Older Participants Research Articles

Age-related changes in reticulospinal contributions to anticipatory postural adjustments between back extensors and abdominal muscles.

Anticipatory postural adjustments (APAs) give feedforward postural control of the trunk, but they are delayed with ageing, affecting balance and mobility in older individuals. The reticulospinal tract contributes to postural control of the trunk; however, the extent to which age-related changes affect the reticulospinal contributions to APAs of the trunk remains unknown in humans. Here, we tested the hypothesis that a startling acoustic sound, which activates the reticulospinal tract, improves delayed APAs in older individuals. Twenty-two old (75±6years) and 20 healthy young adults (21±4years) performed a self-initiated fast bilateral shoulder flexion or shoulder extension task in response to visual, visual and auditory (80dB), or visual and startling (115dB) cues. Electromyography (EMG) was recorded from bilateral anterior deltoid (AD) and erector spinae (ES) during shoulder flexion and from bilateral posterior deltoid (PD) and rectus abdominis (RA) during shoulder extension. EMG onset of all muscles shortened during the startling cue in both age groups, suggesting a non-specific modulation of the reticulospinal tract on prime movers (AD or PD) and non-prime movers (ES or RA). Interestingly, APAs of the ES were accelerated in older participants to a similar degree as in younger participants during the startling cue. Conversely, APAs of the RA were not influenced by the startling cue in older participants. Our results suggest differential effects of ageing on functional contributions of the reticulospinal tract to APAs between back extensors and abdominal muscles.

Association between executive functions and COMT Val108/158Met polymorphism among healthy younger and older adults: A preliminary study.

Genetic variability in the dopaminergic system could contribute to age-related impairments in executive control. In this study, we examined whether genetic polymorphism for catechol-O-methyltransferase (COMT Val158Met) is related to performance on updating, shifting and inhibition tasks. We administered a battery of executive tasks assessing updating, shifting and inhibition functions to 45 older and 55 younger healthy participants, and created composite z-scores associated to each function. Six groups were created based on genetic alleles (Val/Val, Val/Met, Met/Met) derived from the COMT gene and age (younger, older). Age and genotype effects were assessed with t-test and ANOVA (p<0.05). A lower performance was observed in the older group for the three executive processes, and more particularly for inhibition. Moreover, older participants homozygous for the Val allele have a lower performance on the inhibition composite in comparison to younger Val/Val. These results confirm presence of executive performance decrease in healthy aging. With regard to genetic effect, older participants seem particularly disadvantaged when they have a lower baseline dopamine level (i.e., Val/Val homozygous) that is magnified by aging, and when the executive measure emphasize the need of stable representations (as in inhibition task requiring to maintain active the instruction to not perform an automated process).

Predictors, Protective Factors, and Adverse Outcomes of Joint Pain among Malaysian Community-Dwelling Older Adults: Findings from the LRGS-TUA Longitudinal Study

Background: Joint pain has been recognized as one of the major causes of limitations in mobility, functional decline, and consequently declined quality of life in older adults. Hence, this study aimed to identify the predictors, protective factors, and adverse outcomes of joint pain in community-dwelling older adults. Methods: In this Long-term Research Grant Scheme—Towards Useful Ageing (LRGS-TUA) longitudinal study, a total of 1005 older participants aged 60 years and above who were successfully followed up after five years were included in the analysis. The participants self-reported their joint pain status at baseline and during the fifth year. Subsequently, the baseline characteristics were used to predict changes in joint pain status. Adverse outcomes related to joint pain were evaluated based on the participants’ joint pain statuses. Results: Results showed that being female, having diabetes mellitus, and higher body mass index were associated with the incidence of joint pain. Meanwhile, increased intake of pantothenic acid and higher levels of blood albumin levels were associated with recovery from joint pain. Participants with persistent joint pain at baseline and follow-up showed higher levels of depression and disability compared to individuals who never experience any joint pain. However, participants who had recovered from joint pain did not differ significantly from those without joint pain at baseline and follow-up in these measures. Conclusions: By identifying the modifiable risk factors, factors associated with recovery, and adverse outcomes related to joint pain, this study adds to current evidence that may contribute to further management strategies for joint pain in older adults.

