Economic and social implications of aging societies

Development of a Printed Sensor and Wireless Measurement System for Urination Monitoring

The development of reliable and efficient sensors is essential for advances in health monitoring technologies. This study focused on the fabrication and evaluation of a multichannel printed sensor electrode designed for long-term stability and effective data acquisition. Using rapid printing technology, we created a urine sensor array with extended electrodes for the measurement of urine volume and frequency. The ultrathin design of the sensor electrode, with an average thickness of only 30 microns, ensures both user comfort and measurement accuracy. The sensor electrode dimensions were meticulously designed, measured, and optimized through successful trial manufacturing of the sensor electrode and sensor array. Comprehensive evaluation of the fabricated sensor demonstrated excellent performance, including a high response speed of ≤1 s and long-term stability exceeding 5 weeks. In addition, wireless transmission capabilities and user interfaces were developed for field experiments. Finally, animal experiments were performed to evaluate the field performance of the fabricated sensor. Accordingly, we are confident that the sensor developed herein will contribute to enhancing healthcare in an aging society.

Artificial Intelligence in the Management of Heart Failure

Artificial intelligence (AI) has the potential to revolutionize the management of heart failure. AI-based tools can guide the diagnosis and treatment of known risk factors, identify asymptomatic structural heart disease, improve cardiomyopathy diagnosis and symptomatic heart failure treatment, and uncover patients transitioning to advanced disease. By integrating multimodal data, including omics, imaging, signals, and electronic health records, state-of-the-art algorithms allow for a more tailored approach to patient care, addressing the unique needs of the individual. The past decade has led to the development of numerous AI solutions targeting each aspect of the heart failure syndrome. However, significant barriers to implementation remain and have limited clinical uptake. Data-privacy concerns, real-world model performance, integration challenges, trust in AI, model governance, and concerns about fairness and bias are some of the topics requiring additional research and the development of best practices. This review highlights progress in the use of AI to guide the diagnosis and management of heart failure while underscoring the importance of overcoming key implementation challenges that are currently slowing progress.

Forecasting Subjective Cognitive Decline: AI Approach Using Dynamic Bayesian Networks

BACKGROUND

Several potentially modifiable risk factors are associated with subjective cognitive decline (SCD). However, developmental patterns of these risk factors have not been used before to forecast later SCD. Practical tools for the prevention of cognitive decline are needed.

OBJECTIVE

We examined multifactorial trajectories of risk factors and their associations with SCD using an artificial intelligence (AI) approach to build a score calculator that forecasts later SCD. In addition, we aimed to develop a new risk score tool to facilitate personalized risk assessment and intervention planning and to validate SCD against register-based dementia diagnoses and dementia-related medications.

METHODS

Five repeated surveys (2000-2022) of the Helsinki Health Study (N=8960; n=7168, 80% women, aged 40-60 years in phase 1) were used to build dynamic Bayesian networks for estimating the odds of SCD. The model structure was developed using expert knowledge and automated techniques, implementing a score-based approach for training dynamic Bayesian networks with the quotient normalized maximum likelihood criterion. The developed model was used to predict SCD (memory, learning, and concentration) based on the history of consumption of fruit and vegetables, smoking, alcohol consumption, leisure time physical activity, BMI, and insomnia symptoms, adjusting for sociodemographic covariates. Model performance was assessed using 5-fold cross-validation to calculate the area under the receiver operating characteristic curve. Bayesian credible intervals were used to quantify uncertainty in model estimates.

RESULTS

Of the participants, 1842 of 5865 (31%) reported a decline in memory, 2818 of 5879 (47.4%) in learning abilities, and 1828 of 5888 (30.7%) in concentration in 2022. Physical activity was the strongest predictor of SCD in a 5-year interval, with an odds ratio of 0.76 (95% Bayesian credible interval 0.59-0.99) for physically active compared to inactive participants. Alcohol consumption showed a U-shaped relationship with SCD. Other risk factors had minor effects. Moreover, our validation confirmed that SCD has prognostic value for diagnosed dementia, with individuals reporting memory decline being over 3 times more likely to have dementia in 2017 (age 57-77 years), and this risk increased to more than 5 times by 2022 (age 62-82 years). The receiver operating characteristic curve analysis further supported the predictive validity of our outcome, with an area under the curve of 0.78 in 2017 and 0.75 in 2022.

CONCLUSIONS

A new risk score tool was developed that enables individuals to inspect their risk profiles and explore potential targets for interventions and their estimated contributions to later SCD. Using AI-driven predictive modeling, the tool can aid health care professionals in providing personalized prevention strategies. A dynamic decision heatmap was presented as a communication tool to be used at health care consultations. Our findings suggest that early identification of individuals with SCD could improve targeted intervention strategies for reducing dementia risk. Future research should explore the integration of AI-based risk prediction models into clinical workflows and assess their effectiveness in guiding lifestyle interventions to mitigate SCD and dementia.

Implementation and acceptability of the Caregiver Care Model in general practice: a mixed-method feasibility study

BACKGROUND

Being a caregiver can be demanding. Therefore, we developed the Caregiver Care Model for general practice. The model consists of a mandatory dialogue questionnaire, which is used to identify support needs in caregivers, grief-facilitating questions, and an overview of community-based caregiver initiatives for caregivers in need of support. We aimed to test the implementation and acceptability of the model in general practice.

METHODS

We used a fixed, convergent, mixed-methods approach to test the model in five general practices in the Central Denmark Region among 40 caregivers. Quantitative data included monitoring data collected by health professionals in an online database at inclusion and after each consultation. Qualitative data were derived from five introductory meetings and semi-structured interviews with ten health professionals. The analysis focused on the implementation (delivery and process) and the health professionals' acceptability of the model.

RESULTS

All 40 caregivers participated in the first consultation, and 29 (73%) had two or more consultations. Eight caregivers (20%) were referred to community-based initiatives or a private-practice psychologist. The mandatory dialogue questionnaire was completed by 30 (75%) caregivers prior to the first consultation, and it was rated useful by general practitioners (GPs) and staff in 26 (74%) of encounters. GPs and staff perceived the dialogue questionnaire to be useful to direct the first consultations towards the most relevant issues, whereas the usefulness of the facilitating questions was unclear due to the brief introduction to them. The list of community-based initiatives was considered useful in urban areas, but not in rural areas with long distance to initiatives. Here, support from general practice was needed to promote mental health in caregivers and avoid sick leave.

CONCLUSION

The Caregiver Care Model was in line with core values of general practice and the dialogue questionnaire targeted the consultations on relevant issues for the caregiver. Health professionals provided targeted support, including follow-up consultations and referred a group for community-based initiatives, especially caregivers in urban settings. The findings call for increased focus on caregivers and education of general practitioners and staff to facilitate caregiver reactions in connection with loss and grief.

Capturing Potential Interventions for the Empowerment of Older People and Informal Caregivers in Transitional Care Decision-Making: A Qualitative Study Using Focus Groups

AIM

To capture older people's, informal caregivers' and health professionals' ideas on potential interventions for empowering older people and informal caregivers in transitional care decision-making.

DESIGN

A descriptive qualitative design was adopted.

METHODS

The study was conducted between February and May 2022 in the region of Flanders, Belgium, as part of the TRANS-SENIOR consortium's collaborative research. Data were collected using focus groups, including older people, informal caregivers and healthcare professionals involved in any physical relocation of the older person across home, hospital or nursing home settings. Thematic data analysis was performed based on Braun and Clarke's six-step method.

RESULTS

A total of 40 people participated in the focus groups. Four main themes were identified, which describe ideas on how to empower older people and informal caregivers in transitional care: Providing clear and timely information, preparing people for what is to come, person-centredness and providing professional and peer support for informal caregivers.

CONCLUSIONS

Healthcare (professionals) should facilitate older people's and informal caregivers' empowerment in transitional care decision-making by setting them at the core and inception of the decision-making process. While informal caregivers support their loved ones in decision-making processes, they should also be supported and monitored for burdensome issues.

IMPLICATIONS TO PATIENT CARE

Multicomponent, well-planned and personalised interventions are needed to empower older people and informal caregivers in transitional care decision-making. The ideas raised by all stakeholders who participated in this study can inform these interventions.

REPORTING METHOD

Adhered to consolidated criteria for reporting qualitative research checklist.

PATIENT OR PUBLIC CONTRIBUTION

Organisations advocating for the interests of older people and informal caregivers played a pivotal role in shaping the TRANS SENIOR project. Furthermore, the study benefitted from the collaborative input of AGE Platform Europe, which amplified the voices and representation of older people during the project design phase.

