Older Adults In Low- And Middle-income Countries Research Articles

Cancer incidence estimates in adults aged 60 years and older living in low-and-middle-income countries for the years 2020 and 2040.

Previous studies have shown a disproportionate rise in cancer incidence in low-and-middle-income countries (LMICs) due to rapid population ageing. This study aims to describe the cancer incidence in adults aged 60 years and older in LMICs to inform cancer control planning. Using the latest GLOBOCAN estimates for 2020, we describe the cancer incidence and the top five cancer sites among adults aged 60 years and older living in LMICs. We also project the incidence in 2040 by applying population projections, assuming no changes in incidence rates and risk profiles over time. In 2020, 6.3 million new cancer cases were diagnosed in older adults in LMICs, constituting over half of the global incidence burden (55%). In females aged 60 years and older living in LMICs, breast, lung, colon, stomach, and cervix uteri were the most frequent cancer types representing 51% of the total number of new cancer cases in older females. In males aged 60 years and older living in LMICs, lung, prostate, stomach, liver and colon were the most frequent cancer types representing 58% of the total number of new cancer cases in this subgroup. Variations were observed between income categories. The number of new cancer diagnoses in adults aged 60 years and older living in LMICs will almost double by 2040, reaching 11.5 million new cancer cases. The greatest increase is expected to happen in lower-income countries (+158% in lower-middle-income countries (excluding India) and +99% in low-income countries versus +38% in upper-middle-income countries). In conclusion, our findings call for an urgent adaptation of healthcare systems in LMICs by developing geriatric oncology and by including older adults in research, clinical guidelines, insurance schemes and cancer prevention policies.

Food insecurity and subjective cognitive complaints among adults aged ≥ 65 years from low- and middle-income countries

PurposeTo date, no study has investigated the association between food insecurity and subjective cognitive complaints (SCC). Thus, the aims of the present study were to examine this association among older adults in low- and middle-income countries (LMICs), and to identify the potential mediators in this association, given the importance of SCC in dementia risk among older people, and the projected particularly large increase in dementia in this setting.MethodsCross-sectional, community-based, nationally representative data from the World Health Organization (WHO) Study on global AGEing and Adult Health (SAGE) collected between 2007 and 2010 were analyzed. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 (No SCC) to 100 (worse SCC). Past 12 month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable linear regression and mediation (Karlson–Holm–Breen method) analyses were conducted to assess associations.ResultsData on 14,585 individuals aged ≥ 65 years [mean (SD) age 72.6 (11.5) years; 55.0% females] were analyzed. Severe food insecurity (vs. no food insecurity) was associated with 9.16 (95% CI = 6.95–11.37) points higher mean SCC score. Sleep/energy (mediated% 37.9%; P < 0.001), perceived stress (37.2%; P = 0.001), and depression (13.7%; P = 0.008) partially explained the association between severe food insecurity and SCC.ConclusionFood insecurity was associated with SCC among older adults in LMICs. Future studies should assess whether addressing food insecurity among older adults in LMICs can improve cognitive health.

My Parent, Myself, or My Child: Whose Education Matters Most for Trajectories of Cognitive Aging in Middle Age?

The growing body of evidence linking intergenerational education and late-life cognitive decline is almost exclusively from high-income countries, despite rapid intergenerational changes in education in low- and middle-income countries (LMICs). We used data from the Mexican Health and Aging Study (n=8,822), a cohort study of Mexican adults aged ≥50 years (2001-2018), to evaluate whether parental education (none vs. any formal schooling), one's own education (less than primary school vs. completion of primary school), or an adult child's education (less than high school vs. completion of high school) was associated with verbal memory z scores. We used linear mixed models with inverse probability of attrition weights. Educational attainment in all 3 generations was associated with baseline verbal memory scores, independent of the prior generation's education. Lower parental (β=-0.005, 95% confidence interval: -0.009, -0.002) and respondent (β=-0.013, 95% confidence interval: -0.017, -0.010) educational level were associated with faster decline in delayed (but not immediate) verbal memory z scores. Associations between adult child's education and respondent's verbal memory decline varied by exposure specification. The educational attainment of parents and adult children may influence the cognitive aging of middle-aged and older adults in LMICs. These results have important implications given recent structural shifts in educational attainment in many LMICs.