Health Literacy of Japanese Elderly who Participated in A Long-term Care Prevention Exercise Program by Household Composition

Objectives: With the development of services to improve the daily lives of older adults and the use of Internet of Things technology in healthcare in Japan, there is a growing need to address health literacy, especially among older adults living alone. The current study aims to fill this research gap by assessing the current state of health literacy in this population, and potentially providing guidance for future support strategies.Methods: In this study, 22 older female participants in long-term care preventive services were assessed for health literacy, cognitive function, and activities of daily living using the Household Composition and Basic Demographic Information, the Health Literacy Scale, the Japanese version of the Montreal Cognitive Assessment, and the Occupational Self-Assessment-Short Form.Results: The household composition was 13 older adults living alone and nine living with others. Older adults living alone had significantly lower functional health literacy than those living with others, which affected their ability to understand and apply health information. Difficulties reading health materials were also prevalent in this group, suggesting that visual impairment or a lack of assistive devices may affect their understanding of health information. Considering these specific needs through tailored strategies is essential for helping older adults to adapt to an increasingly digital society.Conclusions: Understanding the current state of functional health literacy among older adults living alone in the community is essential for developing strategies to improve their well-being, prevent isolation, and enable them to make informed decisions about their health.

Exploring biorepository donation patterns, experiences, and recommendations: a mixed-methods study among Appalachian adults enrolled in a sugary drink reduction program

BackgroundUnder-represented subgroups in biomarker research linked to behavioral health trials may impact the promise of precision health. This mixed methods study examines biorepository donations across an Appalachian sample enrolled in a sugary drink reduction intervention trial.MethodsParticipants enrolled in the behavioral trial were asked to join an optional biomarker study and were tracked for enrollment and biospecimen returns (stool and/or buccal sample). At 6 months, participants completed a summative interview on decision-making process, experiences collecting samples, and recommendations to encourage biospecimen donation. Return rates were analyzed across demographics (i.e., age, gender, race, education, income, health literacy status, and rurality status) using chi-squares. Qualitative data were content coded with differences compared by biomarker study enrollment and donation choices.ResultsOf the 249 invited participants, 171 (61%) enrolled, and 63% (n = 157) returned buccal samples and 49% (n = 122) returned stool samples. Metro residing participants were significantly more likely (56%) to return stool samples compared to non-metro (39%) counterparts [x2(1) = 6.61; p = 0.01]. Buccal sample return had a similar trend, 67 and 57%, respectively for metro vs. non-metro [x2(1) = 2.84; p = 0.09]. An additional trend indicated that older (≥40 years) participants were more likely (55%) to donate stool samples than younger (43%) participants [x2(1) = 3.39; p = 0.07]. No other demographics were significantly associated with biospecimen return. Qualitative data indicated that societal (66–81%) and personal (41–51%) benefits were the most reported reasons for deciding to donate one or both samples, whereas mistrust (3–11%) and negative perceptions of the collection process (44–71%) were cited the most by those who declined one or both samples. Clear instructions (60%) and simple collection kits (73%) were donation facilitators while challenges included difficult stool collection kits (16%) and inconveniently located FedEx centers (16%). Recommendations to encourage future biorepository donation were to clarify benefits to science and others (58%), provide commensurate incentives (25%), explain purpose (19%) and privacy protections (20%), and assure ease in sample collection (19%).ConclusionStudy findings suggest the need for biomarker research awareness campaigns. Researchers planning for future biomarker studies in medically underserved regions, like Appalachia, may be able to apply findings to optimize enrollment.

Insomnia symptom prevalence in England: a comparison of cross-sectional self-reported data and primary care records in the UK Biobank

ObjectivesWe aimed to use a large dataset to compare self-reported and primary care measures of insomnia symptom prevalence in England and establish whether they identify participants with similar characteristics.DesignCross-sectional study...

