Older Population Research Articles

The associations between internet use and loneliness among older adults: a three-level meta-analysis

ABSTRACT Loneliness is a significant risk factor for physical and mental health in older adults. Internet use was closely associated with loneliness in the older population in the digital age, but consensus on the association is lacking. The present study aims to conduct a meta-analysis to quantify how internet use is associated with loneliness in older adults. Based on the PRISMA method, the present study used a three-level meta-analysis with 41 studies (N = 75,736) to explore the association between internet use and loneliness in older adults and the possible moderating variables of this association. The results revealed a significant negative association between internet use and loneliness in older adults (r = −0.080, p < 0.001), with I 2 = 95.5% indicating considerable heterogeneity. Moreover, age [F (1, 70) = 5.729, p = 0.019], internet use measurement [F (2, 104) = 9.739, p < 0.001], and purposes of internet use [F (3, 48) = 5.428, p = 0.003] were found to moderate the association significantly, as the negative correlation was stronger with age increasing; the negative correlation was stronger by the frequency measure of internet use (r = −0.105) than by the duration measure of internet use (r = 0.067), and the negative correlation was stronger for communication (r = −0.116) than for information acquisition (r = −0.052) and entertainment (r = 0.022). Through a comprehensive exploration of the overall effect and moderating variables, this meta-analysis offers further insights into the relationship between internet use and loneliness among older adults.

A Comprehensive Review of Suicide among Migrant Older Adults (65+ Years) in Australia

Australia's multicultural society, influenced by high levels of immigration, presents unique challenges for older migrants (aged 65 years and older). This review focuses on factors influencing increased suicide rates among older migrants, a critical but underexplored public health issue. This review examines the interaction between migration history, acculturation, and ageing, highlighting the compounding risk of mental illness, loneliness, and social isolation. The review used a comprehensive review approach, combining data from Australian and international sources. It identified key risk factors such as acculturative stress, chronic health conditions, and bereavement, as well as protective factors such as community engagement and access to culturally sensitive mental health services. Notably, suicide rates were higher among older male migrants, particularly those with limited social support or loss of autonomy. The findings emphasize the importance of developing specific initiatives to meet the mental health requirements of elderly people from culturally and linguistically diverse backgrounds. Recommendations include improving access to mental health care, strengthening social integration programs, and culturally tailored suicide prevention strategies. This review contributes to a deeper understanding of the vulnerabilities of Australia's older migrant population and provides a foundation for evidence-based policy and practice.

Determinants of the utilization of general health check-up among older adults in Saxony-Anhalt: What is the influence of access to health services?

Due to the nature of demographic developmens, there is an increasing need for prevention measures in healthcare. In Germany, people with statutory health insurance have a legal right to general health check-ups for early detection of diseases that are significant in terms of population medicine. However, the older population has thus far made inadequate use of these services, resulting in significant losses of prevention potential. This paper examines the impact of objective and subjectively perceived access to health services on the use of general health check-up among citizens aged 55 years and older in the state of Saxony-Anhalt, Germany.The study uses data from a written cross-sectional survey of residents from four major and minor cities in Saxony-Anhalt. Bivariate logistic regression models were used for the statistical analysis of data to evaluate the relation between access parameters to health services and utilization.In all, 953 questionnaires were included in the analyses; 59.7% of the respondents used the general health check-up in the recommended time interval. In the multivariate analyses, the study showed that neither subjective satisfaction with access nor self-reported travel times to family doctors were significant factors affecting the utilization. On the other hand, being a member of statutory health insurance funds and the use of a private car increased the likelihood of utilization. Other determinants that had an influence on the use of general health checks were net household income and need for long-term care.The results of this study indicate potential for increasing utilization of general health check-up among older people. However, increased use of free health check-ups by this section of the population cannot be achieved primarily by improving accessibility, but must be addressed by other factors, such as attitudes towards health checks, which requires further analysis.

