Healthy lifestyle in late-life, longevity genes, and life expectancy among older adults: a 20-year, population-based, prospective cohort study

Social isolation, healthy lifestyle, and intrinsic capacity among older adults in China: A longitudinal study

OBJECTIVES

This study aimed to investigate the independent and interactive associations of social isolation and a healthy lifestyle on intrinsic capacity (IC) among older adults in China.

DESIGN AND SETTING

A longitudinal cohort study was conducted using data from the China Health and Retirement Longitudinal Study (CHARLS), spanning three waves (2011, 2013, and 2015) and involving adults aged 60 years and older.

PARTICIPANTS

A total of 4495 older adults with complete data on IC, social isolation, healthy lifestyle, and relevant covariates at baseline were included in the final analysis.

MEASUREMENTS

IC was assessed using a composite score across five domains: locomotor, cognitive, sensory, vitality, and psychological. Social isolation was measured using an index based on living arrangements, marital status, contact with children, and social participation. A healthy lifestyle was defined based on five factors: smoking, alcohol consumption, physical activity, sleep duration, and body mass index (BMI). Multiple linear regression and linear mixed-effects models were used to examine cross-sectional and longitudinal associations. Interactive terms between social isolation and a healthy lifestyle were analyzed. Sensitivity analyses were performed by stratifying participants by age and gender.

RESULTS

At baseline, 31.0%, 62.3%, and 6.7% of participants had social isolation scores of 0, 1-2, and 3-4, respectively, while 28.5%, 37.0%, and 34.6% had healthy lifestyle scores of 0-2, 3, and 4-5, respectively. Compared to participants with no social isolation (score = 0), the IC scores decreased for participants with social isolation scores of 1-2 and 3-4 (β = -0.36, 95% confidence interval [CI]: -0.42 to -0.30) and (β = -0.65, 95% CI: -0.77 to -0.53), respectively. In contrast, adherence to a healthy lifestyle was associated with improved IC (β = 0.27, 95% CI: 0.20 to 0.34 for score 3; β = 0.54, 95% CI: 0.47 to 0.60 for score 4-5). Interactive analysis showed that a healthy lifestyle mitigated the adverse associations of social isolation on IC, but this protective effect weakened as social isolation increased. Sensitivity analyses confirmed the robustness of these findings.

CONCLUSION

This study identified significant associations between social isolation, healthy lifestyle, and intrinsic capacity in older Chinese adults. Social isolation was negatively associated with IC, while a healthy lifestyle was positively associated with IC. The observed interaction between social isolation and healthy lifestyle highlights the importance of integrated interventions targeting both social engagement and health behaviors in supporting IC during aging.

Bidirectional association between physical activity and sleep in healthy Japanese super-seniors: the Japan Healthy Aging Study (J-HAS)

To address the challenges of an ageing population, it is important to promote health by identifying factors for healthy ageing. The aim of this study was to investigate the bidirectional association between physical activity (PA) and sleep in healthy Japanese super-seniors over the age of 80. For approximately 1 year, 124 participants wore wearable devices and answered daily lifestyle questionnaires. PA was defined as daily step count and minutes in light activity. Sleep was measured using 24-h total sleep time (TST) and time in bed (TIB). Associations were analysed bidirectionally using multilevel mixed-effects linear regression models. Fully adjusted models revealed significant and inverse associations between sleep and PA from the same 24-h period. Similarly, the results were significant and inverse with PA from the day before as exposure and the next 24-h sleep measures as outcome. The between-individual associations between sleep measures and PA from the subsequent day were significant and inverse. However, there was a positive within-individual association between TST and step count from the subsequent day. The study suggests that associations between PA and sleep in super-seniors differ from patterns previously described in younger adults. Very old individuals with increasing 24-h total sleep time may compensate for a lower step count on one day by increasing their step count the following day.

Three-year lifestyle changes, genetic risk, and risk of frailty among older adults: A national community-based cohort study

BACKGROUND

The association between change in lifestyle in late-life and frailty mediated by genetic risk is yet to be elucidated. This study aimed to investigate the associations of change in lifestyle in late-life and genetic risk with frailty among older adults.

METHODS

6945 participants aged 65 or older were included from the Chinese Longitudinal Healthy Longevity Survey. Three-year lifestyle changes were assessed by comparing the first survey (2002, 2005, 2008, 2011) with the second survey (2005, 2008, 2011, 2014), evaluating changes in overall lifestyle scores, lifestyle combinations, and four factors (smoking, alcohol use, physical activity, and diet). A weighted polygenic risk score was constructed using 25 frailty-associated Single Nucleotide Polymorphism in a subsample of 4346 participants. Frailty was defined as a frailty index ≥0.25. Cox proportional hazards regression models, with age as the time scale and stratified by 5-year age groups, were used to estimate the interaction between genetic and lifestyle factors on frailty risk.

RESULTS

During a median follow-up time of 5.7 years [interquartile range (IQR): 3.1-8.9), 2525 participants developed frailty. Compared to consistently unhealthy lifestyles, the hazard ratios (HRs) for frailty were 0.64 [95 % confidence interval (CI): 0.54-0.75] for healthy-to-healthy, 0.80 (95 % CI: 0.68-0.93) for moderate-to-moderate, and 0.83 (95 % CI: 0.70-0.99) for moderate-to-healthy changes. Participants with a high genetic risk group suffered from 87 % (95%CI: 1.68-2.08) higher risk of frailty. Notably, the highest frailty risk was observed in individuals with high genetic risk who changed from a healthy to an unhealthy lifestyle (HR: 2.86, 95%CI: 1.89-4.34).