Acceptability of teledentistry use among residents and staff in aged residential care facilities in the Otago region of New Zealand.

To assess ARC residents' and staff perceptions of the benefits of, and comfort with, teledentistry use in ARC facilities in the Otago region of NZ, and identify end-user-level factors associated with its use. Difficulty in accessing oral healthcare services is a key barrier to aged residential care (ARC) residents' oral health and well-being. Teledentistry offers a possible solution, yet studies on its acceptability in ARCs are sparse, especially in New Zealand (NZ). This study assessed ARC residents' and staff perceptions of the benefits of, and comfort with, teledentistry use in ARC facilities in the Otago region of NZ and identified end-user-level factors associated with its use. Rest home-level residents and care staff in ARC facilities in the Otago region of NZ were surveyed to assess their awareness of teledentistry, perceptions of benefit and comfort using teledentistry, and end-user-level factors associated with the feasibility of using it in ARCs. One hundred residents and 77 care staff from 14 facilities participated. Three-quarters of resident participants thought that teledentistry was beneficial. Three in five resident participants were comfortable receiving remote dental consultations and care advice through teledentistry. Acceptability, as measured by perceived benefits and comfort, was lower among older participants. Staff participants were receptive to teledentistry use for residents and were comfortable facilitating remote dental consultations and care through teledentistry. No staff participants disagreed with the potential benefits of teledentistry for ARC residents. Teledentistry would likely be acceptable to residents and staff in ARC facilities in NZ, contributing to residents' improved access to oral health care and improved oral health and well-being.

Association of Rest-Activity Rhythm and Risk of Developing Dementia or Mild Cognitive Impairment in the Middle-Aged and Older Population: Prospective Cohort Study.

The relationship between 24-hour rest-activity rhythms (RARs) and risk for dementia or mild cognitive impairment (MCI) remains an area of growing interest. Previous studies were often limited by small sample sizes, short follow-ups, and older participants. More studies are required to fully explore the link between disrupted RARs and dementia or MCI in middle-aged and older adults. We leveraged the UK Biobank data to examine how RAR disturbances correlate with the risk of developing dementia and MCI in middle-aged and older adults. We analyzed the data of 91,517 UK Biobank participants aged between 43 and 79 years. Wrist actigraphy recordings were used to derive nonparametric RAR metrics, including the activity level of the most active 10-hour period (M10) and its midpoint, the activity level of the least active 5-hour period (L5) and its midpoint, relative amplitude (RA) of the 24-hour cycle [RA=(M10-L5)/(M10+L5)], interdaily stability, and intradaily variability, as well as the amplitude and acrophase of 24-hour rhythms (cosinor analysis). We used Cox proportional hazards models to examine the associations between baseline RAR and subsequent incidence of dementia or MCI, adjusting for demographic characteristics, comorbidities, lifestyle factors, shiftwork status, and genetic risk for Alzheimer's disease. During the follow-up of up to 7.5 years, 555 participants developed MCI or dementia. The dementia or MCI risk increased for those with lower M10 activity (hazard ratio [HR] 1.28, 95% CI 1.14-1.44, per 1-SD decrease), higher L5 activity (HR 1.15, 95% CI 1.10-1.21, per 1-SD increase), lower RA (HR 1.23, 95% CI 1.16-1.29, per 1-SD decrease), lower amplitude (HR 1.32, 95% CI 1.17-1.49, per 1-SD decrease), and higher intradaily variability (HR 1.14, 95% CI 1.05-1.24, per 1-SD increase) as well as advanced L5 midpoint (HR 0.92, 95% CI 0.85-0.99, per 1-SD advance). These associations were similar in people aged <70 and >70 years, and in non-shift workers, and they were independent of genetic and cardiovascular risk factors. No significant associations were observed for M10 midpoint, interdaily stability, or acrophase. Based on findings from a large sample of middle-to-older adults with objective RAR assessment and almost 8-years of follow-up, we suggest that suppressed and fragmented daily activity rhythms precede the onset of dementia or MCI and may serve as risk biomarkers for preclinical dementia in middle-aged and older adults.

