A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks

Temporal trends and projections of urolithiasis in China and globally from 1990 to 2030: insights from the global burden of disease study 2021

Urolithiasis is a prevalent urological condition that poses a significant public health challenge worldwide. This study investigates the impact of urolithiasis in China and globally between 1990 and 2021, with projections through 2030. Data on incidence and disability-adjusted life years (DALYs), along with age-standardized rates (ASR), were obtained from the Global Burden of Disease (GBD) 2021. Temporal trends were assessed by utilizing the Estimated Annual Percentage Change (EAPC) and Joinpoint regression analysis. Decomposition analyses were performed to assess the contributions of population growth, aging, and epidemiological changes. Future age-standardized incidence rates (ASIR) were forecast using the Auto-Regressive Integrated Moving Average (ARIMA) model. In 2021, the global number of urolithiasis cases reached 73.12 million, with China accounting for over 18 million. The condition primarily affects males and individuals aged 50-59 years. In both China and globally, the ASR of incidence and DALYs showed a downward trend from 1990 to 2021, with a more pronounced decline in China. However, the total number of incident cases continued to rise. Decomposition analysis revealed that population aging was a major contributor to the increase in cases in China, while global increases were largely driven by population growth. Projections from the ARIMA model indicate a slight further decrease in ASIRs by 2030 for both China and globally. These findings highlight the need for future efforts to focus on optimizing healthcare resources and strengthening primary prevention strategies to mitigate the public health impact of urolithiasis.

Exploring the experiences of older adults with burn injuries in China: A qualitative study

OBJECTIVE

This qualitative study explores the experiences and feelings of older burn patients in China to inform targeted intervention strategies.

METHODS

Eighteen older burn patients were purposively sampled for semi-structured interviews, which were transcribed and analyzed thematically.

RESULTS

The interview identified four interrelated themes: physiological and psychological dual torment, unmet needs during hospitalization, gains in the rehabilitation process, and concerns and aspirations for future life. Specifically, we identified some findings that are unique to a Chinese socio-cultural context, including the unmet privacy needs of wound exposure, the positive gains and appreciation for their family members' care and support, as well as the concerns about imposing caregiver burden on their adult children.

CONCLUSIONS

Older burn patients face both physical and psychological challenges, with unmet service needs and limited access to resources. This study offers valuable insights for developing integrated intervention strategies to improve care and health outcomes for this population.

Hybrid Deep Learning Architecture with Adaptive Feature Fusion for Multi-Stage Alzheimer's Disease Classification

BACKGROUND/OBJECTIVES

Alzheimer's disease (AD), a progressive neurodegenerative disorder, demands precise early diagnosis to enable timely interventions. Traditional convolutional neural networks (CNNs) and deep learning models often fail to effectively integrate localized brain changes with global connectivity patterns, limiting their efficacy in Alzheimer's disease (AD) classification.

METHODS

This research proposes a novel deep learning framework for multi-stage Alzheimer's disease (AD) classification using T1-weighted MRI scans. The adaptive feature fusion layer, a pivotal advancement, facilitates the dynamic integration of features extracted from a ResNet50-based CNN and a vision transformer (ViT). Unlike static fusion methods, our adaptive feature fusion layer employs an attention mechanism to dynamically integrate ResNet50's localized structural features and vision transformer (ViT) global connectivity patterns, significantly enhancing stage-specific Alzheimer's disease classification accuracy.

RESULTS

Evaluated on the Alzheimer's 5-Class (AD5C) dataset comprising 2380 MRI scans, the framework achieves an accuracy of 99.42% (precision: 99.55%; recall: 99.46%; F1-score: 99.50%), surpassing the prior benchmark of 98.24% by 1.18%. Ablation studies underscore the essential role of adaptive feature fusion in minimizing misclassifications, while external validation on a four-class dataset confirms robust generalizability.

CONCLUSIONS

This framework enables precise early Alzheimer's disease (AD) diagnosis by integrating multi-scale neuroimaging features, empowering clinicians to optimize patient care through timely and targeted interventions.

The research progress on periodontitis by the National Natural Science Foundation of China

Periodontitis has emerged as one of the most critical oral diseases, and research on this condition holds great importance for the advancement of stomatology. As the most authoritative national scientific research funding institution in China, the National Natural Science Foundation of China (NSFC) has played a pivotal role in driving the progress of periodontal science by supporting research on periodontitis. This article provides a comprehensive review of the research and development progress related to periodontitis in China from 2014 to 2023, highlighting the significant contributions of the NSFC to this field. We have summarized the detailed funding information from the NSFC, including the number of applicant codes, funded programs and the distribution of funded scholars. These data illustrate the efforts of the NSFC in cultivating young scientists and building research groups to address key challenges in national scientific research. This study offers an overview of the current hot topics, recent breakthroughs and future research prospects related to periodontitis in China.

Anti-inflammatory diet and low muscle mass among older adults: a cohort study based on clhls

There is limited evidence on a longitudinal association between an anti-inflammatory diet (AID2) and low muscle mass (LMM3) in older adults. This study used data from the 2011-2017 Chinese Longitudinal Survey of Health and Longevity (CLHLS) to analyze the association between AID and LMM risk using cox regression models. At the same time, restricted cubic spline analysis and subgroup analysis were carried out. The study involved 675 elderly people in China. The incidence of low muscle mass was 34.67 %. The anti-inflammatory diet had a significant protective effect on muscle mass in older adults (HR = 0.82, 95 % CI: 0.70-0.96). In addition, the LMM risk was 32 % lower in the high AID rating group (T2) compared to the low AID rating group (T1). We encourage older adults to improve muscle mass by increasing their anti-inflammatory dietary intake to prevent or delay the onset of sarcopenia.

Socioeconomic inequalities in meeting the needs of the elderly in western Iran

OBJECTIVE

The increasing demographic shift toward an aging population in Iran highlights the urgent need to understand how socioeconomic inequalities affect the ability of older individuals to access essential resources and services. This study examined socioeconomic inequalities in meeting the needs of older people in Hamadan, Iran.

METHOD

This cross-sectional study was conducted on the 501 elderly people living in western Iran. Data collection was carried out from December 1, 2022 to March 31, 2023, among elderly individuals who were registered in the SIB (Unified Health System). system. Elderly were selected by stratified random sampling among 17 comprehensive urban health centers (CURHCs) in Hamadan province. The data collection process consisted of four sections, including: A demographic information questionnaire, the Abbreviated Mental Test (AMT) questionnaire to determine the absence of dementia, cognitive impairment and the Barthel Index questionnaire to measure functional independence status and 4) Camberwell Assessment of Need for the Elderly. Socio-economic inequalities were assessed using the concentration index and a decomposition approach, determining the contribution of each factor to the socio-economic inequality at 95% CI.

RESULTS

The concentration index for met needs was 0.15 (95% CI: 0.12, 0.19), indicating a concentration of met needs among the elderly with higher economic status. Subgroup analysis (with statistically significant results) revealed that the lowest levels of met needs were observed among illiterate people (53.09% vs. 92.11% (p < 0.001)) and those with dyslipidemia (55.86% vs. 65.98, p = 0.050). Education (60.38%) and economic status (25.32%) were the primary contributors to inequality in elderly individuals' met needs.

CONCLUSION

The findings reveal significant disparities in meeting the needs of the elderly, particularly among the wealthy, the illiterate, and those with dyslipidemia. To address these issues, public health initiatives should focus on expanding education and providing economic support to disadvantaged older adults. In addition, personalized health care for those with chronic conditions is essential. Proposed solutions include training health care workers in geriatric care, developing community-based programs with home care, and creating economic support packages for low-income seniors.

Urban health inequities and healthy longevity: traditional and emerging risk factors across the cities and policy implications

Urbanization is reshaping global health, with over 55% of the world's population residing in urban areas, a figure projected to reach 68% by 2050. This demographic shift presents significant challenges and opportunities for public health, as urban environments exacerbate health disparities rooted in social determinants of health, such as economic stability, education, neighborhood conditions, and access to healthcare. Rapid urban growth, particularly in low- and middle-income countries, has led to the emergence of inequitable living conditions, environmental hazards, and limited access to essential health services, contributing to the early onset of multimorbidity and rising non-communicable disease burdens. Urbanization-driven factors such as obesogenic environments, sedentary lifestyles, air pollution, and inadequate sleep exacerbate cardiovascular and metabolic risks, while social exclusion, overcrowding, and inadequate mental health services heighten vulnerabilities. Emerging risks, including urban heat islands, noise pollution, and exposure to endocrine-disrupting chemicals, further compound urban health inequities. Effective mitigation requires multi-sectoral policies that prioritize health-promoting infrastructure, reduce environmental pollutants, foster equitable healthcare access, and address systemic barriers affecting marginalized groups. This review explores the intersections between urbanization and health inequities, emphasizing the importance of addressing traditional and emerging risk factors across the lifespan. Policy implications include promoting green infrastructure, enhancing urban mobility, expanding mental health care, and leveraging participatory governance to foster resilient and inclusive cities. By adopting an integrated approach that prioritizes social equity and sustainability, cities can mitigate health disparities and create healthier, more inclusive urban environments that support the well-being of all residents.

Did China's hospital reforms improve curative care expenditures? Evidence from Beijing hospitals

INTRODUCTION

To assess whether the comprehensive reforms in 2017 (Reform 1) and 2019 (Reform 2) in Beijing have achieved the anticipated targets by analyzing the changes in curative care expenditure (CCE) and related indicators before and after the reforms.

METHODS

Due to the Covid-19 pandemic, data are not comparable for the period after 2019, we obtained records of patients from the Hospital Information System (HIS) between January 1, 2016 and December 31, 2019. The multistage stratified cluster random sampling was used to obtain sample data, and the System of Health Accounts 2011 was applied to account for the CCE of all hospitals in Beijing. We used an interrupted time series analysis (ITSA) to compare the changes in levels and trends before and after the reforms.

