely popular and offers great levels of cognitive demands, thus may facilitate cognitive benefits. In addition, researchers have proposed that cardiac autonomic function, assessed via heart rate variability (HRV), is associated with cognitive executive function. However, few exergame training studies have investigated this relationship. This study aimed to investigate the effects of 10-week exergame training on executive function and HRV in middle-aged and older adults. Ninety-one participants were randomly assigned to either an exergame training group (63.73±4.48years) or a control group (62.46±4.77years). The training program was 50min per session, twice per week for 10weeks. The control group was instructed to maintain their usual lifestyle. All participants completed questionnaires and received assessments of executive functions and electrocardiography at baseline and postintervention. Results revealed significant group-by-time interaction effects for the three indices of the digit span test and the total initiation time of the Tower of London task with better postintervention performances achieved by the exergame group. The 6 min walk test also improved significantly in the exergame group but not in the control group. No significant change in HRV was observed for both groups. There were significant correlations between HRV and digit span test scores. Our results suggest that the 10-week exergame training program was effective in improving executive functions of working memory, inhibitory control, and planning ability as well as aerobic fitness in middle-aged and older adults. Moreover, HRV was associated with improved executive function.

Skin tactile perception is associated with longitudinal gait performance in middle-aged and older Japanese community dwellers.

Skin tactile perception may indicate frailty in older adults. Although gait performance is crucial for diagnosing frailty, its association with skin tactile perception has not yet been explored. To examine the association between skin tactile perception and changes in step length, cadence, and gait speed in middle-aged and older adults. A longitudinal study (mean follow-up: 10.8 years) SETTING: Community-based survey PARTICIPANTS: A total of 1,403 middle-aged and older adults (aged 40-79 years, 53.6 % men) from the National Institute for Longevity Sciences-Longitudinal Study of Aging were included in this study. These participants completed the baseline survey (1997-2000) and at least two follow-up surveys (2000-2012), had no history of cerebrovascular disease, rheumatoid arthritis, or Parkinson's disease, and had complete data with no outliers in skin tactile perception measurements. Skin tactile perception was assessed using a two-point discrimination test. Step length (cm), cadence (steps/min), and gait speed (m/min) were evaluated on an 11-m walkway at a usual speed. The mean age of participants was 56.4 years. After full adjustment, mixed-effects models with splines revealed that the association between skin tactile perception and gait parameters varied with age. In adults aged 60 and above, we observed non-linear relationships between skin tactile perception and gait parameters. A consistent inflection point around 10 mm in tactile perception was identified across different age groups and gait parameters. Among community-dwelling middle-aged and older Japanese adults, skin tactile perception was associated with changes in gait parameters, particularly in those aged 60 and above. The 10-mm threshold in tactile perception may serve as a critical indicator for predicting changes in gait performance. Skin tactile perception tests may prove clinically useful for screening patients at elevated risk of impaired gait performance.

Association of depressive symptom trajectories with chronic kidney disease in middle-aged and older adults.

This study aimed to investigate the association between trajectories of depressive symptoms and the subsequent risk of chronic kidney disease (CKD) by measuring depressive symptoms repeatedly in older adults with normal renal function. A total of 9650 participants, comprising community-dwelling middle-aged and older adults from the China Health and Retirement Longitudinal Study, were included. Depressive symptoms were assessed at three time points: Wave 1 (2011-2012), Wave 2 (2013-2014), and Wave 3 (2015-2016). Trajectories of depressive symptoms were determined using latent mixed models, and the association between these trajectories and CKD was verified using COX proportional hazards models. Five trajectory patterns of depressive symptoms were identified: low CESD-10 score (Low-Stable, 3702 participants, 38.36%), moderate CESD-10 score (Moderate-Stable, 3602 participants, 37.33%), continuously increasing CESD-10 score from moderate initiation (Moderate-Increasing, 825 participants, 8.55%), continuously decreasing CESD-10 score from high initiation (High-Decreasing, 1032 participants, 10.69%), and stable high CESD-10 score (High-stable, 489 participants, 5.07%). During the two-year follow-up period from Wave 3 to Wave 4 (2017-2018), 420 CKD events occurred. Participants in the Moderate-Stable, Moderate-Increasing, High-Decreasing, and High-Stable groups had an increased risk of developing CKD compared to those in the Low-Stable group, with multivariable-adjusted hazard ratios (95% confidence interval) were 1.32 (1.02-1.71), 1.68 (1.15-2.45), 2.26 (1.63-3.13), and 3.73 (2.57-5.43), respectively, comparted to those with low-stable trajectory. Middle-aged and older adults with increasing (Moderate-Increasing) and persistent depressive symptoms (including Moderate-Stable, High-Decreasing, and High-Stable) face a higher risk of developing CKD over time.

Longitudinal association between ADL disability and depression in middle-aged and elderly: national cohort study.

The decline in daily living abilities (ADL) among older adults is a notable predictor of depressive symptoms and the occurrence of disease. However, the effects of changes in ADL disability on the progression of depression have not been extensively studied. This research aims to examine the relationship between current ADL disability and depression in individuals aged 45 and older, as well as to explore how ADL disability influences the progression of depression in later life within China. This study analyzed 7-year data from the China Health and Retirement Longitudinal Study (CHARLS), involving 2,205 middle-aged and older adults. The ADL disability (BADL: such as eating, dressing; IADL: such as shopping, cooking) were obtained using ADL scale (scores 0-12, lower is better), and depression was measured by the Center for Epidemiologic Studies Depression Scale (scores 0-30, lower is better). The latent growth curve and cross-lagged models were analyzed after adjusting relevant control variables to study the effect of ADL disability on the progression of depression. The mean values for depression, basic activities of daily living (BADL), and instrumental activities of daily living (IADL) varied from 9.44 to 11.08, 6.45 to 6.81, and 6.86 to 7.29, respectively. The analysis indicated a potential association between depression and ADL. Specifically, the trajectory of BADL was a significant predictor of both initial depression (β = 0.138, 95%CI = 0.039-0.237) and its trajectory (β = 0.579, 95%CI = 0.403-0.754). Although IADL did not significantly predict the trajectory of depression, it was a significant predictor of initial depression (β = 0.471, 95%CI = 0.404-0.538). Additionally, cross-lag regression analysis provided further support for the relationship between depression and BADL disability. This research highlights how ADL disability can forecast future depression in Chinese middle-aged and older adults. The findings indicate a significant connection between ADL disability and both changes in and future instances of depression in this group. Therefore, it is crucial for the Chinese government to prioritize interventions that enhance physical functioning in the elderly, as such measures can effectively mitigate the worsening of depression and promote positive aging.