The Best Predictor of Future Behavior May Be the Past: Exploring Behavior Change in Men Who Have Sex with Men Using Pre-exposure Prophylaxis in the Netherlands.

Pre-exposure prophylaxis (PrEP) use prevents HIV transmission, and may lead to changes in sexual behavior. We aimed to explore sexual behavior over time, and identify predictors of behavior change in men who have sex with men (MSM) using PrEP at sexual health centers (SHC) in the Netherlands. We used longitudinal data from the national STI surveillance database (January 2018-June 2021) of HIV-negative MSM who first initiated PrEP in the national PrEP pilot. We modelled behavior change after PrEP initiation, and identified predictors of behavior change using multi-state Markov models. The probability of stopping group sex, chemsex, use of poppers or erection stimulants, and having ≥ 10 partners in the past 6 months among included MSM (n = 4,349, n SHC visits = 21,820) was higher compared to the probability of starting with these behaviors after PrEP initiation. However, MSM who used condoms consistently during anal sex had a high probability of changing to inconsistent condom use (0.8) at the next visit, and inconsistent condom users mostly remained inconsistent (0.8). First visit, visiting the SHC more often (vs. regular), and STI diagnosis were predictors of starting or continuing with most of the behaviors associated with increased risk. Behavior change was less likely among older participants (> 34 compared to ≤ 34years), and during COVID-19 lockdown and post-lockdown periods compared to pre-COVID-19. Although condom use decreased over time, transitions towards stopping with other behaviors associated with increased likelihood of acquiring an STI after PrEP initiation were common. This may suggest increased sexual empowerment, especially among younger MSM. Predictors of behavior change may help to identify MSM who are likely to start with or continue to engage in these behaviors in the near future and to provide suitable and timely counselling about behavior and PrEP adherence.

Sex, race, and BMI in clinical trials of medications for obesity over the past three decades: a systematic review.

Medications for obesity have been studied in various populations over the past three decades. We aimed to quantify the baseline demographic characteristics of BMI, sex, age, and race in randomised clinical trials (RCTs) across three decades to establish whether the population studied is representative of the global population affected by the disease. Clinical trials of 12 medications for obesity (ie, orlistat, naltrexone-bupropion, topiramate-phentermine, liraglutide, semaglutide, lorcaserin, sibutramine, rimonabant, taranabant, tirzepatide, retatrutide, and orforglipron) published from Jan 20, 1999, to Nov 12, 2023, were assessed through a systematic review for methodological quality and baseline demographic characteristics. 246 RCTs were included, involving 139 566 participants with or without type 2 diabetes. Most trials over-recruited White, female participants aged 40 years or older with class 1 (30·0-34·9 kg/m2) and class 2 (35·0-39·9 kg/m2) obesity; older participants, those with class 3 (≥40·0 kg/m2) obesity, non-White participants, and male participants were under-recruited. Our systematic review suggests that future trials need to recruit traditionally under-represented populations to allow for accurate measures of efficacy of medications for obesity, enabling more informed decisions by clinicians. It is also hoped that these data will help to refine trial recruitment strategies to ensure that future studies are relevant to the population affected by obesity.

“I’m Part of Something That Matters”: Exploring What Older Adults Value Through Their Engagement in Age-Friendly Community Initiatives

ABSTRACT Older adults’ engagement in age-friendly community (AFC) initiatives is considered an essential element of community transformation. However, research on older adults’ experiences of engaging in AFC initiatives remains nascent. Based on qualitative interviews with 23 older adult participants from 15 AFC initiatives across four states in the United States (U.S.), our reflexive thematic analysisidentified three themes regarding what participants value from their engagement: (a) social contribution; (b) social connectedness and integration; and (c) staying active and personal growth. Exploring older adults’ interest in contributing to, connecting with, and growing in their community can inform recruitment and retention in AFC initiatives.

