Energy expenditure estimation during activities of daily living in middle-aged and older adults using an accelerometer integrated into a hearing aid.

Background: Accelerometers were traditionally worn on the hip to estimate energy expenditure (EE) during physical activity but are increasingly replaced by products worn on the wrist to enhance wear compliance, despite potential compromises in EE estimation accuracy. In the older population, where the prevalence of hearing loss is higher, a new, integrated option may arise. Thus, this study aimed to investigate the accuracy and precision of EE estimates using an accelerometer integrated into a hearing aid and compare its performance with sensors simultaneously worn on the wrist and hip. Methods: Sixty middle-aged to older adults (average age 64.0 ± 8.0 years, 48% female) participated. They performed a 20-min resting energy expenditure measurement (after overnight fast) followed by a standardized breakfast and 13 different activities of daily living, 12 of them were individually selected from a set of 35 activities, ranging from sedentary and low intensity to more dynamic and physically demanding activities. Using indirect calorimetry as a reference for the metabolic equivalent of task (MET), we compared the EE estimations made using a hearing aid integrated device (Audéo) against those of a research device worn on the hip (ZurichMove) and consumer devices positioned on the wrist (Garmin and Fitbit). Class-estimated and class-known models were used to evaluate the accuracy and precision of EE estimates via Bland-Altman analyses. Results: The findings reveal a mean bias and 95% limit of agreement for Audéo (class-estimated model) of -0.23 ± 3.33 METs, indicating a slight advantage over wrist-worn consumer devices (Garmin: -0.64 ± 3.53 METs and Fitbit: -0.67 ± 3.40 METs). Class-know models reveal a comparable performance between Audéo (-0.21 ± 2.51 METs) and ZurichMove (-0.13 ± 2.49 METs). Sub-analyses show substantial variability in accuracy for different activities and good accuracy when activities are averaged over a typical day's usage of 10 h (+61 ± 302 kcal). Discussion: This study shows the potential of hearing aid-integrated accelerometers in accurately estimating EE across a wide range of activities in the target demographic, while also highlighting the necessity for ongoing optimization efforts considering precision limitations observed across both consumer and research devices.

The association between the 'at risk of developing undernutrition' category of the Short Nutritional Assessment Questionnaire 65+ and incident undernutrition in community-dwelling older adults.

BACKGROUND & AIMS: Screening tools like the Short Nutritional Assessment Questionnaire 65+ (SNAQ65+) have been developed for the early recognition of undernutrition in older adults. The SNAQ65+ screens for being undernourished (red), being 'at risk of developing undernutrition' (i.e. 'at risk', orange), or 'not at risk' (green). This study investigated whether community-dwelling older adults 'at risk' (orange) are more likely to develop undernutrition during a 3-year follow-up compared to those 'not at risk' (green). METHODS: Prospective data from a Longitudinal Aging Study were used. A total of 5461 observations, using multiple 3-year waves of participants aged ≥65 years with an orange or green baseline score were included. Logistic mixed models were used to assess the association with four indicators of incident undernutrition at 3-year follow-up: (1) red SNAQ65+ score (mid upper arm circumference (MUAC) < 25 cm and/or ≥4 kg self-reported unintended weight loss in 6 months); (2) MUAC <25 cm; (3) ≥4 kg self-reported unintended weight loss in 6 months; and (4) ≥10% objectively measured weight loss in 3 years. RESULTS: There were 53.1% female participants across waves, with a mean age of 74.2 (SD 6.1) years. Overall, 6.2% were 'at risk of developing undernutrition' (orange) at baseline. The incidence rates of undernutrition based on a red SNAQ65+ score, MUAC <25 cm, ≥4 kg self-reported unintended weight loss, and ≥10% measured weight loss were 10.4%, 2.9%, 6.4%, and 5.4%, respectively. Those 'at risk' (orange) had a higher odds ratio of incident undernutrition based on these four indicators than those 'not at risk' (green) (respective odds ratio's: 2.51 (95%CI 1.74-3.62); 2.16 (95%CI 1.11-4.20); 2.43 (95%CI 1.61-3.65); and 2.08 (95%CI 1.28-3.37)). CONCLUSION: Community-dwelling older adults screened to be 'at risk of developing undernutrition' (orange) with the SNAQ65+ have a more than two-fold higher odds ratio of developing undernutrition during a 3-year follow-up compared to those 'not at risk' (green).