RESULTS

Overall, the reforms failed to impact the rising trend in CCE, but successfully lowered the level of drug and consumable prices in all hospitals and optimized the hospital revenue structure. The reforms' impact on patient burden was also mixed. For Reform 1, outpatient costs rose in tertiary hospitals, fell for inpatients in tertiary and secondary hospitals, and exhibited no change in all other hospitals. In terms of the trend, Reform 1 saw a fall in patient burden except for a rise inpatients in tertiary and primary hospitals. For Reform 2, the level of total expenditures per outpatient visit fell in primary hospitals, rose per inpatient bed day in secondary hospitals and had no change in all other hospitals. The impact of reforms on Beijing's hierarchical medical system (HMS) was not significant.

CONCLUSION

The reform outcomes were only partially in line with the reforms' aims. While echoing the call for more resources for primary hospitals, only major patient medical service pricing changes would shift patients away from tertiary and secondary hospitals towards primary hospitals. We suggest that several measures be taken to enhance the service capacity of primary hospitals and that an advertising campaign be launched to inform and encourage patients to use primary hospitals as gatekeepers.

Lifetime probabilities of developing and dying from cancer in China: comparison with Japan and the United States in 2022

The numbers of new cancer cases and deaths in China were the largest in the world, causing a huge social and economic burden. We attempt to use more intuitive indicators to measure the probabilities of being diagnosed of or dying from cancer in China and compare these probabilities with those in Japan and the United States (US). We obtained the cancer data from GLOBOCAN 2022 for China, Japan, and the US and the all-cause mortality and population data from the United Nations. The lifetime risks of developing and dying from cancer were estimated with adjusted actual life expectancy, multiple primaries, and death-competing risks from causes other than cancers. Approximately 27.61% of Chinese people developed cancer and 1 in 5 persons were likely to die from cancer. The highest-risk cancer among men and women was lung cancer in China, but in the US and Japan, prostate cancer among men and breast cancer among women posed the highest risk. Lung cancer presented the highest likelihood of death, but women in Japan had the highest likelihood of dying from colorectal cancer. China had a lower lifetime risk of developing cancer compared with Japan and the US, but a higher probability of dying from cancer than the US. Although the probability of developing cancer was not as high as that in Japan and the US, China was still faced with enormous pressure due to its huge population and contradictory cancer patterns. Estimating lifetime risks can provide essential information to formulate appropriate cancer prevention and control plans.

Sexual Response Problems and Their Correlates Among Older Adults From the Sexual Well-Being (SWELL) Study in China: Multicenter Cross-Sectional Study

Background

Sexual response problems among older adults are not an inevitable consequence of aging but rather a response to sexual health. However, there is a lack of recent and multicenter data on this issue in China.

Objective

This study aims to assess the prevalence of sexual response problems and their correlates among older adults.

Methods

A multicenter cross-sectional study on sexual well-being was conducted among individuals aged more than 50 years in China between June 2020 and December 2022. Data on sociodemographics, physical health, psychological health, and sexual response problems were collected through face-to-face interviews. We included sexually active older adults who reported either vaginal, oral, or anal sex in the past 12 months for this study. Sexual response problems included a lack of interest or enjoyment in sex; feeling anxious, having pain, or no excitement during sex; no desire or orgasms; and the lack of lubrication in sex. The stepwise logistic regression models were used to examine the correlates of sexual response problems.

Results

A total of 1317 sexually active older adults (842 men, 475 women) were included. Older women reported a higher prevalence of sexual response problems than older men (52.0% [247/475] vs 43.1% [363/842]). Common factors associated with at least one of the sexual response problems included living in rural areas (men: adjusted odds ratio [aOR]=0.31, 95% CI 0.22-0.43; women: aOR=0.29, 95% CI 0.19-0.43) and abnormal BMI (aOR=men: 1.52, 95% CI1.11-2.07; women: aOR=2.19, 95% CI 1.47-3.28). Among older men, sleep quality (aOR=1.87, 95% CI 1.30-2.68), emotional connection with sex partners during sexual intercourse (aOR=0.69, 95% CI 0.50-0.96), frequently experienced fatigue (aOR=2.47, 95% CI 1.59-3.90), anxiety (aOR=4.26, 95% CI 1.12-21.27), and seeking professional help for sex life (aOR=1.58, 95% CI 1.14-2.21) were associated with sexual response problems. Among older women, sexual response problems were associated with a lack of physical exercise (aOR=1.69, 95% CI 1.13-2.54), poor sex-partner relationships (aOR=1.70, 95% CI 1.12-2.60), and depressive symptoms (aOR=3.18, 95% CI 1.18-10.24).

Conclusions

Sexual response problems are common among older adults. These problems were associated with adverse physical health, mental health, and poor sex-partner relationships. These findings highlight the importance for health care providers to take into account the physical and psychological health of older adults, as well as the quality of their relationships with sexual partners when diagnosing and addressing sexual response problems.

A computational grounded theory based analysis of research on China's old-age social welfare system

Purpose

By the end of 2024, 22% of the Chinese population was aged 60 and above, making old-age social welfare a critical challenge. Despite abundant literature, a gap remains between research and policy. This study applies Nelson's computational grounded theory to systematically analyze China's old-age social welfare research and propose targeted policy priorities.

Methods

We searched Chinese literature (2014-2024) from the Wanfang, CNKI, and CQVIP databases. After preprocessing the abstracts, we applied topic modeling using the latent Dirichlet allocation, guided by human analysts. Optimal topics were determined using perplexity and coherence metrics. Researchers then linked each topic to sociologically meaningful concepts to derive abstract policy conclusions.

Results

A total of 413 articles met eligibility criteria. Seven topics emerged: (1) the theoretical significance of social welfare policy; (2) enhancing rural old-age care; (3) providing care for special groups; (4) promoting a home-community care model; (5) optimizing precision care through collaborative mechanisms; (6) developing community culture; and (7) establishing supply-driven care services. Notably, topics two and seven dominated the literature.

Conclusion

Based on these themes, we propose policy priorities to enhance comprehensive social welfare programs. China's big government model-a top-level design involving diverse stakeholders-may serve as an effective framework for addressing a global aging society marked by rising non-communicable diseases and AI-driven economic growth. Moreover, our computer-assisted approach offers a valuable method for information scientists, aiding policymakers in navigating extensive digital data for more cost-effective and timely decision-making.

Public health insurance for the elderly: an insight from bibliometric analysis

PURPOSE

The study examines worldwide public health insurance and ageing studies. This was accomplished by doing a thorough bibliometric analysis of publications published between 2002 and 2022 (till 31st May), which includes 479 articles for the analysis.

DESIGN/METHODOLOGY/APPROACH

This study used the Web of Science database to analyse the vast quantity of data from the journals referenced above. VOSviewer creates network maps, keyword concurrences and cross-country co-authorship. The research analyses parameters like article distribution by year and citation frequency to determine top publications. After that, co-authorship, country co-authorship and keyword co-occurrence bibliometric network maps are shown.

FINDINGS

The finding of the study reveals that the year 2020 is the most productive year for publication; BMJ Open is referred to as the most productive journal in this area, and "Depression in the Elderly" is the most referenced paper. The US has published the highest number of articles. We've seen 21 authors work with "Akishita and Ishizaki". The USA is the most collaborative author with other countries and conducted a keywords-based cluster analysis in which "Public health insurance, older adults and long-term care" are the most frequent keywords in this domain.

ORIGINALITY/VALUE

This article aligns with the current literature on elderly public health insurance. The authors utilize bibliometric analysis to provide a more comprehensive and robust understanding of this area. Those interested in conducting further research in this field can use the findings of this study as a guide.

Health poverty reduction effect of medical insurance in China's middle-aged and elderly populations: a cross-sectional study

OBJECTIVES

In the context of demographic structure and disease spectrum changes: to study the role of the medical insurance system in providing protection and risk resilience for middle-aged and elderly vulnerable groups who are prone to impoverishment by medical expenses (IME), identify the vulnerable points and propose recommendations for improving the medical insurance system.

SETTING

The research used data from the 2018 China Health and Retirement Longitudinal Study.

PARTICIPANTS

9184 households were included in the research ultimately.

PRIMARY AND SECONDARY OUTCOME MEASURES

We use the WHO's recommended composite measure of disease-related poverty and algorithm to determine the occurrence of IME in households. Instrumental variable probit regression model was used to target the characteristics of vulnerable groups and the influencing factors with strong correlation with IME.

RESULTS

The overall incidence of IME is 8.25% and the high incidence is concentrated in rural populations (9.79%). The risk of IME from stroke (13.17%) has been higher than cancer (7.38%). The incidence of IME is higher in families with five types of non-communicable diseases enrolled in Urban-Rural Integrated Medical Insurance (URRMI) (min 10.00%-max 14.29%) and New Rural Cooperative Medical Insurance Scheme (NRCMS) (min 8.97%-max 15.24%) health insurance than the overall IME incidence (8.25%).

CONCLUSIONS

The medical insurance system has achieved the inclusive economic protection function for most people, but the risk resistance function for the middle-aged and older adults with multiple vulnerabilities still needs to be strengthened.,the.Finally, to address the benefit gap of the NRCMS, the next stage of medical insurance development should focus on improving the top-level design of the reimbursement framework for urban and rural resident medical insurance.

Global burden of Parkinson's disease from 1990 to 2021: a population-based study

OBJECTIVES

Parkinson's disease (PD) has become a public health concern with global ageing. With a focus on PD, this study sought to project its burden and trends at the national, regional and worldwide levels between 1990 and 2021.

STUDY DESIGN

Population-based study.

METHODS

The Global Burden of Disease (GBD) 2021 provided the PD burden data. The GBD data are considered globally and regionally representative, as it integrates multiple data sources and employs standardised estimation methods. The age-standardised rate (ASR) and estimated annual percentage change (EAPC) were used to estimate trends in the incidence, prevalence, mortality and disability-adjusted life years (DALYs) of PD from 1990 to 2021. ASR was used to calculate the EAPCs using a linear regression model. A Bayesian age-period-cohort model was used to predict future trends up to 2046.

