The "double jeopardy" of midlife and old age mortality trends in the United States.

Since 2010, US life expectancy growth has stagnated. Much research on US mortality has focused on working-age adults given adverse trends in drug overdose deaths, other external causes of death, and cardiometabolic deaths in midlife. We show that the adverse mortality trend at retirement ages (65+ y) has in fact been more consequential to the US life expectancy stagnation since 2010, as well as excess deaths and years of life lost in 2019, than adverse mortality trends at working ages. These results reveal that the United States is experiencing a "double jeopardy" that is driven by both mid-life and older-age mortality trends, but more so by older-age mortality. Understanding and addressing the causes behind the worsening mortality trend in older ages will be essential to returning to the pace of life expectancy improvements that the United States had experienced for decades.

Aging, generational shifts, and energy consumption in urban China.

China is recognized as the largest energy consumer and is also the country with the largest and fastest-aging population. Ongoing demographic changes may reshape China's household-based energy consumption patterns because of the large gap in consumption behavior between the elderly and the young as well as varying attitudes toward the environment among generations. However, when the impact of China's aging population on energy consumption is projected, the heterogeneous cognitive norms of generations in the process of demographic transition are not well understood. In this study, we assessed the future impact of China's demographic transition on energy consumption using a proposed theoretical framework to distinguish between age and generational effects. Specifically, we used age-period-cohort (APC) detrended analysis to estimate age and generational effects based on China's urban household survey data from 1992 to 2015. The results indicated large differences in energy use propensity across ages and generations. The elderly and younger generations tended to be energy-intensive consumers, resulting in higher energy consumption in this aging society. Our results consequently show that future changes in China's elderly population will result in a substantial increase in energy consumption. By 2050, the changing consumption share of the elderly population will account for ∼17 to 26% of total energy consumption in the residential sector, which is close to 115 million tons of standard coal (Mtce). These findings highlight the need to interlace environmental education policies and demographic transitions to promote energy conservation behavior in children and youth for low-carbon, sustainable development.

Characteristics, Treatment, and Prognosis in Octogenarian and Older Patients With Acute Heart Failure in Japan　- Prospective Observational Study on Acute Pharmacotherapy and Prognosis in Management of Acute Heart Failure (POPEYE-AHF Registry).

BACKGROUND: The number of older people in Japan is increasing more quickly than in other countries; with this aging of society, the number of elderly patients hospitalized for acute heart failure (HF) is also increasing. The treatment and prognosis of acute HF may be changing, but there are insufficient recent data, especially for octogenarian and older patients. METHODS AND RESULTS: This study investigated the characteristics and treatment of acute HF patients in Japan. From 2018 to 2020, 1,146 patients from 7 Tokai area hospitals were followed for at least 1 year. The mean age was 78 years. Compared with patients aged <80 years, those aged ≥80 years were more likely to be female (57.4% vs. 34.2%), have a lower body mass index (22.2 vs. 24.9 kg/m2), and have HF with preserved ejection fraction (43.1% vs. 21.4%), and less likely to have HF with reduced ejection fraction (38.9% vs. 61.7%). During hospitalization, 6.5% died. After discharge, patients faced high risks of rehospitalization for HF and death (27.6 and 14.2 per 100 patient-years, respectively). Notably, prescription rates of HF medications have declined over time for all patients, but especially for those aged ≥80 years. CONCLUSIONS: Guideline-directed medical therapy should be provided based on a thorough understanding of an individual's background rather than withheld simply because of clinical inertia due to a patient's advanced age.

The paradox of aging population and firm digital transformation in China.

Although a number researchers have acknowledged that the aging population inhibits firm digital transformation, others find it promoting digital transformation in some firms. As the relevant literature to clarify such paradox is still scare, this paper wants to fill the gap regarding the labor cost theory, the capital-skill complementarity hypothesis, and the human capital externality theory. Based on the empirical tests of Chinese A-share listed companies from 2001 to 2022, this study detected a U-shaped relationship between the aging population and digital transformation. In terms of the institutional environment, higher marketization strengthens the U-shaped relationship by making the slopes on either side of it steeper. However, higher minimum wage levels weaken the U-shaped relationship. In terms of firm strategy, firms with stronger marketing capabilities strengthened the U-shaped relationship. However, firms with higher customer concentration weakened the U-shaped relationship. Overall, we enriched scholarly understanding of the impact of the aging population on digital transformation and demonstrated the dual potential impact of aging populations. Instead of assuming they are detrimental to the economy and society, positive contributions in the form of innovation and progress for companies can be detected.

