Population Of Older Adults Research Articles

Measuring the Prevalence, Treatment, and Associated Treatment Costs of Injury for Older Adults in India: Insights from the National Longitudinal Aging Study

This cross-sectional analysis of secondary data aimed to examine the injury prevalence, treatment, and associated healthcare expenditure among older adults in India. Longitudinal Aging Study India Wave 1 data for those aged 60+ years comprising sociodemographic characteristics and self-reported major injury, injury mechanism, falls and joint/bone fractures, treatment sought, and out-of-pocket expenditure (OOPE) were analyzed. Descriptive, relative risk, bivariate, and two-part regression model analyses were conducted. Fifteen percent of the 31,464 older adults surveyed had experienced a major injury, 13% a fall and 5% a bone/joint fracture. The risk of injury increased with age and income and was higher for urban residents and females. Seventy-eight percent of those who experienced injury sought medical treatment, 56% needing treatment for a serious fall and 3% undergoing surgery. Higher proportions of females than males required medical treatment for falls and injury-related surgery, yet on average, females were spending less than males for public or private hospital treatment. Injury-related OOPE increased with age and decreased with lower education. Scaling up injury prevention efforts specifically focused on older adults will be vital given the projected growth in the older adult population in India in coming years. Such efforts will prevent unnecessary health impacts and reduce health system utilization and associated individual and family economic burden.

Hierarchical Regression of Diabetes Self-Management and Health Related Quality of Life among Older Adults Patients with Type 2 Diabetes Mellitus.

The global elderly population is experiencing a rising prevalence of diabetes mellitus (DM). As a chronic and noncommunicable disease, diabetes requires strict daily self-management, significantly affecting the health-related quality of life (HRQOL). We investigated the relationship between diabetes self-management behaviors and HRQOL in a population of older adults diagnosed with type 2 diabetes mellitus (T2DM). This cross-sectional study was conducted between March 2022 and August 2022 at Phramongkutklao Hospital, Bangkok, Thailand. Participants completed questionnaires measuring sociodemographic factors, we utilized the Diabetes Self-Management Questionnaire (DSMQ) and the Diabetes-39 Questionnaire (D-39) to assess self-management behaviors. Hierarchical linear regression analysis was then employed to investigate the association between diabetes self-management and HRQOL. A total of 252 participants with a mean age of 68.96 years (SD = 6.64) were included. Most participants were aged 60-69 years (57.0%), female (59.9%), married (81.0%), had an undergraduate education (56.7%), and had an income lower than or equal to 40,000 baht (76.6%). Three factors were associated with HRQOL: compliance with cardiovascular disease (β = 0.233, P < 0.001), acute pancreatitis (β = 0.132, P < 0.05), and diabetes self-management (β = -0.376, P < 0.001). Our findings from the final Model 3 analysis revealed a statistically significant positive association between cardiovascular disease (CVD) and HRQOL (standardized β = 0.233, P < 0.001). This indicates that individuals with CVD reported lower HRQOL compared to those without the condition. Similarly, a significant positive association emerged between acute pancreatitis (AP) and HRQOL (standardized β = 0.132, P < 0.05), suggesting a negative impact of this acute illness on HRQOL. Conversely, diabetes self-management demonstrated a significant negative association with HRQOL (standardized β = -0.376, P < 0.001). This implies that better self-management practices among diabetic patients were linked to improved HRQOL. These findings highlight the crucial role of understanding patient perspectives on self-management. Healthcare providers and researchers should prioritize investigating these perspectives to develop and implement interventions that deliver effective diabetes self-management education. Such targeted interventions have the potential to significantly enhance the HRQOL of patients living with diabetes.

Key Considerations for the Design, Development and Deployment of AgeTech Solutions Supporting Aging in the Right Place.