RESULTS

Globally, the overall ASR of PD incidence, prevalence, DALYs and mortality increased from 1990 to 2021. The EAPCs were 1.09 (95% CI: 1.07 to 1.11) for incidence, 1.52 (95% CI: 1.49 to 1.54) for prevalence, 0.32 (95% CI: 0.28 to 0.36) for DALYs and 0.18 (95% CI: 0.13 to 0.23) for mortality. The incidence, prevalence, mortality and DALYs of PD in 2021 were higher in men than in women. The age-standardized incidence rate (ASIR) was 18.52 per 100 000 in men and 12.92 per 100 000 in women (EAPC: 1.11, 95% CI: 1.09 to 1.13 vs 1.07, 95% CI: 1.05 to 1.09). The age-standardized prevalence rate (ASPR) was 157.42 per 100 000 in men and 121.84 per 100 000 in women (EAPC: 1.70, 95% CI: 1.67 to 1.73 vs 1.25, 95% CI: 1.22 to 1.27). The ASMR was 6.57 per 100 000 in men and 3.59 per 100 000 in women (EAPC: 0.21, 95% CI: 0.14 to 0.28 vs -0.01, 95% CI: -0.04 to 0.03). The ASDR was 97.12 per 100 000 in men and 81.23 per 100 000 in women (EAPC: 0.37, 95% CI: 0.33 to 0.42 vs 0.14, 95% CI: 0.10 to 0.18). From 1990 to 2021, the burden of PD remained consistently higher in men than in women, with the gender difference widening with age. The prevalence, incidence, DALYs and mortality rates of PD increased with age before declining, peaking in the 80-84 age group for prevalence and incidence, while peaking in the 90-94 age group for mortality. DALY rates peaked in the 85-89 age group. The ASR of incidence and prevalence increased significantly in Norway (EAPC=3.39, 95% CI: 3.15 to 3.64; EAPC=5.04, 95% CI: 4.65 to 5.43). Lesotho was the nation with the highest rise in age-standardised DALYs for PD (EAPC=1.67, 95% CI: 1.41 to 1.93). The United Arab Emirates had the fastest increase in age-standardised mortality for PD (EAPC=1.98, 95% CI: 1.24 to 2.71). The global ASPR of PD is projected to show a continuous upward trend.

CONCLUSIONS

From 1990 to 2021, there were rising trends in the prevalence and burden of PD in most areas and nations worldwide. Our research indicates that the management and control of PD need significant improvement, particularly in light of the ageing population.

Global, regional, and national burden of disease analysis on paralytic ileus and intestinal obstruction in adults aged 65 and over from 1990 to 2021, with projections for 2030: a Global Burden of Disease Study 2021 analysis

OBJECTIVE

This study aimed to evaluate the burden and trends of paralytic ileus and bowel obstruction in individuals aged ≥ 65 years, offering insights into prevention, treatment, and healthcare policy.

METHODS

Data from the Global Burden of Disease Study 2021 were used to analyze paralytic ileus and intestinal obstruction by demographics, year, country/region, and Socio-Demographic Index (SDI). The statistical methods included Joinpoint regression, decomposition analysis, and Bayesian Age-Period-Cohort modeling.

RESULTS

In 2021, the global age-standardized incidence of paralytic ileus and intestinal obstruction among the elderly was 643.45 cases per 100,000 individuals. The corresponding prevalence was 24.05 per 100,000 individuals, with disability-adjusted life years (DALYs) of 294.01 per 100,000 person-years and a mortality rate of 20.55 per 100,000 individuals. Between 1990 and 2021, the age-standardized incidence and prevalence of paralytic ileus and intestinal obstruction in the elderly gradually increased, while age-standardized DALYs and mortality consistently declined. Despite similar trends observed across both genders, the disease burden increased with age and was more pronounced in males than in females. Furthermore, the age-standardized incidence and prevalence of these conditions increased with SDI, whereas mortality and DALYs decreased. By 2030, the incidence and prevalence are expected to continue increasing, whereas mortality and DALYs are expected to decrease.

CONCLUSIONS

Despite the consistent decrease in mortality and DALYs associated with paralytic ileus and bowel obstruction in the elderly population aged ≥ 65 years, their incidence and prevalence continue to increase annually. This underscores the importance of improving preventive measures, early screening, and treatment efforts to address this pressing public health challenge.

The hidden network: community sense, social desirability, and their protective influence on negative emotions in aging populations

Background

With aging populations, understanding mechanisms linking social factors to emotional well-being in the older adult is critical. This study examines how social capital, social support, community sense, and social desirability interact to influence negative emotions.

Methods

A cross-sectional survey of 904 older adult individuals in Liaoning, China, utilized standardized scales: GDS-10 (negative emotions), SSRS (social support), BSCS (community sense), and MCSDS (social desirability). Mediation and moderation analyses were conducted.

Results

The results demonstrated significant negative correlations between social capital/social support and negative emotions. Social support was identified as a mediating factor linking social capital to reduced negative emotions. Additionally, community sense and social desirability moderated the relationship between social support and negative emotions, with stronger community belonging and higher social desirability amplifying the protective effect of social support.

Conclusion

These findings underscore the importance of fostering social capital, strengthening social support networks, cultivating community integration, and addressing social desirability biases to alleviate negative emotions in the older adult. The study provides actionable insights for designing targeted mental health interventions aimed at improving emotional well-being in aging populations.

Viral Infections in Elderly Individuals: A Comprehensive Overview of SARS-CoV-2 and Influenza Susceptibility, Pathogenesis, and Clinical Treatment Strategies

As age increases, the immune function of elderly individuals gradually decreases, increasing their susceptibility to infectious diseases. Therefore, further research on common viral infections in the elderly population, especially severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza viruses, is crucial for scientific progress. This review delves into the genetic structure, infection mechanisms, and impact of coinfections with these two viruses and provides a detailed analysis of the reasons for the increased susceptibility of elderly individuals to dual viral infections. We evaluated the clinical manifestations in elderly individuals following coinfections, including complications in the respiratory, gastrointestinal, nervous, and cardiovascular systems. Ultimately, we have summarized the current strategies for the prevention, diagnosis, and treatment of SARS-CoV-2 and influenza coinfections in older adults. Through these studies, we aim to reduce the risk of dual infections in elderly individuals and provide a scientific basis for the prevention, diagnosis, and treatment of age-related viral diseases, thereby improving their health status.

The trend in pancreatic cancer incidence from 2009 to 2019 and the prediction from 2020 to 2030: An analysis of provincial data in China

OBJECTIVE

As a malignant tumour with a very high mortality rate, the incidence of pancreatic cancer is on the rise globally, but the long-term trend at the provincial level in China is not yet clear. This study aimed to investigate the trend of pancreatic cancer incidence in Jiangsu Province from 2009 to 2019 and to predict pancreatic cancer incidence from 2020 to 2030.

STUDY DESIGN

Descriptive study.

METHODS

Data on pancreatic cancer incidence in Jiangsu Province were obtained from the Jiangsu Cancer Registry. Trends in pancreatic cancer incidence from 2009 to 2019 were examined based on the Joinpoint regression model. Age-period-cohort (APC) models were introduced to estimate the independent effects of age, period, and cohort on the incidence of pancreatic cancer and to project pancreatic cancer incidence from 2020 to 2030.

RESULTS

From 2009 to 2019, the number of pancreatic cancer cases in Jiangsu Province increased from 1146 to 2088, and the age-standardized incidence rate (ASIR) increased from 4.59 to 5.64 per 100,000 people. In 2019, the ASIR was higher in males than in females, and the ASIR was higher in urban areas than in rural areas. The APC analysis also showed that the age effect was the most important factor influencing pancreatic cancer incidence in Jiangsu Province. Predictions suggest that pancreatic cancer incidence will continue to increase from 2020 to 2030.

CONCLUSIONS

From 2009 to 2019, the pancreatic cancer incidence in Jiangsu Province showed an increasing trend. The incidence rate is higher among males and urban residents. It is expected that the incidence of pancreatic cancer will continue to increase in the next decade. Therefore, pancreatic cancer prevention and control efforts should continue to focus on older adults and males. This study develops an advanced provincial prediction model, which provides a quantitative basis for allocating screening resources to high-risk populations and provides a reference paradigm for cancer prevention and control strategies in other developing countries undergoing industrialization.

Determinants influencing the implementation of community health management for cognitive impairment: a qualitative study

BACKGROUND

Cognitive impairment constitutes a significant global public health challenge, particularly for countries or regions experiencing the largest increases in aging populations. Most countries have reached a consensus that cognitive impairment screening, care, and intervention should be conducted within community settings.

OBJECTIVE

To identify multilevel barriers and facilitators for community health management for cognitive impairment, this study utilized the Consolidated Framework for Implementation Research (CFIR) to systematically evaluate the implementation of strategies for managing cognitive impairment in Shanghai, China.

METHODS

A semi-structured interview guide was developed based on the CFIR. Purposeful sampling was used to select 14 stakeholders from diverse sectors, including public health authorities, community health service centers, and experts in health management related to cognitive impairment, for semi-structured interviews. CFIR served as the coding framework for inductive analysis to identify and clarify the facilitators and barriers to cognitive impairment health management within the existing policy environment.

RESULTS

Qualitative interviews with stakeholders in community-based cognitive impairment health management revealed eight facilitators and ten barriers. The facilitators included enhanced social engagement for older adults, efficient digital tools, a supportive policy environment, adequate funding, integration into basic public health services, sufficient community human resources, supportive internal and external teams, and health education. Collectively, these factors fostered a conducive environment for effective cognitive impairment health management. In contrast, the identified barriers comprised a lack of validation for smart tools, absence of collaborative mechanisms, insufficient incentives for primary care physicians (PCPs), a lack of long-term mechanisms, inadequate professional expertise, low energy levels, limited training channels, insufficient disease awareness among older adults, absence of standardized implementation plans, and superficial work practices. These barriers hindered the effective execution of community-based cognitive impairment health management strategies.

CONCLUSION

This study identified the primary facilitators and barriers to community-based cognitive impairment management within the context of current policies. To enhance the effectiveness of interventions, policymakers, health departments, and community organizations should actively address the identified barriers and leverage the facilitators. Additionally, the findings provide valuable insights for other countries facing similar challenges in cognitive impairment management. Future research should focus on integrating these factors into practical applications and evaluating the effectiveness of such interventions.