Tricin Delays Aging and Enhances Muscle Function via Activating AMPK-Mediated Autophagy in Diverse Model Organisms

Aging leads to progressive decline in the functions of cells, tissues, and organs, severely affecting muscle performance and overall health, highlighting the urgent need for effective therapeutic agents. This study investigated the antiaging properties of tricin, a flavonoid abundant in grains, using biological models, including human fibroblasts, Caenorhabditis elegans (C. elegans), and mice. Tricin significantly alleviated the senescent phenotype in human fibroblasts induced by D-galactose (D-gal), doxorubicin, and replicative senescence, as evidenced by reduced SA-β-gal activity, downregulated senescence markers (p16, p21), and decreased SASP factors. Mechanistically, tricin binds to AMPK and activates the AMPK-mTOR-p70S6K signaling pathway, promoting autophagy and delaying cellular aging. In vivo, tricin extended lifespan, enhanced stress resistance, and improved mobility in C. elegans through aak-2/AMPK-mediated autophagy. In D-gal-induced aging mice, tricin improved muscle function, reducing p16, p21, and SASP expression in muscle tissues. These findings underscore tricin's potential as a promising antiaging therapeutic via AMPK-mediated autophagy activation.

The influence of intergenerational relationships on depressive symptoms in elderly patients with multiple chronic conditions: the mediating roles of self-rated health and well-being

BACKGROUND

The superimposition of multiple chronic conditions places a heavy physical burden and life pressure on older adults, making them more prone to psychological distress and significantly increasing their risk of depression, which has become an urgent public health issue. Intergenerational relationships, as the main source of social support for older adults, have a profound effect on their mental health. This study aims to explore the potential mediating mechanisms by which intergenerational relationships influence depressive symptoms among older adults within the context of the Chinese "filial piety" culture, providing a theoretical foundation for optimizing intergenerational support and improving the psychological well-being of older adults.

METHODS

Data from the 2020 China Family Panel Study (CFPS) were used, and 739 elderly patients with multiple chronic conditions were selected as the study subjects. Data on intergenerational relationships, self-rated health, well-being, and depressive symptoms were also obtained. A chain mediation model was developed using SPSS PROCESS macro model 6, and one-way ANOVA, Pearson correlation analysis, and mediation effect tests were performed to investigate the effects of intergenerational relationships, self-rated health, and well-being on depressive symptoms in elderly patients with multiple chronic conditions.

RESULTS

Intergenerational relationships, self-rated health, and well-being were found to be significantly correlated with depressive symptoms (P < 0.05). Intergenerational relationships negatively predicted depressive symptoms (β = -0.610, P < 0.01). Self-rated health (β = -1.115, P < 0.001) and well-being (β = -0.653, P < 0.001) mediated the effect of intergenerational relationships on depressive symptoms. Additionally, self-rated health and well-being were identified as chain mediators in this relationship for elderly patients with multiple chronic conditions (β = -1.118, P < 0.001).

CONCLUSION

Intergenerational relationships can reduce depressive symptoms among elderly patients with multiple chronic conditions by enhancing self-rated health and well-being. These findings highlight the importance of family support and emotional communication in mental health interventions for older adults. Therefore, healthcare professionals should incorporate family support and encourage positive intergenerational relationships when designing interventions to foster a supportive environment and improve quality of life.

Induced Pluripotent Stem Cells-Based Regenerative Therapies in Treating Human Aging-Related Functional Decline and Diseases

A significant increase in life expectancy worldwide has resulted in a growing aging population, accompanied by a rise in aging-related diseases that pose substantial societal, economic, and medical challenges. This trend has prompted extensive efforts within many scientific and medical communities to develop and enhance therapies aimed at delaying aging processes, mitigating aging-related functional decline, and addressing aging-associated diseases to extend health span. Research in aging biology has focused on unraveling various biochemical and genetic pathways contributing to aging-related changes, including genomic instability, telomere shortening, and cellular senescence. The advent of induced pluripotent stem cells (iPSCs), derived through reprogramming human somatic cells, has revolutionized disease modeling and understanding in humans by addressing the limitations of conventional animal models and primary human cells. iPSCs offer significant advantages over other pluripotent stem cells, such as embryonic stem cells, as they can be obtained without the need for embryo destruction and are not restricted by the availability of healthy donors or patients. These attributes position iPSC technology as a promising avenue for modeling and deciphering mechanisms that underlie aging and associated diseases, as well as for studying drug effects. Moreover, iPSCs exhibit remarkable versatility in differentiating into diverse cell types, making them a promising tool for personalized regenerative therapies aimed at replacing aged or damaged cells with healthy, functional equivalents. This review explores the breadth of research in iPSC-based regenerative therapies and their potential applications in addressing a spectrum of aging-related conditions.

Advance Care Planning and Unlimited Treatment Preferences in Dementia Scenarios: Insights From Community-Dwelling Adults

Introduction: Dementia leads to progressive cognitive decline, impairing self-care and decision making. Advance directives (AdvDirs) enable individuals to document healthcare preferences while cognitively capable, ensuring value-aligned care and reducing caregiver burden. This study explores factors influencing preferences for unlimited medical treatment in hypothetical Alzheimer's disease/dementia scenarios among community-dwelling adults. Methods: This cross-sectional study surveyed 163 community-dwelling adults (18+), using structured questionnaires to collect sociodemographic, health, and AdvDir-related data. Key predictors included attitudes toward life-sustaining treatments, comfort discussing death, religious practices, and interest in quality-of-life information related to end-of-life care. The primary outcome was preference for unlimited medical treatment in hypothetical dementia scenarios. Bivariate and multivariate logistic analyses assessed associations, adjusting for covariates. Results: In the dementia scenario, 26.9% of participants preferred unlimited medical treatment. This preference was strongly associated with a pre-existing attitude favoring life-sustaining treatments (OR = 4.24, 95% CI: 1.73 - 10.37, P = 0.002) and religious beliefs (OR = 5.68, 95% CI: 1.51-21.43, P = 0.01). Conversely, an interest in learning about quality of life at the end of life was negatively associated with preferring unlimited treatment (OR = 0.29, 95% CI: 0.09-0.89, P = 0.03). Discussion: Our findings highlight the need to align advance care planning with individuals' values, beliefs, and religious practices. Raising awareness of quality-of-life considerations in end-of-life care may lead to a shift in preference toward palliative care rather than aggressive treatment. Healthcare providers should discuss treatment trade-offs with cultural and religious sensitivity to support informed decision making.

Adult age differences in the integration of values for self and other

Previous research suggests that older adults may display more prosocial behavior than younger adults. However, recent meta-analyses indicate that effects are heterogeneous, may be small, and are influenced by how prosociality is measured. Further, the precise cognitive and computational factors contributing to age-related differences in prosocial behavior remain largely unknown. In this study, we utilized a modified dictator game to combine a value-based decision framework with Bayesian hierarchical drift-diffusion modeling to investigate prosocial decision-making in a sample of younger (n = 63) and older adults (n = 48). We observed differences in how older and younger individuals incorporate information corresponding to potential gains for themselves (self) and another person (other) to reach a (potentially prosocial) decision. Younger adults integrated values for benefits for themselves and others in the decision-making process and demonstrated increased decision-making efficiency by effectively integrating both sources of information. In contrast, older adults showed improved decision-making efficiency when solely considering values for self and others separately. Interestingly, individual differences in the capacity of inhibitory control in older adults moderated the observed age effects: older adults with stronger inhibitory control abilities made decisions based on the integrated information of benefits for themselves and others. Together, these findings offer new insights into the behavioral and computational mechanisms influencing age effects in prosocial decision-making.

Compression of morbidity by interventions that steepen the survival curve

Longevity research aims to extend the healthspan while minimizing the duration of disability and morbidity, known as the sickspan. Most longevity interventions in model organisms extend healthspan, but it is not known whether they compress sickspan relative to the lifespan. Here, we present a theory that predicts which interventions compress relative sickspan, based on the shape of the survival curve. Interventions such as caloric restriction that extend mean lifespan while preserving the shape of the survival curve, are predicted to extend the sickspan proportionally, without compressing it. Conversely, a subset of interventions that extend lifespan and steepen the shape of the survival curve are predicted to compress the relative sickspan. We explain this based on the saturating-removal mathematical model of aging, and present evidence from longitudinal health data in mice, Caenorhabditis elegans and Drosophila melanogaster. We apply this theory to identify potential interventions for compressing the sickspan in mice, and to combinations of longevity interventions. This approach offers potential strategies for compressing morbidity and extending healthspan.