Impact of infection on healthcare costs and clinical outcomes in elderly hospitalized patients with multimorbidity.

Background: Elderly patients with multimorbidity are at higher risk of greater healthcare costs and poor outcomes due to decreased physical function. The aim of this study was to investigate the impact of infection on healthcare costs and poor outcomes in elderly hospitalized patients with multimorbidity. Methods: We retrospectively enrolled 264 patients who met the inclusion criteria from the department of geriatrics of a large public hospital in Shanghai, China between January 2020 and December 2020. Patients were divided into two groups based on whether they had infection [infection present on admission (IPOA) or healthcare-associated infection(HAI)]. We recorded the basic information and follow-up information of all patients. The follow-up information included 30-day and 1-year all-cause readmission and mortality. Then we analyzed the association between infection and healthcare costs and clinical outcomes. Results: Among 264 subjects, 47.73 % of them achieved IPOA or HAI. The 30-day poor outcomes rate was 45.45 %, and the 1-year poor outcomes rate was 78.41 %. Compared with subjects without infection, the number of drugs and the disease burden were greater in subjects with infection(P < 0.001). Subjects with infection had longer length of hospital stay(P < 0.001) and had greater healthcare cost(P < 0.001). Moreover, subjects with infection had higher poor outcomes rates of 30-day and 1-year(P < 0.001). Infection could predict greater total cost [odds ratio (OR): 1.32, 95 % CI: 1.18,1.49,P < 0.001], nursing cost(OR: 11.45, 95 % CI: 3.49,37.63,P < 0.001), and medicine cost (OR: 2.37, 95 % CI: 1.70,3.31,P < 0.001). In addition, infection was also independently associated with the 30-day poor outcomes rate(OR:3.07, 95%CI: 1.80,5.24,P < 0.001), but we found no association between infection and 1-year poor outcomes rate(OR:1.43, 95 % CI:0.73,2.79,P = 0.300) after adjustment. Conclusions: Infection was a risk factor for higher healthcare cost and 30-day poor outcome rate in elderly hospitalized patients with multimorbidity.

Quantification of Oversupply of Chronic Disease Medications among Patients Aged ≥55 Years in Japan.

Medication waste may be caused by medication oversupply; however, the degree of medication oversupply in Japan is unclear. This study aimed to quantify the degree of oversupply of chronic disease medications per patient, the proportion of oversupplied patients, and the excess days and costs of the oversupplied medications in Japan. This retrospective nationwide cohort study using a large insurance claims database from Japan was conducted in patients aged ≥55 years who received one or a combination of the following five classes of medications dispensed in FY 2019: third-generation calcium antagonists, angiotensin 2 receptor blockers, statins, dipeptidyl peptidase-4 inhibitors, and biguanides. Medications with the same ingredient having the same specification were treated as the same medication. Medication oversupply was defined as a medication possession ratio (MPR) during persistence >1.0. The proportions of oversupplied patients and excessively oversupplied patients with ≥30 excess days/year were approximately 16 and 1-2% for all drug classes, respectively. Three-quarters of the oversupplied patients had fewer excess day (≤14/year), and the median oversupplied medication cost was less than 1000 yen/year for all classes. However, there was a patient with oversupplied medication estimated as 983 excess days per year and a patient with oversupplied medication costs of nearly 90000 yen per year. Using the MPR and excess days as indicators, it is necessary to accelerate estimation of the oversupply per patient, as well as the development of patient intervention strategies and a national system to reduce medication oversupply.

Meta-analysis of the quantitative assessment of lower extremity motor function in elderly individuals based on objective detection.