"The use of technology to support AIRP [aging in the right place] holds great promise," (Kokorelias et al. 2024: 16) and ethical and human rights considerations must be considered in the design, development and deployment of AgeTech solutions. This may be realized through interprofessional and intersectoral collaboration, as well as meaningful inclusion and engagement of lived expertise and experience from older adults and their caregivers. Theoretical frameworks and evidence-based design/research models can structure the consultation processes. They can guide the agile and iterative development of AgeTech based on input and feedback from end-users and community stakeholders. Funders and accelerator programs also play an important role in ensuring that AgeTech solutions that they endorse or sponsor would be ethical, accessible and feasible to older adult populations that are ethnically, culturally and linguistically diverse at various levels of digital literacy.

Criminalizing Abuse, Neglect, and Financial Exploitation of Older Adults

The criminalization of abuse, neglect, and financial exploitation of older adults did not begin until the late 1990s in the United States. During this time, a number of states enacted laws criminalizing certain abusive and exploitive behaviors committed against older adults and added punishment enhancements to existing laws if victims were over a certain age. These laws and policies, and the impetus for them, mirrored those enacted decades prior as part of the child welfare movement, with connections drawn between the vulnerability of younger and older victims. Despite passage of these various abuse and exploitation laws for older adults, significant challenges remain in the identification, investigation, and prosecution of crimes committed against this population. Further, the population of older adults has been rapidly expanding along with rates of victimization, elevating the importance of this escalating social problem. This paper identifies limitations in the prior research by describing the past, present, and likely future of U.S. law and policy intended to effectively respond to crimes against older adults and concludes with a research and policy agenda.

Longitudinal Decline of Exercise Capacity in Male and Female Mice.

The population of older adults is exponentially expanding. Alongside aging comes the onset of chronic disease, decline of functional capacity, and reduced quality of life. Thus, this population increase will stress the capacity and financial viability of health and long-term care systems. Developing pre-clinical models for age-related functional decline is imperative to advancing therapies that extend healthspan and prolong independence. Previously in a cross-sectional study, we established a powerful composite scoring system we termed CFAB (comprehensive functional assessment battery). CFAB measures physical function and exercise capacity using well-validated determinants to measure overall motor function, fore-limb strength, four-limb strength/endurance, aerobic capacity, and volitional exercise/activity rate. In the current work, we used CFAB to track cohorts of male and female C57BL/6 mice over the lifespan (measuring CFAB at 6, 12, 18, 24, and 28 months of age). Overall, we found statistically significantly declining function as the mice aged, with some differences between males and females in trajectory and slope. We also determined that body mass changes presented differently between sexes, and tracked body composition (fat percentage, using magnetic resonance imagery) in females. In a subset of mice, we tracked in vivo contractile physiology noting declines in plantar flexor maximum isometric torque. In summary, our data suggest that males and females declined at different rates. We confirmed the efficacy of CFAB to track longitudinal changes in exercise capacity and physical fitness in both males and females, further validating the system to track age-related functional decline.

Older Adults' Perceptions of Cognitive, Physical, and Exergame Training: A Mixed Methods Investigation of a Four-Armed Randomized Controlled Pilot Trial.

Purpose: Although the health benefits of behavioral interventions for older adults are well studied, research focused on intervention acceptability in older adult populations is less established and is needed. This mixed methods study investigated older adults' perceptions of training interventions. Methods: Community-dwelling older adults (N = 41) were randomized into three groups (cognitive, physical, and exergame) and completed 20 in-lab training sessions over 10 weeks. At every fifth session, participants provided feedback on their perceived gains across functional domains, enjoyment of and motivation to complete training, and aspects they most and least enjoyed regarding study participation. Results: Based on the multivariate analysis of variance, perceived cognitive and everyday function gains did not vary by training group. However, physical and exergame groups perceived greater improvement in physical function than the cognitive training group (P < 0.001). Enjoyment of and motivation to complete training did not vary by training group. Exploratory qualitative coding results suggest that participants across groups most enjoyed social interaction and feelings of improvement. Participants least enjoyed traveling to the study site and engaging in aspects of training (e.g., specific games, structure or duration of training). Conclusion: These findings highlight the importance of incorporating meaningful social engagement and balancing the challenge of training components with goal attainment when working with older adults, regardless of the intervention type. Future research and practice should consider salient aspects of the participant experience (e.g., social connection, accessible locations or remote options) when designing interventions for older adults.