CLINICAL TRIAL NUMBER

Not applicable.

Knowledge, attitudes, and practices regarding intrinsic capacity in the elderly population: A cross-sectional study in Shanghai, China

To investigate the knowledge, attitudes, and practices (KAP) of the elderly population regarding their intrinsic capacity, as defined by the World Health Organization as a marker of healthy aging. A cross-sectional study was conducted at the Shanghai Traditional Chinese Medicine Hospital from July to November 2023. Participants' socio-demographic information and KAP scores were collected through a self-designed questionnaire. A total of 507 elderly individuals participated, with 53.25% being male and a mean age of 70.76 ± 7.63 years. The mean knowledge, attitude, and practice scores were 19.58 ± 8.85, 30.07 ± 4.81, and 34.71 ± 7.77, respectively. Pearson's correlation analysis showed significant positive correlations among the KAP scores (all P < 0.001). Multivariate logistic regression indicated that knowledge scores (OR = 1.127, P < 0.001), attitude scores (OR = 1.189, P < 0.001), and current employment status (OR = 2.759, P = 0.009) were associated with proactive practices. Structural equation modeling demonstrated that knowledge had a direct influence on attitude (β = 0.572, P < 0.001) and practice (β = 0.776, P < 0.001), while attitude directly impacted practice (β = 0.412, P < 0.001). The study reveals that the elderly lack knowledge but have positive attitudes and proactive behaviors about intrinsic capacity. Enhancing education and attitudes is vital for healthy aging and well-being.

Muscle mass mediates the association between dietary diversity and mortality among the older adults: A prospective cohort study

AIMS

The association between dietary diversity and increased mortality risk is well-documented. However, it remains unclear whether and to what extent dietary diversity affects mortality through appendicular skeletal muscle mass (ASM). Therefore, we assessed whether ASM mediated the association between dietary diversity and mortality.

METHODS

We used data from the Chinese longitudinal healthy longevity survey (CLHLS) (2011-2018). The baseline Dietary Diversity Score (DDS) was derived from 9 food items, and the Anti-inflammatory Dietary Diversity Score (AIDDS) was used to assess the diversity of anti-inflammatory foods in the diet. Cox regression models were employed to estimate the association of DDS and AIDDS with mortality. Interaction analysis was performed to analyze the association between DDS, AIDDS, and ASM in different groups. Subsequently, mediation analysis was performed to examine whether ASM partly accounted for the association.

RESULTS

A total of 5422 participants (average age 85.99 years) were included in the analysis. Among them, 3241 participants died during the follow-up period. We observed that participants with higher DDS (HR = 0.907, 95 % CI: 0.842-0.977) and AIDDS scores (HR = 0.947, 95 % CI: 0.917-0.977) had lower mortality rates. Subgroup analyses showed no interaction between DDS, AIDDS, and ASM (p for interaction>0.05). ASM mediated the 14.0 % association between DDS and mortality, and the 10.7 % association between AIDDS and mortality.

CONCLUSIONS

Dietary diversity and anti-inflammatory dietary diversity could reduce mortality risk and promote longevity in older adults. The association between these factors was partially mediated by an increase in muscle mass among older adults.

Epidemiological trends and age-period-cohort effects on periodontal diseases incidence across the BRICS from 1992 to 2021

BACKGROUND

Periodontal diseases are prevalent oral conditions, particularly burdensome in developing countries. This study examines global and BRICS countries' changing trends in periodontal diseases incidence from 1992 to 2021, focusing on associations with age, period, and cohort effects.

MATERIALS AND METHODS

A cross-sectional burden of disease study was conducted. Data on the total population and periodontal diseases cases, all-age incidence rate, age-standardized incidence rate, and relative change in periodontal diseases incidence from 1992 to 2021 within BRICS were obtained from the Global Burden of Disease study (GBD) 2021. Furthermore, the Age-Period-Cohort (APC) model with an intrinsic estimator (IE) algorithm was employed to assess the effects of net drift, local drift, age, period, and cohort on the incidence rates of periodontal diseases over specific time periods.

RESULTS

Globally, the new cases of periodontal diseases in 2021 were reported at 8961 thousand (95% uncertainty intervals: 7907, 10101), reflecting a 71.21% increase compared to 1992. In 2021, the age-standardized incidence rate of periodontal diseases across the BRICS countries ranged from 600.50 (95% uncertainty intervals: 481.27, 763.54) per 100,000 population in South Africa to 1268.96 (95% uncertainty intervals: 1119.16, 1409.94) per 100,000 population in India. The age distribution of periodontal diseases cases was relatively stable globally and among BRICS countries from 1992 to 2021. Countries exhibited similar age-effect patterns, with increasing risk with increasing age, and varying period and cohort effects, indicative of differential control measures and temporal incidence trends.

CONCLUSIONS

Brazil, India, and China experienced an increasing trend in the age-standardized incidence rates of periodontal diseases from 1992 to 2021, in contrast to the declining trends observed in the Russian Federation and South Africa. Furthermore, the APC analysis indicates the intricate dynamics of age, period, and cohort influences on periodontal diseases incidence. Distinct national trajectories, shaped by varying socioeconomic, cultural, and historical frameworks, highlight that public health initiatives must be meticulously customized to mitigate and control the periodontal diseases burden across diverse settings.

Evaluation of long-term care insurance pilot city policies in China: a cross-sectional study

Background

The acceleration of China's aging process makes examining policy experiences from LTCI pilot cities highly significant for advancing the LTCI system in China and other emerging nations.

Methods

Policy documents were gathered using Citespace 6.3.R1, with primary data sources obtained from official government websites. A comparative study of LTCI policies in pilot cities was conducted, focusing on policy support, participation scope, financing channels, benefit provision, care conditions, and management structures to evaluate the programs' logic.

Results

Pilot cities have developed distinct approaches in the LTCI development process. However, issues persist, including a singular financing channel, misalignment between benefit provision supply and demand, substandard care quality, and the need for improved management effectiveness.

Discussion

Establishing a sustainable LTCI system requires implementing an independent financing mechanism and a standardized financial model, developing an efficient LTCI service supply framework, strengthening LTCI oversight and administration, and fostering the commercial insurance market.

A Novel Diagnostic Framework with an Optimized Ensemble of Vision Transformers and Convolutional Neural Networks for Enhanced Alzheimer's Disease Detection in Medical Imaging

Background/Objectives: Alzheimer's disease (AD) is a progressive, neurodegenerative disorder, which causes memory loss and loss of cognitive functioning, along with behavioral changes. Early detection is important to delay disease progression, timely intervention and to increase patients' and caregivers' quality of life (QoL). One of the major and primary challenges for preventing any disease is to identify the disease at the initial stage through a quick and reliable detection process. Different researchers across the world are still working relentlessly, coming up with significant solutions. Artificial intelligence-based solutions are putting great importance on identifying the disease efficiently, where deep learning with medical imaging is highly being utilized to develop disease detection frameworks. In this work, a novel and optimized detection framework has been proposed that comes with remarkable performance that can classify the level of Alzheimer's accurately and efficiently. Methods: A powerful vision transformer model (ViT-B16) with three efficient Convolutional Neural Network (CNN) models (VGG19, ResNet152V2, and EfficientNetV2B3) has been trained with a benchmark dataset, 'OASIS', that comes with a high volume of brain Magnetic Resonance Images (MRI). Results: A weighted average ensemble technique with a Grasshopper optimization algorithm has been designed and utilized to ensure maximum performance with high accuracy of 97.31%, precision of 97.32, recall of 97.35, and F1 score of 0.97. Conclusions: The work has been compared with other existing state-of-the-art techniques, where it comes with high efficiency, sensitivity, and reliability. The framework can be utilized in IoMT infrastructure where one can access smart and remote diagnosis services.

Time trends in subarachnoid haemorrhage mortality across the BRICS (Brazil, Russian Federation, India, China and South Africa): an age-period-cohort analysis for the GBD 2021

OBJECTIVES

Subarachnoid haemorrhage (SAH) is the third most prevalent subtype of stroke, representing a critical and potentially life-threatening cerebrovascular emergency. Given their large populations and diverse healthcare infrastructures, the BRICS (Brazil, Russian Federation, India, China and South Africa) nations play a pivotal role in the global SAH landscape. This investigation assesses the mortality trends of SAH in BRICS countries from 1982 to 2021.

DESIGN AND PARTICIPANTS

This study uses data from the Global Burden of Disease (GBD) 2021 public dataset to investigate the temporal trends in SAH mortality over four decades globally and within BRICS countries. The age-period-cohort (APC) model was employed to estimate net drift, local drift, age-specific curves and period (cohort) relative risks.

PRIMARY OUTCOME MEASURES

Mortality.

RESULTS

From 1982 to 2021, there was a 3.85% increase in global SAH deaths and a 59.46% decrease in age-standardised mortality rates. SAH mortality rates are increasing across various age groups in BRICS countries, except in China and the Russian Federation, where most age groups show increasing trends. The annual net drift in SAH mortality varied from a decrease of 5.62% in China to an increase of 0.31% in the Russian Federation. Countries demonstrated similar age-effect patterns, with risk decreasing as age increased. However, period and cohort effects varied, suggesting different control measures and temporal mortality trends.

CONCLUSIONS

Changing patterns of mortality from SAH in the BRICS countries over the last four decades vary. We suggest using local resources to step up SAH prevention. Healthcare for all ages, especially the vulnerable, should improve to prevent and treat SAH better.

