Gender differences in the relationship between walking activity and sleep disturbance among community-dwelling older adult with diabetes in Taiwan.

This study explored the gender differences in the relationship between walking activity and sleep disturbances. A cross-sectional study of 201 community-dwelling older adults with diabetes was conducted in southern Taiwan. Using the Taiwanese version of the International Physical Activity Questionnaire, self-administered short version (IPAQ-SS), information on physical activity and sleep disturbance conditions was collected. Among older female adults with diabetes, 54.2% reported sleep disturbance significantly higher than males (38.1%). Logistic regression analysis suggested that for women, in addition to the active group, older adults in the low-active, high-walking group exhibited a significantly lower rate of sleep disturbance than did those who walked less.

What works in falls prevention in Asia: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: There is strong research evidence for falls prevention among older people in the community setting, although most is from Western countries. Differences between countries (eg sunlight exposure, diet, environment, exercise preferences) may influence the success of implementing falls prevention approaches in Asian countries that have been shown to be effective elsewhere in the world. The aim of this review is to evaluate the scope and effectiveness of falls prevention randomized controlled trials (RCTs) from the Asian region. METHOD: RCTs investigating falls prevention interventions conducted in Asian countries from (i) the most recent (2012) Cochrane community setting falls prevention review, and (ii) subsequent published RCTs meeting the same criteria were identified, classified and grouped according to the ProFANE intervention classification. Characteristics of included trials were extracted from both the Cochrane review and original publications. Where ≥2 studies investigated an intervention type in the Asian region, a meta-analysis was performed. RESULTS: Fifteen of 159 RCTs in the Cochrane review were conducted in the Asian region (9%), and a further 11 recent RCTs conducted in Asia were identified (total 26 Asian studies: median 160 participants, mean age:75.1, female:71.9%). Exercise (15 RCTs) and home assessment/modification (n = 2) were the only single interventions with ≥2 RCTs. Intervention types with ≥1 effective RCT in reducing fall outcomes were exercise (6 effective), home modification (1 effective), and medication (vitamin D) (1 effective). One multiple and one multifactorial intervention also had positive falls outcomes. Meta-analysis of exercise interventions identified significant benefit (number of fallers: Odds Ratio 0.43 [0.34,0.53]; number of falls: 0.35 [0.21,0.57]; and number of fallers injured: 0.50 [0.35,0.71]); but multifactorial interventions did not reach significance (number of fallers OR = 0.57 [0.23,1.44]). CONCLUSION: There is a small but growing research base of falls prevention RCTs from Asian countries, with exercise approaches being most researched and effective. For other interventions shown to be effective elsewhere, consideration of local issues is required to ensure that research and programs implemented in these countries are effective, and relevant to the local context, people, and health system. There is also a need for further high quality, appropriately powered falls prevention trials in Asian countries.

Functional mobility and its contributing factors for older adults in different cities in Taiwan.

BACKGROUND/PURPOSE: Impaired mobility is one of the primary causes of declined functional capacity in old age. The timed up-and-go test (TUG), a common mobility test, has been studied extensively in Western countries. The purposes of this study were to compare and identify factors associated with TUG performance in older adults with impaired mobility and living in different cities in Taiwan. METHODS: Older adults living in Taipei, Tainan, and Niaosong cities were screened for mobility impairments and then recruited. A series of questionnaires and physical and functional tests were used to obtain information and measurements for potential contributing factors and TUG. Regression analysis was conducted to determine factors contributing to TUG. RESULTS: A total of 413 older adults participated in the study. The mean TUG was 14.3 seconds for participants across the three cities, and was significantly shorter in Tainan. Age, number of medications, fear of falling, depression, high intensity activity time, reaction time, single leg stance time, and functional reach distance were found to have significant contribution. These factors accounted for approximately half of the variance in TUG. The regression equations were not equal for the different cities, with depression being the only common determinant. CONCLUSION: Taiwanese older adults with mobility problems living in different cities performed differently in TUG and the contributing factors were also different. These findings indicate a need of further studies examining older adults in different environments.

Measurement equivalence across gender and education in the WHOQOL-BREF for community-dwelling elderly Taiwanese.