OBJECTIVE: To avoid deviation caused by the traditional scale method, the present study explored the accuracy, advantages, and disadvantages of different objective detection methods in evaluating lower extremity motor function in elderly individuals. METHODS: Studies on lower extremity motor function assessment in elderly individuals published in the PubMed, Web of Science, Cochrane Library and EMBASE databases in the past five years were searched. The methodological quality of the included trials was assessed using RevMan 5.4.1 and Stata, followed by statistical analyses. RESULTS: In total, 19 randomized controlled trials with a total of 2626 participants, were included. The results of the meta-analysis showed that inertial measurement units (IMUs), motion sensors, 3D motion capture systems, and observational gait analysis had statistical significance in evaluating the changes in step velocity and step length of lower extremity movement in elderly individuals (P < 0.00001), which can be used as a standardized basis for the assessment of motor function in elderly individuals. Subgroup analysis showed that there was significant heterogeneity in the assessment of step velocity [SMD=-0.98, 95%CI(-1.23, -0.72), I2 = 91.3%, P < 0.00001] and step length [SMD=-1.40, 95%CI(-1.77, -1.02), I2 = 86.4%, P < 0.00001] in elderly individuals. However, the sensors (I2 = 9%, I2 = 0%) and 3D motion capture systems (I2 = 0%) showed low heterogeneity in terms of step velocity and step length. The sensitivity analysis and publication bias test demonstrated that the results were stable and reliable. CONCLUSION: observational gait analysis, motion sensors, 3D motion capture systems, and IMUs, as evaluation means, play a certain role in evaluating the characteristic parameters of step velocity and step length in lower extremity motor function of elderly individuals, which has good accuracy and clinical value in preventing motor injury. However, the high heterogeneity of observational gait analysis and IMUs suggested that different evaluation methods use different calculation formulas and indicators, resulting in the failure to obtain standardized indicators in clinical applications. Thus, multimodal quantitative evaluation should be integrated.

[Layer based epidemiological quality assessment of architecture of care security and geriatric wards]. / Warstwowa ocena epidemiologiczna architektury zakladów opiekunczo-leczniczych i oddzialów geriatrycznych.

BACKGROUND: The article describes the potential use of an original model called the layered epidemiological assessment (warstwowa ocena epidemiologiczna - WOE) for assessing the potential risk of infections in facilities intended for elderly individuals. MATERIAL AND METHODS: To verify the possibility of using the WOE method for assessing epidemiological safety hazards in the built environment, available literature sources related to the legal requirements in Poland regarding the assessment of medical facility ergonomics in terms of infection transmission were analyzed. The article also referred to the guidelines of the New European Bauhaus and the Baukultur Quality System as a standardized method for assessing the quality of the built environment. The article presents the fundamental assumption of the author's WOE method, which allows for the assessment of the risk of infection transmission separately for each component of a building. The effectiveness of the method was demonstrated by using it to assess the risk of infections in a geriatric ward room as an example. RESULTS: The article demonstrates that by employing the WOE, it is possible to clearly differentiate potential infection routes within the analyzed facilities and assign them to specific building components. Furthermore, by applying the presented method, it is possible to define necessary procedures and develop action plans to minimize the risk of infection spread within the analyzed properties. CONCLUSIONS: The application of the WOE for evaluating architectural solutions in facilities intended for the elderly offers several benefits. The WOE method presented in the article can serve as an expert tool for quick and precise assessment of potential epidemiological hazards. An important advantage of the WOE method is its ability to be used separately for different types of epidemiological hazards characterized by different routes of infection transmission. Med Pr Work Health Saf. 2024;75(3):199-209.

Assessment of the Zulfiqar Frailty Scale (ZFS) in Primary Healthcare.