Barriers and facilitators of exercise behaviour for frail older adults in nursing homes: protocol for a qualitative study in China

Exercise is significant for older adults to improve their poor health outcomes. It can delay weakness, enhance the quality of muscle and body balance, and prevent adverse events. However, the factors that hinder or promote exercise among frail nursing home residents are unclear. Few studies have investigated the exercise-related experiences and coping strategies of frail older adults, and it is necessary to further understand the overall situation among older adults. Therefore, this study aims to obtain information about the impact of exercise-related barriers and facilitators on the daily life of frail older adults and how they cope with this condition. Qualitative research design uses a phenomenological framework. Older adults participating in the study will be invited to describe their life experiences with exercise-related barriers and facilitators, the impact on their daily lives and the strategies they use to cope with the condition. This study will use purposeful sampling to ensure the sample provides informative cases representative of frail older adults with exercise-related barriers and facilitators. Face-to-face, personal and semi-structured interviews will be conducted in nursing homes in Sichuan, China. A trained qualitative researcher will conduct interviews. Transcripts will be analysed using NVivo V.10 qualitative software, and themes will be synthesised to highlight the critical issues raised by frail older adults about the exercise process. Understanding the awareness of frail older adults on exercise management care will help improve the existing health services in this area. This research data will be used in future research to develop a validated survey, which can be used by medical staff working in nursing homes to understand and strengthen the health service provision of frail older adults.

Association of clinical biomarker-based biological age and aging trajectory with cardiovascular disease and all-cause mortality in Chinese adults: a population-based cohort study

BACKGROUND

Evidence on the association of clinical biomarker-based biological age (BA) with cardiovascular disease (CVD) and mortality remains insufficient, particularly concerning aging trajectories' relationship with these two outcomes.

METHODS

Seventy-five thousand five hundred thirty-seven Chinese adults from the Kailuan study who participated in the first checkup (2006-2007) were included. BA was predicted by 32 clinical indicators using deep neural networks models. Aging status was divided into decelerated, accelerated, and normal aging based on BA in the first checkup. Six aging trajectories were developed in the initial three checkups. CVD and mortality were followed up till December 31, 2021.

RESULTS

After adjusting for chronological age, sex, education level, occupation, physical activity, smoking status, alcohol consumption, salt consumption habit, history of hypertension, diabetes, and dyslipidemia, as well as the use of antihypertensive, antidiabetic, and lipid-lowering drugs, Cox proportional hazard models showed that relative to normal aging, accelerated aging was a risk factor for CVD (adjusted hazard ratio [aHR], 1.17 [95% CI 1.11-1.23]) and mortality (aHR, 1.17 [1.12-1.22]), while participants with decelerated aging had a lower risk for CVD (aHR, 0.85 [0.80-0.90]) and mortality (aHR, 0.86 [0.82-0.90]). Relative to low-stable trajectory, other aging trajectories associated with higher risk of CVD and death, and high-stable trajectory associated with the highest risk of CVD (aHR, 1.62 [1.45-1.81]) and mortality (aHR, 1.55 [1.41-1.71]). Relative to high-stable trajectory, high-decreasing trajectory was associated with lower risk of CVD (aHR, 0.76 [0.67-0.86]) and death (aHR, 0.78 [0.70-0.87]), and decreasing-increasing trajectory was associated with lower risk of death (aHR, 0.86 [0.75-0.98]).

CONCLUSIONS

Accelerated BA aging is associated with a higher risk of CVD and mortality, whereas decelerated aging is associated with a lower risk compared to normal aging. Those persistently at high aging levels are at the highest risk for both CVD and death; conversely, it is the act of lowering and continually maintaining a reduced aging state that effectively mitigates these risks.

Caring perception questionnaire of the home-dwelling elderly: development and validation study

BACKGROUND

The care requirements of the elderly who live at home should receive enough attention as the world's population ages. On the basis of this, a questionnaire on the elderly who live at home must be created and validated.

OBJECTIVE

The objective is to create and validate a tool that will allow caregivers to more accurately measure how well-cared-for elderly people perceive them to be at home.

METHODS

This study developed a caring perception questionnaire through literature review and interviews in Wuhan. Fifteen experts from six provinces reviewed the initial 43-item draft. When faulty questionnaires were eliminated, the valid sample size for the exploratory factor analysis of the first survey was 238. For confirmatory factor analysis, the second survey's valid sample size was 260. The final version included 31 items, validated for reliability and validity.

RESULTS

A 52-item questionnaire was created based on interviews, refined to 43 items after expert feedback, with a content validity index of 0.88. The first survey (238 valid responses) showed a Cronbach's α of 0.945, and the second (260 valid responses) confirmed good model fit and consistency. The final version has 31 items.

CONCLUSIONS

With good reliability and validity, the caring perception questionnaire of the home-dwelling elderly was developed, which could be used as a tool to evaluate the current situation of humanistic care for the home-dwelling elderly.

Adherence to the cMIND and AIDD diets and their associations with anxiety in older adults in China

Introduction

Anxiety is highly prevalent among older adults, and dietary interventions targeting nutrition may offer effective, practical strategies for preventing mental disorders. This study aimed to explore the association between the cMIND diet, anti-inflammatory dietary diversity (AIDD), and the risk of anxiety in older adults.

Methods

A cross-sectional analysis was conducted using data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Anxiety symptoms were assessed using the Generalized Anxiety Disorder (GAD-7) scale, while adherence to the cMIND diet and AIDD was evaluated through a food frequency questionnaire. Univariable and multivariable logistic regression analyses were performed to examine associations between dietary patterns and anxiety risk, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. Random forest analysis was used to identify key factors influencing anxiety, and sensitivity analyses were conducted to test the robustness of the results.

Results

A total of 13,815 participants aged 65 and older were included, with 1,550 (11.2%) identified with anxiety. Multivariable logistic models indicated that adherence to the cMIND diet or higher AIDD was associated with a 16-26% reduced risk of anxiety, with the adjusted ORs (95% CIs) for the cMIND diet ranging from 0.75 (0.64-0.87) to 0.75 (0.61-0.91), and for AIDD from 0.74 (0.62-0.88) to 0.84 (0.73-0.96). Sensitivity analyses confirmed the stability of these findings. Depression and sleep quality were identified as the most important factors contributing to anxiety, while diet was one of the few modifiable factors.

Conclusion

This study provides evidence supporting the association between diet and anxiety in older adults, highlighting the potential of promoting healthy dietary patterns and targeted nutritional interventions as effective strategies for improving mental health in the aging population.

Burden of nasopharyngeal carcinoma in Asia from 1990 to 2021

OBJECTIVES

The study aimed to investigate the disease burden of nasopharyngeal carcinoma (NPC) in Asia.

MATERIAL AND METHODS

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 data evaluated NPC metrics by sex, and age in Asia. Estimated annual percentage changes (EAPCs) were calculated to assess the trends of NPC burden. The decomposition analysis was used to analyze drivers of deaths and disability-adjusted life years (DALYs) of NPC. The DALYs of NPC attributed to modifiable risk factors were also assessed. And we predicted changes of NPC burden to 2044.

RESULTS

In 2021, there were 101,841.49 (95 % UI: 88,093.77 to 118,402.42) incident cases, 62,079.09 (95 % UI: 54,879.91 to 70,240.60) deaths, and 2,041,239.04 (95 % UI: 1,796,551.45 to 2,315,547.51) DALYs due to NPC in Asia. From 1990 to 2021, age-standardized rates (ASR) showed a downward trend in Asia. East Asia bore the heaviest burden of NPC in the Asian region. China and India stood out as facing the most severe burdens. Central Asia was the only region in Asia where both ASIR and ASMR showed an upward trend, while ASR in Armenia experienced the fastest growth in Asian countries. The decomposition analysis showed that population growth was the main factor influencing NPC in Asia. Behavioral risks were the primary factors affecting NPC in Asia.

CONCLUSION

NPC remains a significant public health issue in Asia, especially in East Asia. China and India still face challenges due to population aging and population growth. Armenia's rising incidence highlights urgent concerns. Strengthening prevention and treatment of NPC is crucial.

CLINICAL SIGNIFICANCE

NPC continues to pose a significant public health challenge in Asia, especially in East Asia. The disease burden of Asian NPCs is increased by population growth. Targeted prevention and control policies of NPC must be implemented for high-risk areas, alongside efforts to reduce behavioral risk factors.

Experiences of women of childbearing age with diabetes skin pruritus: An interpretative phenomenological analysis

AIM

This study aims to explore the experiences and feelings of women of childbearing age with diabetes skin pruritus after being diagnosed.

METHODS

Using the Interpretative Phenomenological Analysis method, semi-structured interviews were conducted with women of childbearing age who suffer from diabetes skin pruritus, followed by data analysis.

RESULTS

Three superordinate themes and eight subthemes were identified, including psychological distress (self-identity, lack of understanding from others, emotional damage and self-disgust), physical impairment (loss of bodily control, treatment challenges, impact on female sexual characteristics), and coping post-trauma (social withdrawal, active coping).

CONCLUSION

The physical and mental health of women of childbearing age with diabetes skin pruritus has been severely compromised, particularly their sense of self-worth as women of childbearing age. Despite this, they demonstrate a solid willingness to seek treatment. Therefore, it is recommended to strengthen research in this field, improve health education, establish online support platforms for sharing experiences, and enhance government oversight of social security measures. These initiatives will promote active treatment and recovery among patients, ultimately improving their quality of life.

Effectiveness of Integrated Care for Older Pepole (ICOPE) in Improving Intrinsic Capacity in Older Adults: A Systematic Review and Meta-Analysis

OBJECTIVE

Conduct a systematic review of existing studies on intrinsic capacity (IC) and a meta-analysis of studies to assess the overall effectiveness of ICOPE in improving IC in older adults.

METHODS

Ten databases were systematically searched from inception to November 8, 2023, and the search was last updated on January 2, 2024. Randomised controlled trials (RCTs) were included. The main outcomes were IC (cognition, psychological, sensory, vitality and locomotion).

RESULTS

The results showed ICOPE had a significant effect in improving cognitive function (SMD = 0.36; 95% CI, 0.17 to 0.56, p < 0.001, 12 RCTs, 7926 participants) and depressive symptoms (SMD = -0.70; 95% CI, -0.96 to -0.43, p < 0.001, 26 RCTs, 11,034 participants), but there was no statistically significant difference in improving locomotion (SMD = 0.16; 95% CI, -0.03 to 0.34, p = 0.098, 3 RCTs, 1580 participants). Meta-regression analysis shows that intervention duration should be paid attention to when the source of heterogeneity is discussed on the cognition.