Incidence and Outcomes of Cataract in Eyes with Ocular Cicatricial Pemphigoid

ABSTRACT Purpose To identify the incidence of cataract and the outcomes of cataract surgery in eyes with ocular cicatricial pemphigoid (OCP) Methods Phakic eyes were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study and followed for the incidence of visually significant cataract defined as: newly reduced visual acuity 20/50 or worse attributed to cataract; and/or incident cataract surgery. Secondarily, all eyes with OCP that underwent cataract surgery and had a year of follow up thereafter, were included in an analysis of visual outcome. Results Three hundred fifty-five phakic eyes (200 patients) with OCP were at risk. Eighty eyes developed visually significant cataract over 1064 eye years (incidence rate = 7.5%/eye-year, 95% confidence interval [CI] = 5.6 to 10.1). Higher age was associated with increased incidence of cataract (adjusted hazard ratio [aHR] = 4.47; 95% CI, 1.95–10.23 for age 60–75 inclusive and aHR = 8.37; 95% CI, 3.60–19.42 for age > 75, each compared with age <60 years). Seventy-nine eyes of 61 patients were monitored for > = 1 year following cataract surgery. Cataract surgery was associated with an improvement of vision around 4 lines, which was sustained through at least 48 months. Poorer pre-operative visual acuity was associated with poorer long-term visual outcome. Conclusions The incidence of cataract was high in this older population. No factors predictive of cataract such as duration of OCP or use of corticosteroids were identified. Visual acuity improved after surgery by a median of 4 lines’ gain at one year; poorer long-term outcome among those with initially poorer visual acuity may be secondary to corneal scarring.

Perspectives on Diet and Exercise Interaction for Healthy Aging: Opportunities to Reduce Malnutrition Risk and Optimize Fitness

Nutrition and exercise play a pivotal role in counteracting the effects of aging, promoting health, and improving physical fitness in older adults. This perspective study examines their interplay, highlighting their combined potential to preserve muscle mass, cognitive function, and quality of life. The objective is to address gaps in the current understanding, such as the frequent neglect of dietary intake in exercise interventions and vice versa, which can limit their effectiveness. Through a synthesis of the existing literature, we identify key findings, emphasizing the importance of adequate nutritional intake—particularly protein, essential amino acids, and micronutrients—in supporting exercise benefits and preventing sarcopenia and malnutrition. Additionally, supplementation strategies, such as omega-3 fatty acids, creatine, and essential amino acids, are explored alongside the emerging role of the gut microbiota in mediating the benefits of nutrition and exercise. Despite these advances, challenges remain, including determining optimal dosages and timing and addressing individual variability in responses. Personalized approaches tailored to sex differences, gut microbiota diversity, and baseline health conditions are critical for maximizing intervention outcomes. Our conclusions underscore the necessity of integrated strategies that align dietary and exercise interventions to support healthy and active aging. By addressing these gaps, future research can provide actionable insights to optimize health and quality of life in older populations.

Engagement of Older Adults in the Design, Implementation and Evaluation of Artificial Intelligence Systems for Aging: A Scoping Review.

Integration of artificial intelligence (AI) in health and healthcare, especially for older adults, has significantly advanced healthcare delivery. AI technologies, with capabilities such as self-learning and pattern recognition, are employed to address social isolation and monitor older adults' daily activities. However, rapid AI development often fails to consider the heterogeneous needs of older populations, which could exacerbate an existing digital divide and inequality. This scoping review examines older adults' involvement in AI system design, implementation, and evaluation of AI systems in health and healthcare literature, emphasizing the necessity of their input for beneficial AI systems. We conducted a scoping review according to PRISMA-SCR. We reviewed 17 studies, finding that half of these studies (n = 8) engaged older adults during the design phase, a small number (n = 3) during the evaluation stage, and even fewer (n = 2) involved older adults in the implementation stage. Despite AI's growing role, design processes often overlook older adults' needs. Our findings emphasize the need for inclusive, participatory design approaches to address ethical and equity challenges, enhancing user engagement and relevance. We also highlight how these approaches address the needs of older adults and improve outcomes. Specifically, we integrated evidence showing the practical benefits of these approaches for better accessibility, usability, and engagement among older adults. While AI has potential to improve healthcare delivery, these approaches must be part of broader efforts to ensure ethical, inclusive, and equitable AI practices, especially in gerontology.

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 &amp;lt; 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.

Enhancing the quality of life of older people in rural Türkiye: A randomised controlled appraisal of solution-focused case management.