An inevitably ageing world: analysis on the evolutionary pattern of age structure in 200 countries

Human reproductive, mortality and migration behaviours can often be standardized across countries. However, the universality of population growth laws remains a subject of debate. This study models age-specific population data as a three-dimensional tensor and applies high-dimensional tensor decomposition to uncover macro-level patterns in demographic systems across 200 countries over the past 70 years. The findings reveal that, while disparities in age demographics are widening, most nations follow remarkably similar evolutionary trajectories, differing mainly in the pace of change. A universal transition from the demographic dividend to population ageing is evident, with even labour-abundant regions such as Africa, Asia and South America inevitably facing this demographic shift. By incorporating economic indicators, the study quantitatively demonstrates the coordination between population structure and economic growth, while identifying notable exceptions, such as Gulf states that remain both affluent and youthful, and countries like North Korea, Tunisia, Sri Lanka and Ukraine that are ageing without first achieving significant economic wealth.

Performance Analysis of Data Augmentation Approaches for Improving Wrist-Based Fall Detection System

The aging of society is a global concern nowadays. Falls and fall-related injuries can influence the elderly's daily living, including physical damage, psychological effects, and financial problems. A reliable fall detection system can trigger an alert immediately when a fall event happens to reduce the adverse effects of falls. Notably, the wrist-based fall detection system provides the most acceptable placement for the elderly; however, the performance is the worst due to the complicated hand movement modeling. Many works recently implemented deep learning technology on wrist-based fall detection systems to address the worst, but class imbalance and data scarcity issues occur. In this study, we analyze different data augmentation methodologies to enhance the performance of wrist-based fall detection systems using deep learning technology. Based on the results, the conditional diffusion model is an ideal data augmentation approach, which improves the F1 score by 6.58% when trained with only 25% of the actual data, and the synthetic data maintains a high quality.

Multistate analysis and decomposition of disability-free life expectancy trends at mid-to-older ages in Italy, 2004-19

Italy has witnessed increases in life expectancy and population ageing, raising concerns about their impact on population health. Disability status greatly affects the participation of mid-to-older-aged adults in various aspects of life. We examine the long-term trend in disability-free life expectancy (DFLE) in Italy, over three different periods between 2004 and 2019, and explore disability dynamics (onset and recovery) and changes in disability-specific mortality. We use IT-SILC longitudinal data to estimate transition probabilities and DFLE between ages 50 and 79 and decompose DFLE changes in terms of these transitions. Overall, DFLE has improved over recent decades but not always as favourably as life expectancy. The trends indicate compression of disability between ages 50 and 79 in the most recent years. Changes in disability transitions have had the greatest influence, whereas disability-specific mortality has had much less impact on DFLE changes. The greatest contributions have come from increases in the probability of recovery from disability.

Key Predictors of Generativity in Adulthood: A Machine Learning Analysis

OBJECTIVES

This study aimed to explore a broad range of predictors of generativity in older adults. The study included over 60 predictors across multiple domains, including personality, daily functioning, socioeconomic factors, health status, and mental well-being.

METHODS

A random forest machine learning algorithm was used. Data were drawn from the Midlife in the United States (MIDUS) survey.

RESULTS

Social potency, openness, social integration, personal growth, and achievement orientation were the strongest predictors of generativity. Notably, many demographic (e.g., income) and health-related variables (e.g., chronic health conditions) were found to be much less predictive.

DISCUSSION

This study provides new data-driven insights into the nature of generativity. The findings suggest that generativity is more closely associated with eudaimonic and plasticity-related variables (e.g., personal growth and social potency) rather than hedonic and homeostasis-oriented ones (e.g., life satisfaction and emotional stability). This indicates that generativity is an inherently dynamic construct, driven by a desire for exploration, social contribution, and personal growth.

Stigma, colorectal cancer knowledge and self-efficacy among colorectal cancer survivors: A cross-sectional study based on random forest analysis

PURPOSE

To assess the stigma levels among colorectal cancer (CRC) survivors, identify determinants, examine correlations with CRC knowledge and self-efficacy, and quantify the relative influence of various contributing factors.

METHODS

In total, 301 CRC survivors were enrolled from a tertiary oncology center in southern China. The participants completed the Social Impact Scale (SIS), Bowel Cancer Awareness Measure (Bowel CAM), General Self-Efficacy Scale (GSES), and a demographic and disease-related questionnaire. The analytical framework included multiple linear regression to identify the factors influencing stigma, LASSO regression for variable refinement, and random forest modeling to construct hierarchies of factor importance.

RESULTS

Participants demonstrated moderate levels across all measures: stigma (54.63 ± 8.37), CRC knowledge (8.25 ± 4.74), and self-efficacy (26.81 ± 5.95). Multiple linear regression identified type of medical insurance, support from peers, unwillingness to accept colonoscopy, CRC knowledge, and self-efficacy as significant factors influencing stigma. Random forest analysis ranked factor importance by Gini index: self-efficacy (4366.41), support from peers (1618.03), CRC knowledge (1029.04), type of medical insurance (886.66), and unwillingness to accept colonoscopy (750.16).

CONCLUSIONS

Healthcare providers should pay more attention to stigma among CRC patients. Effective stigma reduction necessitates culturally-sensitive psychosocial interventions, including enhancing patients' confidence in managing their disease, strengthening professional-driven online popularization of science campaigns, and facilitating social support networks.

Association of low bone mineral density and dementia in older women: insights from the Longevity Improvement and Fair Evidence Study

BACKGROUND

Both osteoporosis and dementia have emerged as important public health challenges in Japan's aging population. This study aimed to investigate the impact of low bone mineral density (BMD) on the subsequent risk of dementia in older Japanese women aged ≥65 years, given the overlapping demographics of individuals affected by these two conditions.

METHODS

This cohort study was conducted using osteoporosis screening data and insurance claims data from a municipality. We identified 8618 women (median age: 73 years) who underwent osteoporosis screening between April 2019 and March 2021. Participants with a BMD <80% of the young adult mean were assigned to a low-BMD group (n = 2297), whereas those with a BMD ≥80% were assigned to a control group (n = 6321). The study outcomes were new-onset all-cause dementia and Alzheimer's disease (AD). To estimate the risk of low BMD on these outcomes, we constructed Cox proportional hazards models that adjusted for covariates (age, care needs, year of cohort entry, comorbidities and medications) using inverse probability of treatment weighting.

RESULTS

The low-BMD group had a significantly higher risk of developing both all-cause dementia (adjusted hazard ratio: 1.58, 95% confidence interval: 1.20-2.08) and AD (1.61, 1.11-2.36) than the control group over approximately 30 months of follow-up.

CONCLUSION

These findings suggest that low BMD is associated with medium-term onset of dementia. Osteoporosis screenings could be useful not only for the secondary prevention of osteoporosis, but also for the primary prevention of dementia.

Elucidating emerging signaling pathways driving endothelial dysfunction in cardiovascular aging

The risk for developing cardiovascular diseases dramatically increases in older individuals, and aging vasculature plays a crucial role in determining their morbidity and mortality. Aging disrupts endothelial balance between vasodilators and vasoconstrictors, impairing function and promoting pathological vascular remodeling. In this Review, we discuss the impact of key and emerging molecular pathways that transduce aberrant inflammatory signals (i.e., chronic low-grade inflammation-inflammaging), oxidative stress, and mitochondrial dysfunction in aging vascular compartment. We focus on the interplay between these events, which contribute to generating a vicious cycle driving the progressive alterations in vascular structure and function during cardiovascular aging. We also discuss the primary role of senescent endothelial cells and vascular smooth muscle cells, and the potential link between vascular and myeloid cells, in impairing plaque stability and promoting the progression of atherosclerosis. The aim of this summary is to provide potential novel insights into targeting these processes for therapeutic benefit.

Hydrogels empowered mesenchymal stem cells and the derived exosomes for regenerative medicine in age-related musculoskeletal diseases

As the population ages, musculoskeletal diseases (MSK) have emerged as a significant burden for individuals, healthcare systems, and social care systems. Recently, regenerative medicine has exhibited vast potential in age-related MSK, with mesenchymal stromal cells (MSCs) and their derived exosomes (Exos) therapies showing distinct advantages. However, these therapies face several limitations, including issues related to ensuring stability and effective distribution within the body. Hydrogels, acting as an ideal carrier, can enhance the therapeutic effects and application range of MSCs and Exos derived from MSCs (MSC-Exos). Therefore, this review comprehensively summarizes the application progress of MSCs and MSC-Exos combined with hydrogels in age-related MSK disease research. It aims to provide a detailed perspective, showcasing the functional enhancement of MSCs and MSC-Exos when incorporated into hydrogels. Additionally, this review explores their potential and challenges in treating age-related MSK diseases, offering references for future research directions and potential innovative strategies.

