Community-Dwelling Older Adults Research Articles

Changes in Cerebral Hemodynamics and Progression of Subclinical Vascular Brain Disease: A Population-Based Cohort Study.

Cerebral hypoperfusion is associated with vascular brain injury and neurodegeneration, but their longitudinal relationship is largely unknown, especially in healthy older adults. We investigated the longitudinal relationship between cerebral hemodynamics and subclinical vascular brain disease in community-dwelling older adults without stroke or dementia at baseline. Participants underwent brain magnetic resonance imaging scans every 3 to 4 years between 2005 and 2016. Cerebral blood flow (CBF) was measured through 2-dimensional phase-contrast magnetic resonance imaging; the cerebrovascular resistance index (CVRi) was defined as the ratio of mean arterial blood pressure to total CBF. Simultaneous progression in subclinical brain disease was evaluated through repeated magnetic resonance imaging assessment of white matter hyperintensities (WMH), cerebral microbleeds, lacune, and brain atrophy. The longitudinal relationship was estimated using generalized estimating equations, with adjustment for age, sex, smoking habits, body mass index, systolic blood pressure (for CBF measures), lipid level, history of diabetes and cardiovascular disease, and the baseline burden of magnetic resonance imaging markers. Among 3623 older adults (mean age, 61.4±9.3 years; 54.6% women), large decreases and increases in CBF and increases in CVRi over time were associated with white matter hyperintensity progression. The risk ratios for white matter hyperintensity progression were 1.36 (95% CI, 1.19-1.55) for large decreases in total CBF (lowest quartile), 1.02 (95% CI, 0.91-1.14) for moderate decreases (second quartile), and 1.28 (95% CI, 1.14-1.45) for large increases (highest quartile), compared with stable CBF (third quartile). The corresponding risk ratios for changes in CVRi were 1.13 (95% CI, 1.00-1.30), 1.25 (95% CI, 1.09-1.43), and 1.33 (95% CI, 1.16-1.52) for the second to fourth (versus lowest) quartiles, respectively, showing a dose-response relationship. The changes in CBF also demonstrate a similar U-shaped association with the progression of brain atrophy and incident microbleeds, whereas increases in CVRi were associated with lower microbleed risk. Longitudinal changes in CBF and CVRi may capture distinct pathophysiologies linking cerebral hemodynamics to subclinical brain disease, extending beyond single-time point measurements.

Sleep disturbances and racial-ethnic disparities in 10-year dementia risk among a national sample of older adults in the USA.

Race/ethnicity and sleep disturbances are associated with dementia risk. To explore racial-ethnic disparities in sleep disturbances, and whether race/ethnicity moderates the relationship between sleep disturbances and dementia risk among older adults. We analysed ten annual waves (2011-2020) of prospective cohort data from the National Health and Aging Trends Study, a nationally representative USA sample of 6284 non-Hispanic White (n = 4394), non-Hispanic Black (n = 1311), Hispanic (n = 342) and non-Hispanic Asian (n = 108) community-dwelling older adults. Sleep disturbances were converted into three longitudinal measures: (a) sleep-initiation difficulty (trouble falling asleep within 30 min), (b) sleep-maintenance difficulty (trouble falling asleep after waking up early) and (c) sleep medication usage (taking medication to sleep). Cox proportional hazards models analysed time to dementia, after applying sampling weights and adjusting for sociodemographic characteristics and health. Black, Hispanic and Asian respondents exhibited higher frequencies of sleep-initiation and sleep-maintenance difficulties, but had less sleep medication usage, compared with White older adults. Among Hispanic respondents, sleep-initiation difficulty was associated with significantly decreased dementia risk (adjusted hazard ratio (aHR) = 0.34, 95% CI 0.15-0.76), but sleep-maintenance difficulty was associated with increased dementia risk (aHR = 2.68, 95% CI 1.17-6.13), compared with White respondents. Asian respondents using sleep medications had a significantly higher dementia risk (aHR = 3.85, 95% CI 1.64-9.04). There were no significant interactions for Black respondents. Sleep disturbances are more frequent among older Black, Hispanic and Asian adults, and should be considered when addressing dementia disparities. Research is needed to explore how certain sleep disturbances may elevate dementia risk across different racial and ethnic subgroups.

