Search Results (377)

Objective: This study aimed to assess whether older American adults with multimorbidity are at higher risk of becoming edentate over time. Methods: We used data from three waves of the Health and Retirement Study (HRS), a longitudinal survey of older American adults aged 50 years and over. Data on multimorbidity was from 2012, while data on complete tooth loss was from 2018. Multimorbidity included five common and serious conditions, namely diabetes, heart conditions, lung diseases, cancer, and stroke. Socioeconomic factor was indicated by total wealth in 2006; behaviour was indicated by smoking in 2012. We used Structural Equation Modelling (SEM) to assess the relationship between multimorbidity in 2012 and complete tooth loss in 2018. Participants with complete tooth loss in 2012 were excluded from the analysis. Results: Among 6286 participants with complete data across all three waves, each additional chronic condition in 2012 was associated with 1.30 times higher odds of edentulism in 2018 (95% CI: 1.12, 1.52). In the SEM, multimorbidity in 2012 was positively associated with being edentate in 2018 (estimate: 0.01, 95% CI 0.01, 0.02); smoking and wealth were also significantly associated with edentulism. Wealth and smoking were also associated with multimorbidity. Conclusions: Older adults with multimorbidity appear to have a higher probability for becoming edentate. The findings highlight the need for oral health promotion activities for those with multimorbidity. Full article

Background: Population ageing increases reliance on family caregivers (FCGs) for very old adults (80+). While caregiving is often studied as a source of burden, its impact on caregivers’ daily life and occupational balance remains underexplored. This study aimed to explore how caregiving responsibilities shape the daily lives, occupational balance, and support needs of FCGs, using the Stress Process Model (SPM) and the concept of Occupational Balance (OB). Methods: A qualitative study was conducted in the PACA region (France) within the SCOPE project. Seventeen semi-structured interviews were analysed using thematic content analysis, with independent double coding by two researchers. Results: Six themes were identified: caregiving role and identity, consequences, occupational patterns, needs, proposed actions, and barriers and facilitators. Caregiving generated both primary stressors (physical and emotional demands) and secondary stressors (role conflicts, financial strain, and social isolation). It also led to occupational imbalance, characterized by reduced leisure, diminished self-care, and reorganization of daily routines. Working FCGs reported greater role strain and time constraints, whereas retired FCGs emphasized informational needs and adaptation strategies. Across both groups, caregivers’ needs were rarely formally assessed. Conclusions: These findings highlight that caregiving for very old adults profoundly reshapes caregivers’ daily lives through both stress-related mechanisms and disruptions in occupational balance. They underscore the need for tailored, context-sensitive support strategies, including systematic needs assessment and more structured, individualized coordination approaches such as case management. Full article

Objectives: Diagnostic delay in pulmonary tuberculosis remains a significant barrier to effective disease control, even in low-incidence settings. This study aimed to identify factors associated with total delay and its components among adults with pulmonary tuberculosis in such a setting. Patients and methods: A retrospective observational study was conducted on adults with pulmonary tuberculosis treated at a tuberculosis care centre in Croatia. Total delay was defined as the interval between symptom onset and treatment initiation. Data were collected through structured patient interviews using a standardized questionnaire, medical record review, and routine tuberculosis notification forms from the national public health registry. Sociodemographic and clinical predictors were evaluated using multivariable linear and logistic regression analyses. Results: Among 116 participants, the median total delay was 85 days (interquartile range 48.5–155.3). Rural residence was the strongest independent predictor, with patients experiencing an 88% longer delay than urban residents (p = 0.006). Individuals living in one-person households had a 49% longer delay (p = 0.047). Absence of chest pain was associated with shorter delay (−38%, p = 0.032) and lower odds of extreme delay (odds ratio 0.39, p = 0.047). Retired status independently predicted prolonged health system delay (42.1 days longer) and treatment delay (3.4 days longer). Conclusion: Prolonged delay may become increasingly important in the context of population ageing and changing household structures. Targeted strategies focused on rural, retired, and people living in one-person households may improve the timeliness of tuberculosis detection in settings where declining incidence can reduce clinical suspicion. Full article