Leisure-time physical activity and sarcopenia among older adults from low- and middle-income countries.

There are no data on the association between leisure-time physical activity (LTPA) and sarcopenia in older adults from low- and middle-income countries (LMICs). This study aimed to investigate the association between LTPA and sarcopenia in individuals aged ≥65years living in six LMICs. Cross-sectional data from the Study on Global AGEing and Adult Health (China, Ghana, India, Mexico, Russia and South Africa) were analysed. Sarcopenia referred to the presence of both low skeletal muscle mass and weak handgrip strength. LTPA was assessed using the Global Physical Activity Questionnaire and was analysed as a dichotomized variable [high LTPA (>150min/week of moderate-to-vigorous LTPA) or low LTPA (≤150min/week)]. Multivariable logistic regression analysis was conducted to assess associations. There were 14585 individuals included in this study [mean (SD) age 72.6 (11.5) years; 55.0% women]. The prevalence of high LTPA and sarcopenia was 8.9% and 12.0%, respectively. After adjusting for potential confounders, low LTPA was significantly associated with higher odds for sarcopenia [prevalence odds ratio (POR)=1.85, 95% confidence interval (CI)=1.29-2.65] compared with high LTPA. Significant associations were found in women (POR=3.22, 95% CI=1.82-5.68) but not in men (POR=1.52, 95% CI=0.99-2.35). A positive and significant association between low LTPA and sarcopenia was found among older adults from LMICs. The promotion of LTPA among older adults in LMICs may aid in the prevention of sarcopenia, especially among females, pending future longitudinal research.

Physical multimorbidity, suicidal ideation, and suicide attempts among adults aged ≥50years from low- and middle-income countries.

The association between physical multimorbidity and suicidal ideation or suicide attempts among older adults from low- and middle-income countries (LMICs) is largely unknown. We aimed to assess this association as well as its mediators using nationally representative data from six LMICs. Cross-sectional, community-based data from the Study on Global Aging and Adult Health were analyzed. A total of 11 chronic physical conditions were assessed. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analyses were conducted. The final sample consisted of 34,129 adults aged ≥50years (mean [SD] age 62.4 (16.0) years; maximum age 114years; 52.1% females). In the overall sample, physical multimorbidity was associated with increased odds for suicidal ideation (OR=2.99; 95% CI=2.06-4.34) and suicide attempts (OR=2.79; 95% CI=1.58-4.95), with the association being stronger in males than females. The association between multimorbidity and suicidal ideation or suicide attempts was largely mediated by pain/discomfort (mediated% 33.3%-44.2%), sleep/energy (28.2%-33.8%), and mobility limitations (26.6%-34.8%). Physical multimorbidity among older adults in LMICs was associated with a substantially increased risk for suicidal ideation and suicide attempts. Addressing the identified mediators in people with physical multimorbidity may aid in the prevention of suicidal ideation and suicide attempts.

Chronic physical conditions, physical multimorbidity, and quality of life among adults aged ≥ 50 years from six low- and middle-income countries

PurposeMultimorbidity (i.e., ≥ 2 chronic conditions) poses a challenge for health systems and governments, globally. Several studies have found inverse associations between multimorbidity and quality of life (QoL). However, there is a paucity of studies from low- and middle-income countries (LMICs), especially among the older population, as well as studies examining mediating factors in this association. Thus, the present study aimed to explore the associations, and mediating factors, between multimorbidity and QoL among older adults in LMICs.MethodsCross-sectional nationally representative data from the Study on Global Ageing and Adult Health were analyzed. A total of 11 chronic conditions were assessed. QoL was assessed with the 8-item WHO QoL instrument (range 0–100) with higher scores representing better QoL. Multivariable linear regression and mediation analyses were conducted to assess associations.ResultsThe final sample consisted of 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; age range 50–114 years; 52.0% females]. Compared to no chronic conditions, 2 (b-coefficient − 5.89; 95% CI − 6.83, − 4.95), 3 (− 8.35; − 9.63, − 7.06), 4 (− 10.87; − 12.37, − 9.36), and ≥ 5 (− 13.48; − 15.91, − 11.06) chronic conditions were significantly associated with lower QoL, dose-dependently. The mediation analysis showed that mobility (47.9%) explained the largest proportion of the association between multimorbidity and QoL, followed by pain/discomfort (43.5%), sleep/energy (35.0%), negative affect (31.9%), cognition (20.2%), self-care (17.0%), and interpersonal activities (12.0%).ConclusionA greater number of chronic conditions was associated with lower QoL dose-dependently among older adults in LMICs. Public health and medical practitioners should aim to address the identified mediators to improve QoL in patients with multimorbidity.