Foreclosure, memory decline, and dementia probability: A longitudinal cohort study.

Housing insecurity is rising among older adults; health researchers know little about how this may impact their cognitive health. We investigated links between foreclosure and older adults' memory and probability of dementia. Using the Health and Retirement Study (2008 to 2018), we fit mixed models comparing the memory and dementia probability scores of 249 older adults who experienced foreclosure (treated) with 15,645 who did not. Baseline covariates included sociodemographics, health, and cognition. Models were stratified by age group. Foreclosure was associated with faster memory decline among middle-aged (50 to 64) older adults (-0.007 standard deviations/year, 95% confidence interval: -0.13, -0.001). Compared to average memory decline among middle-aged older adults who were stably housed, foreclosure equated to 3.7 additional years of aging over 10 years. Among those 65+, differences between those who were and were not foreclosed upon were short-lived and less clear, potentially driven by depletion-of-susceptibles bias. Foreclosure may endanger older adults' memory. Housing instability is a key determinant of cognitive aging. We examined foreclosure and levels and changes in memory and dementia probability scores in the US older adult population. Foreclosure was associated with faster memory decline among middle-aged (50 to 64) older adults, equivalent to 3.7 additional years of cognitive aging over 10 years. Foreclosure yielded sharp memory declines and increases in dementia probability among older adults 65 and above. Foreclosure imposes a greater risk for older adults' cognitive decline.

Functional disability among the older adult population in Kedah, Malaysia

BackgroundFunctional disability, defined as acquired difficulty in performing basic daily tasks or more complex tasks needed for independent living. Functional assessment among community dwelling elderly is critical due to the changes taking place during the normal aging process, acute illness, worsening chronic illness, and hospitalization which compromises their performances necessary to live independently. Measuring their functional ability can provide objective data to assist with targeting individualized care plan for older adults being the highest consumers of medications due to greater burden of medical conditions in addition to being vulnerable to the effects of medications. It is crucial for the pharmacists to be aware of the geriatric functional disability as pharmacies are often the first point-of-care this elderly group may encounter in community settings. MethodsThis study was conducted to estimate the prevalence of functional disability and the common difficulties in the daily task performance among elderly from a state in the Northern region of Malaysia. Besides, the differences in terms of functional disability in both genders were also explored. Among a total of 266 elderly participants. ResultsAround 42 % was estimated to face at least one difficulty with Activities of Daily Living while more than half, 57 %, had at least one difficulty with Instrumental Activities of Daily Living. The most common difficulties reported with Activities of Daily Living and Instrumental Activities of Daily Living were transferring (22 %) and transportation (33 %), respectively. ConclusionIn order to deliver effective pharmaceutical care plan emphatically, both senior-friendly pharmacy curricula and pharmacy settings are imperative to address the most common difficulties faced by this vulnerable group.

Role of Food Texture, Oral Processing Responses, Bolus Properties, and Digestive Conditions on the Nutrient Bioaccessibility of Al Dente and Soft-Cooked Red Lentil Pasta.

The purpose of this study was to assess the impact of food texture, oral processing, bolus characteristics, and in vitro digestive conditions on the starch and protein digestibility of al dente and soft-cooked commercial red lentil pasta. For that, samples were cooked as suggested by the provider and their texture properties were promptly analysed. Then, normal and deficient masticated pasta boluses were produced by four healthy subjects, characterised in terms of their oral processing, bolus granulometry, texture and viscoelastic properties, and finally subjected to static in vitro digestion, according to the INFOGEST consensus for both adults and the older adult population. Normal masticated boluses exhibited greater saliva impregnation and lower proportions of large particles, hardness, and stiffness than deficient masticated boluses. Likewise, insufficiently masticated al dente-cooked pasta boluses caused a delay in oral starch digestion owing to the larger particles attained during food oral processing, while reduced intestinal conditions in the elderly only interfere with the release of total soluble proteins in all samples. This work evidences the importance of considering the initial texture of products, oral capabilities, processing behaviour, and physical and mechanical properties of food boluses in digestion studies, opening new prospects in designing pulse-based foods that meet the nutritional requirements of the world's population.