Chronicling menstrual cycle patterns across the reproductive lifespan with real-world data

The intricate hormonal and physiological changes of the menstrual cycle can influence health on a daily basis. Although prior studies have helped improve our understanding of the menstrual cycle, they often lack diversity in the populations included, sample size, and the span of reproductive and life stages. This paper aims to describe the dynamic differences in menstrual cycle characteristics and associated symptoms by age in a large global cohort of period-tracking application users. This work aims to contribute to our knowledge and understanding of female physiology at varying stages of reproductive aging. This cohort study included self-reported menstrual cycle and symptom information in a sample of Flo application users aged 18–55. Cycle and period length and their variability, and frequency of menstrual cycle symptom logs are described by the age of the user. Based on data logged by over 19 million global users of the Flo app, the length of the menstrual cycle and period show clear age-associated patterns. With higher age, cycles tend to get shorter (Cycle length: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 1.85 days, Cohen’s D = 0.59) and more variable (Cycle length SD: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 0.42 days, Cohen’s D = 0.09), until close to the chronological age (40–44) suggesting menopausal transition, when both cycles and periods become longer (Cycle length: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 0.86 days, t = 48.85, Cohen’s D = 0.26; Period length: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 0.08, t = 15.6, Cohen’s D = 0.07) and more variable (Cycle length SD: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 2.80 days, t = 111.43, d = 0.51; Period length SD: D¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\overline{\ ext{D}}}$$\\end{document} = 0.23 days, t = 67.81, Cohen’s D = 0.31). The proportion of individuals with irregular cycles was highest in participants aged 51–55 (44.7%), and lowest in the 36–40 age group (28.3%). The spectrum of common menstrual cycle-related symptoms also varies with age. The frequency of logging of cramps and acne is lower in older participants, while logs of headache, backache, stress, and insomnia are higher in older users. Other symptoms show different patterns, such as breast tenderness and fatigue peaking between the ages of 20–40, or mood swings being most frequently logged in the youngest and oldest users. The menstrual cycle and related symptoms are not static throughout the lifespan. Understanding these age-related differences in cycle characteristics and symptoms is essential in understanding how best to care for and improve the daily experience for menstruators across the reproductive life span.

Laughter in everyday life: an event-based experience sampling method study using wrist-worn wearables

Laughter is a universal, nonverbal vocal expression of broad significance for humans. Interestingly, rather little is known about how often we laugh and how laughter is associated with our personality. In a large, event-based, experience sampling method study (N = 52; k = 9,261 assessments) using wrist-worn wearables and a physical analogue scale, we analyzed belly laughs and fit of laughter events in participants’ everyday life for 4 weeks. Additionally, we assessed associations with laughter frequency such as personality, happiness, life satisfaction, gelotophobia (i.e., fear of being laughed at), and cheerfulness. Validating our new measurement approach (i.e., wearables, physical analogue scale), laughter events elicited higher happiness ratings compared to reference assessments, as expected. On average, participants reported 2.5 belly laughs per day and on every fourth day a fit of laughter. As expected, participants who were happier and more satisfied with their life laughed more frequently than unhappier, unsatisfied participants. Women and younger participants laughed significantly more than men and older participants. Regarding personality, laughter frequency was positively associated with openness and conscientiousness. No significant association was found for gelotophobia, and results for cheerfulness and related concepts were mixed. By using state-of-the-art statistical methods (i.e., recurrent event regression) for the event-based, multi-level data on laughter, we could replicate past results on laughing.

Short communication: Lifetime musical activity and resting-state functional connectivity in cognitive networks.