Metabolic Status Modulates Global and Local Brain Age Estimates in Overweight and Obese Adults

BACKGROUND

As people live longer, maintaining brain health becomes essential for extending health span and preserving independence. Brain degeneration and cognitive decline are major contributors to disability. In this study, we investigated how metabolic health influences the brain age gap estimate (brainAGE), which measures the difference between neuroimaging-predicted brain age and chronological age.

METHODS

K-means clustering was applied to fasting metabolic markers including insulin, glucose, leptin, cortisol, triglycerides, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, steady-state plasma glucose, and body mass index of 114 physically and cognitively healthy adults. The homeostatic model assessment for insulin resistance served as a reference. T1-weighted brain magnetic resonance imaging was used to calculate voxel-level and global brainAGE. Longitudinal data were available for 53 participants over a 3-year interval.

RESULTS

K-means clustering divided the sample into 2 groups, those with favorable (n = 58) and those with suboptimal (n = 56) metabolic health. The suboptimal group showed signs of insulin resistance and dyslipidemia (false discovery rate-corrected p < .05) and had older global brainAGE and local brainAGE, with deviations most prominent in cerebellar, ventromedial prefrontal, and medial temporal regions (familywise error-corrected p < .05). Longitudinal analysis revealed group differences but no significant time or interaction effects on brainAGE measures.

CONCLUSIONS

Suboptimal metabolic status is linked to accelerated brain aging, particularly in brain regions rich in insulin receptors. These findings highlight the importance of metabolic health in maintaining brain function and suggest that promoting metabolic well-being may help extend health span.

Digital technologies as solutions to China's aging population: a systematic review of their opportunities and challenges in rural development

Introduction

Differences exist in the rate of aging between individuals residing in urban and rural areas in China, with rural areas experiencing a more pronounced impact. Smart aging represents a prevalent future trend in this regard, though its development will inevitably face challenges. However, studies focusing on rural areas are scarce. Future models of aging in less developed regions, including rural areas and townships, are expected to integrate and draw inspiration from the smart aging paradigm.

Methods

We present a systematic review of the current application of digital technologies in caring for older people in rural areas. We conducted extracted and screened 26 articles out of 823, sourced from five databases: Web of Science, IEEE Xplore, Engineering Village, PubMed/MEDLINE and CNKI.

Results

The articles focus on digital technologies that cater to the daily life, medical care, spiritual comfort, and cultural entertainment needs of rural older people. In our review, we focused on four aspects of digital technology: mobile applications (apps), websites and platforms, mobile devices and terminals, and VR technologies or other unspecified technologies.

Discussion

We found that current digital technologies for smart aging have room for improvement in meeting the recreational and mental comfort needs of older adults. Digital technologies are predominantly applied to the smart community/rural and smart healthcare sectors, with limited applications in the smart home sector. Future studies should explore smart-home older adults care services to address digital cognitive barriers faced by older adults.

Exercise intensity matters: A review on evaluating the effects of aerobic exercise intensity on muscle-derived neuroprotective myokines

Exercise as a medical intervention is effective to help prevent and manage many chronic and complex diseases, including dementia. There is evidence to suggest that regular aerobic exercise protects against age-related brain atrophy and reduces the risk of cognitive decline. The mechanisms by which exercise infers a neuroprotective effect remain to be established but may be related to a maintenance of brain volume and neuronal survival, improved cerebrovascular density and function, and/or increased synaptic plasticity. In addition, there is growing evidence to suggest the beneficial effects of exercise on brain health and cognitive function are, at least in part, mediated by factors released by skeletal muscle during contraction. The fact that the brain responds to exercise suggests that muscle-derived peripheral factors, or "myokines," may play a key role in muscle-brain crosstalk and exercise neuroprotection. However, the most effective "dose" of aerobic exercise to promote beneficial changes in these myokine pathways is currently unknown. Specifically, most of the evidence to date is from studies that have used moderate-intensity exercise, and research investigating the merit of high-intensity exercise is scarce. Considering the well-established role of high-intensity interval training in protecting against numerous medical conditions, more research is needed to identify the most effective "dose" of exercise to improve the beneficial effects of these myokines.

Highlights

Neuroprotection through exercise: Regular aerobic exercise mitigates age-related brain atrophy and cognitive decline via multiple mechanisms, including brain volume maintenance, improved cerebrovascular function, and synaptic plasticity. Myokines as mediators: Muscle-derived factors (myokines) play a crucial role in muscle-brain crosstalk, significantly contributing to the neuroprotective effects of exercise. Intensity matters: The review underscores the necessity to define and study exercise intensity, revealing high-intensity exercise may be as effective, if not more, in promoting neuroprotective myokine levels compared to moderate-intensity exercise. Future research directions: This review emphasizes the need for well-controlled studies to explore the optimal exercise dose for enhancing myokine pathways and their implications for neurodegenerative disease prevention.

Conceptualizing the Facilitators and Barriers of Successful Multidisciplinary Teamwork Within the Reablement Process: A Scoping Review

Background

As the global population ages, there is increasing pressure on health systems to provide high-quality and cost-effective care for this growing segment of the population. Reablement, primarily a strategic home-based rehabilitation approach, has been demonstrated to be a cost-effective, multidisciplinary, holistic, and person-centred approach to maintaining functional independence as one ages. Given that care delivery in the home setting for older persons is complex, a key feature of effective implementation of reablement is the integration of a multidisciplinary team.

Objective

The primary objective of this study was to identify the facilitators and barriers that lead to successful teamwork in a multidisciplinary reablement team setting.

Methods

Scoping review approach was used in this study to determine trends, and mapping themes prevalent in the peer-reviewed literature. Eligible articles were sourced from four electronic databases, and data were extracted, coded, analyzed and chartered in February 2024.

Results

Twenty studies were included in this study. Six main themes were identified: (1) multidisciplinary teamwork for quality service development, (2) dynamics of multidisciplinary collaboration, (3) professional autonomy and reflective practice, (4) towards a flat organizational structure and shared goals, (5) openness and flexibility of developing new cultures, and (6) open and frequent communication for success. Each of the themes can exert a facilitating or/and inhibiting effect depending on the context.

Conclusion

The findings indicate that multidisciplinary teamwork in reablement settings is diverse, complex, and situational. In this paper, we propose a conceptual model that integrates each theme as a way to understand the complexity and interconnectedness of the themes along the quest for greater multidisciplinary teamwork in reablement. Given the positive outcomes of both service consumers and providers, amplification of multidisciplinary teamwork within reablement holds the promise of effective care for older persons in a time of growing service demands.

The ecology of ageing in wild societies: linking age structure and social behaviour

The age of individuals has consequences not only for their fitness and behaviour but also for the functioning of the groups they form. Because social behaviour often changes with age, population age structure is expected to shape the social organization, the social environments individuals experience and the operation of social processes within populations. Although research has explored changes in individual social behaviour with age, particularly in controlled settings, there is limited understanding of how age structure governs sociality in wild populations. Here, we synthesize previous research into age-related effects on social processes in natural populations, and discuss the links between age structure, sociality and ecology, specifically focusing on how population age structure might influence social structure and functioning. We highlight the potential for using empirical data from natural populations in combination with social network approaches to uncover pathways linking individual social ageing, population age structure and societal functioning. We discuss the broader implications of these insights for understanding the social impacts of anthropogenic effects on animal population demography and for building a deeper understanding of societal ageing in general.This article is part of the discussion meeting issue 'Understanding age and society using natural populations'.

Regional disparities in home health care utilization for older adults and their associated factors at the secondary medical area level: A Nationwide study in Japan

AIM

As aging populations shift health care from hospitals to communities, Japan has implemented policies to promote home health care. This study explored regional differences in home health care recipients among older adults and related factors.

METHODS

We used nationwide data from 2020 to describe the proportion of older adults receiving regular home visits and the medical institutions utilized across secondary medical areas: urban, middle and depopulated areas. We examined factors associated with the proportion of patients receiving regular home visits. Exposures included each secondary medical area's medical and long-term-care (LTC) resources, adjusted for the older adult population; proportion of single-person households; and regional factors. We performed a multivariate negative binomial distribution analysis.