Preoperative Modified Frailty Index-11 versus EuroSCORE II in Predicting Postoperative Mortality and Complications in Elderly Patients Who Underwent Elective Open Cardiac Surgery: A Retrospective Cohort Study.

OBJECTIVE: To compare sensitivity, specificity, receiver operating characteristic (ROC), and area under the curve (AUC) values using the modified Frailty Index 11 (mFI-11), EuroSCORE II, and combined mFI-11 and EuroSCORE II to predict in-hospital mortality and composite morbidities. DESIGN: Retrospective cohort study SETTING: Songklanagarind Hospital, a tertiary care center in southern Thailand. PARTICIPANTS: Elderly patients age ≥60 years who underwent elective open-heart surgical procedures on a pump between January 2017 and December 2022 were included. INTERVENTIONS: ROC curves were constructed to evaluate the discriminatory power of EuroSCORE II and mFI-11 for predicting in-hospital mortality and postoperative complications. MEASUREMENTS AND MAIN RESULTS: The actual in-hospital mortality was 2.5% for all patients. The discriminative accuracy of mFI-11, EuroSCORE II, and combined mFI-11 with EuroSCORE II for predicting in-hospital mortality was good, with respective AUC values of 0.733 (95% confidence interval [CI], 0.6157-0.8499), 0.793 (95% CI, 0.6826-0.9026), and 0.78 (95% CI, 0.6686-0.893). The AUC of mFI-11 for predicting postoperative cardiac, respiratory, neurologic, and renal complications was 0.558 (95% CI, 0.5101-0.6063), 0.606 (95% CI, 0.5542-0.6581), 0.543 (95% CI, 0.4533-0.6337), and 0.652 (95% CI, 0.5859-0.7179), respectively, and that of EuroSCORE II was 0.553 (95% CI, 0.5038-0.6013), 0.631 (95% CI, 0.578-0.6836), 0.619 (95% CI, 0.5306-0.7076), and 0.702 (95% CI, 0.6378-0.7657), respectively. CONCLUSIONS: The mFI-11 and EuroSCORE II demonstrated good discrimination in ROC analysis, with EuroSCORE II showing superior predictive accuracy for in-hospital mortality in elderly elective cardiac surgery patients. However, neither score independently predicted mortality in multiple logistic regression, nor did combining them enhance predictive power significantly. Furthermore, both scores were less effective in predicting postoperative complications.

The distribution structure of medical and care resources based on regional characteristics throughout Japan in 2020.

BACKGROUND: Given Japan's rapidly aging population, the Ministry of Health, Labour and Welfare's policy of reducing hospital beds and replacing medical care with nursing care requires the establishment of a coordinated system of medical and care services tailored to regional characteristics. To gain useful knowledge for the development of such a system, this study aimed to identify differences in the structure of the relationship between medical and care resources due to differences in regional characteristics. METHODS: Initially, regional characteristics were used to group all 334 secondary medical areas (SMA) in Japan by principal component analysis. Subsequently, the related structure of the distribution of medical and care resources for each group were compared. For these　comparisons, first, the related structure of the distribution of medical and care resources nationwide was modeled using structural equation modeling. Secondly, multigroup analysis was conducted to investigate differences among the models across groups. RESULTS: The nationwide SMAs were grouped largely based on urbanicity and middle-density regionality. The groups with high urbanicity and high middle-density regionality consisted of SMAs with a high and medium population density. By contrast, the low middle-density regionality group consisted of SMAs containing large cities with a high population density and depopulated areas with a low population density. The model of the related structure of the distribution of medical and care resources differed among these groups. In the non-urbanicity and middle-density regionality groups, nursing care abundance tended to increase acute care abundance. In addition, in all groups, nursing care abundance tended to increase long-term hospitalization care abundance and clinic care abundance (with beds). CONCLUSIONS: The key finding of this study was that the government's objective of reducing hospital beds may not be achieved solely by expanding nursing homes. This is because many of the models did not show a tendency that higher nursing care abundance reduces the values of the factors which increase more hospital beds. This finding was particularly relevant in middle-density regionality groups. This finding suggests that the location of nursing homes should be monitored because of concerns about the oversupply of nursing homes and sprawl in those areas.