With a rapidly growing older population in rural Türkiye, it is crucial to identify their unmet needs and develop targeted intervention programs to enhance their quality of life (QoL). This study aimed to evaluate the impact of a solution-focused case management program, that incorporated an ecosystemic framework, on the QoL of Turkish older adults living in rural areas whose family caregivers were receiving a home care allowance. A randomised controlled experimental design was employed. Sixty older adults participated, with the experimental group receiving a solution-focused case management program in addition to the home care allowance provided to their family caregivers. The control group only received the home care allowance. The intervention lasted 8 months and involved contact every 3 weeks. The QoL of older adults in both groups was measured using the WHOQOL-OLD scale. The intervention significantly improved the overall QoL, autonomy, past, present and future activities, and social participation domains in the experimental group. There was no significant impact on the death and dying or intimacy domains. In the control group, there was a significant reduction in the overall QoL, past, present and future activities, and death and dying domain scores, with no changes observed in sensory abilities, autonomy, social participation or intimacy domain scores. The findings indicate that the solution-focused case management program effectively enhances the QoL of Turkish rural older adults. Home care allowance alone did not impact the QoL, highlighting the importance of targeted interventions in this population.

Tailored Approach to Designing a Digital Research Platform for Adults Aged 95 and older: SuperAgers Family Study.

The SuperAgers Family study aims to investigate phenotypic and genetic mechanisms related to healthy aging in nonagenarians, centenarians, and their family members. A remote study design was tested to demonstrate the feasibility of using digital technology to conduct health research within this rare population of advanced age. This paper describes key design elements of the digital research platform developed to deliver consent, enrollment, and study data collection in a cohort of older adults. SuperAgers participants aged 95 years or older, their offspring, and offspring's spouses were invited to join the study via media and community outreach. Participants completed registration, consent, submitted study data, and completed remote biospecimen collection via the web-based study app. Platform design elements and functionality were adapted for use by older aged adults. Qualitative process evaluation assessed usability and participant data entry completion throughout the study workflow. Preliminary data from SuperAgers (n = 160) of average age 98 years (± 3 SD) and offspring/spouses (n = 127) of average age 69 years (± 5 SD) were evaluated. 97% of participants in both groups successfully used the platform to complete eligibility screening, eConsent, and study surveys. SuperAgers and offspring successfully used the digital research platform to complete eConsent and submit study data. This supports the feasibility of conducting digitally enabled research in older-aged populations using tailored platform design elements that increase usability and minimize entry errors. These findings may contribute to the development of best practices for digitally delivered research studies in aging populations.

Epidemiology of urinary tract infections in the Middle East and North Africa, 1990–2021

ObjectiveThis research reports the incidence, mortality, and disability-adjusted life years (DALYs) associated with urinary tract infections (UTIs) in the Middle East and North Africa (MENA) region, stratified by sex, age, and Socio-demographic Index (SDI) from 1990 to 2021.MethodsData were sourced from the Global Burden of Disease 2021 study, encompassing all 21 countries in the region. Metrics such as absolute counts, age-standardised rates, and percentage changes from 1990 to 2021 are presented with 95% uncertainty intervals (UIs).ResultsIn 2019, the MENA region recorded an incidence rate of 4,033.4 per 100,000 (95% UIs: 3,553.7–4,548.7) and 7,687 deaths (95% UIs: 6,663–8,969). The DALY rate was 41.3 per 100,000 (95% UIs: 36.1–47.2), which was highest among older adults, reaching a peak in the 80–89 age range, and increasing with age, particularly from the 50 + age groups. A non-linear relationship was identified between the burden of UTIs and the SDI, with higher-than-expected rates in lower SDI countries such as Syria and Lebanon.ConclusionDespite a substantial increase in the total number of UTI cases and DALYs in the region from 1990 to 2021, the age-standardised rates remained stable. The larger burden in lower SDI countries highlights the urgent need for targeted public health interventions. Improving healthcare access and antibiotic stewardship is crucial to mitigating the growing burden of UTIs, particularly among older populations in the region.

Use and Discontinuation Rates of Long-Acting Injectable Antipsychotics Between Race/Ethnicity in Older Adults Using Medicaid Databases.