RESULTS

A total of 333 secondary medical areas were included. Urban areas had more patients receiving regular home visits, primarily from enhanced home care support clinics/hospitals (HCSCs). Fewer patients received regular home visits in depopulated areas, and conventional HCSCs were more common. Multivariate analysis revealed that the number of conventional HCSCs (coefficient, 0.17 [95% confidence intervals (CI), 0.08 to 0.26]), enhanced HCSCs (coefficient, 0.21 [95% CI, 0.14 to 0.29]) and population density (coefficient, 0.10 [95% CI, 0.02 to 0.19]) were positively associated with higher home-visit rates. Beds in LTC welfare facilities (coefficient, -0.10 [95% CI, -0.19 to -0.01]) and beds in LTC health facilities (coefficient, -0.09 [95% CI, -0.17 to 0.00]) were negatively associated.

CONCLUSIONS

Policies to promote home health care have led to high home-visit rates in urban areas. Medical and LTC resources and regional factors influence disparities. As Japan's population ages, it is crucial to recognize these disparities and develop medical and LTC systems tailored to each region's characteristics. Geriatr Gerontol Int 2024; 24: 1350-1361.

The effects of a short exercise bout on executive functions in healthy older adults

Regular physical activity is associated with healthier brains and improved cognition among older adults. Yet, the impact of a short bout of exercise on older adults' cognition still is not fully clarified. The present study explored the effects of 20 min of moderate-intensity aerobic exercise (on a cycle ergometer) on cognition. Forty-eight healthy older adults were randomly assigned to an exercise or a control group and completed four cognitive tests: Affective Go/No-Go (AGN), Simple Reaction Time (SRT), Spatial Working Memory (SWM) and a Backward Counting task. Tests were administered prior to and immediately after 20 min of cycling (exercise group) or rest (control group). Mixed-design 2 × 2 ANOVAs indicated a significant interaction of Group x Session, for commission errors on the positive valence of the Affective Go/No-go task, indicating that the exercise group performed better on one aspect of this inhibition test after cycling (p = 0.004), while the control group's performance declined after rest. A similar pattern was found for the SWM, with the exercise group showing a significantly better performance after the exercise both for total error (p = 0.027) and the strategy (p = 0.002), while no improvement was observed after rest (controls). The study suggests that inhibitory control functions and working memory may be improved by a single relatively short bout of moderate exercise. However, the null effects of exercise on the other cognitive measures indicate that the neurocognitive benefits of acute exercise for older adults may be selectively sensitive to exercise parameters and to specific aspects of cognition.

The Epistemic Policies of Anti-Ageing Medicines in the European Union

Anti-ageing medicines are products intended to extend lifespan and healthspan in humans that have a good potential use in public health policies. In the European Union, their development, production and consumption are dependent on regulatory science performed by the European Medicines Agency and its associated epistemic policies. They impose, among other things, an unfavourable burden of proof, a strict standard of proof and meta-methodological constrictions related to some theoretical issues. This results in a distribution of errors that tends to reduce false positives while increasing false negatives, leading to a set of social consequences that are generally accepted when the focus is placed on conventional medicines. However, when the same epistemic policies are applied to anti-ageing medicines, the distribution of errors is imbalanced, and undesirable outcomes like research discouragement and waiting time extensions appear. Three possible strategies that policymakers could implement to unblock the situation are presented for future reflection: the consideration of ageing as a disease, the application of methodological asymmetry and the use of biomarkers during clinical research.

Alleviating D-Galactose-Induced Aging in Mice by Modulating Gut-Liver Axis Using Lactiplantibacillus plantarum TY-Y10

Oxidative stress is closely linked to aging. Probiotics, whether viable or heat-inactivated, have shown antioxidant properties; however, their effect and mechanism of action in reducing oxidative stress during aging remains underexplored. This study examined the effects of viable and heat-inactivated Lactiplantibacillus plantarum TY-Y10 (L. plantarum TY-Y10) on D-galactose (D-gal)-induced aging in mice, aiming to uncover potential anti-aging mechanisms. Mice were induced to age with D-gal injections, then treated with sodium ascorbate (positive control) or varying doses of L. plantarum TY-Y10 for eight weeks. After treatment, oxidative stress markers, gut microbiota, and liver health were analyzed. Results showed that L. plantarum TY-Y10 decreased malondialdehyde (MDA) and inflammatory markers while increasing antioxidant levels (glutathione, superoxide dismutase, catalase and glutathione peroxidase). Liver damage was reduced, and expression of Nrf2 and related antioxidant enzymes improved. Additionally, L. plantarum TY-Y10 enhanced the abundance of short-chain fatty acid-producing bacteria, boosting fecal short-chain fatty acid levels. In short, both viable and heat-inactivated L. plantarum TY-Y10 mitigated oxidative stress in aging mice by modulating gut microbiota and activating liver antioxidant pathways through the gut-liver axis.

Exploring the intersection of income and race in an age diverse sample of people with Type 1 diabetes

Prior literature suggests that the social gradient in health is racialised such that Black individuals receive fewer health benefits from socioeconomic status than White individuals, yet scarce research studies examine whether this relationship persists in the context of Type 1 diabetes (T1D). Further, most research studies on racial health disparities in T1D outcomes focus on health during early life. We used data from the 2017-2018 wave of the T1D Exchange Registry (N = 11,963) and examined the relationship between household income, race and HbA1c in an age diverse sample of people with T1D. Results revealed that the inverse association between income and HbA1c is stronger for Black T1Ds compared to White T1Ds. Despite this, Black T1Ds with an income of $100,000 or more had higher HbA1c values compared to White individuals with an income of less than $25,000. Further, Black adolescents with T1D had particularly high HbA1c values. There is an urgent need for more research on the interpersonal and structural barriers associated with suboptimal glycaemic control among Black individuals.

Aging wisely: The impact of Internet use on older adults' mental health

This study aims to explore the impact of Internet use on the mental health of older adults and its pathway mechanisms and to provide a theoretical basis and practical guidance for improving the mental health of older adults and better realizing active aging. Using cross-sectional data from the 2020 China Health and Retirement Longitudinal Survey, 6722 older adults over 60 were finally included. We conducted descriptive and correlation analyses of the data; we analyzed the correlation of Internet use on the depression level and cognitive ability of older adults using seemingly unrelated regression; we further explored the mediating role of socialization frequency in the relationship between Internet use and the depression level and cognitive ability of older adults and its differences through mediation analysis. The results showed that the mean age of older adults in this study was (68.52 ± 5.97), the mean Internet use score was (1.12 ± 1.63), the mean depression score was (8.44 ± 6.31), and the mean cognitive score was (12.17 ± 3.27). Internet use had a positive impact on the mental health of older adults, including lowering depression (β = -0.275, P < 0.05) and improving cognition (β = 0.300, P < 0.05). Socialization frequency mediated the relationship between Internet use and depression/cognitive ability (95 % CI = -0.034 to -0.008, 95 % CI = 0.007-0.022). Therefore, it is essential to encourage older adults to use the Internet, actively integrate into the digital society, promote wise aging, share the fruits of technological development, and utilize the Internet to maintain the mental health of older adults.

Polypharmacy in Older Adults: The Hazard of Hospitalization and Mortality is Mediated by Potentially Inappropriate Prescriptions, Findings From the Moli-sani Study

Objectives

We evaluated the impact of polypharmacy on the health of community-dwelling older adults.

Methods

We prospectively analyzed 5,631 individuals from the Moli-sani study (51% men, aged ≥65 years, recruitment 2005-2010, follow-up 2005-2020). Exposure was categorized as chronic polypharmacy therapy (C-PT; ≥5 therapeutic groups and >2 defined daily doses (DDDs)) or non-chronic polypharmacy therapy (NC-PT; polypharmacy but ≤2 DDDs). Hospitalization and mortality were the main outcomes. The mediating role of potentially inappropriate prescriptions (PIP) was examined.

Results

Compared to individuals not on polypharmacy, those in NC-PT and C-PT had higher hazards of mortality [21% (95% CI 7%-37%) and 30% (16%-46%), respectively] and hospitalization [39% (28%-51%) and 61% (49%-75%), respectively]. Similar results were found for cardiovascular outcomes. PIP mediated the association between polypharmacy and outcomes, with mediation effects ranging from 13.6% for mortality to 6.0% for hospitalization. Older adults without multimorbidity experienced the same harm from multiple medications as those with multimorbidity.