Food Insecurity Among Older Adults Living in Low- and Middle-Income Countries: AScoping Review.

Food insecurity is considered an increasing public health problem worldwide with adverse effects, especially among older adults. Although the literature related to food insecurity among older adults in low- and middle-income countries (LMIC) are expanding, little is known about existing patterns and knowledge gaps in these settings. This scoping review aims to provide a comprehensive overview of the current research related to food insecurity among older adults in LMIC. A systematic search was conducted in November 2021 and revised in July 2022 on six databases using terms related to food insecurity and older adults. Data were extracted, and the emerging themes from the main findings were summarized using a social-ecological model (SEM). Forty-one studies met the inclusion criteria. Almost half (48.8%) were published in the last 2years and utilized a quantitative approach (n=38). Only one study was conducted in a low-income country. Using the SEM, most studies included in this review focused on addressing the relationship between food insecurity with intrapersonal factors. Several gaps in the current literature were identified. There is a lack of longitudinal and qualitative studies available on this topic. Also, only 15 LMIC were represented in the literature. Acritical point in this review is that only a few studies addressed the relationship between food insecurity and the policy/social structure, institutional, community, and interpersonal levels. These identified gaps can serve as a guide for future research on this topic.

Association between sarcopenia and quality of life among adults aged ≥ 65years from low- and middle-income countries.

Sarcopenia has been associated with a lower quality of life (QoL). However, studies on this association from low- and middle-income countries (LMICs) are scarce. To examine the association between sarcopenia and QoL, in a large nationally representative sample of older adults from six LMICs. Cross-sectional, community-based data from the WHO study on global ageing and adult health (SAGE) were analysed. Non-severe sarcopenia was defined as having low skeletal muscle mass (SMM) and weak handgrip strength but no slow gait speed, while severe sarcopenia was defined as having low SMM, weak handgrip strength, and slow gait speed. QoL was assessed with the 8-item WHO QoL instrument (range 0-100) with higher scores representing better QoL. Multivariable linear regression analysis was conducted. Data on 14,585 people aged ≥ 65years were analyzed [mean (SD) age 72.6 (11.5) years; 55.0% female]. After adjustment for potential confounders, compared to no sarcopenia, severe sarcopenia was associated with a significant -3.37 points [95% CI -5.56, -1.18] lower QoL score. Non-severe sarcopenia was not significantly associated with lower QoL. The association between sarcopenia and QoL observed in our study may be explained by factors such as functional impairment and disability related with sarcopenia. In this large representative sample of older adults from multiple LMICs, compared to no sarcopenia, only severe sarcopenia was associated with a significantly lower QoL score. Interventions to prevent or manage sarcopenia among older adults in LMICs may contribute to better QoL in this population.

Simultaneously Developing Interventions for Low-/Middle-Income and High-Income Settings: Considerations and Opportunities.

Most older adults reside in low- and middle-income countries (LMICs) but most research dollars spent on interventions to improve the lives of older adults are awarded to researchers in high-income countries (HICs). One approach to improve the implementation of evidence-based innovations for older adults in LMICs is designing interventions that are relevant to LMICs and HICs simultaneously. We propose that researchers in HICs could partner with stakeholders in an LMIC throughout the intervention design process to better position their intervention for the implementation in that LMIC. We provide an example study from an adaptation of the Resources for Enhancing Caregiver Health II in Vietnam, which did not use this strategy but may have benefited from this strategy. We then turn to several considerations that are important for researchers to contemplate when incorporating this strategy. Finally, we explore incentives for creating interventions that are relevant to both HICs and LMICs for funders, intervention designers, and intervention receivers. Although this is not the only strategy to bring interventions to LMICs, it may represent another tool in researchers' toolboxes to help expedite the implementation of efficacious interventions in LMICs.