CONCLUSION

Improving or maintaining a healthy lifestyle over three years, even in late life, was associated with a lower risk of frailty. This underscores the importance of a healthy lifestyle in preventing frailty, particularly for individuals with a high genetic risk.

Prevalence and network structure of depression and its association with quality of life among older stroke survivors: findings from a national survey in China

Background

Post-stroke depression (PSD) is a common neuropsychiatric problem associated with a high disease burden and reduced quality of life (QoL). To date, few studies have examined the network structure of depressive symptoms and their relationships with QoL in stroke survivors.

Aims

This study aimed to explore the network structure of depressive symptoms in PSD and investigate the interrelationships between specific depressive symptoms and QoL among older stroke survivors.

Methods

This study was based on the 2017-2018 collection of data from a large national survey in China. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CESD), while QoL was measured with the World Health Organization Quality of Life-brief version. Network analysis was employed to explore the structure of PSD, using expected influence (EI) to identify the most central symptoms and the flow function to investigate the association between depressive symptoms and QoL.

Results

A total of 1123 stroke survivors were included, with an overall prevalence of depression of 34.3% (n=385; 95% confidence interval 31.5% to 37.2%). A higher risk of PSD was significantly associated with limited activities of daily living (odds ratio (OR)=1.340; p=0.048), presence of heart diseases (OR=1.589; p=0.002) and more severe anxiety symptoms (OR=1.472; p<0.001). In the network model of depression, the most central symptoms were CESD3 ('feeling blue/depressed', EI: 1.180), CESD6 ('feeling nervous/fearful', EI: 0.864) and CESD8 ('loneliness', EI: 0.843). In addition, CESD5 ('hopelessness', EI: -0.195), CESD10 ('sleep disturbances', EI: -0.169) and CESD4 ('everything was an effort', EI: -0.150) had strong negative associations with QoL.

Conclusion

This study found that PSD was common among older Chinese stroke survivors. Given its negative impact on QoL, appropriate interventions targeting central symptoms and those associated with QoL should be developed and implemented for stroke survivors with PSD.

Artificial Intelligence-Driven Biological Age Prediction Model Using Comprehensive Health Checkup Data: Development and Validation Study

Background

The global increase in life expectancy has not shown a similar rise in healthy life expectancy. Accurate assessment of biological aging is crucial for mitigating diseases and socioeconomic burdens associated with aging. Current biological age prediction models are limited by their reliance on conventional statistical methods and constrained clinical information.

Objective

This study aimed to develop and validate an aging clock model using artificial intelligence, based on comprehensive health check-up data, to predict biological age and assess its clinical relevance.

Methods

We used data from Koreans who underwent health checkups at the Seoul National University Hospital Gangnam Center as well as from the Korean Genome and Epidemiology Study. Our model incorporated 27 clinical factors and employed machine learning algorithms, including linear regression, least absolute shrinkage and selection operator, ridge regression, elastic net, random forest, support vector machine, gradient boosting, and K-nearest neighbors. Model performance was evaluated using adjusted R2 and the mean squared error (MSE) values. Shapley Additive exPlanation (SHAP) analysis was conducted to interpret the model's predictions.

Results

The Gradient Boosting model achieved the best performance with a mean (SE) MSE of 4.219 (0.14) and a mean (SE) R2 of 0.967 (0.001). SHAP analysis identified significant predictors of biological age, including kidney function markers, gender, glycated hemoglobin level, liver function markers, and anthropometric measurements. After adjusting for the chronological age, the predicted biological age showed strong associations with multiple clinical factors, such as metabolic status, body compositions, fatty liver, smoking status, and pulmonary function.

Conclusions

Our aging clock model demonstrates a high predictive accuracy and clinical relevance, offering a valuable tool for personalized health monitoring and intervention. The model's applicability in routine health checkups could enhance health management and promote regular health evaluations.

Changes and trends in mortality, disability-adjusted life years, life expectancy, and healthy life expectancy in China from 1990 to 2021: a secondary analysis of the global burden of disease 2021

BACKGROUND

The aging population in China is increasingly evident, leading to a shift in the patterns of disease burden. This study aims to investigate changes and trends in mortality, disability-adjusted life years (DALYs), life expectancy (LE), and health-adjusted life expectancy (HALE) in China from 1990 to 2021.

METHODS

This study presents a secondary analysis of data from the Global Burden of Disease Study 2021, with a focus on mortality, DALYs, LE, and HALE. We examined changes in these indicators in China from 1990 to 2021, comparing them with global averages and across five SDI regions. Using Joinpoint Regression Software, we analyzed trends in the top ten cause-specific DALY rates in 2021. Furthermore, we employed the Bayesian Age-Period-Cohort model to forecast age-standardized rates (ASR) of mortality for the next decade.

RESULTS

China witnessed a decrease in the ASRs of mortality (1198.16/100,000 [1098.61-1294.10] to 644.68/100,000 [555.12-735.51]) and DALYs (43085.42/100,000 [39330.62-47273.39] to 22717.19/100,000 [19748.18-25903.34]) from 1990 to 2021. During the COVID-19 pandemic, the ASRs of mortality and DALY declined in China (23009.47/100,000 [19661.21-26495.58] in 2019), but global rates and those across the five SDI (Socio-demographic Index) regions increased. Projections indicate a continued decline in the ASRs of mortality over the next decade, from 2019 to 2035 and 2021 to 2035. Notably, DALY rates for the top 10 level 2 causes in 2021 decreased over the past three decades, except for musculoskeletal disorders (AAPC% 95%CI, 0.10 [0.07-0.14], men; 0.05 [-0.02-0.13], women) and sense organ diseases (AAPC% 95%CI, 0.38 [0.33-0.43], men; 0.35 [0.30-0.41], women). LE and HALE increased across all age groups in China over the same period, although there was no significant change in the HALE/LE ratio.