The primary objective of this study was to assess the prescribing patterns of long acting injectable (LAI) antipsychotics in an older adult population. Secondary objectives were to determine if there were differences in treatment discontinuation rates between different LAI agents and race/ethnicity. Merative MarketScan Multi-State Medicaid Databases (2017-2021) were used to identify patients 65 years or older who were prescribed a LAI antipsychotic. Pharmacy claims for LAI antipsychotics were referenced via National Drug Code (NDC) by brand/generic name and dose. International Classification of Diseases, 10th edition (ICD-10) codes were used to identify older adults diagnosed with schizophrenia, schizotypal or schizoaffective disorders. Those with dementia or related disorders were censored. Conditional associations between race/ethnicity and generation of LAI antipsychotics were investigated using logistic regression controlling for age, sex, and health plan. Cox proportional hazard regression was used to compare the distribution of time until treatment discontinuation among older adults across LAI antipsychotics. A total of 526 older adults (59% female) with an average age of 70.4 ± 5.5 years met inclusion for analysis. The most commonly used LAI antipsychotics included paliperidone palmitate-1 month formulation (~35%), haloperidol decanoate (~24%), and risperidone microspheres (~15%). Overall, approximately 32% received LAI first-generation antipsychotics and 68% received LAI second generation antipsychotics. Blacks (n = 204) received LAI first-generation antipsychotics more often than Whites (n = 283); (OR: 1.74, 95% [1.18, 2.56], p < 0.01). When controlling for age, sex, and race/ethnicity, LAI first-generation antipsychotics showed earlier discontinuation rates compared to LAI second-generation antipsychotics (HR: 2.12, 95% CI [1.45, 3.10], p < 0.001). LAI first-generation antipsychotics showed treatment discontinuation significantly earlier compared to LAI second-generation antipsychotics. Furthermore, Blacks were prescribed LAI first-generation antipsychotics at a higher rate than Whites, which may contribute to poorer health outcomes. Futures studies are needed to establish a causal relationship.

Role of visual function and performance of activities of daily living in cognitive function in patients with mild cognitive impairment: a cross-sectional study

BackgroundMild cognitive impairment (MCI) is a precursor to dementia, with many patients showing early decline in activities of daily living (ADLs). However, the role of visual impairment in this process is underexplored despite evidence suggesting it may accelerate cognitive decline. Current research does not understand how visual dysfunction affects cognitive abilities and how ADLs might moderate this relationship. This gap is crucial because early interventions targeting visual impairments could potentially delay progression to dementia, offering new avenues for supporting MCI patients.ObjectiveThis study investigates the relationship between visual function and cognitive abilities in patients with MCI. Specifically, it seeks to determine how different aspects of visual function, such as visual field indices and visual acuity, correlate with various cognitive domains measured by standardized assessments. Additionally, the study aims to examine the role of ADLs as a potential moderating factor in this relationship. By analyzing how ADL performance influences the strength and direction of the association between visual impairments and cognitive function, this research intends to identify key areas where visual deficits may contribute to cognitive decline in MCI.MethodsThis is a cross-sectional study. Two hundred and seventy four elderly patients were diagnosed with MCI from various communities in Taicang City, Jiangsu Province, China. Most participants were women (68.6%), and the average age was 69 years. Notable comorbidities included hypertension (41.6%) and diabetes (33.2%), indicating a higher burden of health conditions than typical older adult populations. Visual function, Montreal Cognitive Assessment (MoCA), and the ADLs were measured. Pearson's correlation coefficients were used to examine the unadjusted associations between visual function measures and cognitive performance. Multivariable linear regression models were employed to further explore these relationships and to assess the moderating role of ADLs.ResultsSignificant positive correlations were found between visual function and cognitive performance, particularly with Visual Function Index (VFI) showing a strong initial correlation with the total MoCA score (r = 0.61, p &amp;lt; 0.001), which was attenuated after adjusting for ADL (β = 0.06, p = 0.23). Maximum Visual Field (Max VF) was positively correlated with language skills (r = 0.13, p &amp;lt; 0.05). The negative correlation of Minimum Visual Field (Min VF) with cognitive performance became positive after ADL adjustment (β = 0.12, p = 0.04).ConclusionsThese findings suggest that visual function plays a crucial role in the cognitive and functional abilities of patients with MCI. Early interventions targeting visual impairments may help mitigate cognitive decline and improve the quality of life for these patients.