Association between cooking with solid fuels and depressive symptoms among middle-aged and older adults in China: The mediating effect of the residential environment.

BACKGROUND: Depression is a common issue among elderly people in both developing and developed countries. Existing research indicates that cooking with solid fuels has a negative impact on the mental health of middle-aged and elderly people (aged 45 and older). However, the potential role of the residential environment in this process is not yet clear. Clarifying this issue may help identify effective interventions to improve public health for elderly people. This study aimed to explore the association between cooking with solid fuels and depressive symptoms, as well as the potential mediating role of the residential environment in this relationship. METHOD: This study utilized cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS) for 2020, involving approximately 19,000 respondents aged 45 years and older. Propensity score matching (PSM) was used to explore the association between cooking with solid fuels and depressive symptoms. Additionally, a range of potential covariates were adjusted, and the Sobel test was applied to assess the potential mediating effect of the residential environment on this relationship. RESULTS: According to the fully adjusted model, cooking with solid fuels was significantly associated with an increased risk of depressive symptoms in middle-aged and older adults (ß = 0.315, P < 0.001), and this finding was confirmed through robustness tests using different propensity score matching methods. Heterogeneity analysis revealed that this association was particularly significant among men (ß = 0.318, P < 0.001), those aged 60-74 (ß = 0.347, P < 0.001), and individuals with a middle school education (ß = 0.353, P < 0.001). Mediation effect analysis revealed that indoor cleanliness (ß = 0.0090, P < 0.001), indoor broadband coverage (ß = 0.0077, P < 0.001), and the installation of indoor air purifiers (ß = 0.0010, P < 0.1) mediated the relationships between cooking with solid fuels and depressive symptoms. CONCLUSION: Given the growing attention given to improving indoor environments and enhancing mental health, the findings of this paper highlight that improving indoor cleanliness, increasing broadband coverage indoors, and installing air purifiers can effectively intervene in and prevent depressive symptoms caused by cooking with solid fuels.

Chewing difficulties mediated association between edentulism and depressive symptoms among middle aged and older population.

BACKGROUND: Depression is a major health condition among the aging population. Previous studies indicated that edentulism was a risk factor for depression. The link between edentulism and depression has not been fully clarified. OBJECTIVES: This study aimed to estimate whether chewing difficulties play a mediating role in the association between edentulism and depression among middle-aged and older populations with national cross-sectional data. METHODS: Data were obtained from the latest fourth wave of the China Health and Retirement Longitudinal Study (CHARLS). The outcome variable was set as depression, which was measured by the Center for Epidemiologic Studies Depression Scale (CES-D-10). Independent and mediated variables were separately set as self-assessed edentulism and chewing difficulties. The nearest neighbour propensity score matching (PSM) method was used to construct a matching group to balance the basic characteristics of individuals with and without edentulism with minimised bias in the estimation. Causal mediation analysis was performed to estimate the degree of contribution of chewing difficulties to the association between edentulism and depression. Several sensitivity analyses were performed to evaluate the robustness of the primary result. RESULTS: A total of 15 853 individuals remained for analysis. After PSM, 809 individuals with edentulism and 2628 without edentulism remained for analysis. Among the matched individuals, the mean age was 66.3 ± 9.2 years, 58.5% were female, 78.8% lived in rural areas, 23.5% had edentulism, 51.1% had depressive symptoms, and 50.1% had chewing difficulties. Logistic regression results showed that a higher incidence of edentulism was associated with a higher rate of depression (OR: 1.39, 95% CI: 1.19-1.63) in the matching group. Causal mediation analysis results indicated that the average mediation effect of chewing difficulties on the association between edentulism and depression was 0.010 (95% CI: 0.005-0.015), and the average direct effect was 0.072 (95% CI: 0.036-0.11). The mediation proportion of chewing difficulties was 11.7% (95% CI: 0.079-0.21). CONCLUSION: A higher prevalence of edentulism was associated with a higher rate of depression among middle-aged and elderly populations. Chewing difficulties moderately mediated the association between edentulism and depression. Fundamental oral function should not be neglected to improve mental health among the aging population.