BACKGROUND: The WHOQOL-BREF, a generic quality of life (QoL) instrument, has been widely used clinically and for research on older populations. However, its measurement equivalence/invariance (ME/I) has not been well examined for the elderly (≥ 65 years) across some different demographics. METHODS: The data were derived from a cross-sectional study with a convenience sampling design in Taiwan. We enrolled 244 elderly participants: men = 143 (58.6%); educational level ≤ primary school = 121 (49.6%). The ME/I was examined using multiple group confirmatory factor analysis (MGCFA) across gender and educational level. RESULTS: The fit indices were satisfactory for the configural models of gender and educational level (standardized root mean square residual [SRMR] = 0.0742 and 0.0770; root mean square error of approximation [RMSEA] = 0.0655 and 0.0686; comparative fit index [CFI] = 0.953). In addition, MGCFAs showed that ME/I was supported across gender (ΔSRMR = 0.001 to 0.019; ΔRMSEA = -0.003 to 0.001; ΔCFI = -0.003 to 0.000) and educational level (ΔSRMR = 0.002 to 0.006; ΔRMSEA = -0.002 to 0.004; ΔCFI = -0.007 to 0.000). CONCLUSION: The WHOQOL-BREF Taiwan version is appropriate for combined use and for comparisons in older people across gender and different educational levels.

Cognitive Function and Quality of Life in Community-Dwelling Seniors with Mild Cognitive Impairment in Taiwan.

The aims of this study were to examine the relationships between overall cognitive function and the quality of life (QOL) domains, and to compare the differences in these by age, gender, and educational level in community-dwelling seniors in Taiwan. A cross-sectional study was conducted, with the participants screened and recruited from Southern Tainan. The Saint Louis University Mental Status Examination was used to screen the cognitive status of the participants. A total of 144 seniors participated in this study were assessed using the Taiwanese version of WHOQOL-BREF. The results showed that the participants performed better in the cognitive domains of "figure identification" and "orientation" while they performed poor in "delayed recall" and "immediate paragraph recall". No significant relationship between cognitive function and overall QOL, but a positive relationship between cognitive function and the physical health domain of QOL was found. The findings of this study provide valuable information for community healthcare providers.

The relationships between activity and quality of life for older men and women at different ages in Taiwan.

This study investigated the relationships between types of activity and quality of life (QOL) for older men and women at different ages. Based on cross-sectional data that included 220 community-dwelling elderly persons aged 65 and older in southern Taiwan, the results showed that the participation rates in many activities declined with age for both genders. Social activity and solitary leisure activity were significantly associated with QOL for old-old men, but not for young-old men. Only social activity was significantly associated with QOL for young-old women, but there was no significant association between any activity and QOL for old-old women.

Ipsilateral lower limb motor performance and its association with gait after stroke.

BACKGROUND AND PURPOSE: Motor deficits of the ipsilateral lower limb could occur after stroke and may be associated with walking performance. This study aimed to determine whether the accuracy and movement path of targeted movement in the ipsilateral lower limb would be impaired in the chronic stage of stroke and whether this impairment would contribution to gait. METHODS: Twenty adults with chronic stroke and 20 age-matched controls went through Mini Mental Status Examination (MMSE), and a series of sensorimotor tests. The targeted movement tasks were to place the big toe ipsilateral to the lesion at an external visual target (EXT) or a proprioceptive target (PRO, contralateral big toe) with eyes open (EO) or closed (EC) in a seated position. A motion analysis system was used to obtain the data for the calculation of error distance, deviation from a straight path, and peak toe-height during the targeted movement tasks and gait velocity, step length, step width and step length symmetry of the lower limb ipsilateral to the brain lesion during walking. RESULTS: The stroke group had significantly lower MMSE and poorer visual acuity on the ipsilateral side, but did not differ in age or other sensorimotor functions when compared to the controls. For the targeted movement performance, only the deviation in PRO-EC showed significant between-group differences (p = 0.02). Toe-height in both EXT-EO and in PRO-EO was a significant predictor of step length (R2 = 0.294, p = 0.026) and step length symmetry (R2 = 0.359, p = 0.014), respectively. DISCUSSION AND CONCLUSIONS: The performance of ipsilateral lower limb targeted movement could be impaired after stroke and was associated with step length and its symmetry. The training of ipsilateral targeted movement with unseen proprioceptive target may be considered in stroke rehabilitation.

The cortical control of cycling exercise in stroke patients: an fNIRS study.