CONCLUSION

Effective policy implementation and technological advancements could play a crucial role in alleviating disease burdens associated with aging in China, thereby reducing the country's all-cause mortality rate and enhancing the quality of life for its residents.

Functional outcomes following injury in centenarians: a nationwide retrospective observational study

BACKGROUND

Advances in healthcare and the development of various technologies have improved disease-free longevity. Although the number of healthy centenarians is gradually increasing, studies on postinjury functions among centenarians are lacking. Therefore, we aimed to determine the clinical predictors of mortality and unfavorable functions after injury among centenarians.

METHOD

A retrospective study was conducted using a nationwide trauma database, and data from patients aged ≥ 100 years across ≥ 250 institutions during 2019-2022 were analyzed. Patient demographics, comorbidities, mechanism of injury, injury severity, vital signs on arrival, and pre- and in-hospital treatments were compared between survivors and non-survivors as well as between survivors who had and did not have the ability to live independently at discharge, which was defined as Glasgow Outcome Scale (GCS) score of ≤ 3. Independent predictors of in-hospital mortality and unfavorable functions after injury were examined using a generalized estimating equation model to account for institutional and regional differences in the management and characteristics of centenarians.

RESULTS

Of the 409 centenarians, 384 (93.9%) survived to discharge. Although 208 (50.9%) patients had lived independently before the injury, only 91 (22.2%) could live independently at discharge. All patients had blunt injury, and fall from standing was the most frequent (86.6%) mechanism. The injury severity score was 10 ± 5, and surgery/angiography was performed in < 2% of the centenarians, except for fracture fixation in the extremity/pelvis, which was conducted in 225 (55.0%) patients. The adjusted model revealed three independent predictors of in-hospital mortality: male gender, mechanism of injury other than fall from standing, and GCS score on arrival. In contrast, only injury severity in the extremity/pelvis was an independent predictor of unfavorable functions after injury.

CONCLUSION

Male gender, mechanisms of injury other than fall from standing, and GCS on arrival were associated with higher in-hospital mortality. Injury severity in the extremity/pelvis was related to dependent living after injury among centenarians.

Lifestyle behaviours and physical, psychological, and cognitive multimorbidity among older hypertensive population in remote areas of China

OBJECTIVES

With the intensification of aging, the proportion of people affected by multimorbidity is steadily increasing worldwide. In remote areas of China, where economic development is lagging and healthcare resources are limited, the older hypertensive population may experience a higher burden of multimorbidity. However, comprehensive evidence is still lacking on how specific combinations of lifestyle behaviours (LBs) impact particular multimorbidity health outcomes in older hypertensive individuals.

STUDY DESIGN

A cross-sectional study was conducted among the older hypertensive population (aged ≥65 years) from 1 July to August 31, 2023 in Jia County, a remote area of China.

METHODS

A total of 40 diseases were categorized into physical, psychological and cognitive disorders. Multivariable-adjusted logistic regression models were used to estimate ORs and 95 % CIs for the associations between LBs and multimorbidity.

RESULTS

Among 17,728 participants, the prevalence of physical, psychological, cognitive, physical-psychological multimorbidity (PPsM), physical-cognitive multimorbidity (PCM), psychological-cognitive multimorbidity (PsCM), and physical-psychological-cognitive multimorbidity (PPsCM) were 63.55 %, 30.12 %, 64.55 %, 22.31 %, 42.03 %, 22.57 %, and 16.74 %, respectively. Compared to participants without any healthy LBs, those with five healthy LBs were associated with a lower risk of physical, psychological, cognitive, PPsM, PCM, PsCM, and PPsCM. Overall, the risk of adverse outcomes decreased with the number of healthy LBs (Ptrend<0.001). However, combinations of healthy LBs of the same quantity but from different categories exhibited varying impacts on the outcomes.

CONCLUSIONS

Multimorbidity involving physical, psychological, and cognitive disorders poses a significant challenge for managing hypertention. Strengthening the capacity of primary healthcare workers to promote healthy lifestyle practices and identifying the optimal LB combinations should be prioritized in the management of hypertensive individuals in remote areas of China.