INTRODUCTION: The primary aim of the study was to validate the Zulfiqar Frailty Scale (ZFS) and examine its concordance with the modified Short Emergency Geriatric Assessment (mSEGA) scale, Part A. METHODS: A prospective observational study was conducted in Guadeloupe (France) over a two-month duration (from 20 February to 20 April 2024), involving elderly individuals aged 65 and older, deemed self-sufficient with an ADL (Activities of Daily Living) score exceeding four out of six. RESULTS: Within this community cohort of 98 individuals, averaging 75 years in age, frailty according to the modified SEGA criteria was prevalent in 29%. Frailty according to the "ZFS" score was prevalent in 40%. Key predictors of frailty identified in our study included age, comorbidity (Charlson score), polypharmacy (total number of medications and therapeutic classes), and functional ability (ADL scores). Notably, experiences of falls and hospitalizations within the past six months significantly influenced the classification of frailty according to both ZFS and SEGA scales. Significant associations with the presence of home care aides (p < 0.0001), monopodal support test results (p < 0.0001), memory impairments (p < 0.0001), and recent hospitalizations (p = 0.0054) underscored the multidimensional impact of frailty. The Pearson correlation coefficient and its 95% confidence interval between the SEGA and Zulfiqar Frailty Scales stood at 0.73 [0.61: 0.81]. The discernment threshold for frailty was set at three out of six criteria, showcasing a sensitivity of 64% and a negative predictive value of 80%. The area under the curve (AUC) for the Zulfiqar Frailty Scale was reported as 0.8. CONCLUSION: The "ZFS" tool allows for the detection of frailty with a highly satisfactory sensitivity and negative predictive value.

Exploring influential factors in the self-assessment of life satisfaction among Chinese elderly: a structural equation modeling analysis.

The aging problem is becoming more and more prominent globally. Attention to the quality of life and related health improvement among the elderly has become an important issue in modern society. This study utilized a tracking survey conducted in 2017-2018, involving 9,327 Chinese older adults, to examine health influencing factors, and applied structural equation modeling to analyze the influencing factors on the self-assessment of life satisfaction among older adults in different regions (cities, counties, and villages) in China. This study revealed that economic status, psychological status, personal situation, life behaviors, and child care are important influences on older people's self- assessed life satisfaction. There is a positive correlation between economic status, psychological status, child care and the results of the self-assessment of life satisfaction of the elderly. Psychological status and child care have a greater impact on the self-assessment of life satisfaction among the elderly in urban areas compared to villages and towns. The influence of economic status on the self-assessment of life satisfaction of the elderly is lower in urban areas than in rural areas. There is a significant difference in the influence of personal situations on the self-assessment of life satisfaction among the elderly. Additionally, older individuals tend to report higher levels of self-assessment of life satisfaction. Furthermore, female elderly individuals tend to report higher levels of satisfaction compared to males. Findings from this study indicate that improving health self-assessment in older adults requires targeted efforts based on different geographic areas of life and the age stages of older adults, and more attention needs to be paid to men who are just entering old age.

Assessment of polypharmacy, potentially inappropriate medications, and drug-drug interactions in older patients with cancer.

INTRODUCTION: This study aimed to determine polypharmacy, potentially inappropriate medications, and potential drug-drug interactions in elderly patients hospitalized in the oncology services of a university hospital in Turkey. METHODS: This retrospective cross-sectional study was conducted between September 2021 and September 2022 on cancer patients over 65 years old hospitalized at Suleyman Demirel University Medical Faculty Hospital in Isparta, Turkey. Potentially inappropriate medications were defined according to the 2023 Beers Criteria of the American Geriatrics Society. Potential drug-drug interactions were determined with Medscape® drug interaction checker. RESULTS: The median (min-max) of drugs used by the patients was 6 (2-15). Most of the patients (74.3%) had polypharmacy. Approximately half of the patients (51.4%) had potentially inappropriate medications. The most commonly used potentially inappropriate medications were diuretics (22.1%), metoclopramide (11.4%), antidepressant drugs (7.9%), and opioids (6.4%). The presence of comorbidities, mental, behavioral, and neurodevelopmental disorders, circulatory system diseases, and respiratory system diseases were found to be statistically significantly higher in the group with potentially inappropriate medication than in the group without potentially inappropriate medication (p < 0.05). In total, 98 patients (70%) had at least one potential drug-drug interaction. Potential drug-drug interactions were minor in 33.3%, major in 57.5%, serious in 7.74%, and contraindicated in 0.22. CONCLUSION: According to our study, polypharmacy, potentially inappropriate medications, and potential drug-drug interactions were high in elderly cancer patients. It is important to determine potential drug-drug interactions and potentially inappropriate medications in cancer patients by a multidisciplinary team, including the clinical pharmacist, to prevent possible negative consequences.