Stroke survivors suffering from deficits in motor control typically have limited functional abilities, which could result in poor quality of life. Cycling exercise is a common training paradigm for restoring locomotion rhythm in patients. The provision of speed feedback has been used to facilitate the learning of controlled cycling performance and the neuromuscular control of the affected leg. However, the central mechanism for motor relearning of active and passive pedaling motions in stroke patients has not been investigated as extensively. The aim of this study was to measure the cortical activation patterns during active cycling with and without speed feedback and during power-assisted (passive) cycling in stroke patients. A frequency-domain near-infrared spectroscopy (FD-NIRS) system was used to detect the hemodynamic changes resulting from neuronal activity during the pedaling exercise from the bilateral sensorimotor cortices (SMCs), supplementary motor areas (SMAs), and premotor cortices (PMCs). The variation in cycling speed and the level of symmetry of muscle activation of bilateral rectus femoris were used to evaluate cycling performance. The results showed that passive cycling had a similar cortical activation pattern to that observed during active cycling without feedback but with a smaller intensity of the SMC of the unaffected hemisphere. Enhanced PMC activation of the unaffected side with improved cycling performance was observed during active cycling with feedback, with respect to that observed without feedback. This suggests that the speed feedback enhanced the PMC activation and improved cycling performance in stroke patients.

Effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults with risk of falls.

OBJECTIVE: To evaluate effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults. DESIGN: Multicenter randomized controlled trial. SETTING: Three medical centers and adjacent community health centers. PARTICIPANTS: Community-dwelling older adults (N=616) who have fallen in the previous year or are at risk of falling. INTERVENTIONS: After baseline assessment, eligible subjects were randomly allocated into the intervention group (IG) or the control group (CG), stratified by the Physiological Profile Assessment (PPA) fall risk level. The IG received a 3-month multifactorial intervention program including 8 weeks of exercise training, health education, home hazards evaluation/modification, along with medication review and ophthalmology/other specialty consults. The CG received health education brochures, referrals, and recommendations without direct exercise intervention. MAIN OUTCOME MEASURES: Primary outcome was fall incidence within 1 year. Secondary outcomes were PPA battery (overall fall risk index, vision, muscular strength, reaction time, balance, and proprioception), Timed Up & Go (TUG) test, Taiwan version of the International Physical Activity Questionnaire, EuroQol-5D, Geriatric Depression Scale (GDS), and the Falls Efficacy Scale-International at 3 months after randomization. RESULTS: Participants were 76±7 years old and included low risk 25.6%, moderate risk 25.6%, and marked risk 48.7%. The cumulative 1-year fall incidence was 25.2% in the IG and 27.6% in the CG (hazard ratio=.90; 95% confidence interval, .66-1.23). The IG improved more favorably than the CG on overall PPA fall risk index, reaction time, postural sway with eyes open, TUG test, and GDS, especially for those with marked fall risk. CONCLUSIONS: The multifactorial fall prevention program with exercise intervention improved functional performance at 3 months for community-dwelling older adults with risk of falls, but did not reduce falls at 1-year follow-up. Fall incidence might have been decreased simultaneously in both groups by heightened awareness engendered during assessments, education, referrals, and recommendations.

Walking performance of persons with chronic stroke changed when looking down but not in dimly lit environment.

Background and purpose: It is common to walk under different conditions, such as looking straight head, looking down at the feet or in dimly lit environment. The purpose of this study was to determine the impact of these different conditions on walking performance in persons with and without stroke. Methods: This was a case-control study. Persons with chronic unilateral stroke and age-matched control (n = 29 each) underwent visual acuity test, Mini Mental Status Examination (MMSE) and joint position sense test of the knee and ankle. The participants walked at their preferred speed under three walking conditions, looking ahead (AHD), looking down (DWN), and in dimly lit environment (DIM). A motion analysis system was used for the recording of the limb matching test and walking tasks. Results: Stroke participants differed from the control group in MMSE, but not in age, visual acuity or joint position sense. For the control group, the differences between the three walking conditions were nonsignificant. For the stroke group, DWN had significantly slower walking speed, greater step width and shorter single leg support phase, but not different symmetry index or COM location, compared to AHD. The differences between AHD and DIM were nonsignificant. Conclusion: Healthy adults did not change their gait patterns under the different walking conditions. Persons with chronic stroke walked more cautiously but not more symmetrically when looking down at the feet, but not in dimly lit environment. Ambulatory persons with stroke may need to be advised that looking down at the feet while walking could be more challenging.