Sport and longevity: an observational study of international athletes

The human lifespan is influenced by various factors, with physical activity being a significant contributor. Despite the clear benefit of exercise on health and longevity, the association between different types of sports and lifespan is yet to be considered. Accordingly, we aimed to study this association in a large international cohort of former athletes using a robust linear regression model. We collected data on athletes from public sources, accumulating a total of 95,210 observations, 95.5% of which were accounted for by males. The dataset represented athletes born between 1862 and 2002 from 183 countries across 44 sports disciplines. We calculated the change in lifespan by measuring the difference in age between athletes and the corresponding reference populations, while accounting for variations caused by sex, year of death, and country. The results revealed that various sports impacted lifespan differently, with male athletes being more likely to experience benefits from sports than female athletes. Among male athletes, pole vaulting and gymnastics were linked to the highest extension in lifespan (8.4 years, 95% CI [6.8, 9.9] and 8.2 years, 95% CI [7.4, 9], respectively), while volleyball and sumo wrestling were the most negatively associated with lifespan (- 5.4 years, 95% CI [- 7, - 3.8]; - 9.8 years, 95% CI [- 11, - 8.6], respectively). The association between lifespan and popular team sports in males was positive for cricket, rowing, baseball, water polo, Australian rules, hurling, lacrosse, field hockey, minimal for rugby, canoeing and kayaking, basketball, gridiron football, and football (soccer), and negative for handball and volleyball. Racquet sports (i.e., tennis and badminton) exhibited a consistent and positive association in both male and female athletes, as shown by an extended lifespan of up to 5.7 years in males (95% CI [5, 6.5]) and 2.8 years in females (95% CI [1.8, 3.9]). Although lacking conclusive evidence, we theorize that the observed results may be attributed to the aerobic and anaerobic characteristics of each sport, with mixed sports yielding the maximum benefits for the lifespan. While results from female athletes should be cautiously interpreted, our study highlights the complex interplay between sports and lifespan and contributes to the growing body of knowledge on the multifaceted relationship between physical activity and human longevity.

Osteoporosis risk and its association with all-cause and cause-specific mortality among the elderly: a 16-year nationwide cohort study

BACKGROUND

Aged osteoporosis poses a significant threat to the well-being and longevity of older individuals, yet evidence regarding the relationship between osteoporosis risk and mortality among the elderly population in Asia remains unknown.

AIMS

Our study aimed to investigate associations between osteoporosis risk and all-cause mortality, as well as cause-specific mortality, among the Chinese elderly population.

METHODS

Pooled data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted between 2002 and 2018 were utilized to analyze the associations between osteoporosis risk and all-cause, heart disease, cardiovascular disease (CVD), respiratory disease, and cancer mortality. Cox proportional hazards models were employed for this analysis. Osteoporosis risk was assessed using the Osteoporosis Self-Assessment Tool for Asians (OSTA). Restricted cubic spline (RCS) functions were applied to explore the nonlinear relationship between OSTA and mortality. The robustness of the Cox models was evaluated through internal verification, subgroup analyses, and sensitivity analyses.

RESULTS

A total of 12,711 elderly individuals aged ≥ 65 years were included for analysis at baseline. During a 16-year follow-up, 7,963 individuals in the cohort were identified as deceased. Compared to those with low osteoporosis risk, elderly individuals with high osteoporosis risk demonstrated a significantly elevated risk of all-cause, heart disease, CVD, respiratory disease and cancer mortality. The relationship between OSTA level and all-cause and cause-specific mortality exhibited a significant L-shaped pattern.

CONCLUSIONS

The risk of osteoporosis is independently associated with the prediction of mortality. The OSTA may serve as a suitable predictor for mortality related to osteoporosis among the Asian population.

Digital Multidomain Lifestyle Intervention for Community-Dwelling Older Adults: A Mixed Methods Evaluation

Objectives

As life expectancy rises at a faster rate than healthy life expectancy, there is a global need for scalable and cost-effective interventions that enhance the health-related quality of life of older adults. This study aimed to examine the user experience and usability of a 12-week digital multidomain lifestyle intervention in community-dwelling older adults aged 65 years and above.

Methods

The intervention was developed involving older adults and delivered through a mobile application (app) focusing on physical activity, nutrition, sleep and mindfulness/relaxation. We used a mixed methods sequential explanatory approach to evaluate the user experience and usability of the intervention. We delivered online questionnaires before and after the intervention, collected app usage data and conducted semi-structured interviews.

Results

One hundred eight older adults participated in the study. Fifty-six percent of participants completed the 12-week intervention. Users who completed the intervention experienced it as highly satisfactory and rated the usability as high. User engagement was particularly high for the physical activity content.

Conclusion

Although participant retention can be a challenge, a digital multidomain lifestyle intervention developed involving community-dwelling older adults can lead to positive user experience and high usability.

Association of healthy lifestyle and the incidence of atrial fibrillation in senior adults: a prospective cohort study

BACKGROUND

Limited evidence was available on the association of the integrated effect of multidimensional lifestyle factors with AF incidence among Chinese old adults. This cohort study was to examine the effect of combined lifestyle factors on AF risk among Chinese older adults.

METHODS

A total of 3,253 adults aged 60 years or more from the Guangzhou Heart Study were successfully followed up. The healthy lifestyle score (HLS) was established using a weighted approach from seven dimensions of lifestyles, including diet quality, leisure-time physical activity, sleep quality, alcohol drinking, smoking, mental status, and waist-to-hip ratio. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated using the Cox proportional hazard regression model.

RESULTS

During a median of 31.13 months of follow-up, 76 (2.34%) new-onset of AF were observed. After adjustment for confounders, HLS was associated with a 46% (HR: 0.54, 95% CI: 0.32-0.93) reduced AF risk when comparing the high with low tertiles of weight HLS, with an exposure-response trend. Every 0.1-unit increment of HLS was associated with 49% reduced AF risk. The protective effect of HLS on AF incidence was remarkable in the young-old (HR: 0.47, 95% CI: 0.29-0.79) but not in the old-old (HR: 0.85, 95% CI: 0.29-2.48), when comparing the high with low tertiles.

CONCLUSION

The results suggest that higher HLS was associated with lower AF incidence among Chinese old adults, and the findings highlight the need to consider multi-dimensional lifestyles when developing health promotion strategies to lower the risk of new-onset AF the risk of new-onset AF.