Conclusion

Polypharmacy is associated with a higher hazard of mortality and hospitalization, with PIP playing an important role. Addressing "medication without harm" requires assessing the appropriateness of drug prescriptions and monitoring for adverse effects.

Developmental trajectories and heterogeneity of social engagement among Chinese older adults: a growth mixture model

BACKGROUND

Social engagement is closely related to well-being among older adults. However, studies on the changing trajectory and influencing factors (especially time-varying factors) of social engagement are limited. This study aimed to examine the social engagement trajectory of older Chinese adults and explore its time-fixed and time-varying factors, thus providing evidence for the development of strategies to promote a rational implementation for healthy aging.

METHODS

This study included 2,195 participants from a subset of four surveys from the Chinese Longitudinal Healthy Longevity Survey conducted from 2008 to 2018 (with the latest survey completed in 2018), with follow-ups conducted approximately every three years. Growth mixture modeling was used to explore the social engagement trajectory of older adults and the effects of time-varying variables. In addition, multinomial logistic regression was employed to analyze the association between time-fixed variables and latent classes.

RESULTS

Three distinct trajectories of social engagement among older adults in China were identified: slow declining (n = 204; 9.3%), which meant social engagement score decreased continuously, but social engagement level improved; slow rising (n = 1,039; 47.3%), marked by an increased score of social engagement, but with an depressed engagement level; and middle stabilizing (n = 952; 43.4%), which meant social engagement score and engagement level remained quite stable. A time-fixed analysis indicated that age, marital status, educational level, and annual family income had a significant impact on social engagement (P < 0.05). In contrast, the time-varying analysis showed that a decline in functional ability, insufficient exercise (means no exercise at present), deteriorating self-reported health and quality of life, negative mood, monotonous diet, and reduced community services were closely related to the reduction in social engagement levels (P < 0.05).

CONCLUSION

Three trends were observed at the social engagement level. Older adults with initially high levels of social engagement exhibited a continuous upward trend, whereas those with initially low levels experienced a decline in their social engagement, and those with initially intermediate levels remained quite stable. Considering the primary heterogeneous factors, it is imperative for governments to enhance basic services and prioritize the well-being of older adults. Additionally, families should diligently monitor the emotional well-being of older adults and make appropriate arrangements for meals.

Integrating social, climate and environmental changes to confront accelerating global aging

INTRODUCTION

The global increase in the aging population presents critical challenges for healthcare systems, social security, and economic stability worldwide. Although the studies of the global rate of aging have increased more than four times in the past two decades, few studies have integrated the potential combined effects of socio-economic, climatic, and environmental factors.

METHODS

We calculated the geographic heterogeneity of aging population growth rates from 218 countries between 1960 and 2022. Public databases were then integrated to assess the impacts of seven global stressors: socio-economic vulnerability, temperature, drought, seasonality, climate extremes, air pollution, and greening vulnerability on growth rates of aging population (a totally 156 countries). Linear regression models were primarily used to test the statistically significant effects of these stressors on the rate of aging, and multiple model inference was then used to test whether the number of stressors exceeding specific thresholds (e.g., > 25, 50, and 75%) was consistently significant in the best models. The importance of stressors and the number of stressors exceeding thresholds was verified using random forest models for countries experiencing different population aging rates.

RESULTS

Our analysis identified significant heterogeneity in growth rates of aging population globally, with many African countries exhibiting significantly lower aging rates compared with Europe. High socio-economic vulnerability, increased climate risks (such as high temperature and intensive extreme climate), and decreased environmental quality were found to significantly increase growth rates of the aging population (P < 0.05). The positive combined impacts of these stressors were diminished at medium-high levels of stressors (i.e., relative to their maximum levels observed in nature). The number of global stressors exceeding the 25% threshold emerged as an important predictor of global aging rates. Demographic changes in regions with relatively rapid aging (e.g., Africa and Asia) are more sensitive to climate change (e.g., extreme climate and drought) and the number of global stressors, and regions with low to medium rates of aging (e.g., Europe and the Americas) are more sensitive to socio-economic vulnerability and environmental stability (e.g., drought, green fragility and air pollution).

CONCLUSIONS

Our findings underscore that policy tools or methods must be developed that consider the holistic dimension of the global factor. Further investigations are essential to understand the complex interactions between multiple stressors and their combined effects on global aging.

E-Skin and Its Advanced Applications in Ubiquitous Health Monitoring

E-skin is a bionic device with flexible and intelligent sensing ability that can mimic the touch, temperature, pressure, and other sensing functions of human skin. Because of its flexibility, breathability, biocompatibility, and other characteristics, it is widely used in health management, personalized medicine, disease prevention, and other pan-health fields. With the proposal of new sensing principles, the development of advanced functional materials, the development of microfabrication technology, and the integration of artificial intelligence and algorithms, e-skin has developed rapidly. This paper focuses on the characteristics, fundamentals, new principles, key technologies, and their specific applications in health management, exercise monitoring, emotion and heart monitoring, etc. that advanced e-skin needs to have in the healthcare field. In addition, its significance in infant and child care, elderly care, and assistive devices for the disabled is analyzed. Finally, the current challenges and future directions of the field are discussed. It is expected that this review will generate great interest and inspiration for the development and improvement of novel e-skins and advanced health monitoring systems.

Effects of Combined Visual-Motor Response Training on Cognitive Function and Brain Plasticity Mechanisms in Various Populations: Protocol for a Single-Center, Open-Label, Controlled Clinical Trial

BACKGROUND

Cognitive impairment is one of the major diseases facing the aging population. The progressive decline of cognitive function can lead to declining health or even the loss of life, work, and social ability. Exercise and behavioral stimulation can increase neurotransmitters in the brain and improve overall health and cognitive function. Reactivity training can mobilize neuromuscular function and induce changes in brain plasticity, which may effectively improve cognitive dysfunction and delay the occurrence and development of Alzheimer disease; however, the evidence supporting its effectiveness is still limited.

OBJECTIVE

This study aims to explore the effectiveness and reliability of visual-motor reaction training in improving cognitive function, thereby promoting the application of novel nonpharmacological therapies.

METHODS

This study is a single-center, open-label, controlled clinical trial. A total of 78 participants will be recruited for the study, including an equal number of athletes, ordinary healthy college students, and ordinary older adults in the community. Participants will receive 2 weeks of visual-motor response training. The primary outcome of this study is to assess differences in functional magnetic resonance imaging (fMRI) at 2 weeks. The secondary outcomes were the following: acousto-optic response time, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Mini Mental State Examination (MMSE), Activity of Daily Living (ADL) Scale, Subjective Cognitive Decline Questionnaire-9 (SCD-Q9), a 10-word memory test, and safety.

RESULTS

The study was approved by the Shanghai Clinical Research Ethics Committee on January 2, 2024 (SECCR/2023-162-01). As of September 11, 2024, we have completed the recruitment of all 3 groups of volunteers. We expect to complete data collection and analysis by February 2025.

CONCLUSIONS

The purpose of this study is to compare improvements in brain perceptual motor functions and cognitive levels across different populations through response ability training and to explore the efficacy and safety of exercise-based nonpharmacological therapies in improving cognitive function. Other potential benefits include understanding the functional differences and perceptual characteristics of the brain's perceptual-motor system between athletes and the general population and exploring the adaptability of the brain in acquiring skills during competitive sports training. This could provide an evidence base for early sports talent development and broader youth development.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2400079602; https://tinyurl.com/23fbbndw.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56424.

Urban resilience reduces depressive symptoms among middle-aged and elderly adults: A multidimensional analysis based on China longitudinal healthy longevity survey

With the rapid urbanization and aging population, depression has become a severe public health issue globally, affecting millions of individuals and significantly impacting their quality of life and healthcare costs. Urban resilience refers to a city's ability to absorb, recover, and prepare for future shocks, ensuring sustainable development despite challenges. This study aims to explore the impact of urban resilience on depressive symptoms among middle-aged and elderly adults. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we analyzed five dimensions of urban resilience: economic, social, ecological, institutional, and infrastructural resilience. The results of cox proportional hazards model indicate that high levels of urban resilience significantly reduce the risk of depressive symptoms (HR = 0.875, 95% CI: 0.832-0.920, P < 0.001). Specifically, economic resilience (HR = 0.883, 95% CI: 0.846-0.921, P < 0.001), social resilience (HR = 0.916, 95% CI: 0.876-0.958, P < 0.001), ecological resilience (HR = 0.670, 95% CI: 0.516-0.869, P = 0.003), institutional resilience (HR = 0.922, 95% CI: 0.886-0.960, P < 0.001), and infrastructural resilience (HR = 0.875, 95% CI: 0.826-0.926, P < 0.001) all show significant negative correlations with depressive symptoms. Furthermore, the mitigation of depressive symptoms risk resulting from improved urban resilience disproportionately benefits vulnerable groups and those with healthy living habits. These findings provide scientific evidence for urban planning and policy formulation, contributing to the promotion of mental health and healthy aging among middle-aged and elderly populations.