Usefulness of non-surgical treatment without weight bearing restriction versus surgical treatment for maintaining activities of daily living in patients with peri-prosthetic femoral fractures.

PURPOSE: Non-surgical treatment without weight-bearing restriction, even in the early post-injury phase, may have a favourable effect on the activities of daily living (ADLs) in elderly patients with peri-prosthetic femoral fractures (PFFs). This study aimed to assess the effectiveness of surgical and non-surgical treatments for PFFs in terms of ADL maintenance and clinical safety. METHODS: This retrospective cohort study included 44 patients with PFFs proximal to the stem fixation site without stem loosening. Rehabilitation with weight bearing was initiated after internal fixation of the fracture site in the surgical group (n = 12) and immediately after the injury in the non-surgical group (n = 32). Clinical and radiological outcomes, including time until the first weight-bearing exercise, time until independent walking, ADL deterioration, and bone union rate, were compared between groups. Independent risk factors for ADL deterioration were also evaluated. RESULTS: The time until first weight-bearing exercise was shorter and the ADL deterioration rate was smaller in the non-surgical group than in the surgical group (8.8 ± 9.2 vs. 21 ± 13 days, P = 0.004; 6.2% vs. 12.5%, P = 0.04, respectively). Bone union rates were similar between groups (91% vs. 83%, P = 0.42), and aseptic loosening of the stem was not observed. Time until first weight-bearing exercise was identified as an independent risk factor for ADL deterioration (odds ratio, 1.13; 95% confidence interval, 1.01-1.26; P = 0.03). CONCLUSION: Non-surgical treatment of PFFs proximal to the stem fixation site without stem loosening, which does not restrict early weight-bearing exercise after injury, is an effective and safe treatment procedure that maintains ADL performance in elderly patients.

Trajectory classes of depressive symptoms among middle-aged and older adults following the transition to living alone.

This study identified the trajectory classes of depressive symptoms after transitioning to living alone and the factors affecting these trajectories. Data from the initial to the seventh waves of the Korean Longitudinal Study of Aging were analyzed, focusing on four consecutive waves. We selected 369 participants aged ≥45 who transitioned to living alone between consecutive waves (T1 and T2). They were followed up for six years (T1 to T4) while living alone from T2 to T4. Using latent class growth modeling, three trajectories emerged: low-lessening, moderate-lessening, and high-stable. The highly stable class was associated with older age, more chronic diseases, lower satisfaction with health and financial status, and less frequent social interactions at T1 than the low-lessening class. These findings underscore the importance of community-based interventions for middle-aged and older adults with risk factors as they face an increased risk of depression over time after transitioning to living alone.

EQ-5D-3L Norms for the European Older Population: Country-Specific Norms for 15 European Countires Based on the Survey of Health, Ageing, and Retirement in Europe.

OBJECTIVES: This study presents a country-specific 3-level version of EQ-5D population norms for the European older population. METHODS: Norm data were obtained from the fourth wave of the Survey of Health, Ageing and Retirement in Europe, and determined, for each EQ-5D dimension, the EQ-visual analog scale (EQ-VAS) and EQ-5D index values by 7 age groups and sex for 15 European countries. The EQ-5D index values were calculated using the European VAS value set for all countries. RESULTS: Data resulting from 50 013 older respondents (mean age 65.9 years, range 50-111 years, 55.6% women) revealed an increasing number of self-reported health problems on EQ-5D dimensions and decreasing EQ-VAS scores with increasing age and for women compared with men. There are notable differences between countries in terms of the age gradient, the proportion of respondents in full health, and sex. Across all age groups, problems with pain & discomfort are the most frequent (36%-73% any problems), whereas problems with self-care are the least frequent (3%-31% any problems). The mean EQ-VAS score is 71.2 and the mean European VAS score is 0.79. CONCLUSIONS: Given the growing number of older adults and elderly people in Europe, these population norms provide a valuable source of reference data that can be used to compare older adults or patient subgroups to the average of the general elderly population in a similar age or sex group in 15 European countries. The index value results may be further used to assess the burden of disease across older European populations and to identify the unmet needs of targeted older patient populations.