CONCLUSION

The results suggest that ICOPE may be a potentially effective approach to help improve the IC in older adults, showing significant potential for improving cognitive function and reducing depressive symptoms in particular.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

ICOPE is expected to provide effective strategies to enhance issues such as IC and may be an innovative way to improve the overall health of older adults. This result provides strong support for geriatric nursing practice and encourages the adoption of ICOPE as a viable nursing approach to promote healthy ageing.

Exercise prescription prescriptions for frailty improvement in older adults: An evidence-based approach based on the 2024 older adult compendium

OBJECTIVE

This study explored the dose-response relationship of exercise prescriptions for improving frailty in older adults, based on the 2024 Older Adult Compendium. It aims to provide evidence-based support for developing frailty intervention programs and their clinical application.

METHODS

A comprehensive search was conducted in PubMed, OVID, Cochrane Library, Web of Science, and Scopus from inception to November 5th, 2024. Randomized controlled trials (RCTs) related to exercise interventions in older adults were included. Relevant studies meeting the inclusion criteria were selected, and data were extracted for further analysis. The quality of the included studies was assessed. Meta-analysis was performed using R, and the standardized mean difference (SMD) with 95 % confidence intervals (95 % CI) was used to quantify effect sizes.

RESULTS

A total of 16 eligible RCTs comprising 2,716 older adults were included. The meta-analysis revealed that exercise significantly improved frailty among older adults [SMD = -0.81, 95 % CI (-1.25, -0.38), P < 0.001]. However, high-intensity exercise did not demonstrate a significant effect on frailty improvement [SMD = -0.45, 95 % CI (-0.96, 0.06), P = 0.3]. The analysis indicated a nonlinear dose-response relationship between exercise and frailty improvement. The predicted values for frailty improvement at the minimum and maximum exercise doses recommended by the World Health Organization (600 MET-minutes/week and 1200 MET-minutes/week, respectively) were -0.79 (95 % CI [-1.17, -0.41]) and -1.39 (95 % CI [-2.62, -0.15]), respectively.

CONCLUSION

Low- to moderate-intensity exercise significantly improves frailty among older adults, while high-intensity exercise programs are not recommended.

Advances in biomarkers and diagnostic significance of organ aging

A complete understanding of aging is a critical first step in treating age-related diseases and postponing aging dysfunction in the context of an aging global population. Aging in organisms is driven by related molecular alterations that gradually occur in many organs. There has previously been a wealth of knowledge of how cells behave as they age, but when aging is investigated as a disease, the discovery and selection of aging biomarkers and how to diagnose the aging of the organism are crucial. Here, we provide a summary of the state of the field and suggest future potential routes for research on organ senescence markers. We reviewed research on biomarkers of risk of aging from the perspective of organ aging and summarized the biomarkers currently used on three scales. We emphasize that the combination of traditional markers with emerging multifaceted biomarkers may be a better way to diagnose age-related diseases.

Bridging accessibility gaps in urban community-based basic older adult care: a comprehensive framework validated in Xi'an, China

Objectives

Accessibility is a critical factor in ensuring equitable public services. In urban older adult care systems, resource allocation and service disparities present unique challenges. The classical "5A" theory-availability, accessibility, affordability, adaptability, and acceptability-provides a robust framework for evaluating service delivery. However, its application in urban older adult care, especially in rapidly aging societies like China, remains limited. This study aims to develop and validate a framework to address affordability, resource allocation, and service mismatches in urban older adult care systems.

Methods

A web-based cross-sectional study was performed in 2023. A multi-phase methodology was adopted to construct the framework, grounded in the "5A" theory. Indicators were refined through expert consultations using the Delphi method, involving 20 experts, while the entropy weight method ensured objective indicator weighting. The framework was empirically validated in Xi'an, China, using survey data collected from 438 older adult residents across urban strata. A fuzzy comprehensive evaluation (FCE) method was employed to assess accessibility and identify key service gaps.

Results

This study constructs a comprehensive evaluation framework for basic older adult care services (BECS), structured around 5 primary dimensions, 14 sary indicators, and 37 tertiary indicators. Empirical validation in Xi'an further demonstrates the framework's scientific rigor and practical applicability. While the framework identifies strong spatial accessibility (3.8815), it also reveals critical gaps in affordability (3.1347) and psychological care (3.0862), confirming its effectiveness in diagnosing systemic disparities and guiding policy interventions.

Conclusion

This study introduces a novel accessibility evaluation framework tailored for basic older adult care services, addressing critical gaps in affordability, psychological care, and service responsiveness. Empirical results validate the framework's practicality and its alignment with the real-world conditions of urban aging societies. Furthermore, an innovative "Matching-Realization-Satisfaction" improvement pathway is proposed, offering actionable strategies to enhance accessibility and optimize service delivery. This framework serves as a replicable model for advancing equitable older adult care in rapidly aging urban communities.

Development and Validation of a Risk Predictive Model for Adverse Postoperative Health Status of Elderly Patients Undergoing Major Abdominal Surgery Using Lasso-Logistic Regression

Background

The postoperative health status of elderly patients has a substantial impact on both the individuals themselves and their families, and this impact became more pronounced with advancing age. The aim of this study was to identify risk factors that can predict the health status of patients aged 80 and over after major abdominal surgery and to establish a nomogram model.

Methods

We conducted a retrospective study of elderly patients (aged 80+) who underwent major abdominal surgery at the First Affiliated Hospital of Soochow University from January 2017 to June 2023. Least absolute shrinkage and selection operator (lasso) regression analysis was employed to identify potential perioperative factors associated with the patients' health status one year post-surgery. Subsequently, logistic regression was then used to refine these factors for the model. The nomogram's performance was assessed through discriminative ability, calibration, and clinical utility in both training and validation datasets.

Results

In total, 576 and 145 individuals were allocated to the training and validation sets, respectively. Lasso regression first identified 10 variables as candidate risk factors. After further screening through univariate and multivariate logistic regression, it was confirmed that seven variables, including tumor, operative duration, left ventricular ejection fraction (LVEF), blood transfusion, direct bilirubin, erythrocyte, and self-care, were included in the final nomogram model. The Hosmer-Lemeshow test, with a P-value of 0.835, indicates that the model was well-fitted. The area under the Receiver Operating Characteristic curve (ROC-AUC) for the model on the training set was 0.81 (95% CI 0.764-0.855), and for the validation set, it was 0.83 (95% CI 0.751-0.91). Additionally, the calibration curves and decision curve analyses in both the training and validation sets demonstrated the accuracy and clinical applicability of the predictive model.

Conclusion

The nomogram has a good predictive ability for the health status of older patients aged 80 years and above after abdominal surgery for one year, which can help clinical doctors develop better treatment plans.

Moderating effect of instrumental activities of daily living on the relationship between loneliness and depression in people with cognitive frailty

BACKGROUND

The identification of depression and loneliness among people with cognitive frailty (CF) could prevent negative psychological and physical health outcomes. Few studies have focused on physical and mental health together, and little is known about the role of daily activity in the association between depression and loneliness among elderly individuals with CF.

OBJECTIVES

To determine the positive effect of loneliness on depression among community-dwelling older adults with CF as well as the moderating effect of instrumental activities of daily living (IADL) on this association.

DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS

This cross-sectional study included 529 adults aged 65 years and older from a community-dwelling population who were screened for CF and was conducted from July 2023 to December 2023. The participants were assessed via validation instruments for the following main variables: Short-form Geriatric Depression Scale, Loneliness Questionnaire, Athens Insomnia Scale, Instrumental Activities of Daily Living (IADL), Social Support Scale, and sociodemographic characteristics. The participants were classified as having reversable CF (RCF) or potentially reversable CF (PRCF).

RESULTS

The IADL, depression, insomnia, and loneliness scores were lower among individuals with RCF than among individuals PRCF. The moderating effect of IADL scores shows that the relationship between loneliness and depression has a steeper and positive slope when lower levels of IADL exist, compared with a straight line when there are higher levels of IADL, for this case, the line is less steep and showed negative association.

CONCLUSIONS

The integrity of physical and social connections has a protective effect on the mental health of elderly people with CF. It is necessary to pay attention to disability and loneliness among elderly individuals. Targeted interventions for improving physical activity and social participation seem to be practical and feasible solutions to alleviate depressive symptoms.

Temporal trends in the burden of vertebral fractures caused by falls in China and globally from 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

This study aimed to estimate temporal trends in the burden of vertebral fractures (VFs) caused by falls by gender and age in China and globally from 1990 to 2021.

METHODS

Data concerning the characteristics of VFs caused by falls in China and worldwide, with a focus on metrics in incidence, prevalence and years lived with disability (YLDs) and their age-standardised rates, were sourced from the Global Burden of Disease (GBD) Study 2021. Joinpoint regression analysis was used to identify periods with significant changes. The average annual percentage change (AAPC) was calculated to reflect the temporal trends from 1990 to 2021. We utilised the age-period-cohort (APC) model to assess the effects of age, period, and cohort on the burden of VFs in China.

RESULTS

From 1990 to 2021, the age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR) and age-standardised YLD rate (ASYR) of VFs caused by falls exhibited an overall increase in China, whereas a general decline was observed globally. Furthermore, the ASIR, ASPR and ASYR were higher for males than females in China and worldwide. In 2021, across all age groups, the disease burden of VFs was primarily observed among the elderly population, particularly in the older female population, both in China and globally. The impact of age, period, and cohort on the incidence, prevalence, and YLDs exhibited variations in China.

CONCLUSION

The burden of VFs in China remains significant, particularly among older females. Given the considerable size of the elderly population and the ageing of the Chinese population, VFs remain critical public issues. Therefore, continued efforts must be made to address the health consequences of VFs caused by falls.

Chronic obstructive pulmonary disease burden attributable to tobacco and the trend change from 1990 to 2021 in China

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) poses a serious disease burden in China, and tobacco control is considered an effective and feasible means to reduce this burden. This study analyzes the impact of tobacco on the burden of COPD in China from 1990 to 2021.