Ingenious Structure Engineering to Enhance Piezoelectricity in Poly(vinylidene fluoride) for Biomedical Applications

The future development of wearable/implantable sensing and medical devices relies on substrates with excellent flexibility, stability, biocompatibility, and self-powered capabilities. Enhancing the energy efficiency and convenience is crucial, and converting external mechanical energy into electrical energy is a promising strategy for long-term advancement. Poly(vinylidene fluoride) (PVDF), known for its piezoelectricity, is an outstanding representative of an electroactive polymer. Ingeniously designed PVDF-based polymers have been fabricated as piezoelectric devices for various applications. Notably, the piezoelectric performance of PVDF-based platforms is determined by their structural characteristics at different scales. This Review highlights how researchers can strategically engineer structures on microscopic, mesoscopic, and macroscopic scales. We discuss advanced research on PVDF-based piezoelectric platforms with diverse structural designs in biomedical sensing, disease diagnosis, and treatment. Ultimately, we try to give perspectives for future development trends of PVDF-based piezoelectric platforms in biomedicine, providing valuable insights for further research.

Spatiotemporal heterogeneity of the association between socioeconomic development and health policy attention: a geographically and temporally weighted regression modeling study in China

Objectives

Health policy attention (HPA) refers to the extent of attention given by governments to health issues in public policy and is generally influenced by socioeconomic development. This study aimed to examine the spatiotemporal heterogeneity and clustering of the associations between socioeconomic factors and HPA.

Study design

Longitudinal study.

Methods

This study examined the spatiotemporal heterogeneity of the association between public and provincial government attention, economic development, and demographic transition and HPA by using geographically and temporally weighted regression (GTWR). Word2Vec machine learning technology was utilized to calculate HPA data in 323 cities and independent variable data was collected in each city in China over the period of 2018-2021.

Results

The results showed that there is a substantial overall rise in HPA levels throughout China following the COVID-19 pandemic. Furthermore, the GTWR results revealed significant spatiotemporal heterogeneity in the associations between HPA and public and provincial government attention, economic development, and demographic transition, particularly in the context of COVID-19. The impact of provincial government attention on HPA decreased from the capital of the political center outward, while the impact of public financial investment decreased in less developed cities during the pandemic. It was only cities with high levels of aging are more likely to receive greater HPA.

Conclusion

The finding highlighted the remarkable spatial and temporal variations in the associations between the variables and HPA across different regions in China, emphasizing the need for region-specific policies to strengthen the focus on health by municipal governments.

National income accounting attributes and economic welfare. Evidence from Pakistan

Economic welfare is essential in the modern economy since it directly reflects the standard of living, distribution of resources, and general social satisfaction, which influences individual and social well-being. This study aims to explore the relationship between national income accounting different attributes and the economic welfare in Pakistan. However, this study used data from 1950 to 2022, and data was downloaded from the World Bank data portal. Regression analysis is used to investigate the relationship between them and is very effective in measuring the relationship between endogenous and exogenous variables. Moreover, generalized methods of movement (GMM) are used as the robustness of the regression. Our results show that foreign direct investment outflow, Gross domestic product growth rate, GDP per capita, higher Interest, market capitalization, and population growth have a significant negative on the unemployment rate, indicating the rise in these factors leads to a decrease in the employment rate in Pakistan. Trade and savings have a significant positive impact on the unemployment rate, indicating the rise in these factors leads to an increase in the unemployment rate for various reasons. Moreover, all the factors of national income accounting have a significant positive relationship with life expectancy, indicating that an increase in these factors leads to an increase in economic welfare and life expectancy due to better health facilities, many resources, and correct economic policies. However, foreign direct investment, inflation rate, lending interest rate, and population growth have significant positive effects on age dependency, indicating these factors increase the age dependency. Moreover, GDP growth and GDP per capita negatively impact age dependency. Similarly, all the national income accounting factors have a significant negative relationship with legal rights that leads to decreased legal rights. Moreover, due to better health facilities and health planning, there is a negative significant relationship between national income accounting attributes and motility rate among children. Our study advocated the implications for the policymakers and the government to make policies for the welfare and increase the social factors.

Brain responses to intermittent fasting and the healthy living diet in older adults

Diet may promote brain health in metabolically impaired older individuals. In an 8-week randomized clinical trial involving 40 cognitively intact older adults with insulin resistance, we examined the effects of 5:2 intermittent fasting and the healthy living diet on brain health. Although intermittent fasting induced greater weight loss, the two diets had comparable effects in improving insulin signaling biomarkers in neuron-derived extracellular vesicles, decreasing the brain-age-gap estimate (reflecting the pace of biological aging of the brain) on magnetic resonance imaging, reducing brain glucose on magnetic resonance spectroscopy, and improving blood biomarkers of carbohydrate and lipid metabolism, with minimal changes in cerebrospinal fluid biomarkers for Alzheimer's disease. Intermittent fasting and healthy living improved executive function and memory, with intermittent fasting benefiting more certain cognitive measures. In exploratory analyses, sex, body mass index, and apolipoprotein E and SLC16A7 genotypes modulated diet effects. The study provides a blueprint for assessing brain effects of dietary interventions and motivates further research on intermittent fasting and continuous diets for brain health optimization. For further information, please see ClinicalTrials.gov registration: NCT02460783.

Long COVID as a disease of accelerated biological aging: An opportunity to translate geroscience interventions

It has been four years since long COVID-the protracted consequences that survivors of COVID-19 face-was first described. Yet, this entity continues to devastate the quality of life of an increasing number of COVID-19 survivors without any approved therapy and a paucity of clinical trials addressing its biological root causes. Notably, many of the symptoms of long COVID are typically seen with advancing age. Leveraging this similarity, we posit that Geroscience-which aims to target the biological drivers of aging to prevent age-associated conditions as a group-could offer promising therapeutic avenues for long COVID. Bearing this in mind, this review presents a translational framework for studying long COVID as a state of effectively accelerated biological aging, identifying research gaps and offering recommendations for future preclinical and clinical studies.

Electronic Skin for Health Monitoring Systems: Properties, Functions, and Applications

Electronic skin (e-skin), a skin-like wearable electronic device, holds great promise in the fields of telemedicine and personalized healthcare because of its good flexibility, biocompatibility, skin conformability, and sensing performance. E-skin can monitor various health indicators of the human body in real time and over the long term, including physical indicators (exercise, respiration, blood pressure, etc.) and chemical indicators (saliva, sweat, urine, etc.). In recent years, the development of various materials, analysis, and manufacturing technologies has promoted significant development of e-skin, laying the foundation for the application of next-generation wearable medical technologies and devices. Herein, the properties required for e-skin health monitoring devices to achieve long-term and precise monitoring and summarize several detectable indicators in the health monitoring field are discussed. Subsequently, the applications of integrated e-skin health monitoring systems are reviewed. Finally, current challenges and future development directions in this field are discussed. This review is expected to generate great interest and inspiration for the development and improvement of e-skin and health monitoring systems.

Anti-obesity and immunomodulatory effects of oil and fermented extract dried from Tenebrio molitor larvae on aged obese mice

Preventing disease and maintaining the health of the elderly are crucial goals for an aging population, with obesity and immune function restoration being of paramount importance. Obesity, particularly visceral obesity characterized by excessive fat accumulation around the abdominal organs, is linked to chronic conditions such as diabetes, hypertension, cardiovascular diseases, and immune dysfunction. Globally, obesity is considered a disease, prompting significant research interest in its treatment. Therefore, it is essential to explore potential therapeutic and preventive strategies to address obesity and the decline in immune function brought about by aging. Tenebrio molitor larvae (TML), commonly known as 'mealworms,' are rich in unsaturated fatty acids, including oleic and linoleic acids, and essential amino acids, such as isoleucine and tyrosine. In this study, we aimed to investigate the effects of the consumption of TML oil and mealworm fermented extract (MWF-1) on obesity and immunological changes in aged obese mice. Our data showed reduced body fat in 23-week-old C57BL/6 mice fed processed TML products for 6 weeks. Additionally, the characteristically high levels of serum triglycerides decreased by treating with TML oil. The immune responsiveness results confirmed an increase in B cells by treating with MWF-1, while cytokine levels (interferon-gamma, tumor necrosis factor-alpha, interleukin-2, and -6) were restored to levels similar to young mice. These results suggest that TML oil and MWF-1 are promising dietary supplements for addressing obesity and restoring immune function.