From Crisis to Insight: Navigating Public Health Challenges in an Aging Society-Lessons from Hong Kong's COVID-19 Experience.

This article critically examines the experience of Hong Kong (HK) with the COVID-19 pandemic and highlights the urgent need for effective public health responses in an aging society. As one of the world's fastest aging societies, Hong Kong's vulnerability to the consequences of pandemics is particularly pronounced due to low birth rates and high life expectancies. The city has experienced multiple waves of the COVID-19 virus, with the fifth wave causing some of the highest mortality rates in the world. However, through continuous learning and adaptation, HK's public health response has evolved to combat the crisis effectively. The discussion aims to highlight the importance of drawing from both positive and negative lessons from past epidemics and the critical role of public health systems in ensuring the well-being of older adults and the wider community. It emphasizes the need for sustained efforts to maintain and strengthen public health systems to tackle the ongoing and future public health challenges in an aging society.

Clinical role of radiofrequency ablation for early-stage hepatocellular carcinoma in an advanced aging society.

AIM: It is unclear whether prognosis differs by age for early-stage hepatocellular carcinoma (HCC). We aimed to examine prognosis and recurrence after radiofrequency ablation (RFA) for early-stage HCC and to determine its prognostic factors for different age groups. METHODS: This retrospective study enrolled 1079 patients with initial early-stage HCC treated with RFA at two institutions. All patients in this study were divided into four groups: <70 years old (group1, n = 483), 70-74 years old (group2, n = 198), 75-79 years old (group3, n = 201), and ≥80 years old (group4, n = 197). Prognostic factors were evaluated by comparing survival and recurrence rates between each group. RESULTS: The median survival time and 5-year survival rates for each group were 113 months and 70.8% in group1, 99.2 months and 71.5% in group2, 91.3 months and 66.5% in group3, and 71 months and 52.6% in group 4, respectively. Group4 had a significantly shorter survival than the other groups (p < 0.05). There were no significant differences in recurrence-free survival among the groups. In group4, the most common cause of death was nonliver-related disease (69.4%). In all groups, modified albumin-bilirubin index grade was a factor contributing to prolonged prognosis, but only in group4 performance status (PS) was a significant factor (hazard ratio, 2.46; 95% confidence interval, 1.16-3.00; p = 0.009). CONCLUSION: For early-stage HCC in the elderly, preoperative evaluation of PS and management of other diseases could contribute to a prolonged prognosis.

Measures of carbohydrate quality and their association with diet quality and cardiometabolic health outcomes in Singapore middle-aged and older adults.

BACKGROUND AND AIMS: Carbohydrate quality may play a key role in cardiometabolic health and disease risk. This study aimed to assess the dietary carbohydrate quality of the free-living middle-aged and older adults in Singapore, and its association with overall diet quality and cardiometabolic health. METHODS AND RESULTS: This cross-sectional study examined the diet and cardiometabolic disease risk indicators of middle-aged and older adults in Singapore (n = 104). Dietary carbohydrate quality was assessed as the pass and fail rate of the population to four measures of carbohydrate quality: (i) dietary fiber recommended daily allowance (RDA), (ii) whole-grain recommendation, (iii) free sugar recommendation, and (iv) carbohydrate metrics. The association between each carbohydrate quality measure and diet quality, as well as cardiometabolic health, was assessed. Except for free sugar recommendation, the carbohydrate quality of the population was found to be poor with a low adherence (20-36%) to three measures. Subjects meeting these measures had generally higher intakes of fiber, protein, and most micronutrients compared with subjects who failed. Meeting different variants of the carbohydrate metrics was associated with 60% lower odds of pre-hypertensive blood pressure (p = 0.037; p = 0.047), and meeting the dietary fiber RDA was associated with lower waist circumference (p = 0.021). CONCLUSION: An improvement in carbohydrate quality is warranted among free-living middle-aged and older adults in Singapore. Not all measures of carbohydrate quality were equally effective in preserving overall diet quality; the carbohydrate metrics and dietary fiber RDA can be identified as effective measures in relation to cardiometabolic disease risk. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ CLINICAL TRIAL REGISTRATION: NCT03554954, 13 Sept. 2018.