Participation in multimodal leisure activities, such as playing a musical instrument, may be protective against brain aging and dementia in older adults (OA). Potential neuroprotective correlates underlying musical activity remain unclear. This cross-sectional study investigated the association between lifetime musical activity and resting-state functional connectivity (RSFC) in three higher-order brain networks: the Default Mode, Fronto-Parietal, and Salience networks. We assessed 130 cognitively unimpaired participants (≥ 60 years) from the baseline cohort of the DZNE-Longitudinal Cognitive Impairment and Dementia Study (DELCODE) study. Lifetime musical activity was operationalized by the self-reported participation in musical instrument playing across early, middle, and late life stages using the Lifetime of Experiences Questionnaire (LEQ). Participants who reported musical activity during all life stages (n = 65) were compared to controls who were matched on demographic and reserve characteristics (including education, intelligence, socioeconomic status, self-reported physical activity, age, and sex) and never played a musical instrument (n = 65) in local (seed-to-voxel) and global (within-network and between-network) RSFC patterns using pre-specified network seeds. Older participants with lifetime musical activity showed significantly higher local RSFC between the medial prefrontal cortex (Default Mode Network seed) and temporal as well as frontal regions, namely the right temporal pole and the right precentral gyrus extending into the superior frontal gyrus, compared to matched controls. There were no significant group differences in global RSFC within or between the three networks. We show that playing a musical instrument during life relates to higher RSFC of the medial prefrontal cortex with distant brain regions involved in higher-order cognitive and motor processes. Preserved or enhanced functional connectivity could potentially contribute to better brain health and resilience in OA with a history in musical activity. German Clinical Trials Register (DRKS00007966, 04/05/2015).

Ethnic model along differentiation between justified death attitude and polls in a cross-cultural generational study

Background: “Justified Death Attitude (JDA) is imminent and likely paradoxical behavior against self threat to keep of self in modification for elimination of the opponent mentally or physically”the first author defined. The former studies have indicated that Justified Death Attitude Scale (JDAS) has both validity and reliability of the young majority society Shia, but we do not know whether or not it is a valid or reliable scale of minority societies Sunni, Assyrian and the old generation. If it has, can the scale discriminate between the JDA and the poll? Objectives: It is a cross-sectional study to evaluate development of JDAS comprehensively because different generations, multi ethnicities, and social variables affect attitude and cognition persistently. Method: 744 participants (368 male and 376 female) were selected through the convenience sampling method in Tehran, Ilam, Khoram Abad, and Sanandaj. The participants were of the following demographic properties: 528 adult and 216 older adult participants; 538 Shia, 108 Sunni, and 98 Assyrian participants; 460 normal and 284 abnormal participants. Participants carried out the General Health Questionnaire-12 (GHQ-12) and JDAS. 115 answer sheets were cancelled (less than 5%). Results: A Pearson product-moment correlation coefficient, binomial tests, Chi square tests, and Jonckheere-Terpstra tests are performed to analyze the data. Multiethnic studies indicate that JDAS is a valid scale for adult and older adult participants and Shia, Sunni, and Assyrian participants (p&gt;0.05). Meanwhile, attitude and polls are two different phenomena in the collision between capital punishment, the kind of death penalties, the agreement of euthanasia, and kind of euthanasia %61, %57, %56, and %61, respectively, because of different propositional and associative processes. The Chi-square indicates that gender, generations, ethnics, and sanity influence polls significantly. In line with the ethnic model of JDA, ethnics influence legal and medical subscales significantly according to Jonckheere-Terpstra tests. Conclusion: The bases of polls and attitude are conformity and self, respectively. So, the poll coefficient of error is very high to assess social ideas. Although you could find some similarities between polls and attitude, they are different phenomena principally.

Distribution of Silent Cerebral Infarcts in Adults With Sickle Cell Disease.