METHODS

This study conducted a comprehensive secondary dataset analysis of COPD attributable to tobacco in China using data from the Global Burden of Disease (GBD) database. This covers a range of statistics, including number of deaths, mortality rates, disability-adjusted life years (DALYs), and DALY rates. Using Joinpoint regression analysis methods, we calculated the annual percentage change (APC) and average annual percentage change (AAPC) to assess trends in COPD attributable to tobacco for various age groups and gender in China.

RESULTS

In 2021, the age-standardized mortality rate (ASMR) of COPD attributable to tobacco in China was 35.46 per 100000, and the age-standardized DALY rate (ASDR) was 589.75 per 100000, both of which were higher than global levels. In China, the ASMR attributable to tobacco showed a consistent decline from 1990 to 2021 (AAPC= -3.69%, p<0.001), as did the ASDR (AAPC= -3.73%, p<0.001), consistent with trends observed globally and across five SDI regions, with China experiencing the fastest decline. In both 1990 and 2021, the burden of COPD attributable to tobacco was greater in males compared to females. During the years from 1990 to 2021, the ASMR of COPD attributable to tobacco and the ASDR showed a declining trend in males (AAPC= -3.29% and -3.41%, respectively) and in females (AAPC= -4.99% and -4.62%, respectively) (all p<0.001). The impact of COPD linked to tobacco use in China increased with age from 1990 to 2021, with the highest mortality and DALY rates observed in the population aged ≥70 years. Regarding secondhand smoke exposure, ASMR for females was 6.29 per 100000 and the ASDR was 119.03 per 100000, while the corresponding values for males were 7.80 per 100000 and 113.10 per 100000 , indicating a higher burden among females.

CONCLUSIONS

From 1990 to 2021, the age-standardized mortality rate and age-standardized DALY rate of COPD attributable to tobacco in China showed a declining trend; however, there remains a slight gap compared to global levels. Significant differences in smoking exposure were observed based on gender and age, with a heavier burden among males and the elderly.

Global, regional, national prevalence, mortality, and disability-adjusted life-years of cutaneous squamous cell carcinoma and trend analysis from 1990 to 2021 and prediction to 2045

Background

A serious worldwide health concern is cutaneous squamous cell carcinoma (cSCC). For the purpose of creating focused strategies, it is essential to comprehend geographical variations in cSCC prevalence and trends.

Methods

This study utilized data from the 2021 Global Burden of Diseases (GBD) survey to analyze cSCC across 204 countries and territories. We assessed the age-standardized prevalence rate (ASPR), mortality rate (ASMR), disability-adjusted life years (ASDR), and estimated annual percentage changes (EAPCs), with trends stratified by region, country, age, sex, and Sociodemographic Index (SDI). To evaluate disparities in cSCC burden, we combined the SDI with the inequality slope and concentration indices for an international health inequality analysis. Decomposition analysis assessed the effects of population growth, aging, and epidemiological trends on disease burden, while frontier analysis linked cSCC outcomes with socio-demographic development. A Bayesian Age-Period-Cohort (BAPC) model projected future prevalence, mortality, and DALYs, identifying key drivers of cSCC burden.

Results

In 2021, there were 2,275,834 cases of cSCC globally, reflecting a 345% increase since 1990. During this period, the ASPR rose from 14.69 to 26.85 per 100,000, while the ASMR increased slightly from 0.67 to 0.69 per 100,000. Disability-adjusted life years (DALYs) rose from 544,973 to 1,210,874. Among socio-demographic regions, the high SDI region had the highest ASPR, while the middle SDI region exhibited the highest ASMR and ASDR. Decomposition analysis identified population growth and demographic aging as key drivers of the rising ASMR. Countries like Georgia showed significant disparities in frontier analysis, indicating potential for better cSCC management. Health inequality analysis confirmed that the burden was concentrated in nations with higher SDI. By 2045, the global ASPR is projected to reach 64.66, with the ASMR and ASDR expected to decrease to 1.02 and 20.63 per 100,000, respectively.

Conclusion

Over the last three decades, the global burden of cSCC has increased significantly. While mortality rates and DALYs are expected to decline over the next twenty years, the prevalence of cSCC is projected to remain high. This highlights the urgent need to reevaluate preventive efforts aimed at reducing morbidity, particularly in areas with substantial populations over the age of 95.

Burden of alopecia areata in China, 1990-2021: Global Burden of Disease Study 2021

BACKGROUND

Research has indicated that the disease burden of alopecia areata (AA) in China exceeds the global average. Therefore, accurate and updated epidemiological information is crucial for policymakers. In this study, we aimed to comprehensively assess the disease burden of AA in China.

METHODS

The following four key indicators were utilized: the prevalence of cases; disability-adjusted life-years (DALYs); the age-standardized prevalence rate (ASPR); and the age-standardized DALY rate (ASDR) of AA according to the Global Burden of Disease (GBD) study 2021. We analyzed the epidemiological burden of AA in China during 2021, examined changes between 1990 and 2021, and performed a Bayesian age-period-cohort analysis to predict trends over the course of the next decade (2022-2030). Additionally, a Gaussian process regression model was applied to estimate the relationship between the gross domestic product (GDP) and the ASPR and ASDR of AA at the provincial level between 1992 and 2021.

RESULTS

In 2021, the estimated number of patients with AA in China was approximately 3.49 million (95% uncertainty interval [UI], 3.37-3.62 million); of these patients, 1.20 million (95% UI, 1.16-1.25 million) were male and 2.29 million (95% UI, 2.20-2.37 million) were female. This large number of patients with AA resulted in a total of 114,431.25 DALYs (95% UI, 74,780.27-160,318.96 DALYs). Additionally, the ASPR and ASDR were 224.61 per 100,000 population (95% UI, 216.73-232.65 per 100,000 population) and 7.41 per 100,000 population (95% UI, 4.85-10.44 per 100,000 population), respectively; both of these rates were higher than the global averages. The most affected demographic groups were young and female individuals 25-39 years of age. Slight regional disparities were observed, with the northern and central regions of China bearing comparatively higher burdens. Between 1990 and 2021, the health loss and disease burden caused by AA in China remained relatively stable. The ASPR and ASDR of AA increased with the GDP when the annual GDP was less than 2 trillion Chinese yuan; however, a downward trend was observed as the GDP surpassed 2 trillion Chinese yuan. A slight upward trend in the disease burden of AA in China is predicted to occur over the next decade.

CONCLUSIONS

AA continues to be a public health concern in China that shows no signs of declining. Targeted efforts for young individuals and females are necessary because they experience a disproportionately high burden of AA.

Association of loneliness with the risk of pain in older Chinese adults

This study investigates the long-term effects of loneliness on pain experiences in older Chinese adults, focusing on the mediating role of depression. Data from the China Health and Retirement Longitudinal Study (2013-2020) included 1,592 participants aged 60 and above. Using robust mixed-effects logistic regression models, the study found that lonely participants were more likely to experience 12 site pain: headache (OR 1.23; 95% CI 1.09-1.39), shoulder (OR 1.16; 95% CI 1.04-1.30), wrist (OR 1.14; 95%CI 1.01-1.28), finger (OR 1.14, 95% CI 1.02-1.28), chest (OR 1.26; 95% CI 1.10-1.44), stomach (OR 1.28, 95% CI 1.12-1.46), back (OR 1.23; 95% CI 1.00-1.51), waist (OR 1.46; 95% CI 1.17-1.83), buttock (OR 1.15, 95% CI 1.02-1.30), leg (OR 1.20, 95% CI 1.08-1.33), knee (OR 1.16; 95% CI 1.04-1.30), and toe (OR 1.18; 95% CI 1.04-1.34) than participants who were not lonely. No such finding was found for neck, arm, or ankle pain. The risk of pain due to loneliness did not decrease with an increase in the frequency of social activities. These findings emphasize the need to address mental health as a crucial factor in pain prevention and management.

Priority analysis of educational needs related to geriatric nursing competence among Chinese undergraduate nursing students: Application of Borich needs assessment, importance-performance analysis and locus for focus model

AIM

This study aimed to assess and identify the priority of educational needs for geriatric nursing competence among Chinese undergraduate nursing students.

BACKGROUND

The increased aging population puts new challenges in geriatric nursing care. Competence in geriatric nursing is essential for nursing students to be well-equipped to be qualified nurses in their future work to meet the growing demand for geriatric nursing. However, research on the educational needs of geriatric nursing competence among nursing students is limited.

DESIGN

A descriptive study with online questionnaire surveys was conducted.

METHODS

The Geriatric Nursing Competence Scale for Clinical Nurses was used to measure nursing undergraduate students' perception of the importance and performance of geriatric nursing competence. Borich'sNeeds Assessment, Important-Performance Analysis (IPA) and the Locus for focus (LF)model were used to analyze thepriorityinnursingstudents' educational needs of geriatric nursing competence.

RESULTS

Items related to geriatric nursing competence had lower performance than importance, emphasizing the need for education. The results showed that three items in the professional practice competence and three items in professional development competence were determined to be the highest priority items by ranking the top 10 in Borich's Needs Assessment and located in the highly important but had low-performance quadrant of IPA and fell within the high-discrepancy and high-importance quadrant of the LF model simultaneously.

CONCLUSIONS

The priorities of educational needs for geriatric nursing competence among undergraduate nursing students identified in this study provide a reference for effective educational planning and innovation.

Preventing Depression Among Older Adults With Severe Illness: The Mediating Role of Life Satisfaction and the Moderating Role of Gender

PURPOSE

The occurrence of severe illness, the risk for which increases as people age, often results in depression. The current study aimed to explore how and when severe illness leads to depression among older adults.

METHOD

Data collected from a sample of 756 older adults were analyzed using moderated mediation analysis to examine the underlying mechanism between severe illness and depression.

RESULTS

Results, as verified by a robustness check, demonstrated that life satisfaction mediated the association between severe illness and depression among older men and women, and that gender moderated the direct relationship between severe illness and depression.

CONCLUSION

The formation path of depression from severe illness among older adults varies according to gender. For men, severe illness did not directly trigger depression, but indirectly triggered depression through decreased life satisfaction; for women, severe illness not only triggered depression directly, but also indirectly triggered depression through decreased life satisfaction. Results yield theoretical and practical implications for gerontological nursing. [Journal of Gerontological Nursing, 51(2), 43-52.].