Underlying Mechanisms of the Protective Effects of Lifestyle Factors On Age-Related Diseases

The rise in life expectancy has significantly increased the occurrence of age-related chronic diseases, leading to escalating expenses for both society and individuals. Among the main factors influencing health and lifespan, lifestyle takes a forefront position. Specifically, nutrition, mental activity, and physical exercise influence the molecular and functional mechanisms that contribute to the prevention of major age-related diseases. Gaining deeper insights into the mechanisms that drive the positive effects of healthy lifestyles is valuable for creating interventions to prevent or postpone the development of chronic degenerative diseases. This review summarizes the main mechanisms that underlie the positive effect of lifestyle factors in counteracting the major age-related diseases involving brain health, musculoskeletal function, cancer, frailty, and cardiovascular diseases, among others. This knowledge will help to identify high-risk populations for targeted intervention trials and discover new biomarkers associated with healthy aging.

[Therapeutic exercise in older adults. Scoping review]

The aim of this review was to know the existing scientific production on therapeutic exercise in older adults. A bibliographic search was carried out on 2023 January in Pubmed, Scopus, Web of Science and Sportdiscus databases. Selection criteria were: people aged 65 and above, healthy or with any pathology, and therapeutic exercise programs exclusive or associated with other complications. Language, publication date, and study design were not limited. Data extracted were: year, study type, design and methodology, country of the study and specialty of the journal where it was published. 1094 studies were obtained from 1967 to 2021. The scientific production had a slow evolution until the 2010s when the number of articles began to be significant. According to the types of study, 6.9% were systematic review, 90% research studies, 0.5% opinion studies, and 2.6% other types of studies. The most abundant specialties are geriatrics and gerontology (38.8%), and rehabilitation (16.1%), concentrating more than 50% of the total production. According to the study countries, only 4 concentrated 50% of the publications: the United States (29.16%), Australia (7.95%), Canada (7.31%) and the United Kingdom (6.95%).

Safeguarding China's long-term sustainability against systemic disruptors

China's long-term sustainability faces socioeconomic and environmental uncertainties. We identify five key systemic risk drivers, called disruptors, which could push China into a polycrisis: pandemic disease, ageing and shrinking population, deglobalization, climate change, and biodiversity loss. Using an integrated simulation model, we quantify the effects of these disruptors on the country's long-term sustainability framed by 17 Sustainable Development Goals (SDGs). Here we show that ageing and shrinking population, and climate change would be the two most influential disruptors on China's long-term sustainability. The compound effects of all disruptors could result in up to 2.1 and 7.0 points decline in the China's SDG score by 2030 and 2050, compared to the baseline with no disruptors and no additional sustainability policies. However, an integrated policy portfolio involving investment in education, healthcare, energy transition, water-use efficiency, ecological conservation and restoration could promote resilience against the compound effects and significantly improve China's long-term sustainability.

Exergames for falls prevention in sheltered homes: a feasibility study

Introduction

Falls prevention is a global priority given its substantial impact on older adults and cost to healthcare systems. Advances in telerehabilitation technology such as `exergaming' show potential for delivering accessible, engaging exercise programs for older adults. This study aimed to establish the feasibility, acceptability and usability of exergaming in sheltered housing.

Methods

A mixed-methods study with participants randomised in 2 sheltered housing facilities to intervention (n = 1 home, 12 participants) and control (n = 1 home 2, 12 participants) provided usual care for all, (physiotherapy prescribed strength and balance exercises and falls prevention advice) and a 6-week supervised exergaming programme (MIRA) offered 3 times per week to the intervention group only. At 6 weeks, feasibility, usability and acceptability outcomes were collected and analysed using descriptive statistics; qualitative focus groups with participants and interviews with staff were also completed and thematically analysed to elicit barriers and facilitators to usability and acceptability.

Results

Mean exercise per week increased from 10.6 to 14.1 minutes in the control group and 9.6 to 36.8 minutes in the intervention group. All study processes and measures appeared feasible; 72% of those invited consented to taking part and 92% completed 6-week follow-up. Individual domains for the System Usability Scores (SUS) showed participants felt `very confident' using the system with support (70%), would `like to use exergames frequently' (50%) and found the system `easy to use' (90%). However, they also felt they `needed to learn a lot at the beginning' (40%) and would `need technical support' (70%) for independent use of the exergames. Mean overall SUS was 63 reflecting moderate usability for independent use. Qualitative data indicated exergames were well received and highlighted motivational and social aspects; costs and set up. Staff also felt exergaming complemented traditional care.

Discussion

Our study contributes to the evidence guiding the use of exergames to deliver suitable falls prevention interventions for older adults within sheltered housing in community settings.

Lifestyle trajectories in middle-aged adults and their relationship with health indicators

Introduction

Understanding the impact of different lifestyle trajectories on health preservation and disease risk is crucial for effective interventions.

Methods

This study analyzed lifestyle engagement over five years in 3,013 healthy adults aged 40-70 from the Barcelona Brain Health Initiative using K-means clustering. Nine modifiable risk factors were considered, including cognitive, physical, and social activity, vital plan, diet, obesity, smoking, alcohol consumption, and sleep. Self-reported diagnoses of new diseases at different time-points after baseline allowed to explore the association between these five profiles and health outcomes.

Results

The data-driven analysis classified subjects into five lifestyle profiles, revealing associations with health behaviors and risk factors. Those exhibiting high scores in health-promoting behaviors and low-risk behaviors, demonstrate a reduced likelihood of developing diseases (p < 0.001). In contrast, profiles with risky habits showed distinct risks for psychiatric, neurological, and cardiovascular diseases. Participant's lifestyle trajectories remained relatively stable over time.

Discussion

Our findings have identified risk for distinct diseases associated to specific lifestyle patterns. These results could help in the personalization of interventions based on data-driven observation of behavioral patterns and policies that promote a healthy lifestyle and can lead to better health outcomes for people in an aging society.

The Effect of Informal Caregiving on Depression: An Asymmetric Panel Fixed-Effects Analysis of In-Home and Out-Of-Home Caregivers Across Europe

Previous research has shown that providing intensive informal care can have a negative effect on an individual's mental health. However, few studies have been able to draw a precise comparison between the experiences of in-home and out-of-home caregivers. This study used data from 16 countries collected from 2011-2019 as part of the Survey of Health, Ageing and Retirement in Europe (SHARE) to conduct asymmetric panel fixed-effects models that examined within-person variation in depression scores after a respondent started providing daily or almost daily personal care either inside or outside of their home. The results substantiated previous findings that in-home caregivers experience more pronounced increases to their reported depressive symptoms after starting to provide daily personal care than do out-of-home caregivers. In addition, in-home caregivers in countries with greater governmental responsibility for long-term care provision (The Northern and Central Clusters) reported fewer increases to their depressive symptoms after starting to provide care than caregivers in countries where long-term care responsibility predominantly rests on families (The Southern and Eastern Cluster). Further, Northern Cluster countries most successfully shrank the pool of out-of-home care providers. Together, these findings underscore the context-specific nature of caregiver wellbeing.

The unmet promise of trustworthy AI in healthcare: why we fail at clinical translation

Artificial intelligence (AI) has the potential to revolutionize healthcare, for example via decision support systems, computer vision approaches, or AI-based prevention tools. Initial results from AI applications in healthcare show promise but are rarely translated into clinical practice successfully and ethically. This occurs despite an abundance of "Trustworthy AI" guidelines. How can we explain the translational gaps of AI in healthcare? This paper offers a fresh perspective on this problem, showing that failing translation of healthcare AI markedly arises from a lack of an operational definition of "trust" and "trustworthiness". This leads to (a) unintentional misuse concerning what trust (worthiness) is and (b) the risk of intentional abuse by industry stakeholders engaging in ethics washing. By pointing out these issues, we aim to highlight the obstacles that hinder translation of Trustworthy medical AI to practice and prevent it from fulfilling its unmet promises.