Previously we demonstrated that 90% of infarcts in children with sickle cell anemia occur in the border zone regions of cerebral blood flow (CBF). We tested the hypothesis that adults with sickle cell disease (SCD) have silent cerebral infarcts (SCIs) in the border zone regions, with a secondary hypothesis that older age and traditional stroke risk factors would be associated with infarct occurrence in regions outside the border zones. Adults with SCD 18-50 years of age were enrolled in a cross-sectional study at 2 centers and completed a 3T brain MRI. Participants with a history of overt stroke were excluded. Infarct masks were manually delineated on T2-fluid-attenuated inversion-recovery MRI and registered to the Montreal Neurological Institute 152 brain atlas to generate an infarct heatmap. Border zone regions between anterior, middle, and posterior cerebral arteries (ACA, MCA, and PCA) were quantified using the Digital 3D Brain MRI Arterial Territories Atlas, and logistic regression was applied to identify relationships between infarct distribution, demographics, and stroke risk factors. Of 113 participants with SCD (median age 26.1 years, interquartile range [IQR] 21.6-31.4 years, 51% male), 56 (49.6%) had SCIs. Participants had a median of 5.5 infarcts (IQR 3.2-13.8). Analysis of infarct distribution showed that 350 of 644 infarcts (54.3%) were in 4 border zones of CBF and 294 (45.6%) were in non-border zone territories. More than 90% of infarcts were in 3 regions: the non-border zone ACA and MCA territories and the ACA-MCA border zone. Logistic regression showed that older participants have an increased chance of infarcts in the MCA territory (odds ratio [OR] 1.08; 95% CI 1.03-1.13; p = 0.001) and a decreased chance of infarcts in the ACA-MCA border zone (OR 0.94; 95% CI 0.90-0.97; p < 0.001). The presence of at least 1 stroke risk factor did not predict SCI location in any model. When compared with children with SCD, in adults with SCD, older age is associated with expanded zones of tissue infarction that stretch beyond the traditional border zones of CBF, with more than 45% of infarcts in non-border zone regions.

Young and Older Patients with Acute Myocardial Infarction: Differences in Risk Factors and Angiographic Characteristics

BackgroundAlthough coronary artery disease mainly affects older individuals, the incidence of myocardial infarction (MI) among younger adults (<55 years) has increased during the past decade. Young and older MI patients have different underlying pathophysiologic characteristics, atherosclerotic plaque morphology, and risk factor profiles. MethodsWe studied 977 patients (≤ 55 years old: 322, > 55 years old: 655) who were hospitalized for MI in the previous 5 years. Patients’ baseline characteristics and daily habits were recorded. Angiographic characteristics and vascular lesions were detected, and further examinations, including flow-mediated dilation (FMD), pulse wave velocity (PWV) and central augmentation index (AIx), were performed. Biomarkers of inflammation (Interleukin-6, Tumor-Necrosis factor-a, Intercellular Adhesion Molecule 1, Osteopontin) were also tested. ResultsThe median age in the younger age group was 49 years [interquartile range (IQR: 44-53)] and 66 years (IQR): 61-73) in the older age group. Arterial hypertension was less prevalent in the young compared to the elderly with MI (47.4% vs 76.2%, p < 0.01). The younger counterparts presented significantly lower rates of diabetes mellitus (19.3% vs 30.6%, p <0.01), dyslipidemia (59% vs 70.8%, p <0.01), and atrial fibrillation (2.6% vs 9.7%, p <0.01) and were more casual smokers (49.3% vs 23.8%, p <0.01) compared to older patients with MI. In terms of arterial stiffness, lower PWV [7.3 m/s (IQR: 6.5-8.4 m/s) vs. 9 m/s (IQR: 8-10.8 m/s), p <0.01] and AIx (20.5 ± 10.8 vs 25.5 ± 7.8, p <0.01) were recorded in the young compared to the elderly with MI. Concerning angiographic characteristics, younger patients were more likely to have none or single-vessel disease (55.6% vs 45.8%, p < 0.02), whereas the older participants more frequently had three or more vessel disease (23.5% vs. 13.6% in the young, p < 0.02). Although significant disparities in blood test results were detected during the acute phase, the great majority of young MI patients were undertreated. ConclusionYounger patients with MI are more likely to be smokers with impaired PWV measures, presenting with non-obstructive or single-vessel disease, while they often remain undertreated. A better knowledge of the risk factors as well as the anatomic and pathophysiologic processes in young adults will help enhance MI prevention and treatment options in this patient population.