Around the EQUATOR With Clin-STAR: AI-Based Randomized Controlled Trial Challenges and Opportunities in Aging Research.

The CONSORT 2010 statement is a guideline that provides an evidence-based checklist of minimum reporting standards for randomized trials. With the rapid growth of Artificial Intelligence (AI) based interventions in the past 10 years, the CONSORT-AI extension was created in 2020 to provide guidelines for AI-based randomized controlled trials (RCT). The Clin-STAR "Around the EQUATOR" series features existing reported standards while also highlighting the inherent complexities of research involving research of older participants. In this work, we propose that when designing AI-based RCTs involving older adults, researchers adopt a conceptual framework (CONSORT-AI-5Ms) designed around the 5Ms (Mind, Mobility, Medications, Matters most, and Multi-complexity) of Age-Friendly Healthcare Systems. Employing the 5Ms in this context, we provide a detailed rationale and include specific examples of challenges and potential solutions to maximize the impact and value of AI RCTs in an older adult population. By combining the original intent of CONSORT-AI with the 5Ms framework, CONSORT-AI-5Ms provides a patient-centered and equitable perspective to consider when designing AI-based RCTs to address the diverse needs and challenges associated with geriatric care.

Development of a Brief Assessment Tool to Evaluate Early Low Nutrition Risk in Community Elderly: Creation of the Tool and Examination of Its Reliability and Criterion-related Validity

To date simple assessment tool to evaluate early low nutrition risk in general older population has not been available. This study aimed to create such tool and examined its reliability and criterion-related validity. 1,192 community elderly with a mean age of 74.7(5.8) years responded to a questionnaire consisting of 48 (Hatoyama) or 34 items (Kusatsu), which have been reported to be associated with nutritional state in older people. Item analysis was conducted on the 34 common items, and items were selected based on the following criteria: adequate pass rates and discriminative power, no gender and regional differences, and a certain level of commonality based on factor analysis. Next, the factor structure of the candidate items was examined through exploratory factor analysis, and confirmatory factor analysis was conducted as the final scale structure. Furthermore, Spearman's partial rank correlation coefficients (sex- and age-adjusted) between the created index and important health indicators were examined to determine the criterion-related validity. Finally, we obtained a semantic coherence of 4 factors (named health beliefs, dietary status, physical activity, and food-related quality of life) totaling 13 items; confirmatory factor analysis of the 4-factor solution yielded good model fit values, χ2 (59) =275.4 (p<0.001), CFI=0.930, and RMSEA=0.056. The factor loadings for each factor ranged from 0.43 to 0.82, indicating adequate loadings. The reliability of the index was shown to be high by Good-Poor analysis and Cronbach's α. The index showed statistically significant correlations with all health indicators. We have developed a simple assessment tool to evaluate early low nutrition risk in general older population.

Applying the Kessler Foundation modified Story Memory Technique (KF-mSMT ®) to Improve New Learning in Aging Populations

Introduction: The current study examines the efficacy of the 10-session Kessler Foundation modified Story Memory Technique (KF-mSMT®) to improve new learning in older adults. Methods. This double-blind, placebo-controlled randomized clinical trial included twenty-eight individuals over age 65 randomized to the treatment group (n=17) or placebo control group (n=13). Participants completed a baseline neuropsychological assessment, including questionnaires assessing everyday memory, and a repeat assessment immediately post-treatment. The primary outcome measure was the total learning score from the California Verbal Learning Test II (CVLT II) and the secondary outcome measure was total score from the Memory Functioning Questionnaire. Results: A significant effect of the KF-mSMT® was noted on the CVLT-II total learning score in the treatment group, demonstrating a large effect size. Post-hoc analysis examining benefit from the KF-mSMT in the healthy aging group as compared with the MCI group showed a trend toward significance (p=.069), with a large effect size. With benefit defined as a 10% or greater improvement on the CVLT total learning, 65% of patients in the treatment group showed improvement from baseline to immediate follow-up, compared with 31% of the control group (p=.06). Significant treatment effects were also noted on a self-report measure of memory in daily life, the Memory Functioning Questionnaire. Post-treatment changes in depression or anxiety from before to after treatment were not significant between the groups. Conclusion: The current study presents preliminary evidence in support of the KF-mSMT® for improving learning and memory abilities in older populations of those aging normally and those meeting criteria for MCI.