The centenarian blueprint: lessons in defying Parkinson's disease

Recent advancements in neurology have shifted focus from mere diagnosis to comprehensive management of movement disorders, particularly Parkinson's Disease (PD), which is rapidly increasing in prevalence due to global ageing trends. While age is a key risk factor for PD, centenarians often exhibit a remarkably low prevalence of the disease, presenting an intriguing paradox. This viewpoint explores potential reasons for this low prevalence, drawing on studies from regions with high centenarian populations, known as Blue Zones. The authors highlight the importance of genetic, lifestyle, and environmental factors in promoting healthy ageing and examines how these may contribute to the resilience against PD found in centenarians. By understanding the protective mechanisms in centenarians, particularly the concept of hormesis and factors like diet, exercise, and social connections, we may inform prevention strategies for PD. The study proposes the "EAT, MOVE, SLEEP, PROTECT, and REPEAT" approach as a framework for lifestyle interventions to counteract PD risk factors. Ultimately, centenarians offer valuable insights into delaying neurodegeneration, providing a model for potential preventive trials for PD.

Combined healthy lifestyle behaviors and all-cause mortality risk in middle-aged and older US adults: A longitudinal cohort study

BACKGROUND

While various lifestyle behaviors separately or partly have been shown to be associated with health outcomes, including a multitude of diseases and death, none of the earlier research has comprehensively investigated the combined impact of modified lifestyle behaviors. This longitudinal study investigated the association between a composite of healthy lifestyle behaviors and all-cause mortality in middle-aged and older Americans.

METHODS

We utilized data from the National Health and Nutrition Examination Survey from 2007 to 2018, as well as relevant mortality data, applying the Healthy Lifestyle Score1 (HLS) index to assess healthy lifestyle behaviors, defined by no smoking, moderate alcohol, appropriate sleep, a balanced diet, adequate physical activity, and limited sedentary time. Weighted multivariate Cox proportional hazards analyses were applied to investigate the associations between these lifestyle practices and overall mortality, followed by stratified analyses to explore potential effect modifications by subgroups.

RESULTS

This study included 5448 participants, categorized into unfavorable (28%), intermediate (56%), and favorable (16%) HLS groups. During a median 103-month follow-up, 388 participants died. Cox regression revealed that individuals with favorable lifestyles had a reduced likelihood of death than those with unfavorable lifestyles (HR = 0.49, 95% CI: 0.34-0.70). There was a linear negative relationship established between HLS and the likelihood of all-cause death (p for non-linearity = 0.0512).

CONCLUSION

Adherence to a composite of healthy habits is linearly and substantially related to decreasing the likelihood of all-cause mortality among the elderly in the U.S., highlighting the substantial benefits of maintaining these behaviors for longevity and health.

Comparison of Nutrient Intake Across Different Dietary Patterns in Brazilian Community-Dwelling Older Adults

BACKGROUND/OBJECTIVES

Dietary patterns are able to capture the complexity of the diet. The present study aimed to compare the nutrient intake across different dietary patterns in Brazilian community-dwelling older adults.

METHODS

Dietary patterns from 295 (predominantly women, 85%) of Brazilian community-dwelling older adults were identified using principal component analysis, based on a 24 h dietary recall (24HR). The following patterns were identified: the "traditional" pattern (consisting of in natura or minimally processed food); the "modified" pattern (consisting of processed foods, confectionery), and the "snack" pattern (composed of coffee, whole milk, bread, toast, butter, or margarine). Participants were divided into three tertiles according to their scores in each pattern. A comparison of energy and nutrient intake across the tertiles of the three patterns was analyzed using the Kruskal-Wallis rank sum test. Then, the intake of energy and macro and micronutrients were analyzed.

RESULTS

Older adults with higher scores for the "traditional" pattern had significantly higher intakes of total energy, all macronutrients, beta-carotene, vitamin C, E and K, thiamine, pyridoxine, and total folate (p < 0.05). Participants with higher scores for the "modified" pattern had significantly higher intakes of total energy, added sugar, total and animal protein, leucine, arginine, monounsaturated fat, cholesterol, niacin, and pyridoxine; the second tertile had lower vitamin A than the first tertile (p < 0.05). Finally, older adults with higher scores for the "snack" pattern had significantly lower intakes of total and insoluble fiber, animal and vegetable proteins, vitamins (A, E, and K), niacin, and pyridoxine (p < 0.05). The "Traditional" pattern exhibited the most appropriate dietary pattern regarding the availability of essential nutrients, resulting in a better quality of habitual intake and outcomes that are related to health promotion and reduction in the risk of non-chronic issues.

CONCLUSIONS

The results reinforce the importance of public policies that encourage the maintenance of the traditional Brazilian dietary pattern, which is in alignment with Brazilian Dietary Guidelines, especially in the older population.

Physical activity, Vitamin D, and all-cause/cardiovascular mortality: a prospective study in older Chinese adults

BACKGROUND

Physical activity was associated with the risk of all-cause and cardiovascular mortality. However, little is known about older adults, especially those aged over 80 years.

METHODS

2863 older adults in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were enrolled. Physical activity score was used to evaluate the physical activity. Serum 25-hydroxyvitamin D and demographic characteristics were collected at baseline. We used multivariable-adjusted Cox regression models and stratified analysis to determine the association between physical activity, vitamin D and all-cause/cardiovascular mortality. Mediation analysis was performed to evaluate the mediating effect of vitamin D between physical activity and all-cause/cardiovascular mortality.