Enhancing surgical outcomes in elderly gastric cancer patients: the role of comprehensive preoperative assessment and support.

BACKGROUND: As the prevalence of gastric cancer rises in aging populations, managing surgical risks and comorbidities in elderly patients presents a unique challenge. The Comprehensive Preoperative Assessment and Support (CPAS) program, through comprehensive preoperative assessments, aims to mitigate surgical stress and improve outcomes by enhancing patient awareness and preparation. This study investigates the efficacy of a CPAS program, incorporating frailty and sarcopenia evaluations, to improve short-term outcomes in elderly gastric cancer patients. METHODS: A retrospective analysis was conducted on 127 patients aged 75 or older who underwent surgery with CPAS between 2018 and August 2023, compared to 170 historical controls from 2012 to 2017. Propensity score matching balanced both groups based on age-adjusted Charlson Comorbidity Index and surgical details. The primary focus was on the impact of CPAS elements such as rehabilitation, nutrition, psychological support, oral frailty, and social support on short-term surgical outcomes. RESULTS: Among 83 matched pairs, the CPAS group, despite 40.4% of patients in the CPAS group and 21.2% in the control group had an ASA-PS score of 3 or higher (P < 0.001), demonstrated significantly reduced blood loss (100 ml vs. 190 ml, P = 0.026) and lower incidence of serious complications (19.3% vs. 33.7%, P = 0.034), especially in infections and respiratory issues. Sarcopenia was identified in 38.6% of CPAS patients who received tailored support. Additionally, the median postoperative hospital stay was notably shorter in the CPAS group (10 days vs. 15 days, P < 0.001), with no in-hospital deaths. These results suggest that personalized preoperative care effectively mitigates operative stress and postoperative complications. CONCLUSION: Implementing CPAS significantly enhances surgical safety and reduces complication rates in elderly gastric cancer patients, emphasizing the critical role of personalized preoperative care in surgical oncology for this demographic.

Aferição da circunferência da panturrilha no rastreio da sarcopenia em idosos / Assessment of the scope circumference in the screening of sarcopenia in elderly people / Medición de la circunferencia de la pantorrilla en el cribado de sarcopenia en ancianos

Objetivo: Analisar a prática do enfermeiro da atenção primária à saúde acerca da aferição da circunferência da panturrilha no rastreio da sarcopenia em idosos. Métodos: Estudo descritivo de abordagem qualitativa, realizado com enfermeiros que atuam na atenção primária à saúde. As entrevistas foram realizadas mediante utilização de roteiro semiestruturado, nos meses de maio a julho de 2019. Resultados: Participaram do estudo 24 enfermeiros com idade média de 31,4 anos, predominantemente do sexo feminino. O tempo de formação dos participantes variou de cinco meses a 15 anos e, a maioria dos entrevistados relatou possuir pós-graduação (n=18), principalmente nas áreas de saúde da família e urgência e emergência. A maioria não utilizava em sua prática diária a avaliação da circunferência da panturrilha e alguns a realizavam apenas em idosos hipertensos e diabéticos. Conclusão: Há uma escassa utilização da aferição da circunferência da panturrilha na prática clínica do enfermeiro, o que compromete o rastreio da sarcopenia, e consequentemente dificulta a realização de ações que minimizam as complicações desta doença. (AU)