Association of psychological resilience with all-cause and cause-specific mortality in older adults: a cohort study

BackgroundPsychological resilience has been associated with increased longevity in the oldest old; however, its significance in the broader older adult population has not been thoroughly explored. There is a lack of understanding regarding its relationship with cause-specific mortality in older adults. This study aims to address these gaps by investigating the association between psychological resilience and both overall mortality and cause-specific mortality in individuals aged 65 and older.MethodsWe enrolled 4,935 participants aged 65 and older in the Chinese Longitudinal Healthy Longevity Survey, with baseline assessments conducted in 2014 and follow-up surveys in 2018. To evaluate the associations between psychological resilience and mortality, we used Cox proportional hazards models. Additionally, we employed restricted cubic spline plots to illustrate the dose-response relationships between these variables.ResultsDuring a mean (Standard Deviation) follow-up of 3.2 years (1.2), 1726 participants died. Higher psychological resilience was independently associated with lower all-cause mortality risk (Hazard ratio [HR] 0.74, 95% confidence interval [CI]: 0.67–0.82) and cause-specific mortality from cardiovascular disease (HR 0.74, 95% CI: 0.59–0.93), respiratory diseases (HR 0.63, 95% CI:0.45–0.87), and other causes (HR 0.69, 95% CI: 0.60–0.78), excluding cancer-related mortality. Similar effects were evident when examining the psychological resilience score. The dose-response analysis further indicated a gradual decrease in mortality risk corresponding to higher psychological resilience scores. Interaction analyses revealed that psychological resilience has a more pronounced effect on mortality from other causes among economically independent older adults (P-interaction = 0.02).ConclusionsEnhanced psychological resilience is independently associated with reduced all-cause and some cause-specific mortality in older adults. These findings underscore the importance of addressing psychological factors in the promotion of healthy aging and longevity.

Serious Games for Cognitive Rehabilitation in Older Adults: A Conceptual Framework

This paper presents a conceptual framework for the development of serious games aimed at cognitive rehabilitation in older adults. Following Jabareen’s methodology, a literature review was conducted to identify concepts and theories that are relevant in this field. The resulting framework comprises the use of virtual reality, integration of physical activity, incorporation of social interaction features, adaptability of difficulty levels, and customization of game content. The interconnections between these concepts and underlying cognitive theories, such as the cognitive reserve hypothesis and the scaffolding theory of aging and cognition, are highlighted. As we are in the early stages of our research, our goal is to introduce and test novel interpretations of current knowledge within this conceptual framework. Additionally, the practical implications of the conceptual framework are discussed, including its strengths and limitations, as well as its relevance for future research and clinical practice in the field of cognitive rehabilitation. It is hoped that this framework will provide a guide for the design and implementation of effective interventions to improve cognitive health and well-being in the older adult population.

Association between cadmium exposure and serum neurofilament light chain levels: A nationwide population-based survey

BackgroundAlthough cadmium exposure had been demonstrated to be toxic to the nervous system, little was known about the link between cadmium exposure and axonal injury. Therefore, the present study aimed to reveal whether there was any correlation between blood cadmium and serum neurofilament light chain (NfL) levels in the general population. MethodsThis study included 1040 participants with a median (IQR) age of 47 (35−60) years from the 2013–2014 National Health and Nutrition Examination Survey. Serum NfL levels were measured through immunoassay, and whole blood cadmium concentrations were detected by means of inductively coupled plasma mass spectrometry. Linear regression and restricted cubic spline model was applied to analyze the significance of relationship between blood cadmium and serum NfL levels. ResultsIn the full adjusted model, blood cadmium levels were found to be positively associated with serum NfL levels (Q4 vs Q1, β = 3.35, 95 %CI: 0.41, 6.30, p for trend = 0.014). A potential linear positive dose-effect relationship was discovered between blood cadmium and serum NfL levels (p for non-linearity = 0.15). According to the result of stratified analysis, the significant positive relationship between blood cadmium and serum NfL levels was present only in the population of middle-aged and older adults. ConclusionThe present study suggested a positive association between blood cadmium and serum NfL levels in the general US population.