RESULTS

The median age of this population was 87 years, and 70.27% were the oldest-old (age ≥ 80 years). We observed a tendency for a higher vitamin D concentration in participants with higher physical activity score levels. Both physical activity and vitamin D levels were inversely associated with all-cause and cardiovascular mortality in all participants. Between physical activity and all-cause/cardiovascular mortality, the mediation proportions of vitamin D were 7.76% (P < 0.001) and 4.13% (P < 0.001), respectively. The mediating effect of vitamin D remained all significant in various types of physical activities. Furthermore, vitamin D accounted for a greater mediating proportion in the physical activities of housework and raising domestic animals/pets.

CONCLUSIONS

Physical activity could reduce the risk of all-cause/cardiovascular mortality and was mediated by vitamin D in older Chinese adults.

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.

Association between window ventilation frequency and depressive symptoms among older Chinese adults

OBJECTIVES

Indoor air pollution exposure is harmful to people's physical and mental health, especially in the elderly population. Depressive symptoms are the most common mental health issue among elderly individuals. However, evidence linking the frequency of indoor natural ventilation to depressive symptoms in the elderly population is limited.

METHODS

This study included 7887 individuals 65 years and older from 2017 to 2018 the China Longitudinal Healthy Longevity Survey (CLHLS). The frequency of indoor window ventilation was measured as the self-reported times of ventilation of indoor window per week in each season, and the four seasons' scores were added up to calculate the annual ventilation frequency. Depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Short Depression Scale (CESD). Using three models adjusted for demographic, socio-economic, health status, and environmental factors successively, the correlation between indoor window ventilation frequency and depressive symptoms was verified through logistic regression.

RESULTS

Among the 7887 elderly people included in this study, 1952 (24.7 %) had depressive symptoms. In the fully adjusted model, compared with the lower indoor annual ventilation frequency group, high indoor annual ventilation frequency group was significantly associated with a 33 % (OR: 0.67, 95%CI: 0.51-0.88) lower probability of depressive symptoms. Subgroup analysis and sensitivity analysis yielded similar results.

CONCLUSIONS

High frequency of window ventilation is significantly associated with the lower risk of depressive symptoms in Chinese individuals aged 65 and older. This result provides strong evidence for health intervention and policy formulation.

Climbing the longevity pyramid: overview of evidence-driven healthcare prevention strategies for human longevity

Longevity medicine is an emerging and iterative healthcare discipline focusing on early detection, preventive measures, and personalized approaches that aim to extend healthy lifespan and promote healthy aging. This comprehensive review introduces the innovative concept of the "Longevity Pyramid." This conceptual framework delineates progressive intervention levels, providing a structured approach to understanding the diverse strategies available in longevity medicine. At the base of the Longevity Pyramid lies the level of prevention, emphasizing early detection strategies and advanced diagnostics or timely identification of potential health issues. Moving upwards, the next step involves lifestyle modifications, health-promoting behaviors, and proactive measures to delay the onset of age-related conditions. The Longevity Pyramid further explores the vast range of personalized interventions, highlighting the importance of tailoring medical approaches based on genetic predispositions, lifestyle factors, and unique health profiles, thereby optimizing interventions for maximal efficacy. These interventions aim to extend lifespan and reduce the impact and severity of age-related conditions, ensuring that additional years are characterized by vitality and wellbeing. By outlining these progressive levels of intervention, this review offers valuable insights into the evolving field of longevity medicine. This structured framework guides researchers and practitioners toward a nuanced strategic approach to advancing the science and practice of healthy aging.

Optimal lifestyle patterns for delaying ageing and reducing all-cause mortality: insights from the UK Biobank

BACKGROUND

With the rapid aging of the global population, identifying lifestyle patterns that effectively delay aging and reduce mortality risk is of paramount importance. This study utilizes the UK Biobank to analyze the associations of the Dietary Inflammatory Index, physical activity, and sleep on biological aging and all-cause mortality.

METHODS

A prospective cohort study was conducted using data from over half a million UK Biobank participants. Two datasets were created by subjective and objective measurements of physical activity: the Subjective Physical Activity (SPA) and Objective Physical Activity (OPA) datasets. Lifestyle patterns, including diet habits, exercise levels, and sleep quality, were assessed within these datasets. Biological aging was quantified using validated methods, including Homeostatic Dysregulation, Klemera-Doubal Method Biological Age, Phenotypic Age, and Telomere Length. All-cause mortality data were obtained from the National Health Service. Statistical analyses included weighted linear regression and Cox proportional hazard models, adjusted for a range of covariates.

RESULTS

The findings indicate that, in most cases, maintaining an anti-inflammatory diet, engaging in at least moderate physical activity, and ensuring healthy sleep conditions are associated with delayed physiological aging (Cohen's d ranging from 0.274 to 0.633) and significantly reduced risk of all-cause mortality (HR-SPA: 0.690, 95% CI: 0.538, 0.884; HR-OPA: 0.493, 95% CI: 0.293, 0.828). These effects are particularly pronounced in individuals under 60 years of age and in women. However, it was observed that the level of physical activity recommended by the World Health Organization (600 MET-minutes/week) does not achieve the optimal effect in delaying biological aging. The best effect in decelerating biological aging was seen in the high-level physical activity group (≥ 3000 MET-minutes/week). The study also highlights the potential of biological age acceleration and telomere length as biomarkers for predicting the risk of mortality.

CONCLUSIONS

Choosing healthy lifestyle patterns, especially an anti-inflammatory diet, at least moderate physical activity, and healthy sleep patterns, is crucial for delaying aging and reducing mortality risk. These findings support the development of targeted interventions to improve public health outcomes. Future research should focus on objective assessments of lifestyle to further validate these associations.