Impact of Chinese visceral adiposity index on all-cause mortality risk in community-dwelling older adults: a prospective cohort study

BackgroundsWhether excess visceral fat tissue increases the risk of death in older individuals remains controversial.AimsTo investigate the association between the Chinese Visceral Adiposity Index (CVAI) and all-cause mortality risk in older Chinese individuals.MethodsThis cohort study utilized data of individuals aged ≥ 65 years in 2014 to 2018 wave from the Chinese Longitudinal Healthy Longevity Survey database. Older individuals in the 2014 wave were included and followed up in 2018. CVAI was calculated based on age, body size, and blood lipid parameters, with higher values indicating increased visceral fat. Survival status was determined from official death certificates, local primary healthcare providers, or the family members of participants. Kaplan-Meier survival curve and log-rank test were employed to analyze cumulative mortality risk through CVAI tertiles (tertile 1: CVAI index < 97.34; tertile 2: 97.43 ≤ CVAI index < 132.21; and tertile 3: CVAI index ≥ 132.21). A Cox proportional hazards regression model was used to assess the relationship between the CVAI groups and all-cause mortality risk. Additionally, a sensitivity analysis was performed by excluding participants who died within the first year of follow-up. A subgroup analysis was performed based on age and sex, and a restricted cubic spline plot was created to analyze the dose-response relationship between CVAI and mortality risk.ResultsA total of 1414 individuals were included, and the mean age of the participants was 84.6 (standard deviation: 10.9) years, of which 46.4% were women and 32.8% were died during a median follow-up time of 36.4 months. In the multivariable adjusted Cox regression model, we observed a significantly lower risk of mortality in the CVAI tertile 2 and 3 groups than in the tertile 1 group. The hazard ratios (HR) of the tertile 2 and 3 groups were 0.68 (95% CI, approximately 0.52–0.89) and 0.63 (95% CI, approximately 0.48–0.82), respectively. Subgroup analysis revealed that the protective effect of higher CVAI levels on mortality was more pronounced in participants aged 65–79 years and in women.ConclusionOur study established a linear relationship between CVAI and mortality risk among community-dwelling older adults, with higher CVAI levels associated with a lower risk of all-cause mortality. These findings highlight the potential importance of visceral adiposity in predicting mortality risk in community-dwelling older adults.

Cognitive frailty and functional disability in older adults: A 10-year prospective cohort study in Japan.

Cognitive frailty is considered a clinical entity associated with a high risk for adverse health outcomes. However, its clinical significance remains poorly understood. This study investigated the association between cognitive frailty and risk for functional disability among community-dwelling older adults. In total, 1,597 Japanese adults aged ≥ 65years that were free of dementia and functional disability at baseline were prospectively followed for 10years. Cognitive frailty was defined as the presence of both physical frailty (using Cardiovascular Health Study criteria) and cognitive impairment (Mini-Mental State Examination score < 26 points). Functional disability was identified using Japan's Long-term Care Insurance System database. Cox proportional hazard models were used to estimate the hazard ratios (HR) for cognitive frailty on the risk for functional disability. Functional disability was identified in 488 participants during follow-up. A multiplicative interaction effect between cognitive impairment and physical frailty on the risk of disability was observed (p = 0.045). Compared with the robust group, the multivariable-adjusted HRs (95% confidence interval) for functional disability were 3.70 (2.37‒5.77) for cognitive frailty, 2.51 (1.81‒3.47) for physical pre-frailty with cognitive impairment, 2.16 (1.42‒3.29) for cognitive impairment only, 1.95 (1.36‒2.80)for physical frailty only, and 1.94 (1.53‒2.46) for physical pre-frailty only. These associations remained after adjusting for the competing risk for death and in sensitivity analyses to minimize potential reverse causality. Cognitive frailty is associated with an increased risk for functional disability in community-dwelling older adults. Cognitive frailty may be a clinically important target for the prevention of functional disability.