Shared decision-making endorses intention to follow through treatment or vaccination recommendations: a multi-method survey study among older adults

BackgroundPrevious studies have shown that shared decision-making (SDM) between a practitioner and a patient strengthens the ideal of treatment adherence. This study employed a multi-method approach to SDM in healthcare to reinforce the theoretical and methodological grounds of this argument. As the study design, self-reported survey items and experimental vignettes were combined in one electronic questionnaire. This technique aimed to analyze the effects of previous experiences and the current preferences regarding SDM on the intentions to follow-through with the medical recommendations.MethodUsing quantitative data collected from the members of the Finnish Pensioners’ Federation (N = 1610), this study focused on the important and growing population of older adults as healthcare consumers. Illustrated vignettes were used in the evaluation of expected adherence to both vaccination and the treatment of an illness, depending on the decision-making style varying among the repeated scenarios. In a within-subjects study design, each study subject acted as their own control.ResultsThe findings demonstrated that SDM correlates with expected adherence to a treatment and vaccination. Both the retrospective experiences and prospective aspirations of SDM in clinical encounters supported the patients’ expected adherence to vaccination and treatment while decreasing the probability of pseudo-compliance. The association between SDM and expected adherence was not affected by the perceived health of the respondents. However, the associations among the expected adherence and decision-making styles were found to differ between the treatment and vaccination scenarios.ConclusionsSDM enables expected treatment adherence among older adults. Thus, the multi-method study emphasizes the importance of SDM in various healthcare encounters. The findings further imply that SDM research benefits from questionnaires combining self-report methods and experimental study designs. Further cross-validation studies using various types of written and illustrated scenarios are encouraged.

Potential protein biomarkers in saliva for detection of frailty syndrome by targeted proteomics

Frailty is a physiological geriatric syndrome, caused by immunosenescence, inflammation and alterations at the protein level leading to metabolic and microbiota changes. Currently, this syndrome is evaluated clinically with the Frailty-VIG index. The aim of the study was therefore to investigate the potential suitability of saliva as a non-invasive proximal biological fluid for the characterisation and identification of possible protein-level biomarkers in frailty syndrome. This cross-sectional study was conducted in a rural population of older Spanish adults using the SMR proteomics technique. A differential protein profile of eight potential and surrogate proteins (CYTC, CYTD, CYTS, CYTB, MIF, ALBU, CD44 and B2MG) was detected in saliva, all of which correlated with factors characterising frailty syndrome, such as vascular ageing (arterial stiffness and cardiovascular disease), obesity, mood problems, global cognitive impairment, changes in gait and hand pressure strength. The proteins CYTD (r = 0.415, p = 0.013) and CYTC (r = 0.280, p = 0.026), which were detected differentially in the protein profile, were associated with the Frailty-VIG index. All analysed proteins are associated not only with the clinical symptoms of frailty syndrome, but also with an acute inflammatory response, endothelial cell proliferation and the complement system, among others.

Automated Detection of In-Home Activities with Ultra-Wideband Sensors.

As Canada's population of older adults rises, the need for aging-in-place solutions is growing due to the declining quality of long-term-care homes and long wait times. While the current standards include questionnaire-based assessments for monitoring activities of daily living (ADLs), there is an urgent need for advanced indoor localization technologies that ensure privacy. This study explores the use of Ultra-Wideband (UWB) technology for activity recognition in a mock condo in the Glenrose Rehabilitation Hospital. UWB systems with built-in Inertial Measurement Unit (IMU) sensors were tested, using anchors set up across the condo and a tag worn by patients. We tested various UWB setups, changed the number of anchors, and varied the tag placement (on the wrist or chest). Wrist-worn tags consistently outperformed chest-worn tags, and the nine-anchor configuration yielded the highest accuracy. Machine learning models were developed to classify activities based on UWB and IMU data. Models that included positional data significantly outperformed those that did not. The Random Forest model with a 4 s data window achieved an accuracy of 94%, compared to 79.2% when positional data were excluded. These findings demonstrate that incorporating positional data with IMU sensors is a promising method for effective remote patient monitoring.