The effect of polluting cooking fuels on depression among older adults in six low- and middle-income countries

BackgroundLittle is known about the association between polluting cooking fuel and depression among older adults living in low- and middle-income countries (LMICs). ObjectiveTo evaluate the association between polluting cooking fuel and depression in older population of LMICs. MethodsWe derived data from WHO Study on global AGEing and adult health (SAGE), which was conducted in six LMICs including China, India, Ghana, South Africa, Mexico and Russia. We applied logistic regression with the propensity score method to examine the relationship of polluting cooking fuel and depression among adults ≥50 years old. ResultsOverall, the odds ratio (OR) of depression was 1.57 [95% confidence intervals (CIs), 1.26–1.93] for older adults relying on polluting cooking fuel in six LMICs. In India and China, polluting cooking fuel was associated with depression with ORs of 2.06 (95%CI, 1.44–2.94) and 1.59 (95%CI, 1.01–2.49), respectively. Positive OR of depression was identified for those polluting cooking fuel users aged over 65 years old (OR, 1.65; 95%CI,1.16–2.36) and those aged 50–65 (OR, 1.50; 95%CI,1.14–1.97). Polluting cooking fuel was associated with depression for females (OR, 1.80; 95%CI, 1.32–2.46), however we did not observe significant association for males. Positive effect of polluting cooking fuel was identified in both rural (OR, 1.72; 95%CI, 1.26–2.34) and urban areas (OR, 1.44; 95%CI, 1.07–1.95). For individuals relying on solid fuel, cooking in a room used for living/sleeping and using open stove/fire was associated with depression with ORs of 1.30 (95%CI, 1.14–1.48) and 1.15 (95%CI, 1.01–1.31), respectively. However, no significant effect was identified for hood. ConclusionPolluting cooking fuel was related to depressive symptoms among older adults in LMICs. In addition, cooking ventilation could be useful intervention to control health hazard of solid fuel.

Association of food insecurity with suicidal ideation and suicide attempts in adults aged ≥50 years from low- and middle-income countries

BackgroundThe aim of the present study was to investigate associations between food insecurity with suicidal ideation and suicide attempts in adults aged ≥50 years from six low- and middle-income countries (LMICs). MethodsCross-sectional, community-based data from the World Health Organisation's Study on Global Aging and Adult Health were analyzed. Self-reported information on past 12-month suicidal ideation and suicide attempts was collected. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted to assess the association between food insecurity and suicidal ideation or suicide attempts. ResultsThe final analytical sample included 34,129 individuals aged ≥50 years [mean (SD) age 62.4 (16.0) years; 52.1% females]. Compared to no food insecurity, severe food insecurity was associated with a significant 2.78 (95%CI = 1.73–4.45) times higher odds for suicidal ideation, while moderate and severe food insecurity were associated with 2.59 (95%CI = 1.35–4.97) and 5.15 (95%CI = 2.52–10.53) times higher odds for suicide attempts, respectively. LimitationsThe cross-sectional design, the use of self-reported wish to die as a measure of suicide ideation, and that suicidal ideation and suicide attempts were only assessed among those who had depressive symptoms, could be considered limitations of our study. ConclusionsFood insecurity was positively associated with suicidal ideation and suicide attempts. Targeting food insecurity among older adults in LMICs may lead to reduction in suicidal ideation and suicide attempts, although future longitudinal studies are warranted to confirm this.

Functioning of Older Adults in Low and Middle Income Countries: A Literature Review

The global population of older adults is rising, with the fastest surge in low and middle income countries (LMIC). Physical functioning determines independence in living. Therefore, it is critical to understand the functioning of older adults in LMIC. Extensive literature informs the functioning profile of older adults in developed nations; however, functioning of older adults in developing nations remains understudied. Physical functioning profile of older adults varies across the world due to differences in socio-demographic and economic factors alongside age-related physiological changes. The present study reviews the functioning profile, factors affecting physical functioning and health related quality of life (H-RQoL), and influence of physical co-morbidities on functioning of older adults in LMIC. Literature search was conducted in PubMed, Google Scholar, CINHAL, and Cochrane database. Eighteen cross-sectional, longitudinal, prospective cohort studies from Asia, Africa, North, South America, and Turkey were included. Most studies focused on singular domain of function. Hand-grip strength, lower extremity muscle strength, balance, and cognition were the most affected variables. Most older adults required partial assistance in bathing and housekeeping, and complete assistance in dressing. Individuals aged ≥ 75 years demonstrated greater limitation in activities of daily living (ADL). Older adults with cognitive impairment were at greater risk of functional decline. Low income, arthritis, and diabetes were major factors responsible for limitation in ADL and poor H-RQoL. Clinicians, researchers, and policymakers can use the present findings to plan culturally suitable rehabilitation programs to impart good health and well-being to older adults, which is central to the attainment of health-related sustainable development goals set forth by the United Nations.