This study examines the transformation of the Balaton region in Hungary from a traditional tourist destination into an international retirement migration destination for older adults from Western Europe. Migration theories and models are applied to illustrate the relationships between migration and development and to explore how tourism, lifestyle aspirations, and socio-economic factors influence the settlement decisions of older migrants. Empirical findings suggest that prior tourism experience can mitigate the uncertainty associated with migration and foster belonging. However, many retirees move to Hungary with limited knowledge of the country, relying on social networks and real estate agents for information. These retired migrants also utilize local services and infrastructure, including healthcare and community spaces, which shape their daily lives and help them integrate into the community. The migration of older adults stimulates the development of peripheral rural areas through real estate purchases, renovations, and small-scale entrepreneurial activities, particularly in the accommodation sector. This challenges the traditional perception of older-age migrants as inactive. Full article

(1) Background: Frailty is a major geriatric syndrome associated with adverse health outcomes, while direct assessment of cardiorespiratory fitness (CRF) is often impractical in routine clinical settings. This study investigated the association between estimated cardiorespiratory fitness (eCRF) and incident frailty in middle-aged and older adults from three nationally representative aging cohorts. (2) Methods: We analyzed longitudinal data from the Health and Retirement Study (HRS; 2006–2020) in the United States, the English Longitudinal Study of Ageing (ELSA; 2004–2018) in England, and the China Health and Retirement Longitudinal Study (CHARLS; 2011–2018) in China. Participants aged 50 years or older were included. eCRF was calculated using validated sex-specific non-exercise algorithms. Frailty was assessed using a 30-item Frailty Index (FI), and incident frailty was defined as FI ≥ 0.25. Cox proportional hazards models were used to evaluate the association between baseline eCRF and incident frailty. (3) Results: A total of 8152 participants (3982 women and 4170 men) were included in the longitudinal analysis. Each 1-SD increase in eCRF was associated with a lower risk of incident frailty in HRS (HR = 0.60, 95% CI: 0.54–0.68), ELSA (HR = 0.54, 95% CI: 0.46–0.64), and CHARLS (HR = 0.74, 95% CI: 0.63–0.87). Compared with the low-eCRF group, the moderate- and high-eCRF groups had progressively lower risks of incident frailty across all three cohorts, indicating a graded inverse dose–response relationship. Findings were generally consistent across subgroup and sensitivity analyses. (4) Conclusions: Higher eCRF was associated with a lower risk of incident frailty among middle-aged and older adults across three nationally representative cohorts. As an accessible, non-invasive metric, eCRF may be useful for identifying individuals at elevated risk of incident frailty. Full article

Objectives: This study examines how different benefit payment modes under China’s long-term care insurance (LTCI) program influence healthcare utilization and medical expenditures among middle-aged and older adults. Specifically, it compares the effects of in-kind benefits and mixed benefits on healthcare service use and financial burden. Methods: This study uses data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, focusing on middle-aged and older adults with functional limitations. Exploiting the staggered implementation of LTCI pilot programs across 14 cities, a difference-in-differences (DID) approach is employed to estimate the causal effects of different benefit payment modes on healthcare utilization and expenditures. Heterogeneity analyses are conducted to explore differences between rural and urban populations. Results: The results indicate that the in-kind benefit mode significantly reduces inpatient visits, total medical costs, and out-of-pocket expenditures. By contrast, the mixed benefit mode shows only a modest reduction observed mainly in outpatient visits. Heterogeneity analysis further reveals that in-kind benefits are particularly effective in reducing healthcare utilization and medical expenditures among rural residents, while urban residents experience higher reductions in out-of-pocket spending. Conclusions: These findings highlight the importance of benefit design in shaping the effectiveness of LTCI policies. Prioritizing service-based benefits may improve healthcare system efficiency and reduce financial burdens among older adults. The results provide policy-relevant insights for optimizing LTCI benefit design in China and other aging societies. Full article