Depressive symptoms in addition to visual impairment, reduced strength and poor balance predict falls in older Taiwanese people.

OBJECTIVE: to determine whether depression is an important and independent predictor of falls in community-dwelling older people living in Taiwan. DESIGN: longitudinal study. SETTING: five randomly selected villages from Tainan city, Taiwan. PARTICIPANTS AND METHODS: in total, 280 community-dwelling people not taking anti-depressant medication aged 65-91 years (mean age 74.9). Participants completed the Geriatric Depression Scale and underwent a range of sensorimotor, balance and mobility tasks and were then followed up for 2 years with monthly telephone calls to determine falls incidence. RESULTS: of the 260 participants with complete follow-up data, 174 (66.9%) experienced no falls, 51 (19.6%) fell once and 35 (13.5%) fell two or more times. Depressive symptoms were significantly more prevalent in recurrent fallers (40.0%) and once-only fallers (27.5%) compared with non-fallers (16.1%). Negative binomial regression analysis identified depression, poor depth perception, reduced lower limb strength and increased sway as independent and significant predictors of falls. CONCLUSION: depressive symptoms were found to be common in older Taiwanese people and associated with an increased fall risk. These findings suggest that in addition to implementing approaches to maximise vision, strength and balance, fall prevention strategies should also include interventions to assess and treat depression.

Effects of ankle proprioceptive interference on locomotion after stroke.

OBJECTIVE: To examine the effects of vibration-induced ankle proprioceptive interference on the locomotion of patients with stroke with intact and impaired ankle joint position sense (JPS). DESIGN: Cross-sectional. SETTING: Rehabilitation department in a tertiary hospital. PARTICIPANTS: Ambulatory patients (N=35) with unilateral stroke received an ankle joint repositioning test and were classified into intact (n=16) or impaired (n=19) JPS group. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The plantar sensitivity and leg muscle strength were tested. Patients were instructed to walk at a self-selected pace on a computerized pressure sensor walkway under 3 conditions: no, affected, or unaffected Achilles' tendon vibration. The stride characteristics of the affected limb were analyzed. RESULTS: Patients with intact and impaired JPS did not differ in their plantar sensitivity or leg muscle strength. The differences in the stride characteristics were nonsignificant between vibration and nonvibration conditions. Shorter single support and longer swing phase were found with the affected side vibration compared with the unaffected side vibration. Patients with intact and impaired JPS did not respond to the proprioceptive interference differently. CONCLUSIONS: After stroke, there could be changes in the central sensory regulation for locomotion control and vibration-induced afferent inputs from the ankle might be viewed as sensory disturbances. Further studies that manipulate other sensory inputs are needed to gain a better understanding of the central sensory integration for locomotion control after stroke.

Corrigendum: Associations between blood-based biomarkers of Alzheimer's disease with cognition in motoric cognitive risk syndrome: A pilot study using plasma Aß42 and total tau.

[This corrects the article DOI: 10.3389/fnagi.2022.981632.].

Associations between blood-based biomarkers of Alzheimer's disease with cognition in motoric cognitive risk syndrome: A pilot study using plasma Aß42 and total tau.

Background: Motoric cognitive risk (MCR) syndrome is a conceptual construct that combines slow gait speed with subjective cognitive complaints and has been shown to be associated with an increased risk of developing dementia. However, the relationships between the pathology of Alzheimer's disease (AD) and MCR syndrome remain uncertain. Therefore, the purpose of this study was to determine the levels of plasma AD biomarkers (Aß42 and total tau) and their relationships with cognition in individuals with MCR. Materials and methods: This was a cross-sectional pilot study that enrolled 25 individuals with normal cognition (NC), 27 with MCR, and 16 with AD. Plasma Aß42 and total tau (t-tau) levels were measured using immunomagnetic reduction (IMR) assays. A comprehensive neuropsychological assessment was also performed. Results: The levels of plasma t-tau proteins did not differ significantly between the MCR and AD groups, but that of plasma t-tau was significantly increased in the MCR and AD groups, compared to the NC group. Visuospatial performance was significantly lower in the MCR group than in the NC group. The levels of plasma t-tau correlated significantly with the Montreal Cognitive Assessment (MoCA) and Boston naming test scores in the MCR group. Conclusion: In this pilot study, we found significantly increased plasma t-tau proteins in the MCR and AD groups, compared with the NC group. The plasma t-tau levels were also significantly correlated with the cognitive function of older adults with MCR. These results implied that MCR and AD may share similar pathology. However, these findings need further confirmation in longitudinal studies.