Brief digital cognitive assessment for detection of cognitive impairment in low‐ and middle‐income countries

AbstractBackgroundRapid technological advances offer a possibility to develop cost‐effective digital cognitive assessment tools. However, it is unclear whether these measures are suitable for application in populations from Low and Middle‐Income Countries (LMIC).MethodsIn this cross‐sectional study, we examined the accuracy and validity of the Brian Health Assessment (BHA) in detecting cognitive impairment in a Cuban population; 146 participants (cognitively healthy=53, MCI=46, dementia=47) were recruited at primary care and tertiary clinics. The main outcomes included: accuracy of the BHA in discriminating between controls and cognitively impaired groups (MCI and dementia) and correlations between the BHA subtests of memory, executive functions, and visuospatial skills and criterion‐standard paper‐and‐pencil tests in the same domains.ResultsThe BHA had an AUC of .95 (95% CI: .91‐ .98) in discriminating between controls and cognitively impaired groups (MCI and dementia, combined) with .91 sensitivity at .85 specificity. In discriminating between control and MCI groups only, the BHA tests had an AUC of .94 (95% CI: .90‐ .99) with .71 sensitivity at .85 specificity. Performance was superior to the MoCA across all diagnostic groups. Concurrent and discriminant validity analyses showed moderate to strong correlations between the BHA tests and standard paper‐and‐pencil measures in the same domain and weak correlations with standard measures in unrelated domains.ConclusionsThe BHA has excellent performance characteristics in detecting cognitive impairment including dementia and MCI in a Hispanic population in Cuba and outperformed the MoCA. These results support potential application of digital cognitive assessment for older adults in LMIC.

Multimorbidity and Anxiety Symptoms among Adults Aged 50 Years and Over from Six Low- and Middle-Income Countries

Currently, there are limited data on the association between multimorbidity (i.e., ≥ 2 chronic conditions) and anxiety, especially among the older population in low- and middle-income countries (LMICs). Thus, the aim of the present study was to examine the association between multimorbidity and anxiety symptoms in a large sample of adults aged ≥ 50 years from six LMICs (China, India, Ghana, Mexico, Russia, South Africa). Cross-sectional, nationally representative, community-based data from the Study on Global Ageing and Adult Health (SAGE) were analysed. A total of 11 chronic physical conditions were assessed. Anxiety symptoms referred to extreme/severe problems with worry or anxiety in the past 30 days. Multivariable logistic regression and meta-analyses were conducted. Data on 34,129 adults aged ≥ 50 years were analysed (mean (SD) age 62.4 (16.0) years; 52.1% females). Compared with no chronic conditions, 2, 3, 4, and ≥ 5 chronic conditions were significantly associated with 1.47 (95% CI = 1.08–1.98), 2.46 (95% CI = 1.74–3.47), 3.04 (95% CI = 2.15–4.30), and 4.70 (95% CI = 2.99–7.38) times higher odds of anxiety symptoms, respectively. A country-wise analysis showed that multimorbidity was significantly associated with anxiety symptoms in all six countries (OR = 1.78–12.39) with the overall estimate based on a meta-analysis being OR = 2.29 (95% CI = 1.71–3.07). Multimorbidity was associated with higher odds of anxiety symptoms among older adults in LMICs. Future longitudinal studies are warranted to assess the temporal associations and mechanisms underlying this association.

Sleep problems and mild cognitive impairment among adults aged ≥50years from low- and middle-income countries.