Objective: To analyze the practice of nurses in primary health care about measuring the circumference of the calf in screening for sarcopenia in the elderly. Methods: Descriptive study with a qualitative approach, carried out with nurses who work in primary health care. The interviews were conducted using a semi-structured script, from May to July 2019. Results: 24 nurses with a mean age of 31.4 years, predominantly female, participated in the study. Participants' training time ranged from five months to 15 years, and most respondents reported having a postgraduate degree (n=18), mainly in the areas of family health and urgency and emergency. Most did not use calf circumference assessment in their daily practice and some performed it only in hypertensive and diabetic elderly. Conclusion: There is little use of calf circumference measurement in clinical nursing practice, which compromises sarcopenia screening and, consequently, makes it difficult to carry out actions that minimize the complications of this disease. (AU)

Objetivo: Analizar la práctica de enfermeras de atención primaria de salud sobre la medición de la circunferencia de la pantorrilla en el cribado de sarcopenia en el anciano. Métodos: Estudio descriptivo con abordaje cualitativo, realizado con enfermeras que laboran en la atención primaria de salud. Las entrevistas se realizaron mediante un guión semiestructurado, de mayo a julio de 2019. Resultados: Participaron del estudio 24 enfermeras con una edad promedio de 31,4 años, predominantemente mujeres. El tiempo de formación de los participantes osciló entre cinco meses y 15 años, y la mayoría de los encuestados informó tener un título de posgrado (n = 18), principalmente en las áreas de salud familiar y urgencia y emergencia. La mayoría no utilizó la evaluación de la circunferencia de la pantorrilla en su práctica diaria y algunos la realizaron solo en ancianos hipertensos y diabéticos. Conclusión: La medición del perímetro de la pantorrilla es escasa en la práctica clínica de enfermería, lo que compromete el cribado de sarcopenia y, en consecuencia, dificulta la realización de acciones que minimicen las complicaciones de esta enfermedad. (AU)

Integrative geriatric assessment. A narrative review of the scales and their use in Ecuador

This study aims to describe the main tools for integrative geriatric assessment and their use in Ecuador. We performed a narrative review with a comprehensive and systematic literature search. 261 original articles were obtained from the primary search, and after the discrimination by the researchers, 76 articles were included in the final analysis. Integrative geriatric assessments cover different areas, including cognitive function, affective function, nutritional status and functionality, and seve-ral tools that are used worldwide for this purpose. In Ecuador, a deeper analysis of their use is required to evaluate their diagnostic efficacy and applicability to impro-ve health outcomes for the elderly population.

Este estudio tiene como objetivo describir las principales herramientas de evalua-ción integral geriátrica y su uso en el Ecuador. Realizamos una revisión narrativa con una búsqueda bibliográfica exhaustiva y sistemática. De la búsqueda primaria se obtuvieron 261 artículos originales, y luego de la discriminación por parte de los investigadores, se incluyeron 76 artículos en el análisis final. La evaluación ge-riátrica cubre diferentes áreas, incluida la función cognitiva, la función afectiva, el estado nutricional y la funcionalidad, y se utilizan varias herramientas en todo el mundo para este propósito. En Ecuador se requiere un análisis más profundo de su uso para evaluar su eficacia diagnóstica y aplicabilidad con el fin de mejorar los resultados de salud de la población adulta mayor.

Hypofractionated radiotherapy for glioblastoma: A large institutional retrospective assessment of 2 approaches.