Effect of Simple Swallowing Training Program on Early Oropharyngeal Dysphagia in Community-Dwelling Older Adults: A Randomized Controlled Study

ObjectivesOropharyngeal dysphagia (OD) in community-dwelling older adults continues to be a challenge due to its insidious onset. This study developed a simple swallowing training program (SSTP) to address these issues and conducted a randomized controlled trial to explore its effect on swallowing function and quality of life. DesignTwo-arm randomized controlled trial. Setting: and ParticipantsA total of 248 community-dwelling older adults with OD from were included in 2024 and randomly divided into intervention and control groups. MethodsThe SSTP was developed through expert consultation. A total of 248 community-dwelling older adults with OD were included in 2024 and randomly divided into intervention and control groups. The intervention group underwent the SSTP twice daily for 21 days, with weekends off, and the control group participants did light physical activities by themselves. The primary outcome was the Gugging Swallowing Screen (GUSS), and the secondary outcomes were the Eating Assessment Tool-10 (EAT-10), Swallowing Quality of Life questionnaire (SWAL-QoL), maximum tongue pressure, masticatory ability, bite force, and meal duration. Assessments were conducted on days 1 and 21, while meal duration was assessed every 3 days for lunch. ResultsTwenty-seven participants withdrew halfway. There were no significant differences in baseline assessments (P > .05). There were significant between-group and interactive effects in the GUSS [(19.07 ± 1.38) vs (17.28 ± 2.17), Fbetween-group = 6.893, Pbetween-group = .009, Finteractive = 59.504, Pinteractive<.001], EAT-10 {[4.00 (3.00, 5.00)] vs [9.00 (7.00, 10.00)], zbetween-group = −3.502, Pbetween-group<.001; zinteractive = −6.252, Pinteractive<.001}, SWAL-QoL {[166.00 (163.00, 171.50)] vs [154.00 (150.00, 158.00)], zbetween-group = 2.681, Pbetween-group = .007; zinteractive = 5.475, Pinteractive<.001}, maximum tongue pressure {[33.10 (26.48, 36.86)] vs [28.85 (19.21, 35.77)], zbetween-group = 3.377, Pbetween-group = .001; zinteractive = −6.208, Pinteractive<.001}, masticatory ability {[176.92 (133.10, 212.91) vs [163.33 (116.66, 189.32)], zbetween-group = 4.801, Pbetween-group<.001; zinteractive = 6.979, Pinteractive<.001}. Between-group, time, and interactive effects were significant in the meal duration [(23.39 ± 4.32) vs (27.64 ± 5.63), Fbetween-group = 8.692, Pbetween-group = .004, Ftime = 138.683, Ptime< 0.001, Pinteractive = 73.196, Pinteractive<.001]. Conclusions and ImplicationsThe SSTP can effectively improve early OD and swallowing-related quality of life in community-dwelling older adults.

Relationships Between Self-Reported Pain and Optimism Among Community-Dwelling Older Adults.

Measures of life outlook in older adults have been investigated in connection to pain, as both pain management and outlook are important factors of successful aging. We hypothesized that higher pain is associated with lower optimism among community-dwelling older adults. We utilized data from the UC San Diego Successful Aging Evaluation (SAGE), a prospective longitudinal cohort study initiated in 2010, to evaluate the relationship between pain and optimism in 378 community-dwelling adults aged ≥50 years. We used the revised Life Orientation Test (LOT-R) to measure optimism and three pain subscales-PROMIS Pain Interference, PROMIS Pain Intensity, and MOS 36-Item Short-Form Health Survey (SF-36)-as pain measures. Regression analyses reveal negative relationships between pain and optimism for all three pain scales, with regression coefficients of -0.277 (p < .0001), -0.246 (p < .0001), and 0.269 (p < .0001) respectively. This indicates value in considering physical and psychological elements in future intervention research to promote healthy aging.

Immediate effects of structured and natural deep breathing on heart rate variability and blood pressure in community-dwelling older adults