Sociocultural interactions and self-perception of health in older adults from an active participation centre: A qualitative study

IntroductionPromoting healthy ageing is a global priority. Active Participation Centres are potentially key in fostering psychosocial and emotional health, contributing to a fulfilling and active lifestyle for older adults. AimsThe study explores self-perceived health, perceptions of sociocultural participation, emotions that emerged when sociocultural participation, and preferences among older adults engaged in community socio-cultural activities from an Active Participation Centre. MethodsWe realised a hermeneutic study; interviews with nine older participants were conducted. Hermeneutic considerations were employed for data analysis. ResultsFindings reveal the centre's significance as a therapeutic space, positively influencing emotional well-being, fostering social connections, and offering diverse activity preferences. ConclusionThis study underscores the nuanced interplay between sociocultural engagement and self-perceived health, emphasising the need for holistic approaches to promote well-being among older adults attending Active Participation Centres.

Choir singing is associated with enhanced structural connectivity across the adult lifespan.

The global ageing of populations calls for effective, ecologically valid methods to support brain health across adult life. Previous evidence suggests that music can promote white matter (WM) microstructure and grey matter (GM) volume while supporting auditory and cognitive functioning and emotional well-being as well as counteracting age-related cognitive decline. Adding a social component to music training, choir singing is a popular leisure activity among older adults, but a systematic account of its potential to support healthy brain structure, especially with regard to ageing, is currently missing. The present study used quantitative anisotropy (QA)-based diffusion MRI connectometry and voxel-based morphometry to explore the relationship of lifetime choir singing experience and brain structure at the whole-brain level. Cross-sectional multiple regression analyses were carried out in a large, balanced sample (N = 95; age range 21-88) of healthy adults with varying levels of choir singing experience across the whole age range and within subgroups defined by age (young, middle-aged, and older adults). Independent of age, choir singing experience was associated with extensive increases in WM QA in commissural, association, and projection tracts across the brain. Corroborating previous work, these overlapped with language and limbic networks. Enhanced corpus callosum microstructure was associated with choir singing experience across all subgroups. In addition, choir singing experience was selectively associated with enhanced QA in the fornix in older participants. No associations between GM volume and choir singing were found. The present study offers the first systematic account of amateur-level choir singing on brain structure. While no evidence for counteracting GM atrophy was found, the present evidence of enhanced structural connectivity coheres well with age-typical structural changes. Corroborating previous behavioural studies, the present results suggest that regular choir singing holds great promise for supporting brain health across the adult life span.

MRNA COVID-19 vaccine safety among older adults from the Canadian National Vaccine Safety Network

This study examined short-to-medium term safety of COVID-19 vaccines among adults aged ≥65 years using the Canadian National Vaccine Safety Network active safety surveillance data. Both vaccinated and unvaccinated older adult participants recruited from seven provinces and territories were included in the analysis. Safety was assessed at 7 days after COVID-19 vaccination (dose 1, 2 and 3), and 7 months after dose 1. Multivariable logistic regression was used to examine the association between BNT162b2/mRNA-1273 COVID-19 vaccines and two short-term health events: 1) health event preventing daily activities or required medical consultation, 2) serious health events resulting in an emergency department visit and/or hospitalization within 7 days following each dose. We also assessed the rates of serious health events for the period between dose 1 and 2, and 7-months following dose 1. Between December 2020 and February 2022, a total of 173,038, 104,452, and 13,970 older adults completed dose 1, dose 2, and dose 3 surveys, respectively. The control survey was completed by 2,955 unvaccinated older adults. Health events occurred more frequently among recipients after dose 2 homologous mRNA-1273 (adjusted odds ratio [95 % confidence interval]: 2.91 [2.24–3.79]) and dose two heterologous (BNT162b2 followed by mRNA-1273): 1.50 [1.12–2.02] compared to unvaccinated counterparts. There was no difference in event rates after any dose of BNT162b2 and unvaccinated participants. The rates of serious health events following COVID-19 vaccination were very low (≤0.3 %) across all vaccine products and doses, and were not higher compared to unvaccinated controls, and were not associated with an emergency department visit or hospitalization within 7 days following vaccination. Reported symptoms were self-limited and rarely required medical assessment. Our findings further strengthen the current evidence that mRNA COVID-19 vaccines are safe and can be used to inform older adults about expected adverse events following COVID-19 vaccination.