Dementia caregiving represents a major public health challenge, with spousal caregivers assuming the greatest burden. Spouses, themselves typically older adults, provide high intensity, long-term, and largely unpaid care across all stages of cognitive decline. Despite their central role in dementia care, the health consequences experienced by spousal caregivers remain insufficiently characterized in the literature and inadequately addressed in clinical and public health practice. This structured narrative review synthesizes current evidence on the multidimensional impact of dementia caregiving on the physical, psychological, cognitive, social, and financial health of spousal caregivers. It further contextualizes these consequences within the trajectory of dementia progression, and identifies interventions, support systems, and policy considerations necessary to mitigate caregiver burden. Spousal caregivers experience disproportionate burden due to continuous, escalating responsibilities that often mirror the progressive deterioration of their partners. Emotional burdens, including uncertainty during pre-diagnostic stages, role strain, conflict, loss of intimacy, and anticipatory grief. Physically, spouses endure musculoskeletal strain, sleep disruption, poor nutrition, and heightened frailty risk. Psychologically, spousal caregivers exhibit elevated rates of depression, anxiety, loneliness, and stress-related disorders. Socially, caregivers experience substantial isolation, stigma, and erosion of social networks. Financial hardship, including early retirement, reduced employment, and uncompensated care hours, further exacerbate stress. Evidence suggests that chronic caregiving stress contributes to biological changes such as immune dysregulation, inflammation, acceleration, aging, and potential cognitive decline in caregivers themselves. Caregiver burden influences patient outcomes as evidenced by increased emergency department use, falls, and earlier institutionalization in persons with dementia whose caregiver is subjected to a high burden. Current care models rarely include routine, caregiver assessment or structured guidance following diagnosis, resulting in substantial unmet needs. Effective mitigation requires integrated, stage-sensitive interventions, including psychosocial support, caregiver education, respite services, culturally tailored programs, and digital health tools, alongside broader policy reforms to reduce financial and structural barriers. Full article

Aging is a complex physiological process influenced by various factors, including individuals’ mental attitude. This interaction between biological vulnerability and psychological resources characterizes the entire life course; however, in older age, it becomes particularly salient due to the higher prevalence of multimorbidity, frailty, functional decline, and existential transitions (e.g., retirement, bereavement, loss of social roles), which intensify the impact of mental outlook on adaptation and quality of survival. Optimism has gained growing attention in clinical practice as a psychological asset associated with better health. This has also encouraged the incorporation of optimism-enhancing strategies into geriatric care. However, encouraging optimism in older patients, although well intentioned, can create ethical tensions in clinical communication, decision-making, and care planning. Sensitivity should be paid to aspects such as education, cultural background and religion within interactions with older adult patients. Uncritical promotion of optimism can undermine autonomy, foster unrealistic expectations, or place emotional burdens on patients who may already feel vulnerable. The appeal of optimism should therefore be balanced with careful ethical consideration. Full article

Background: Frailty is a fluctuating health state that may worsen or improve over time and is linked to adverse outcomes, including musculoskeletal disorders such as arthritis. However, evidence on whether frailty changes predict arthritis onset remains limited. This study examined the relationship between changes in frailty status and incident arthritis among Chinese adults aged 45 years and older. Methods: We performed a longitudinal cohort analysis using data from the China Health and Retirement Longitudinal Study (CHARLS). Frailty was quantified with a 30-item Frailty Index (FI) and categorized as robust, pre-frail, or frail. Frailty transitions were defined by changes in FI-based categories across survey waves. Incident arthritis was identified as self-reported physician-diagnosed arthritis during follow-up. Associations between frailty transitions and arthritis onset were evaluated using Cox regression, reporting hazard ratios (HRs) and 95% confidence intervals (CIs). Models were adjusted for demographic characteristics, health behaviors, and biochemical indicators, and sensitivity analyses were conducted to verify result stability. Results: Among 4982 participants (mean age 58.97 years; 45.58% female). Relative to robust individuals, baseline pre-frailty (HR 1.67, 95% CI 1.41–1.97) and frailty (HR 2.76, 95% CI 1.97–3.85) were associated with higher arthritis risk. Participants whose frailty status worsened from robust to pre-frail or frail also showed higher arthritis risk (HR 1.68, 95% CI 1.34–2.10). In contrast, transitions from frail to pre-frail or robust were associated with lower risk (HR 0.44, 95% CI 0.21–0.92). Higher cumulative frailty burden and greater frailty progression were also associated with increased arthritis risk. Conclusions: Frailty transitions are strongly associated with incident self-reported physician-diagnosed arthritis. Monitoring frailty trajectories may improve arthritis risk stratification and support prevention strategies. Full article