BackgroundThis study investigated the immediate effects of structured deep breathing (SDB) and natural deep breathing (NDB) on heart rate variability (HRV) and blood pressure (BP) in community-dwelling older adults. MethodsTwenty-six participants were randomly assigned to SDB (n = 14) or NDB (n = 12) groups. HRV parameters (time domain: standard deviation of normal-to-normal intervals [SDNN], root mean square of successive differences [RMSSD]; frequency domain: low frequency [LF], high frequency [HF], LF/HF ratio, total power [TP], normalized low frequency [LFnu], normalized high frequency [HFnu]) and BP were assessed during spontaneous breathing, DB, and post DB. ResultsBoth groups showed significant increases during DB in SDNN (p < 0.001), RMSSD (p = 0.021), LF power (p < 0.001), LFnu (p < 0.001), TP (p < 0.001), and LF/HF ratio (p < 0.001). HFnu decreased significantly during DB (p < 0.001) with no group differences. HF power showed no significant effect in group and time. BP remained stable throughout the protocol, with no significant changes in either systolic or diastolic BP across time points or between groups. ConclusionsThis first direct comparison of structured versus natural DB in healthy older adults demonstrates that both approaches effectively enhance parasympathetic activity. These findings support DB as a cost-effective, accessible intervention for promoting autonomic balance in healthy aging, without requiring specialized equipment or instruction.

Impact of Hallux Valgus on Dynamic Balance in Community-Dwelling Older Adults

Objectives: We intend to examine the effects of hallux valgus (HV) on dynamic balance in community-dwelling older adults. Methods: This comparative study was conducted on 29 functionally independent older adults with HV. The subjects were divided into the mild HV severity group and the moderate/severe HV severity group, determined using the Manchester scale. The 4 square step test (FSST) and timed-up and go (TUG) test were used to measure their dynamic balance. The independent t-test was performed to compare the two groups’ balance performance. Results: Significant differences were observed between the two groups. Participants with mild HV severity performed significantly better in the FSST (P&lt;0.05) and TUG test (P&lt;0.05) compared to those with moderate and severe HV severity. Regarding the normative cut-off value of FSST, all the participants were categorized as fallers. Discussion: HV negatively impacts the dynamic balance of community-dwelling older adults with moderate and severe severity grading. This finding suggests that adjusting treatment strategies may be required when managing falls and balance issues in older adults with HV deformities.

A portrait of older adults in naturally occurring retirement communities in Ontario, Canada: A population-based study.

Naturally occurring retirement communities (NORCs) are geographical areas that have naturally become home to a large concentration of older adults. This density means that NORCs have the potential to become a pillar for aging in place strategies, but at present, there is limited data on residents and their health needs. Our objective was to describe and compare the health and healthcare use of older adults living in high-rise NORC buildings to those in all other housing types in the community. We conducted a population-based descriptive study of community-dwelling older adults aged ≥65 years by linking a provincial NORC registry in Ontario, Canada with health administrative records. Individuals were classified as NORC residents if their residential postal code on January 1, 2020 matched the NORC registry. Sociodemographic, clinical, and healthcare use characteristics were compared by NORC status using standardized differences (STD) and stratified by rurality, and further by age and sex in urban settings. Overall, 219,995 (7.7%) of 2,869,706 older adults were NORC residents. Compared to community-dwelling older adults, NORC residents were older (mean 77.4 vs 74.6 years; STD 0.34), and more were female (61.8% vs 52.2%; STD 0.19) and had low income (16.0% vs 9.3%; STD 0.11). NORC residents also had more active chronic conditions (mean 1.9 vs 1.5; STD 0.27), medications (mean 3.4 vs 2.8; STD 0.21), home care use (15.3% vs 9.8%; STD 0.17), and primary care visits (mean 9.7 vs 7.6 visits in prior 2 years; STD 0.22). Findings were robust across rurality, age, and sex. Our findings suggest that NORC residents have greater health needs than other older adults living in the community and underscore NORCs as important targets for equity-focused strategies to support aging in place.

Usefulness of the varus knee screening test using the distance between the medial epicondyles of the femur in community-dwelling older adults

Usefulness of the varus knee screening test using the distance between the medial epicondyles of the femur in community-dwelling older adults

Correlates and Brain Substrates of Happiness in Community-Dwelling Older Adults in India.