Associations among socioeconomic status, multimorbidity of non-communicable diseases, and the risk of household catastrophic health expenditure in China: a population-based cohort study.

BACKGROUND: Multimorbidity of non-communicable diseases (NCDs) is increasingly prevalent among older adults around the world, leading a higher risk of household catastrophic health expenditure (CHE). As current powerful evidence was insufficient, we aimed to estimate the association between multimorbidity of NCDs and the risk of CHE in China. METHODS: We designed a cohort study using data investigated in 2011-2018 from the China Health and Retirement Longitudinal Study, which is a nationally-representative study covering 150 counties of 28 provinces in China. We used mean ± standard deviation (SD) and frequencies and percentages to describe baseline characteristics. Person χ2 test was employed to compare the differences of baseline characteristics between households with and without multimorbidity. Lorenz curve and concentration index were used to measure the socioeconomic inequalities of CHE incidence. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the association between multimorbidity and CHE. RESULTS: Among 17,708 participants, 17,182 individuals were included for the descriptive analysis of the prevalence of multimorbidity in 2011, and 13,299 individuals (8029 households) met inclusion criteria and were included in the final analysis with a median of 83 (interquartile range: 25-84) person-months of follow-up. 45.1% (7752/17,182) individuals and 56.9% (4571/8029) households had multimorbidity at baseline. Participants with higher family economic level (aOR = 0.91, 95% CI: 0.86-0.97) had lower multimorbidity prevalence than those with lowest family economic level. 82.1% of participants with multimorbidity did not make use of outpatient care. The CHE incidence was more concentrated among participants with higher socioeconomic status (SES) with a concentration index of 0.059. The risk of CHE was 19% (aHR = 1.19, 95% CI: 1.16-1.22) higher for each additional NCD. CONCLUSIONS: Approximately half of middle-aged and older adults in China had multimorbidity, causing a 19% higher risk of CHE for each additional NCD. Early interventions for preventing multimorbidity among people with low SES could be intensified to protect older adults from financial hardship. In addition, concerted efforts are needed to increase patients' rational healthcare utilization and strengthen current medical security for people with high SES to reduce economic disparities in CHE.

A scale to measure the perceived quality of mHealth by elderly patients with hypertension in China.

BACKGROUND: The elderly population in China is growing, with hypertension being the most prevalent chronic disease in older adults. Despite the rapid penetration and efficient management effect of mobile health on hypertension healthcare, elderly patients are often less adopted and continue to use mobile health services. Quality perception significantly affects an individual's satisfaction and continued intention to use mobile health services. The evaluation of the significant factors affecting mobile health quality perception by elderly individuals remains largely unexplored. The aim of this study was to develop and validate an evaluation scale to measure the perceived quality of mobile health applications for hypertension and determine the underlying influencing factors. METHODS: A cross-sectional survey was conducted between November 2018 and October 2019. A quality evaluation scale with three factors and seven indicators was developed based on the Information Systems Success model. Data was analyzed using structural equations modelling (SEM) and one-way analysis of variance (ANOVA). All tests were two-sided and statistically significant at P < 0.05. RESULTS: The proposed mobile health application quality evaluation scale from the perspective of the elderly was shown to be a hierarchical, multidimensional construct with valid reliability, convergent validity and discriminant validity, which consists of three factors and seven indicators. The SEM results suggested that information quality and service quality had a significant impact on the satisfaction of elderly individual's with mobile health applications for hypertension management. The results also suggest that the elderly individuals had a low evaluation of mobile medical service quality(4.06 ± 0.70), while the score of information quality was the highest, with an average score of 4.36(SD 0.83) out of 5. Male patients were shown to more readily accept mobile health applications, with their perception of system quality being 0.27 higher than female ones (95% CI 0.00 ~ 0.52; P < .05). Patients with 1-5 years hypertension histories assessed the system (95% CI 0.03 ~ 0.63; P < .05), information (95% CI 0.11 ~ 0.65; P < .05), and service quality (95% CI 0.00 ~ 0.47; P < .05) higher than those with hypertension histories > 10 years. Elderly patients who regularly visited primary hospitals assessed the information quality 0.13 higher (95% CI -0.08 ~ 0.34; P < .05) than those visited tertiary hospitals. CONCLUSIONS: These findings have significant implications for theoretical and practical research on mobile health application quality evaluation, which will be helpful for policymakers and mobile health providers in improving the context and utilisation of mobile health to include elderly users. More mobile health applications attributes, such as timely information and interactive services that meet the characteristics of elderly patients with different mental and health demands need to be considered. Deeply embedding mobile health into primary health services is recommended to help increase the perceived quality of mobile health, and ensure the continuous use.