Change in Healthy Lifestyle and Subsequent Risk of Cognitive Impairment Among Chinese Older Adults: A National Community-Based Cohort Study

BACKGROUND

The association between change in lifestyle and cognitive impairment remains uncertain.

OBJECTIVES

To investigate the association of change in lifestyle with cognitive impairment.

METHODS

In this study, 4 938 participants aged 65 or older were involved from the Chinese Longitudinal Healthy Longevity Survey for years 2008-2018. A weighted healthy lifestyle score was derived from 4 lifestyle factors (smoking, alcohol consumption, physical activity, and diet). Multivariable Cox proportional hazards regression models were applied to investigate the associations between 3-year changes in healthy lifestyle (2008-2011) and cognitive impairment (2011-2018).

RESULTS

Researchers documented 833 new-onset of cognitive impairments more than 20 097 person-years of follow up. Compared with those in the persistently unhealthy group, those in the improved and persistently healthy groups had a lower risk of cognitive impairment, with the multivariate-adjusted hazard ratios (HRs) of 0.67 (95% confidence interval (CI): 0.55, 0.83) and 0.53 (95% CI: 0.40, 0.71), respectively. Furthermore, a significant interaction was observed between change in lifestyle and sex (p-interaction = .032); the HRs were 0.48 (95% CI, 0.34, 0.69) for the improved group and 0.41 (95% CI: 0.26, 0.64) for persistently healthy group among male vs 0.81 (95% CI, 0.63, 1.04) and 0.64 (95% CI, 0.44, 0.92) among female, respectively.

CONCLUSIONS

This study suggests that improving or maintaining a healthy lifestyle can significantly mitigate the risk of cognitive impairment in Chinese older adults. Additionally, researcher's findings emphasize the significance of maintaining a healthy lifestyle and highlights the potential positive impact of improving previous unhealthy habits, especially for older women.

Association of lifestyles and multimorbidity with mortality among individuals aged 60 years or older: Two prospective cohort studies

Lifestyles are associated with all-cause mortality, yet limited research has explored the association in the elderly population with multimorbidity. We aim to investigate the impact of adopting a healthy lifestyle on reducing the risk of all-cause mortality in older individuals with or without multimorbidity in both China and UK. This prospective study included 29,451 and 173,503 older adults aged 60 and over from Chinese Longitudinal Healthy Longevity Survey (CLHLS) and UK Biobank. Lifestyles and multimorbidity were categorized into three groups, respectively. Cox proportional hazards regression was used to estimate the Hazard Ratios (HRs), 95% confidence intervals (95% CIs), and dose-response for all-cause mortality in relation to lifestyles and multimorbidity, as well as the combination of both factors. During a mean follow-up period of 4.7 years in CLHLS and 12.14 years in UK Biobank, we observed 21,540 and 20,720 deaths, respectively. For participants with two or more conditions, compared to those with an unhealthy lifestyle, adopting a healthy lifestyle was associated with a 27%-41% and 22%-42% reduction in mortality risk in the CLHLS and UK Biobank, respectively; Similarly, for individuals without multimorbidity, this reduction ranged from 18% to 41%. Among participants with multimorbidity, individuals with an unhealthy lifestyle had a higher mortality risk compared to those maintaining a healthy lifestyle, with HRs of 1.15 (95% CI: 1.00, 1.32) and 1.27 (95% CI: 1.16, 1.39) for two conditions, and 1.24 (95% CI: 1.06, 1.45) and 1.73 (95% CI: 1.56, 1.91) for three or more conditions in CLHLS and UK Biobank, respectively. Adherence to a healthy lifestyle can yield comparable mortality benefits for older individuals, regardless of their multimorbidity status. Furthermore, maintaining a healthy lifestyle can alleviate the mortality risks linked to a higher number of diseases.

Experiences of older adults participating in dance exergames: A systematic review and meta-synthesis

BACKGROUND

Interventions to encourage adequate physical activity amongst older adults have had limited long-term success. Dancing and exergames, two beneficial and enjoyable physical activities for older adults, may make regular exercise more interesting and effective. Dance exergames are physical exercises that integrate sensory, cognitive, psychological, and physical functions by requiring users to interact with game scenarios through deliberate body motions and receive real-time feedback. They provide an inherently enjoyable gaming and workout experience, which may boost exercise adherence. However, little is known about older adults' experiences with dance exergames.

OBJECTIVE

To synthesise the qualitative experiences of older adults participating in dance exergames.

DESIGN

Systematic review and meta-synthesis.

METHODS

Dance exergame studies (peer-reviewed and grey literature) involving older adults in any setting published in English from inception to 17 August 2023 were included. Qualitative or mixed-method studies must use immersive or non-immersive virtual-reality platforms. PubMed, Scopus, CINAHL, The Cochrane Library, ProQuest Dissertations & Theses Global, Google Scholar, and reference lists of relevant studies and reviews were searched for eligible studies. The search strategy for Scopus was: (TITLE-ABS-KEY (danc*) AND TITLE-ABS-KEY (exergames OR exergame OR video AND games OR virtual AND reality) AND TITLE-ABS-KEY (older AND adults OR elderly OR seniors OR geriatrics)). Thematic synthesis by Thomas and Harden was used for meta-synthesis.