Background: Glioblastoma (GBM) poses therapeutic challenges due to its aggressive nature, particularly for patients with poor functional status and/or advanced disease. Hypofractionated radiotherapy (RT) regimens have demonstrated comparable disease outcomes for this population while allowing treatment to be completed more quickly. Here, we report our institutional outcomes of patients treated with 2 hypofractionated RT regimens: 40 Gy/15fx (3w-RT) and 50 Gy/20fx (4w-RT). Methods: A single-institution retrospective analysis was conducted of 127 GBM patients who underwent 3w-RT or 4w-RT. Patient characteristics, treatment regimens, and outcomes were analyzed. Univariate and multivariable Cox regression models were used to estimate progression-free survival (PFS) and overall survival (OS). The impact of chemotherapy and RT schedule was explored through subgroup analyses. Results: Median OS for the entire cohort was 7.7 months. There were no significant differences in PFS or OS between 3w-RT and 4w-RT groups overall. Receipt and timing of temozolomide (TMZ) emerged as the variable most strongly associated with survival, with patients receiving adjuvant-only or concurrent and adjuvant TMZ having significantly improved PFS and OS (P < .001). In a subgroup analysis of patients that did not receive TMZ, patients in the 4w-RT group demonstrated a trend toward improved OS as compared to the 3w-RT group (P = .12). Conclusions: This study demonstrates comparable survival outcomes between 3w-RT and 4w-RT regimens in GBM patients. Receipt and timing of TMZ were strongly associated with survival outcomes. The potential benefit of dose-escalated hypofractionation for patients not receiving chemotherapy warrants further investigation and emphasizes the importance of personalized treatment approaches.

Within- and between-person associations of time-varying determinants with snacking in older adults: an ecological momentary assessment study.

Promoting healthy snacking is important in addressing malnutrition, overweight and obesity among an ageing population. However, little is known about the factors underlying snacking behaviour in older adults. The present study aimed to explore within- and between-person associations between determinants (i.e. intention, visibility of snacks, social modelling and emotions) and snacking behaviours (i.e. decision to snack, health factor of the snack and portion size) in older adults (60+). Conducting a two-part intensive longitudinal design, data were analysed from forty-eight healthy older adults consisting of (1) an event-based self-report ecological momentary assessment (EMA) diary every time they had a snack and (2) a time-based EMA questionnaire on their phone five times per day. Analysis through generalised linear mixed models indicated that higher intention to snack healthily leads to healthier snacking while higher levels of social modelling and cheerfulness promote unhealthier choices within individuals. At the between-person level, similar results were found for intention and social modelling. Visibility of a snack increased portion size at both a within- and between-person level, while the intention to eat a healthy snack only increased portion size at the between-person level. No associations were found between the decision to snack and all determinants. This is the first study to investigate both within- and between-person associations between time-varying determinants and snacking in older adults. Such information holds the potential for incorporation into just-in-time adaptive interventions, allowing for personalised tailoring, more effective promotion of healthier snacking behaviours and thus pursuing the challenge of healthy ageing.

China's policies: post-COVID-19 challenges for the older population.

On 7 December 2022, the State Council of China released 'Measures to Further Optimize the Implementation of the Prevention and Control of the New Coronavirus Epidemic'. The previous three-year dynamic zero epidemic prevention policy was then replaced with a full liberalization policy. On 5 May 2023, the World Health Organization declared that COVID-19 no longer constituted a 'public health emergency of international concern.' However, given the ongoing prevalence of coronavirus, emerging mutations, and the liberalization of restrictions, there are increased risks of vulnerable people contracting new variants. Low vaccination coverage among older people with compromised immune systems, puts them at further risk. The policy shift will increase pressure on already stretched health infrastructure and medical resources. This short article adds to the current debate arguing that the Chinese government should take commensurate preventive measures, including strengthening medical facilities and equipment and targeting ongoing vaccination in older people.

Paper ContextThe COVID-19 pandemic has disproportionately affected older people.This short paper discusses the consequences of China's liberalization policy on the older population.It suggests that the Chinese government should have taken targeted measures to mitigate health risks occurring under the changed circumstances.

Assessment of cognitive games to improve the quality of life of Parkinson's and Alzheimer's patients.