Exploring concepts and trends in informal caregiver burden: systematic review using citation network and content analysis.

BACKGROUND: With the increase in the aging population, informal caregivers have become an essential pillar for the long-term care of older individuals. However, providing care can have a negative impact and increase the burden on caregivers, which is a cause for concern. OBJECTIVE: This study aimed to comprehensively depict the concept of "informal caregiver burden" through bibliometric and content analyses. METHODS: We searched the Web of Science (WoS) database to obtain bibliometric data and included only papers published between 2013 and 2022. We used content analysis to extract and identify the core concepts within the text systematically. RESULTS: Altogether, 934 papers were included in the bibliometric analysis, from which we selected 19 highly impactful papers for content analysis. The results indicate that researchers have focused on exploring the factors that impact informal caregiver burden. Meanwhile, there has been a widespread discussion regarding the caregiver burden among those caring for recipients with specific illnesses, such as dementia, Alzheimer's disease, and cancer, as these illnesses can contribute to varying levels of burden on informal caregivers. In addition, questionnaires and interviews emerged as the predominant methods for data collection in the realm of informal caregiver research. Furthermore, we identified 26 distinct assessment tools specifically tailored for evaluating burden, such as caregiver strain index (CSI). CONCLUSION: For future studies, we suggest considering the intersectionality of factors contributing to the burden on informal caregivers. This approach could enhance the well-being of both caregivers and older care recipients.

Depressive symptoms decrease health-related quality of life of patients with coronary artery disease and diabetes: a 12-month follow up study in primary care.

OBJECTIVE: Health-related quality of life (HRQoL) is a multidimensional patient-related outcome. Less is known about the role of depressive symptoms on HRQoL in chronic diseases. This follow-up study analyzed depressive symptoms' association with HRQoL change measured with 15D in patients with chronic diseases. DESIGN AND SETTING: A total of 587 patients from the Siilinjärvi Health Center, Finland were followed up due to the treatment of hypertension (HA), coronary artery disease (CAD) or diabetes (DM). Depressive symptoms were based on Beck Depression Inventory (BDI) (BDI ≥10 =depressive symptoms). HRQoL was assessed at the baseline and after 12 months. RESULTS: There were 244 patients with HA (mean age 70 years, 59% women); 103 patients (72 years, 38%) with CAD and 240 with DM (67 years, 52%). The change from baseline to the 12-month follow-up in 15D was significantly different between patients without and with depressive symptoms in CAD (p < 0.001) and DM (p = 0.024). In CAD with depressive symptoms, the change was -0.064 (95% CI: -0.094 to -0.035) and in DM -0.018 (95% CI: -0.037 to 0.001). In the 15 HRQoL dimensions of 15D, a depressive symptoms-related decrease was found in three dimensions with HA, in 9 with CAD and in 7 with DM. As a function of the BDI at baseline, the 15D score decreased significantly among patients with CAD and DM. CONCLUSIONS: Depressive symptoms impact negatively on future HRQoL among primary care patients with coronary artery disease and diabetes emphasizing that mood should be acknowledged in their care and follow-up. TRIAL REGISTRATION: Clinical Trials registration number: NCT02992431, registered December 14th 2016.