Happiness has been shown to influence many health-related outcomes in older adults. Identifying correlates and brain substrates of happiness across countries and cultures is an important goal, as the global older adult population continues to increase. We used univariate and multiple regression to examine associations between happiness and several demographic, health, and lifestyle variables in 665 older adults (39% female) from Kerala, India. We also used Bayesian regression to examine associations between cortical thickness and happiness in a subsample of 188 participants that completed MRI scanning. Happiness was significantly associated with several variables. In our multiple regression model, which included all significant univariate predictors, self-rated health, depression, anxiety, apathy, social network size, social network diversity, and social support significantly predicted happiness. Demographic indicators (age, sex, education, marital status, residence, and employment status/type), cognitive impairment, comorbidities, and leisure activities were not significantly associated with happiness in the multiple regression model. Cortical thickness in several brain regions was positively associated with happiness scores, including frontal, temporal, parietal, occipital, and cingulate regions. Understanding the key correlates is critical for identifying both modifiable factors that can be targeted in well-being interventions and fixed characteristics that identify those at-risk for reduced happiness. The widespread pattern of brain regions associated with happiness is consistent with the multifactorial nature of happiness and, given that the regions identified do not overlap with those vulnerable to cortical thinning, can help explain why subjective well-being, unlike other cognitive functions, is largely resistant to age-related decline.

Assessing Physical Therapists' Outdoor Walking Recommendations and Neighborhood Walkability for Older Adults.

Neighborhood walkability is the extent to which built and social environments support walking. Walkability influences older adults' participation in outdoor physical activity. Identifying factors that influence physical therapists' (PTs) decisions about prescribing outdoor walking is needed, especially for those who are aging in place. The purpose of this study is to describe the neighborhood walkability knowledge, perceptions, and assessment practices of PTs who work with community-dwelling older adults. A cross-sectional survey was sent via email to 5,000 PTs nationwide. The 40-item survey assessed walking prescriptions, walkability perceptions and assessments, and gathered demographic data. Categorical variables were compared using Chi-square analyses. Using a total of 122 PTs who worked in outpatient geriatric physical therapy settings, a significant difference was found between perceptions of whether PTs should assess walkability and whether they actuallyassess walkability (χ2 = 78.7, p < .001). Decisions to prescribe outdoor walking were influenced by the availability (n = 79, 64.8%) and maintenance (n = 11, 9.0%) of sidewalks, crime (n = 9, 7.4%), terrain (n = 7, 5.7%), and aesthetics (n = 6, 4.9%). Objective walkability measures were not used by the respondents. When considering the assessment of walkability, PTs prioritize the built environment over the social environment. Although most believe it is the responsibility of the PT to assess walkability, most do not. Significance/Implications: Assessment of walkability may allow PTs to identify barriers and make more informed recommendations concerning outdoor walking for older adults. Objective measures are available for PTs when prescribing outdoor walking.

Talking on a mobile phone and doing math have a similar impact on walking in community-dwelling older adults?

Talking on a mobile phone and doing math have a similar impact on walking in community-dwelling older adults?

Neighborhood Environment Walkability and Functional Health Status in Community-Dwelling Older Adults: A Descriptive Correlational Study

Neighborhood Environment Walkability and Functional Health Status in Community-Dwelling Older Adults: A Descriptive Correlational Study

Correlation between fall experience and life functions among community-dwelling older adults in Japan

PurposeThis study investigated the correlation between the risk of falls and life functions, including motor function, cognitive function, and urinary disorders, among older adults residing in small cities in the metropolitan areas of Japan and evaluated the contents of fall prevention instructions. MethodsSixty-nine older adults residing at home participated in this case-control study conducted between September and October 2019. The survey items included questions pertaining to the history of falls; grip strength; the 30-s Chair Stand Test (CS-30), Functional Reach Test (FRT), and Timed Up and Go Test (TUG) scores; mental and cognitive functions [Test Your Memory-Japanese version test (TYM-J)]; living conditions; and urination status [Core Lower Urinary Tract Symptom Score (CLSS)]. ResultsParticipants with a history of falls had significantly lower CS-30 and FRT scores, and significantly higher TUG scores and CLSS than those with no history of falls. Grip strength bore significant correlations with the CS-30 and TUG scores. The CS-30 scores were correlated with the FRT and TUG scores. The FRT scores were correlated with the TUG and French State Activity Index (FAI) scores. The TUG scores were correlated with the TYM-J and FAI scores. The CLSS showed no significant correlations with the remaining items. The FRT scores and CLSS exerted a significant effect on the risk of experiencing falls. ConclusionBoth balancing ability and micturition status affect fall risk and should be considered in treatment strategies for urinary disorders in fall prevention programs for older adults.