Against the backdrop of rapid population aging, investigating the intersection and impacts among lifestyle, cognitive health, and retirement holds significant academic value and great practical significance for advancing the achievement of the sustainable development goal (SDG) of “Good Health and Well-being”. This study employs data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) and adopts a Fuzzy Regression Discontinuity Design (FRDD) to examine the impact of lifestyle on cognitive health, identify lifestyle changes induced by retirement, and explore the underlying mechanisms and heterogeneous effects across population subgroups. The empirical results indicate that social engagement and physical exercise exert positive effects on cognitive health, while smoking and drinking significantly impair cognitive health. Retirement leads to reduced social participation and physical activity, as well as increased smoking and drinking, which in turn significantly lower cognitive health through the mediating role of lifestyle. Furthermore, the negative impact of retirement on cognitive health is heterogeneous: it is statistically significant among males, individuals with higher educational attainment, and those employed outside the government departments, but insignificant among females, individuals with lower educational attainment, and those working in the government sector. This study clarifies the functional logic linking retirement, lifestyle, and cognitive health, providing theoretical references and practical implications for formulating policies to safeguard cognitive health among middle-aged and older adults. Full article

Background and Objectives: Population ageing is a major challenge of the 21st century and is associated with declining physical and mental abilities, increased disease burden, and higher mortality. Latvia has the lowest healthy life expectancy in the European Union. Social well-being is an important component of healthy and active ageing and may be associated with older adults’ quality of life (QoL). This study aimed to assess the relationship between social well-being, as a component of health, and QoL, including its components (control, autonomy, self-realisation and pleasure), among adults aged 50 and older in Latvia. Materials and Methods: Data from 1643 Latvian participants in wave 9 of the Survey of Health, Ageing, and Retirement in Europe (2022) were analysed using linear regression. QoL was measured using the 12-item Control, Autonomy, Self-Realisation, and Pleasure (CASP-12) scale. Social well-being factors included household composition, education, employment status, financial capacity, living area, social network (SN) characteristics, and received help, based on self-reported questionnaires. Results were considered statistically significant if the p-value was less than 0.05. Results: The factors positively associated with overall QoL were being employed, better financial capacity, greater satisfaction with SN, larger SN, participation in social activities, and higher educational attainment. Being employed and the ability to make ends meet easily were positively associated with all QoL components. Higher satisfaction with the SN and participation in social activities were positively related to the control, autonomy, pleasure, and self-realisation components. Conclusions: These findings underscore the importance of social and economic resources for QoL in later adulthood, suggesting that both the quality of social relationships and material security play a central role in shaping overall QoL and its components among older adults. Full article

In Sri Lanka, despite cultural norms traditionally encouraging older adults to live with their families, a growing number now reside in homes for the elderly. Limited research has explored how attitudes toward aging affect these institutionalized older adults. This study examined the construct validity of the 12-item Attitudes to Ageing Questionnaire—Short Form (AAQ-SF) and its association with quality of life among 317 residents of 13 retirement homes. The AAQ-SF showed acceptable internal consistency for the total scale (Cronbach’s α = 0.71), though subscale reliabilities were modest. Confirmatory factor analysis supported good construct validity for a three-factor model—χ²/df = 1.91, TLI = 0.94, CFI = 0.95, RMSEA = 0.05—but the results suggested multidimensionality of the psychological growth factor. Positive attitudes toward aging were associated with greater quality of life, providing some evidence for convergent validity. The findings suggest that the AAQ-SF may be appropriate for assessing attitudes toward aging among older adults in Sri Lanka, though further validation is recommended. Full article