Health-related quality of life (HRQoL) is an important dimension of the quality and effectiveness of health care and an important predictor of mortality and morbidity.The main finding was that baseline depressive symptoms were associated with a decrease in the health-related quality of life after 12 months of follow-up, particularly in patients with coronary artery disease and diabetes.Beginning from the lowest scores, the severity of baseline depressive symptoms had a significant relationship with the level of deterioration in HRQoL among patients with coronary artery disease and diabetes.A significant decrease in HRQoL related to depressive symptoms was found in various different dimensions of HRQoL.

The Relationship between the Distribution of Home Medical Clinics and Home Care Service Offices in Japan.

The increasing number of older people in Japan has led to a need for cooperation between home medical and care services. The collaboration between medical and care provisions in home settings is thus a matter for concern. The present study examines the distribution of and relationship between the number of home medical clinics (HMCs) and home care service offices (HCOs) in Japan. We used national data, detailing the total population, percentage of older adults, and number of HMCs and HCOs. Overall, 23,428 HMCs and 35,612 HCOs were identified nationwide. While the southwestern region of Japan had a high number of HMCs relative to the northeastern region, there was not such a clear difference in the regional distribution of number of HCOs. A linear regression analyses, adjusted for the percentage of older people, revealed a significant positive correlation between the number of HMCs per 10,000 older people and HCOs per 10,000 older people (ß = 0.58, p < 0.001). These findings may allow us to understand advances in cooperation between home medical and care services in Japan.

Global Trends in Social Prescribing: Web-Based Crawling Approach.

BACKGROUND: Social loneliness is a prevalent issue in industrialized countries that can lead to adverse health outcomes, including a 26% increased risk of premature mortality, coronary heart disease, stroke, depression, cognitive impairment, and Alzheimer disease. The United Kingdom has implemented a strategy to address loneliness, including social prescribing-a health care model where physicians prescribe nonpharmacological interventions to tackle social loneliness. However, there is a need for evidence-based plans for global social prescribing dissemination. OBJECTIVE: This study aims to identify global trends in social prescribing from 2018. To this end, we intend to collect and analyze words related to social prescribing worldwide and evaluate various trends of related words by classifying the core areas of social prescribing. METHODS: Google's searchable data were collected to analyze web-based data related to social prescribing. With the help of web crawling, 3796 news items were collected for the 5-year period from 2018 to 2022. Key topics were selected to identify keywords for each major topic related to social prescribing. The topics were grouped into 4 categories, namely Healthy, Program, Governance, and Target, and keywords for each topic were selected thereafter. Text mining was used to determine the importance of words collected from new data. RESULTS: Word clouds were generated for words related to social prescribing, which collected 3796 words from Google News databases, including 128 in 2018, 432 in 2019, 566 in 2020, 748 in 2021, and 1922 in 2022, increasing nearly 15-fold between 2018 and 2022 (5 years). Words such as health, prescribing, and GPs (general practitioners) were the highest in terms of frequency in the list for all the years. Between 2020 and 2021, COVID, gardening, and UK were found to be highly related words. In 2022, NHS (National Health Service) and UK ranked high. This dissertation examines social prescribing-related term frequency and classification (2018-2022) in Healthy, Program, Governance, and Target categories. Key findings include increased "Healthy" terms from 2020, "gardening" prominence in "Program," "community" growth across categories, and "Target" term spikes in 2021. CONCLUSIONS: This study's discussion highlights four key aspects: (1) the "Healthy" category trends emphasize mental health, cancer, and sleep; (2) the "Program" category prioritizes gardening, community, home-schooling, and digital initiatives; (3) "Governance" underscores the significance of community resources in social prescribing implementation; and (4) "Target" focuses on 4 main groups: individuals with long-term conditions, low-level mental health issues, social isolation, or complex social needs impacting well-being. Social prescribing is gaining global acceptance and is becoming a global national policy, as the world is witnessing a sharp rise in the aging population, noncontagious diseases, and mental health problems. A successful and sustainable model of social prescribing can be achieved by introducing social prescribing schemes based on the understanding of roles and the impact of multisectoral partnerships.