The Prevalence of Frailty in Community Dwelling Older Adults Living in Tehran

The Prevalence of Frailty in Community Dwelling Older Adults Living in Tehran

Active Learning Through Video Conferencing to Maintain Physical Activity Among Older Adults: A Pilot Randomized Controlled Trial.

This randomized pilot trial investigated the feasibility of an active learning physical activity intervention through video conferencing and its preliminary effects. Participants comprised community-dwelling older adults who could use e-mail. The intervention group underwent a 12-week active learning intervention via video conferencing to promote a healthy lifestyle, particularly physical activity. The control group received information via e-mail once per week. The amount of physical activity and sedentary behavior was measured using an accelerometer at baseline, postintervention, and 24-week postintervention (36weeks). Of the 31 participants, 29 were eligible and randomized into two groups (15 for the intervention and 14 for the control). Adherence to the intervention was 83%-100% (mean, 97%). Compared with the control group, the intervention group showed moderate maintenance effects on total physical activity and sedentary behavior at 36weeks. Active learning physical activity intervention through video conferencing was found to be feasible and contributed to the prevention of physical activity decline in older adults.

Yoga-based lifestyle intervention for healthy ageing in older adults: a two-armed, waitlist randomized controlled trial with multiple primary outcomes.

Yoga-based clinical research has shown considerable promise in varied ageing-related health outcomes in older adults. However, robust frameworks have yet to be used in intervention research to endorse yoga as a healthy ageing intervention to test the multidimensional construct of healthy ageing. This was an assessor-masked, randomized controlled trial conducted among 258 sedentary, community-dwelling older adults aged 60-80years, randomly allocated to 26-week yoga-based intervention (YBI) (n = 132) or waitlist control (WLC) (n = 126). The effectiveness of YBI was assessed through two separate global statistical tests, generalized estimating equations and rank sum-based test, against a comprehensive healthy aging panel comprised of ten markers representing the domains of physiological and metabolic, cognitive, physical capability, psychological, and social well-being. The secondary outcomes were individual primary marker scores, Klotho, inflammatory markers, and auxiliary blood markers. We could establish the healthy aging effect of the 26-week YBI over WLC using two models of global statistical test (GEE, β = 0.29; 95% CI = 0.20 to 0.38, p < 0.001), and rank sum-based test (β = 0.28, 95% CI = 0.19 to 0.36, p < 0.001). There were also significant improvements in direction of benefit at individual levels of all the aging markers. Exploratory evaluation with adopted indices from contemporary clinical trials also validated the potential of YBI for healthy aging; HATICE adapted composite score (mean difference = - 0.18; 95% CI = - 0.26 to - 0.09, p < 0.001) and healthy ageing index (mean difference = - 0.33; 95% CI = - 0.63 to - 0.02, p = 0.03). The global effect of YBI across multiple ageing-related outcomes provides a proof of concept for further large-scale validation. The findings hold a great translational value given the accelerated pace of population aging across the globe. Trial registration: CTRI/2021/02/031373.

Risk Factors for Falls in Community-Dwelling Older Adults During the Novel Coronavirus Pandemic in Japan: A Prospective Cohort Study

This study aimed to test the hypothesis that knowledge derived from indirect assessments can be used to identify fall risk factors during a period of social distancing. A baseline survey of 1953 community-dwelling older adults was conducted in May 2020, with a follow-up survey performed in May 2023 to assess the situation 3 years later. In total, 339 individuals were followed from baseline to follow-up. Baseline age, sex, Questionnaire for Change of Life, Frailty Screening Index, and Questionnaire for Medical Checkup of Old-Old (QMCOO) scores and subscales were used to determine fall predictors. In addition, history of falls in the past year was assessed at follow-up (outcome). The participants were categorized into fall (n = 78) and non-fall (n = 261) groups. Using binary logistic regression analysis, items that showed significant differences in a between-group comparison were analyzed, and age and history of falls, which were sub-items of the QMCOO, were identified as predictors of falls. Although special assessments may be required during periods of social distancing, we believe that it is important for these assessments to continue being performed as they are performed during normal times.

Erratum: Experiences of community-dwelling frail older adults with diabetes: Using phenomenological methods

Erratum: Experiences of community-dwelling frail older adults with diabetes: Using phenomenological methods