Animal-assisted services (AAS) involve providers working in partnership with specially trained animals to deliver therapeutic, educational, and supportive benefits that promote human well-being. Although research shows dog-assisted AAS benefits recipients, little is known about handlers’ motivations and how this work impacts handlers and their dogs. This study explores why individuals engage in AAS with their dogs and the relational benefits and challenges involved. A convenience sample of adult AAS handlers was recruited through various organizations via newsletters and social media. Participants (N = 247), predominantly older, white, and highly educated women, responded to three open-ended survey questions. Data were analyzed using reflexive thematic analysis, which revealed several interconnected themes. Handlers described profound joy, pride, and purpose derived from sharing their dogs with others, and an enhanced capacity to support recipients. Participants reported using AAS to augment professional roles, to pay forward acts of kindness, and to enrich their dogs through social interaction. While overwhelmingly meaningful, this work also involves challenges, underscoring the need for organizational support for AAS teams. Training programs should equip handlers to recognize signs of animal stress, navigate demanding contexts, and engage in proactive conversations about rest, retirement, and loss. Normalizing these experiences may promote handler well-being and sustain ethical, relationship-centered AAS practice. Full article

The Survey of Health, Ageing and Retirement in Europe (SHARE) is a cross-national panel study including approximately 160,000 adults aged ≥50 years from 29 countries. While multiple cognitive subtests are available, the SHARE consortium does not currently recommend a standardised approach to cognitive screening. This scoping review and mapping study aimed to (1) assess how cognition is measured in SHARE publications, (2) identify whether any cognitive screening instruments (CSIs) are validated in the SHARE, and (3) explore the potential to replicate additional CSIs using cognitive measures available in recent waves that include an expanded battery of subtests. SHARE-related publications were identified by searching PubMed, and a dedicated online registry of SHARE publications. Methodical details were extracted and quantitative counts calculated. Among 234 SHARE publications, the most common choices were using single subtests (n = 94), CSIs (n = 56), and standardised scores (n = 50). From 22 unique CSIs used in the SHARE, only the SHARE Cognitive Instrument and Langa–Weir Criteria were formally validated. Cognitive impairment was assessed in 36 studies, yet no validated recognised definition of mild cognitive impairment (MCI) was found. Mapping other potential CSIs (n = 81) identified the 10-Point Cognitive Screener, Six-Item Screener and Mini-Cog as other potential CSIs for use across SHARE waves. Further research is needed to validate existing CSIs and to better operationalise MCI in the SHARE. Full article

Background: Older adults with Alzheimer’s Disease and Related Dementias (ADRD) experience a higher risk of falls. However, research lacks evidence on the effect of fall exposure on cognitive impairment and dementia. We investigated the association of falls and depressive symptoms with cognitive impairment and dementia in a nationally representative sample. Methods: We analyzed data from 6221 participants (age ≥ 65) in the Health and Retirement Study (HRS) from the 2018–2020 waves, using Multinomial logistic regression models. Measures included the HRS health status questionnaire, HRS cognition scale, and the Center for Epidemiological Studies Depression scale. Results: Prevalence of fall exposure across cognition levels was 44.61% for dementia, 37.76% for cognitive impairment, and 32.16% for normal cognition. Having at least one fall exposure in the last 24 months significantly increased odds of having dementia by 42%, while the relationship between fall exposure and cognitive impairment was non-significant. Depressive symptoms were also associated with cognitive impairment and dementia. The stratified analysis by residential areas revealed that having a fall exposure increased the likelihood of having cognitive impairment by 26% and dementia by 73% in urban residents. However, the association between fall exposure and cognitive outcomes was not significant in rural settings. Depressive symptoms increased the odds of cognitive impairment in both strata, with a larger effect size in rural settings (OR = 2.23, 95% CI [1.41, 3.54]). Conversely, the association between depressive symptoms and dementia was only significant in urban settings (OR = 3.20, 95% CI [1.99, 5.15]). Conclusions: Falls and depressive symptoms were significantly associated with the odds of cognitive impairment and dementia, with significant differential effects between rural and urban older adults. Full article