Executive function predict the quality of life and negative emotion in older adults with diabetes: A longitudinal study.

AIMS: To investigate the influence of executive function (EF) on current and future quality of life (QoL) and negative emotion (NE) in older adults with diabetes. METHODS: A total of 128 older adults with diabetes were recruited. Independent variables (demographic information, health and medical conditions, cognitive function, life function) were collected in the first year. Dependent variables (QoL and NE) were collected for 3 years. Pearson's correlation coefficient analysis and stepwise multiple linear regression analysis were performed to identify the predictors of QoL and NE. RESULTS: EF was the strongest predictor for overall QoL and NE in all 3 years, and accounted for 23.0-36.2% and 11.1-17.1% of the variance, respectively. The second strongest predictor for overall QoL in all 3 years was pain interference, which accounted for 3.2-5.8% of the variance. Pain interference was also the second strongest predictor for NE in the second year, accounting for 5.5% of the variance. CONCLUSIONS: The present study revealed that EF is more predictive than pain for current and future QoL and NE in older adults with diabetes. We recommend that EF be included as an indicator for diabetes surveillance, and that prevention of EF decline be a part of diabetes management plans.

Minimal chair height standing ability is independently associated with falls in Taiwanese older people.

OBJECTIVE: To determine whether a test of minimal chair height standing (MCHS) ability is an important predictor of fall risk in community-dwelling older people living in Taiwan, and whether poor performance in this test is associated with impaired sensorimotor functioning, balance, and mobility in this group. DESIGN: Cross-sectional study. SETTING: Community based. PARTICIPANTS: Community-dwelling participants (N=280; mean age, 74.9y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The MCHS test, which measures the lowest height from which a participant can stand; the Physiological Profile Assessment (PPA); and a range of functional balance and mobility tests. RESULTS: In the 12 months before the study, 81 participants (28.9%) experienced 1 or more falls. The fallers had significantly higher MCHS scores compared with the nonfallers: 29.7±9.0 and 25.0± 9.2cm, respectively. Fallers also had significantly higher PPA fall risk scores than nonfallers and performed significantly worse in tests of reaction time, standing and leaning balance, and alternate stepping ability. Discriminant function analysis revealed that poor performance in the MCHS and high PPA scores were both independently and significantly associated with falls. These 2 variables correctly classified 64.5% of participants into faller and nonfaller groups. Participants who reported regular squatting performed significantly better in the MCHS test, and multiple regression analysis revealed that impaired knee extension strength, poor single-leg stance ability, and reduced leaning balance were independent predictors of poor MCHS. CONCLUSIONS: In this study, MCHS was an independent risk factor for falls. It is a functional test similar to deep squatting and underpinned by strength and balance. Because the MCHS is quick to administer, it may have scope for clinical application.

Gender differences in the relationship of social activity and quality of life in community-dwelling Taiwanese elders.

This study explores the gender differences in the relationship between social activity and quality of life (QOL). A cross-sectional survey of 220 community-dwelling elderly people was conducted in southern Taiwan. Social activity was classified into six categories. The brief version of the World Health Organization QOL (WHOQOL-BREF) was used to measure QOL. Findings revealed that the associations of six types of social activities with QOL were weaker among women than men. The regression analyses further showed that for women, only religious activity was positively related to total QOL, while for men only involvement in formal group activity was positively related to total QOL.

Balance performance when responding to visual stimuli in patients with Benign Paroxysmal Positional Vertigo (BPPV).