The limited available literature suggests that sleep problems are linked to an increased risk of mild cognitive impairment (MCI). However, this association has been little studied to date in low-income settings. To investigate the association between sleep problems and MCI in a large sample of adults from six low-and middle-income countries (LMICs). Cross-sectional. Study on Global Ageing and Adult Health (SAGE). 32,715 individuals aged ≥50years with preservation in functional abilities [age range 50-114years; 51.7% females]. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Sleep problems were assessed by the question "Overall in the last 30 days, how much of a problem did you have with sleeping, such as falling asleep, waking up frequently during the night or waking up too early in the morning?" and categorized as "None", "Mild", "Moderate", "Severe/Extreme". Multivariable logistic regression analysis and meta-analysis were conducted. Compared to no sleep problems, mild, moderate, and severe/extreme sleep problems were associated with significant 1.40, 1.83, and 2.69 times higher odds for MCI with similar associations being observed between age groups and sex. Severe/extreme sleep problems were positively associated with MCI (i.e., OR>1) in the six countries studied with the overall estimate being OR=1.80 (95% CI=1.50-2.16), and a low level of between-country heterogeneity was observed (I2=28.2%). Sleep problems were associated with higher odds for MCI. Interventions to improve sleep quality among middle-aged and older adults in LMICs may be an effective strategy in reducing risk of MCI and dementia.

Association between food insecurity and fall-related injury among adults aged ≥65 years in low- and middle-income countries: The role of mental health conditions

PurposeWe investigated the association between food insecurity and fall-related injury among older adults from six low- and middle-income countries (LMICs), and the extent to which this association is mediated by mental health. MethodsCross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Fall-related injury referred to those that occurred in the past 12 months. Multivariable logistic regression analysis and mediation analysis were conducted to assess associations. ResultsData on 14,585 adults aged ≥65 years [mean (SD) age 72.5 (11.5) years; 54.9% females] were analyzed. After adjustment for potential confounders, severe food insecurity (versus no food insecurity) was associated with 1.95 (95%CI = 1.11–3.41) times higher odds for fall-related injury. Moderate food insecurity was not significantly associated with fall-related injury (OR = 1.34; 95%CI = 0.81–2.25). The mediation analysis showed that 37.3%, 21.8%, 17.7%, and 14.0% of the association between severe food insecurity and fall-related injury was explained by anxiety, sleep problems, depression, and cognition, respectively. ConclusionSevere food insecurity was associated with higher odds for injurious falls among older adults in LMICs, and a large proportion of this association may be explained by mental health complications. Interventions to improve mental health among those who are food insecure and a strong focus on societal and government efforts to reduce food insecurity may contribute to a decrease in injurious falls.

The association between objective vision impairment and mild cognitive impairment among older adults in low- and middle-income countries.

The association between visual impairment and mild cognitive impairment (MCI) has not been investigated to date. Thus, we assessed this association among older adults from six low- and middle-income countries (LMICs) (China, India, Ghana, Mexico, Russia, and South Africa) using nationally representative datasets. Cross-sectional, community-based data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Visual acuity was measured using the tumbling ElogMAR chart, and vision impairment (at distance and near) was defined as visual acuity worse than 6/18 (0.48 logMAR) in the better-seeing eye. The definition of MCI was based on the National Institute on Aging-Alzheimer's Association criteria. Multivariable logistic regression was conducted. Data on 32,715 individuals aged ≥ 50years [mean (SD) age 62.1 (15.6) years; 51.2% females] were analyzed. Compared to those without far or near vision impairment, those with near vision impairment but not far vision impairment (OR = 1.33; 95% CI = 1.16-1.52), and those with both far and near vision impairment (OR = 1.70; 95% CI = 1.27-2.29) had significantly higher odds for MCI. Only having far vision impairment was not significantly associated with MCI. Visual impairment is associated with increased odds for MCI among older adults in LMICs with the exception of far vision impairment only. Future longitudinal and intervention studies should examine causality and whether improvements in visual acuity, or early intervention, can reduce risk for MCI and ultimately, dementia.

Mild cognitive impairment is associated with fall-related injury among adults aged ≥65years in low- and middle-income countries.