Needs of older adults in Kazakhstan: analysis and psychometric properties of the localized version of the EASYCare standard 2010 instrument

BackgroundStudies about the needs of older individuals in Central Asia are very sparse. Thus, this study aimed to evaluate the needs of older adults in Kazakhstan with the EASYCare Standard 2010 (EC) questionnaire.MethodsThe study involved 524 participants aged 65 and older from various regions in Kazakhstan. Data were collected by trained research staff, and the participants’ needs were examined using median split with the three summarizing indexes of the EC system (Independence score, Risk of breakdown in care, and Risk of falls).ResultsSubjects with primary education had approximately double odds of scoring above the median compared to those with higher education in Independence score (p &amp;lt; 0.01) and Risk of breakdown in care (p &amp;lt; 0.01). Individuals with primary education also had 60% higher odds of scoring above the Risk of falls scale threshold, indicating a risk in this category (p &amp;lt; 0.05). For the Risk of falls scores, financial situation was also significant; individuals having not enough to make ends meet had 75% higher odds than the remaining ones (p &amp;lt; 0.01).ConclusionOur analysis highlights the importance of tailored interventions to address the unmet needs of the Kazakh population, particularly among those with lower education and those with financial concerns. The study also underscores the need for sustainable, comprehensive eldercare policies in Kazakhstan that account for the growing older population.

Addressing the rising colorectal cancer burden in the older adult: examining modifiable risk and protective factors for comprehensive prevention strategies

BackgroundColorectal cancer is one of the most prevalent and deadly cancer types worldwide. Emerging evidence suggests that high body mass index (BMI) is a significant risk factor for colorectal cancer, particularly among the older adult population. This comprehensive analysis aims to explore the complex epidemiological patterns of colorectal cancer, with a focus on the association between high BMI and disease burden in the older adult.MethodsThe study leveraged data from the Global Burden of Disease (GBD) 2021 study to examine the temporal trends, regional disparities, and the interplay of age, period, and cohort factors in shaping the global colorectal cancer landscape. Epidemiological techniques, including age-period-cohort modeling and joinpoint regression analysis, were employed to provide insights into the potential drivers of the evolving disease burden while controlling for relevant confounding factors.ResultsThe analysis revealed significant geographical disparities in the burden of colorectal cancer among the older adult population. Countries like Uruguay, Monaco, Croatia, Hungary, and Poland exhibited higher mortality and disability-adjusted life-year (DALY) rates, while regions like Bangladesh, Nepal, and much of Africa had relatively lower disease burden. These regional differences are likely attributable to variations in healthcare systems, access to screening and early detection programs, as well as differences in lifestyle behaviors and risk factor prevalence.ConclusionThe strong association between high BMI and colorectal cancer risk, particularly in the older adult population and among men, emphasizes the importance of comprehensive obesity management strategies as part of comprehensive cancer control efforts. Targeted interventions, such as community-based weight management programs and enhanced screening initiatives in high-risk regions, could help mitigate the disproportionate burden of colorectal cancer observed in countries like Monaco, Croatia, and Hungary. Ongoing research and multifaceted public health interventions are crucial to address the growing global burden of colorectal cancer and mitigate the disproportionate impact on vulnerable populations. Strengthening healthcare systems, improving access to quality cancer care, and promoting lifestyle modifications to reduce obesity and other modifiable risk factors should be prioritized to effectively combat this pressing public health challenge.

The association of lipid accumulation product with inflammatory parameters and mortality: evidence from a large population-based study