Objectives: The core objectives of this study centre on enhancing the quality of life and well-being of individuals diagnosed with Parkinson's and Alzheimer's diseases. Our aim is to facilitate the monitoring of patient information, benefiting both caregivers and healthcare professionals. Methods: As part of the PROCare4Life platform sensorial ecosystem, a web application with six engaging cognitive games focusing on developing cognitive training and stimulating brain activity are developed. A set of metrics calculated by the application feed machine learning predictive models to evaluate the cognitive status and evolution over time. Long-term analysis of the daily cognitive ability information is used to generate high-level outcomes and identify deviations for each patient from the multimodal fusion engine. And based on these results, a recommender system provides a set of personalized notifications. Results: A 3-month pilot study that took place in five different countries shows the results obtained from 93 patients. An average of 22.4 games were completed per day and the recommender system generated a total of 260 game notifications, 37.7% of them were marked as read by the patients. The Cognitive State Score and the Deviations in Cognitive Abilities measurement, calculated by the multimodal fusion engine, when used in conjunction present a good overview of the patient's current state and potential deviations. Conclusion: The cognitive games application was well-received by elderly individuals who took part in the study. This tool can be valuable for caregivers and healthcare providers in assessing the cognitive function of patients through engaging in cognitive games.

How to complement traditional instruments to measure the economic dimension of food security in older people? An application for regions of Argentina.

Introduction: One of the dimensions of food security has to do with economic access to food. Aim: Propose a methodology that allows evaluating economic access to food in Argentina for the elderly population. Methods: Dietary guides for the Argentine population are used. Meanwhile, the food consumption patterns observed in the elderly population in Argentina are considered from a household expenditure survey, from which implicit food prices can also be obtained. Results: Six dietary plans corresponding to different regions of the country are designed and evaluated and it is found that they would be affordable only in two of the six regions analyzed. Conclusion: in the Metropolitan, Pampas, Cuyo, and Northeast regions the cost of the ideal basket is higher than food spending, fundamentally in the Northeast region where food spending should increase by 25%.

Older adults preferences for long-term caregivers in China: a discrete choice experiment.

OBJECTIVE: Understanding the preferences of old-age adults for their long-term caregivers can improve person-centred health care and the quality of long-term care (LTC). This study examines Chinese older adults' preferences for long-term caregivers. STUDY DESIGN: This is a cross-sectional study. METHODS: A national representative discrete choice experiment (DCE) surveyed 2031 adults aged 50-70 across 12 provinces in China. Each DCE scenario described five attributes: type of caregivers, place of LTC, contents of LTC, out-of-pocket payments, and quality of life (QoL). Preferences and the marginal willingness to pay (WTP) were derived using mixed-logit and latent class models. RESULTS: Older adults displayed higher preferences for long-term caregivers who improve their QoL, incur lower out-of-pocket payments, and provide medical LTC services at home, with the maximum WTP of $22.832 per month. QoL was rated as the most important LTC factor, followed by the place of LTC and the type of caregivers. When the level of QoL improved from poor to good, respondents would be willing to pay $18.375 per month more (95% confidence interval: 16.858 to 20.137), and the uptake rate increased by 76.47%. There was preference heterogeneity among older people with different sex, education, family size, and knowledge of LTC insurance. CONCLUSION: QoL was the most important factor in older Chinese adults' preference for caregivers. Home care and medical care from formal caregivers was preferred by older adults. We recommend training family caregivers, raising older people's awareness of LTC insurance, and guiding policymakers in developing people-oriented LTC and a multi-level LTC system.

Initial evaluation of a technologyenabled change in delivery of the dementia service during COVID-19 in North Warwickshire.

BACKGROUND: Remote monitoring technologies show potential to help health professionals deliver preventative interventions which can avoid hospital admissions and allow patients to remain in a home setting. AIMS: To assess whether an Internet of Things (IoT) driven remote monitoring technology, used in the care pathway of community dementia patients in North Warwickshire improved access to care for patients and cost effectiveness. METHOD: Patient level changes to anonymised retrospective healthcare utilisation data were analysed alongside costs. RESULTS: Urgent care decreased following use of an IoT driven remote monitoring technology; one preventative intervention avoided an average of three urgent interventions. A Chi-Square test showing this change as significant. Estimates show annualised service activity avoidance of £201,583 for the cohort; £8764 per patient. CONCLUSIONS: IoT driven remote monitoring had a positive impact on health utilisation and cost avoidance. Future expansion of the cohort will allow for validation of the results and consider the impact of the technology on patient health outcomes and staff workflows.