There is a scarcity of data on the association between mild cognitive impairment (MCI) and falls, especially from low- and middle-income countries (LMICs) where 70% of all older adults reside. Thus, we investigated the association between MCI and fall-related injury among older adults residing in six LMICs (China, Ghana, India, Mexico, Russia, South Africa). Cross-sectional, community-based data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria, and information on past 12-month fall-related injury was also collected. Multivariable logistic regression analysis was conducted to assess associations. The analytical sample consisted of 13,623 individuals aged ≥65years [mean (SD) age 72.3 (10.9) years; 45.6% males]. The prevalence of fall-related injury was higher among those with MCI (6.3%) vs. no MCI (4.1%). After adjustment for potential confounders, MCI was associated with a 1.53 (95%CI=1.12-2.07) times higher odds for fall-related injury. MCI was associated with higher odds for fall-related injury among older adults in LMICs. Future studies are warranted to investigate the mechanisms underlying this association and to elucidate whether targeting those with MCI can lead to reduced risk for falls among older adults.

A Brief Digital Cognitive Assessment for Detection of Cognitive Impairment in Cuban Older Adults.

Rapid technological advances offer a possibility to develop cost-effective digital cognitive assessment tools. However, it is unclear whether these measures are suitable for application in populations from Low and middle-income countries (LMIC). To examine the accuracy and validity of the Brain Health Assessment (BHA) in detecting cognitive impairment in a Cuban population. In this cross-sectional study, 146 participants (cognitively healthy = 53, mild cognitive impairment (MCI) = 46, dementia = 47) were recruited at primary care and tertiary clinics. The main outcomes included: accuracy of the BHA and the Montreal Cognitive Assessment (MoCA) in discriminating between controls and cognitively impaired groups (MCI and dementia) and correlations between the BHA subtests of memory, executive functions, and visuospatial skills and criterion-standard paper-and-pencil tests in the same domains. The BHA had an AUC of 0.95 (95% CI: 0.91-0.98) in discriminating between controls and cognitively impaired groups (MCI and dementia, combined) with 0.91 sensitivity at 0.85 specificity. In discriminating between control and MCI groups only, the BHA tests had an AUC of 0.94 (95% CI: 0.90-0.99) with 0.71 sensitivity at 0.85 specificity. Performance was superior to the MoCA across all diagnostic groups. Concurrent and discriminant validity analyses showed moderate to strong correlations between the BHA tests and standard paper-and-pencil measures in the same domain and weak correlations with standard measures in unrelated domains. The BHA has excellent performance characteristics in detecting cognitive impairment including dementia and MCI in a Hispanic population in Cuba and outperformed the MoCA. These results support potential application of digital cognitive assessment for older adults in LMIC.

Physical Activity is Associated With Fewer Subjective Cognitive Complaints in 47 Low- and Middle-Income Countries

ObjectivesTo determine the association between physical activity (PA) and subjective cognitive complaints (SCCs), and the influential factors in this association. DesignCross-sectional study. Setting and ParticipantsCommunity-based data of the World Health Survey, which included 248,504 individuals from 47 low- and middle-income countries (LMICs), were analyzed [mean age = 38.6 (standard deviation 16.1) years; 50.7% female]. MethodsPA was assessed with the International Physical Activity Questionnaire. Participants were grouped into those who meet (high PA) the 150 minutes of moderate-to-vigorous intensity PA per week recommendation, and those who do not (low PA). Two questions on subjective memory and learning complaints in the past 30 days were used (scales ranged from 1 to 5, with higher scores representing more severe SCC). Multivariable ordinal logistic regression and mediation analyses were performed. ResultsOverall, after adjusting for sociodemographic and a wide range of behavioral, psychological, and physical factors, low PA was associated with a higher risk for having more severe subjective memory complaints [odds ratio (OR) = 1.10, 95% confidence interval (CI) = 1.04-1.23] and learning complaints (OR = 1.18, 95% CI = 1.12-1.26). Significant associations were only observed among the middle-aged (45-64 years; learning complaints OR = 1.19, 95% CI = 1.06-1.33) and older populations (≥65 years; memory complaints OR = 1.31, 95% CI = 1.15-1.49, and learning complaints OR = 1.41, 95% CI = 1.24-1.60). Chronic physical conditions, sleep problems, depression, and anxiety explained between 7.7% and 29.4% of the PA-SCC association among those aged ≥45 years. Conclusions and ImplicationsLow PA was associated with increased odds for more severe SCCs in middle-aged and older adults in LMICs. Given the particularly rapid increase in dementia in LMICs, more longitudinal research is warranted from this setting to understand the utility of PA promotion in the prevention of cognitive impairment.