RESULTS

Eleven studies (n = 200 older adults) were included. Three themes and 14 subthemes were synthesised: 1) Dance exergames as dual-task training for physical, cognitive, and psychological well-being, 2) Concerns on usability issues, and 3) Possible enhancements of dance exergames. Older adults recognised that dance exergames could improve their physical, cognitive, and psychological well-being. Existing dance exergame systems had several usability issues. For example, some older adults were unfamiliar with using new technology and had trouble in navigating the game systems. The older adults also provided various suggestions for adaptation to their age group, such as ensuring a variety of dances, difficulty levels suited for older adults' cultural backgrounds, and physical and cognitive capabilities.

CONCLUSIONS

Dance exergames may be an attractive way to encourage older adults to exercise, but appropriate modifications are needed. When designing/selecting dance exergames for older persons, researchers, healthcare professionals, and senior care centres should consider using exergames that have simple designs, varied dances that are locally adapted, and appeal to a large proportion of older adults.

REGISTRATION

PROSPERO CRD42023395709.

The relationship between healthy lifestyles and cognitive function in Chinese older adults: the mediating effect of depressive symptoms

BACKGROUND

Previous studies have proven the positive relationship between healthy lifestyles and cognitive function in older adults. However, the specific impacts and mechanisms require further investigation. Therefore, this study aimed to investigate whether healthy lifestyles and cognitive function were associated with Chinese older adults and whether depressive symptoms mediated their association.

METHODS

8272 valid samples were included using the latest data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Pearson's test was applied to investigate the relationship between the key variables. Regression models were employed to examine the mediating effects of healthy lifestyles, using Sobel's test and the bootstrap method to confirm path effects.

RESULTS

There was a significant correlation between healthy lifestyles, depressive symptoms, and cognitive function (p < 0.01). Healthy lifestyles directly impact cognitive function (β = 0.162, p < 0.01). Healthy lifestyles had a significant effect on depressive symptoms (β=-0.301, p < 0.01), while depressive symptoms have a significant impact on cognitive function (β=-0.108, p < 0.01). Depressive symptoms partially mediated the effect of healthy lifestyles on cognitive function (β = 0.032, p < 0.01). The Sobel and bootstrap tests confirmed the robustness of the regression analysis results.

CONCLUSION

Depressive symptoms mediate the relationship between healthy lifestyles and cognitive function. Our findings suggest that prevention strategies for cognitive impairment in older adults should focus on healthy lifestyles and mental health.

The Effects of a Healthy Lifestyle on Depressive Symptoms in Older Chinese Adults: The Mediating Role of Psychological Resilience

Objectives This study aimed to validate the interrelationships and potential pathways of influence between healthy lifestyles, psychological resilience, and depressive symptoms in the Chinese elderly population. Methods We utilized data from the Chinese Elderly Health Influential Factors Tracking Survey 2018 and included 9448 samples for the study after screening according to the qualifying conditions. The interrelationships among healthy lifestyles, psychological resilience and depressive symptoms were analyzed using stepwise regression, and the robustness of mediation effects was assessed using Sobel and Bootstrap test. Results Among Chinese older adults, healthy lifestyles were negatively associated with depressive symptoms (β = -0.310, 95% CI: -0.405, -0.215), positively associated with psychological resilience (β = 0.137, 95% CI:0.071, 0.023), and psychological resilience was negatively associated with depressive symptoms (β = -1.014, 95% CI: -1.037, -0.990). Conclusions Psychological resilience partially mediated the association between healthy lifestyles and depressive symptoms, with the mediating effect accounting for 44.8% of the total effect. Our study contributes to the understanding of the relationship between healthy lifestyles and depressive symptoms in the elderly population and emphasizes the important role of psychological resilience. It is recommended that the government and policymakers improve depressive symptoms among older adults through comprehensive measures such as promoting healthy lifestyles and education, providing psychological support services, and creating a favorable environment.

Cardiovascular health and life expectancy with and without cardiovascular disease in the middle-aged and elderly Chinese population

BACKGROUND

High cardiovascular health (CVH) was associated with lower risk of cardiovascular disease (CVD) and longer life expectancy. However, whether life years lived without CVD could increase faster than or at least at the same pace as total lifespan remains unknown. We aimed to explore the associations of CVH status with total life expectancy and life years lived with and without CVD among middle-aged and elderly men and women.

METHODS

We included 65,587 participants aged ≥ 45 years from Kailuan study, who were recruited during June 2006 to October 2007. CVH was scored and classified (low [0-49 points], moderate [50-79 points] and high [80-100 points]) with Life's Essential 8, incorporating evaluations of health behaviors and factors. All-cause mortality and incident non-fatal CVD were recorded from baseline to December 31, 2020. The multi-state life table was adopted to explore the associations of CVH status with total life expectancy and life years lived with and without CVD.

RESULTS

Six thousand fifty eight cases of incident non-fatal CVD and 10,580 cases of deaths were identified. Men aged 45 years with low, moderate, and high CVH had a life expectancy of 33.0, 36.5 and 38.5 years, of which 7.8 (23.6%), 6.0 (16.3%) and 3.7 years (9.6%) were spent with CVD. For women, the corresponding life expectancy was 36.6, 43.6 and 48.6 years, and the remaining life years lived with CVD were 7.8 (21.3%), 6.0 (13.7%) and 4.5 years (9.3%), respectively. The benefits of high CVH were persistent across lifespan from age 45 to 85 years and consistent when CVH was evaluated with health behaviors and factors alone.

CONCLUSIONS

High CVH compared with low CVH was associated with longer total life expectancy and fewer years spent with CVD, indicating that promoting CVH is of great importance for CVD prevention and healthy ageing in China.