BackgroundObesity is closely associated with lipid metabolism, and the accumulation of lipids leads to low-level inflammation in the body, which can trigger cardiovascular disease. This study aimed to explore the association between a novel marker of lipid accumulation, the abdominal volume index (AVI), inflammatory parameters, and mortality.MethodsThis study enrolled 2,109 older adult senior citizens (aged over 60 years) with hypertension from the National Health and Nutrition Examination Survey. The primary endpoints included all-cause mortality and cardiovascular mortality, which were assessed by linking the data to the National Death Index records. Cox regression model and subgroup analysis were constructed to investigate the associations between AVI and both all-cause and cardiovascular mortality. Restricted cubic splines were employed to further explore the relationships among AVI, inflammatory parameters, and mortality. By considering inflammatory factors as mediators, we investigate the mediating effects of AVI on mortality.ResultsAfter a median follow-up of 69 months, there were 1,260 deaths, with 337 attributed to cardiovascular causes within the older adult population studied. In the multivariable-adjusted model, AVI was positively associated with both all-cause and cardiovascular mortality [Hazard Ratio (HR) = 1.09, 95% CI = 1.06–1.11 for all-cause mortality; HR = 1.07, 95% CI = 1.03–1.12 for cardiovascular mortality]. Kaplan-Meier survival plots indicated an overall median survival time of 144 months. Mediation analysis revealed that Systemic Inflammatory Response Index (SIRI), Monocyte-to-HDL ratio (MHR), and Neutrophil-to-Lymphocyte ratio (NLR) mediated 27.15%, 35.15%, and 16.55%, respectively, of the association between AVI and all-cause mortality.ConclusionAVI is positively associated with all-cause mortality in older adults with hypertension, and this association appears to be partially mediated by inflammatory parameters.

Real-World Efficacy and Toxicity of Ipilimumab and Nivolumab as First-Line Treatment of Metastatic Renal Cell Carcinoma (mRCC) in a Subpopulation of Elderly and Poor Performance Status Patients

Background: Ipilimumab and nivolumab (ipi/nivo) improved overall survival (OS) compared to sunitinib in the pivotal Checkmate 214 trial of metastatic renal cell carcinoma (mRCC) with International Metastatic RCC Database Consortium (IMDC) intermediate/poor risk disease. We evaluated the efficacy and toxicity of ipi/nivo in older and frailer populations in a real-world mRCC cohort. Methods: Analysis was conducted on a real-world cohort with mRCC (N = 551) treated with first-line ipi/nivo from the Canadian Kidney Cancer information system (CKCis) database from January 2014 to December 2021. A comparison was made between outcomes and toxicity in patients 1. &lt;70 versus (vs.) ≥70 yo, 2. &lt;75 vs. ≥75 yo, and 3. KPS ≥70 vs. &lt;70 yo. OS, progression-free survival (PFS), and time to treatment failure (TTF) were calculated by Kaplan–Meier analysis. Log-rank tests were used for comparison between groups. Results: Ipi/nivo treatment had no impact on survival outcomes or toxicity for patients &gt;70 yo and &gt;75 yo when controlled for IMDC. However, when comparing patients with KPS &gt; 70 vs. KPS &lt; 70, patients with a poor performance status had decreased median OS at 54.5 m vs. 10.8 m (p-value &lt; 0.0001) and PFS at 11.6 vs. 3.1 m (p-value &lt; 0.0001). Conclusions: The use of ipi/nivo in mRCC demonstrated similar survival outcomes and toxicity in an older patient population. In patients with a poor performance status, it was associated with inferior OS and PFS. We believe that ipi/nivo is a reasonable treatment option for these patient populations, particularly in older patients.

Preliminary Validation of a Measure of Interpersonal Problems: A Study of Personality Pathology in Depressed Older Inpatients.

This preliminary study sought to determine the psychometric properties of the Inventory of Interpersonal Problems-Personality Disorders (IIP-PD-25) in a middle-aged to older adult sample in which personality pathology is common. Depressed inpatients (N = 62) between 55 and 92 years (M = 67.60, SD = 8.75) were administered self-report questionnaires to measure personality traits (NEO Five-Factor Inventory), interpersonal processes (IIP-PD-25), depression (Geriatric Depression Scale), and social role impairment (Social Adjustment Scale-Self-Report). We investigated whether the IIP-PD-25 has convergent validity with these measures. After adjusting for covariates, IIP-PD-25 scores were associated with greater depression (ß = .459, p < .001), greater social role impairment (ß = .374, p = .004), greater neuroticism (ß = .614, p < .001), and less agreeableness (ß = -.260, p = .035). Three-fourths of the IIP-PD-25 subscales also showed convergent validity with these constructs in the predicted directions. Based on these findings, the IIP-PD-25 is valid for purposes of capturing interpersonal and personality pathology in a depressed, older inpatient population.