BACKGROUND: Patients with Benign Paroxysmal Positional Vertigo (BPPV) often report a sensation of disequilibrium before treatment with the canalith repositioning maneuvers. Apart from vestibular information, visual input also contributes to balance control. How visual stimuli influence balance control in BPPV patients is unclear. OBJECTIVE: To investigate the influence of visual stimuli on balance performance in BPPV patients. METHODS: Three groups of participants, patients with BPPV, and healthy young and older adults, were instructed to stand under three conditions: 1) eyes open (EO); 2) while watching a static picture via a video display; and 3) while watching a rotating visual scene. Antero-posterior (AP), lateral (ML), and total sway path during standing were analyzed. RESULTS: In all conditions, patients with BPPV showed significantly larger AP, ML and total sway path than young, whereas older adults only showed significantly larger AP and total sway path than young adults. During the visual stimuli, all participants exhibited significantly increased AP and total sway while watching a static image and a moving scene as compared with the EO condition. CONCLUSIONS: Patients with BPPV have similar balance control to older adults, but poorer balance control than young adults. The reduced lack of standing balance control in the coronal plane of patients with BPPV, might affect balance strategy after external perturbations.

Effects of Trunk Exercise on Unstable Surfaces in Persons with Stroke: A Randomized Controlled Trial.

Background: Improving balance-related ability is an important goal in stroke rehabilitation. Evidence is needed to demonstrate how this goal could be better achieved. Aim: Determine if trunk exercises on unstable surfaces would improve trunk control and balance for persons in the subacute stage of stroke. Design: An assessor-blind randomized controlled trial. Setting: Inpatients in the department of rehabilitation in a general hospital. Population: Patients who suffered a first-time stroke with onset from one to six months. Methods: Inpatients with stroke were assigned to upper limb exercises (control group, n = 17) or trunk exercises on unstable surfaces (experimental group, n = 18) to receive training twice a week for six weeks, in addition to their daily conventional stroke rehabilitation. Sensorimotor function tests, including hand grip, plantar sensitivity, stroke rehabilitation assessment of movement and Fugl-Meyer lower extremity motor scale, and clinical outcome assessments, including Trunk Impairment Scale and 6 m walk test, were conducted before and after six weeks of training. The center of the pressure area while maintaining static posture and peak displacement while leaning forward, as well as the average speed of raising the unaffected arm, were measured in sitting without foot support, sitting with foot support and standing to reflect trunk control, sitting balance and standing balance, respectively. Results: The between-group differences in the sensorimotor functions were nonsignificant before and after training. Compared with the control group, the experimental group had significantly greater forward leaning and faster arm raising in sitting without foot support, higher Trunk Impairment Scale total score, and shorter 6 m walking time after training, but not before training. Conclusion: Trunk exercises on unstable surfaces could further improve trunk control, the ability to raise the unaffected arm rapidly in sitting, and walking for persons in the subacute stage of stroke. This intervention may be considered to be included in stroke rehabilitation.

Geriatric syndromes and quality of life in older adults with diabetes.

AIM: To describe geriatric syndromes and their relationships with quality of life in older adults with diabetes. METHODS: Community-dwelling older adults (aged >60 years) with diabetes (n = 316) participated in the present study. Eight geriatric syndromes, including polypharmacy (number of medications), pain (Brief Pain Inventory), urinary incontinence (International Consultation on Incontinence Questionnaire), sleep disturbance (hours of sleep), lower cognitive level (Mini-Mental State Examination), falls, depressive symptoms (Geriatric Depression Scale short form) and functional limitation (Barthel Index and Instrumental Activity of Daily Living), were assessed. The WHOQOL-BREF Taiwan version was used to measure physical, psychological, social and environmental domains of quality of life. RESULTS: Polypharmacy was the most common geriatric syndrome (46.6%), followed by pain (41.5%). Participants with any of the geriatric syndromes, except for polypharmacy and sleep disturbance, had significantly poorer quality of life than those without. The Geriatric Depression Scale score was the only common and significant contributor to all four domains of quality of life, explaining 16~29% of the variance. Number of medications, pain level and cognitive level were also significant contributors, although they explained a small amount (<5%) of the variance. The number of geriatric syndromes (mode = 2) was significantly correlated with all four domains of quality of life (partial correlation r = -0.278~0.460, all P < 0.001). CONCLUSIONS: Geriatric syndromes, especially polypharmacy and pain, were common among older adults with diabetes. A greater number of geriatric syndromes or a higher Geriatric Depression Scale score were associated with poorer quality of life. Further studies focusing on combinations of different geriatric syndromes or comorbidities are required. Geriatr Gerontol Int 2019; 19: 518-524.