Healthcare spending for non-fatal falls among older adults, USA

BackgroundThe older adult (65+) population in the USA is increasing and with it the number of medically treated falls. In 2015, healthcare spending attributable to older adult falls was approximately...

The Association of Vitamin D Levels and Dental Caries in Older Adults: A Cross-Sectional Study.

Most research examining vitamin D and dental caries focuses on children and younger adults. This study investigated the association between vitamin D levels and dental caries in older adults using data from the United States National Health and Nutrition Examination Survey from 2011 to 2016. Data were analyzed from 2723 participants aged 65 years and older who completed both dental examinations and serum 25(OH)D tests. Dental caries assessments included the decayed, missing, and filled teeth (DMFT) index and the presence of untreated dental caries. Vitamin D levels were measured as serum 25(OH)D concentrations and categorized as severely deficient (<25 nmol/L), deficient (25-49.9 nmol/L), insufficient (50-74.9 nmol/L), and normal (≥75 nmol/L). Logistic regression and Poisson regression models were used to assess the association between vitamin D levels and dental caries, adjusting for demographic factors. The mean DMFT score was 17.73 ± 8.34, with 35.1% of participants having untreated dental caries. Vitamin D deficiency was associated with a 1.44 times higher likelihood of untreated caries (95% CI: 1.15, 1.81), which weakened after adjustment for demographic factors (adjusted OR: 1.23, 95% CI: 0.97, 1.55). Severe vitamin D deficiency correlated with a 1.13 times higher DMFT score (95% CI: 1.06, 1.20), with the association remaining similar after adjustment (adjusted RR: 1.12, 95% CI: 1.05, 1.20). Significant differences in vitamin D levels were observed across gender, race/ethnicity, and country of birth. This study suggests the potential importance of adequate vitamin D levels for maintaining dental health among older adults. Vitamin D deficiency is associated with a higher risk of poorer DMFT scores. Public health strategies that include vitamin D screening and supplementation, particularly for high-risk groups, may improve oral health outcomes in the older adult population. Further research is needed to elucidate the mechanisms by which vitamin D influences dental health and the potential for vitamin D supplementation to reduce the burden of dental caries in older adults.

The Utilization of Outpatient Health Services and the Associated Factors Among the Older Adults Covered by Comprehensive Health Service Centers in Rasht

Background: The increase in the older adult population has resulted in a higher demand for outpatient health services and subsequently increased costs paid by older adults. Objectives: This study conducted in Rasht aimed to determine the utilization of outpatient health services among older adults covered by comprehensive health service centers and the factors associated with it. Methods: This cross-sectional analytical study was conducted on 384 older adults aged 60 years and older covered by comprehensive health service centers. The sampling method was stratified random sampling based on consecutive sampling. The information required was collected through a researcher-made two-part questionnaire, including individual-social characteristics and outpatient services, via interviews. Data were analyzed using SPSS version 21 software. The significance level of the tests was considered to be P &lt; 0.05. Results: The results showed that 82.8% of the older adults required outpatient services and 90.9% of them actually received these services. Out of the total, 65.1% went to private sector facilities, 17% to public facilities, and the remaining 18% visited facilities in both sectors. The main reasons for not utilizing outpatient services were the lack of money and the inability to pay. Factors such as place of residence (P = 0.014, OR = 2.417), the presence of chronic disorders (P = 0.047, OR = 1.689), health status (P = 0.012, OR = 0.619), and education level (P = 0.05, OR = 0.763) were found to be associated with the utilization of outpatient services. Conclusions: Two-thirds of the sample had chronic diseases, most of them received outpatient services from the private sector, and about 75% of those who did not receive the service could not afford the costs. Therefore, it is necessary to improve the quality of outpatient services in the public sector and enhance their accessibility. Some individuals were unaware of health screenings for older adults in the comprehensive health services centers, so informing them about these services can be useful in promoting their utilization by older adults and reducing the costs of outpatient services.