Practice and challenge of age-friendly functional restoration of stomatognathic system based on the strategy of functional tooth loss

Geriatric oral health care encounters significant challenges with the increase in the proportion of older individuals. Age-related changes in the dentition, muscles, and joints result in a decline in objective masticatory function, subjective restoration requirements, and acceptability among the elderly population, with individual variations influenced by systemic health. Considering functional requirements, the adaptability of stomatognathic and systemic health conditions, health economics and other factors, the authors believe that it should not be limited to the conventional "one-to-one" strategy for replacing missing teeth in geriatric prosthodontics. There is an urgent need for a precise and adaptable restoration strategy that is more suitable for older individuals. The proposal of a new concept of functional tooth loss updates the minimal restoration standards for elderly patients and establishes the theory of age-friendly functional restoration. Based on the restoration strategy of functional tooth loss, this paper proposes a new concept termed "age-friendly functional restoration of the stomatognathic system", which integrates treatment considerations including endodontics, periodontology, mucosa, muscles, temporomandibular joint, and systemic health. Efforts should be made in four areas as follows. Firstly, the "assessment of accessible function" should be enhanced by considering the interrelationship between stomatognathic and systemic health. Secondly, the "evaluation of appropriate function" is supposed to be optimised in view of subjective needs and objective evaluation of the stomatognathic system. Moreover, the "formulation of treatment plans" needs to be accomplished with the aid of assistive technologies, such as artificial intelligence, to accurately exert appropriate functional restoration. Lastly, the "management and maintenance of health" is likely to be strengthened through follow-ups, propaganda and education, and preventive healthcare, so as to improve quality of life and ultimately achieve healthy ageing among older individuals.

Investigation and analysis of sleep and mental health status among MEFCs

Objective

To investigate the sleep status and mental health of migrants elderly who followed their children (MEFC) and analyze the influencing factors.

Methods

A total of 583 MEFCs were surveyed using a general demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI) scale, and the Symptom Checklist 90 (SCL90) scale.

Results

The mean PSQI score for MEFCs was 6.98 ± 0.17, and the average SCL90 score was 64.06 ± 2.03. Multiple linear regression analysis indicated that health status and adaptation to the migration destination were associated with PSQI scores (P < 0.05). Health status, adaptation to the migration destination, and family harmony were associated with SCL90 scores (P < 0.05). The association coefficient between the total PSQI and SCL90 scores was r=0.462 (P < 0.05).

Conclusion

The sleep and mental health of MEFCs were at a normal level. Health status and adaptation influenced sleep status, while health status, adaptation, and family harmony impacted mental health. However, the association between mental health and sleep status was weak.

Stomach cancer epidemic in Chinese mainland: Current trends and future predictions

BACKGROUND

China is one of the countries with the highest burdens of stomach cancer. The objective of this study was to analyze long-term trends in the incidence and mortality of stomach cancer in Chinese mainland from 1990 to 2019 and to make projections until 2030.

METHODS

Data on stomach cancer were extracted from the Global Burden of Diseases Study 2019. Population data were extracted from the Global Burden of Diseases Study 2019 and World Population Prospects 2019. An age-period-cohort framework and decomposition analysis were used in this study.

RESULTS

The net drift for the incidence of stomach cancer was 0.2% (95% confidence interval [CI]: 0, 0.4%) per year for men and -1.8% (95% CI: -2.0%, -1.6%) for women. The net drift for mortality was -1.6% (95% CI: -1.8%, -1.3%) per year for men and -3.3% (95% CI: -3.5%, -3.1%) for women. In the last 10-15 years, the risk of stomach cancer occurrence and death has continued to decline for both sexes. Regarding birth cohorts, although the risk of stomach cancer death decreased in general among women and men born after 1920, the risk of occurrence increased in recent birth cohorts (men born after 1970 and women born after 1985). It is expected that the age-standardized incidence will increase among men and decrease among women, and age-standardized mortality will decrease for both sexes. The largest contributor to the projected increase in incident cases and deaths is population aging, and elderly individuals are projected to have an increased proportion of occurrence and death.

CONCLUSIONS

In the past three decades, the incidence of stomach cancer among men has increased in Chinese mainland, and this trend is projected to continue. Aging will be the main contributor to future increased stomach cancer occurrence and deaths. To reduce the health impact of stomach cancer, more efforts are needed.

Reperfusion strategies on the clinical outcomes of ST-elevation myocardial infarction patients over 80 years old in China

AIMS

This study aims to explore the efficacy of reperfusion strategies on the clinical outcomes of ST-elevation myocardial infarction (STEMI) patients over 80 years old in China.

METHODS AND RESULTS

A retrospective cohort study was performed on STEMI patients over 80 years old who underwent reperfusion strategies and no reperfusion between January 2014 and December 2021, based on the Chinese Cardiovascular Association (CCA) Database-Chest Pain Center. This study included a total of 42,699 patients (mean age 84.1 ± 3.6 years, 52.2% male), among whom 19,280 (45.2%) underwent no reperfusion, 20,924 (49.0%) underwent primary percutaneous coronary intervention (PCI), and 2495 (5.8%) underwent thrombolytic therapy. After adjusting for potential confounders, multivariable logistic regression analysis revealed that patients who underwent primary PCI strategy showed a significantly lower risk of in-hospital mortality [odds ratio (OR) = 0.62, 95% confidence interval (CI): 0.57-0.67, P < 0.001] and the composite outcome (OR = 0.83, 95% CI: 0.79-0.87, P < 0.001) compared to those who received no reperfusion. In contrast, patients with thrombolytic therapy exhibited a non-significantly higher risk of in-hospital mortality (OR = 0.99, 95% CI: 0.86-1.14, P = 0.890) and a significantly elevated risk of the composite outcome (OR = 1.15, 95% CI: 1.05-1.27, P = 0.004). During a median follow-up of 6.7 months post-hospital admission, there was a percentage 31.4% of patients died, and patients in the primary PCI group consistently demonstrated a reduced incidence of all-cause mortality (hazard ratio (HR) = 0.58, 95% CI: 0.56-0.61, P < 0.001).

CONCLUSION

STEMI patients over 80 years old who underwent the primary PCI strategy are more likely to have favourable clinical outcomes compared to those who received no reperfusion, whereas thrombolytic therapy warrants careful assessment and monitoring.

Risk factors analysis and risk prediction model for failed back surgery syndrome: A prospective cohort study

Introduction

With the growing number of posterior open surgery, the incidence of failed back surgery syndrome (FBSS) increases gradually. Currently, there is a lack of predictive systems and scientific evaluation in clinical practice. This study aimed to risk factors analysis of FBSS and develop a risk prediction model.

Materials and methods

Baseline data were collected from 512 patients. Patients were followed up for one year. Ultimately, 146 patients were classified in the FBSS group, with an incidence rate of 32.5 %. Logistic regression was used to screen for independent risk factors influencing the occurrence of FBSS. The diagnostic power of model was evaluated using the receiver operating characteristic (ROC) curve.

Findings

Age, smoking, type of pain, revision surgery, surgical technique, quality of life, and psychological status were significantly associated with the incidence of FBSS. The strongest factor in this model was the selected surgical technique, with an odds ratio of 0.095. The area under the ROC curve for the model's diagnostic and classification power was 0.852.

Conclusion

The causes of FBSS can stem from underlying factors, lifestyle, surgical causes, and patients' psychological factors. Therefore, prevention and treatment for each individual should be based on their specific cause to achieve optimal results.

Effects of population aging on quality of life and disease burden: a population-based study

BACKGROUND

As population aging intensifies, it becomes increasingly important to elucidate the casual relationship between aging and changes in population health. Therefore, our study proposed to develop a systematic attribution framework to comprehensively evaluate the health impacts of population aging.

METHODS

We used health-adjusted life expectancy (HALE) to measure quality of life and disability-adjusted life years (DALY) to quantify the burden of disease for the population of Guangzhou. The HALE and DALY projections were generated using both the Bayesian age-period-cohort models and the population prediction models. Changes in HALE and DALY between 2010-2020 and 2020-2030 were decomposed to isolate the effects of population aging. Three scenarios were analyzed  to examine the relative relationship between disease burden and population aging. In Scenarios 1 and 2, the disease burden rates in 2030 were assumed to  either remain at 2020 levels or follow historical trends. In Scenario 3, it was assumed that the absolute numbers of years of life lost (YLL) and years lived with disability (YLD) in 2030 would remain unchanged from the 2020 levels.

RESULTS

Between 2010 and 2020, 56.24% [69.73%] of the increase in male [female, values in brackets] HALE was attributable to the mortality effects in the population aged 60 and over, while - 3.74% [- 9.29%] was attributable to the disability effects. The increase in DALY caused by changes in age structure accounted for 72.01% [46.68%] of the total increase in DALY. From 2020 to 2030, 61.43% [69.05%] of the increase in HALE is projected to result from the mortality effects in the population aged 60 and over, while - 3.88% [4.73%] will be attributable to the disability effects. The increase in DALY due to changes in age structure is expected to account for 102.93% [100.99%] of the total increase in DALY. In Scenario 1, YLL are projected to increase by 45.0% [54.7%], and YLD by 31.8% [33.8%], compared to 2020. In Scenario 2, YLL in 2030 is expected to decrease by - 2.9% [- 1.3%], while YLD will increase by 12.7% [14.7%] compared to 2020. In Scenario 3, the expected YLL rates and YLD rates in 2030 would need to be reduced by 15.3% [15.4%] and 15.4% [15.6%], respectively, compared to 2020.

CONCLUSIONS

The disability effects among the elderly population hinder improvements in quality of life, while changes in age structure are the primary driver of disease burden accumulation. To mitigate the excess disease burden caused by population aging, it is essential to achieve a reduction of more than 15% in the disease burden by 2030 compared to 2020. Our proposed attribution framework evaluates the health impacts of population aging across two dimensions: quality of life and disease burden. This framework enables comparisons of these effects over time and across different regions.