Beyond Hypertension: Examining Variable Blood Pressure's Role in Cognition and Brain Structure.

Hypertension or high blood pressure (BP) is one of the 12 modifiable risk factors that contribute to 40% of dementia cases that could be delayed or prevented. Although hypertension is associated with cognitive decline and structural brain changes, less is known about the long-term association between variable BP and cognitive/brain changes. This study examined the relationship between variable BP and longitudinal cognitive, white matter hyperintensity (WMH), gray matter (GM), and white matter (WM) volume change over time and postmortem neuropathology. A total of 4,606 participants (32,776 follow-ups) from RADC Research Resource Sharing Hub (RUSH) and 2,114 participants (9,827 follow-ups) fromtheAlzheimer's Disease Neuroimaging Initiative (ADNI) were included. Participants were divided into 1 of 3 groups: normal, high, or variable BP. Linear-mixed models investigated the relationship between BP and cognition, brain structure, and neuropathology. Older adults with variable BP exhibited the highest rate of cognitive decline followed by high and then normal BP. Increased GM volume loss and WMH burden were also observed in variable compared to high and normal BP. In postmortem neuropathology, both variable and high BP had increased rates compared to normal BP. Results were consistent across the RUSH and ADNI participants, supporting the generalizability of the findings. Damages potentially associated with variable BP may reduce resilience to future dementia-related pathology and increased the risk of dementia more than that caused by high BP. Improved treatment and management of variable BP may help reduce cognitive decline in the older adult population.

Frailty and its association with long-term mortality among community-dwelling older adults aged 75 years and over

BackgroundFrailty, a significant risk factor for adverse outcomes and mortality, poses an emerging challenge with profound implications for public health and clinical practice. The measurement of frailty offers potential enhancements in healthcare services for older adults. The prevalence of frailty and its association with long-term mortality in a nationwide, unselected population of community-dwelling older adults, particularly those aged 75 and over, has not been previously studied on a large scale in Israel.MethodsA retrospective cohort study was conducted at Meuhedet Health Maintenance Organization, Israel’s third largest healthcare service provider, serving 1,276,000 people (13.8% of Israelis). The prevalence of frailty and its association with all-cause mortality were studied among older adults aged 75 years and over who were followed for 2–8 years. Frailty, defined by the cumulative deficit method, utilized clinical data from the preceding 10-year period, comprising 28 chronic diseases and age-related health deficits.ResultsThe cohort included 43,737 older adults, with a median age of 77 years (IQR 75–82 years); among them, 19,300 (44.1%) were males. Overall, 19,396 (44.3%) older adults were frail: 12,260 (28.0%) mildly frail, 5,533 (12.7%) moderately frail and 1,603 (3.7%) severely frail. During the follow-up period 15,064 (34.4%) older adults died: 4,782 (39.0%) mildly frail, 3,016 (54.5%) moderately frail and 1,080 (67.4%) severely frail. Cox regression analysis demonstrated that mortality was associated with severe frailty (HR 2.63, 95%CI 2.45–2.80), moderate frailty (HR 2.05, 95%CI 1.96–2.14), and mild frailty (HR 1.45, 95%CI 1.39–1.51), independent of age, gender, and population sector. Among patients aged 90 years and over, no significant differences in cumulative survival were found between those with moderate and severe frailty (p = 0.408).ConclusionsFrailty is prevalent among community-dwelling Israeli older adults aged 75 years and over, and it is associated with long-term mortality. Considering its association with long-term mortality across frailty levels until the age of 90, early identification and intervention for frailty are recommended within this population. Policymakers should consider the use of the cumulative deficit method for evaluating frailty at both the population health and clinical levels.