Factors Associated with Resilience Among Older People Living with HIV.

Resilience, a measure of stress coping ability, may be important in helping older people (age 50+) living with HIV (PLWH) age successfully, but limited data exist regarding factors that contribute to resilience for this group. This study uses the Connor-Davidson Resilience Scale 2 (CD-RISC2) to assess resilience, based on a cross-sectional analysis of 1047 older PLWH. Bivariate linear regression models were used to identify predictor variables that had a relationship with resilience. Those variables were then included in a multivariable linear regression model, which was pared using backward selection. In the multivariable model, higher income and greater interpersonal support were associated with greater resilience, whereas depression and anxiety were associated with lower resilience. Relevant interventions that address these issues, such as increasing opportunities for social support and increasing screening for and treatment of depression and anxiety, are identified as potential pathways to increase resilience among older PLWH.

Deprescribing for Community-Dwelling Older Adults: a Systematic Review and Meta-analysis.

BACKGROUND: Polypharmacy and use of inappropriate medications have been linked to increased risk of falls, hospitalizations, cognitive impairment, and death. The primary objective of this review was to evaluate the effectiveness, comparative effectiveness, and harms of deprescribing interventions among community-dwelling older adults. METHODS: We searched OVID MEDLINE Embase, CINAHL, and the Cochrane Library from 1990 through February 2019 for controlled clinical trials comparing any deprescribing intervention to usual care or another intervention. Primary outcomes were all-cause mortality, hospitalizations, health-related quality of life, and falls. The secondary outcome was use of potentially inappropriate medications (PIMs). Interventions were categorized as comprehensive medication review, educational initiatives, and computerized decision support. Data abstracted by one investigator were verified by another. We used the Cochrane criteria to rate risk of bias for each study and the GRADE system to determine certainty of evidence (COE) for primary outcomes. RESULTS: Thirty-eight low and medium risk of bias clinical trials were included. Comprehensive medication review may have reduced all-cause mortality (OR 0.74, 95% CI: 0.58 to 0.95, I2 = 0, k = 12, low COE) but probably had little to no effect on falls, health-related quality of life, or hospitalizations (low to moderate COE). Nine of thirteen trials reported fewer PIMs in the intervention group. Educational interventions probably had little to no effect on all-cause mortality, hospitalizations, or health-related quality of life (low to moderate COE). The effect on falls was uncertain (very low COE). All 11 education trials that included PIMs reported fewer in the intervention than in the control groups. Two of 4 computerized decision support trials reported fewer PIMs in the intervention arms; none included any primary outcomes. DISCUSSION: In community-dwelling people aged 65 years and older, medication deprescribing interventions may provide small reductions in mortality and use of potentially inappropriate medications. REGISTRY INFORMATION: PROSPERO - CRD42019132420.

Identifying Adverse Drug Events in Older Community-Dwelling Patients.

PURPOSE: To evaluate a patient-report instrument for identifying adverse drug events (ADEs) in older populations with multimorbidity in the community setting. METHODS: This was a retrospective cohort study of 859 community-dwelling patients aged ≥70 years treated at 15 primary care practices. Patients were asked if they had experienced any of a list of 74 symptoms classified by physiologic system in the previous 6 months and if (1) they believed the symptom to be related to their medication, (2) the symptom had bothered them, (3) they had discussed it with their family physician, and (4) they required hospital care due to the symptom. Self-reported symptoms were independently reviewed by 2 clinicians who determined the likelihood that the symptom was an ADE. Family physician medical records were also reviewed for any report of an ADE. RESULTS: The ADE instrument had an accuracy of 75% (95% CI, 77%-79%), a sensitivity of 29% (95% CI, 27%-31%), and a specificity of 93% (95% CI, 92%-94%). Older people who reported a symptom had an increased likelihood of an ADE (positive likelihood ratio [LR+]: 4.22; 95% CI, 3.78-4.72). Antithrombotic agents were the drugs most commonly associated with ADEs. Patients were most bothered by muscle pain or weakness (75%), dizziness or lightheadedness (61%), cough (53%), and unsteadiness while standing (52%). On average, patients reported 39% of ADEs to their physician. Twenty-six (3%) patients attended a hospital outpatient clinic, and 32 (4%) attended an emergency department due to ADEs. CONCLUSION: Older community-dwelling patients were often not correct in recognizing ADEs. The ADE instrument demonstrated good predictive value and could be used to differentiate between symptoms of ADEs and chronic disease in the community setting.

Geographic disparities associated with travel to medical care and attendance in programs to prevent/manage chronic illness among middle-aged and older adults in Texas.

INTRODUCTION: Accessing care is challenging for adults with chronic conditions. The challenge may be intensified for individuals needing to travel long distances to receive medical care. Transportation difficulties are associated with poor medication adherence and delayed or missed care. This study investigated the relationship between those traveling greater distances for medical care and their utilization of programs to prevent and/or manage their health problems. It was hypothesized that those traveling longer distances for medical care attended greater chronic disease management programs. METHODS: Thirty six thousand households in nine counties of central Texas received an invitation letter to participate in a mailed health assessment survey in English or Spanish. A total of 5230 participants agreed to participate and returned the fully completed survey. To investigate distance traveled for medical services and participation in a chronic disease management program, the analyses were limited to 2108 adults aged ≥51 years with one or more chronic conditions who visited a healthcare professional at least once in the previous year. Other variables of interest included residential rurality, health status, and personal characteristics. The data were first analyzed using descriptive and bivariate analyses. Then, an ordinal logistic regression model was fitted to identify factors associated with longer distances traveled to medical services. Additionally, a binary logistic regression model was fitted to identify factors associated with attending a chronic disease self-management program. RESULTS: Among 2108 adults, rural participants (p<0.001), those with more chronic conditions (p<0.001), and those attending a chronic disease program (p=0.037) reported traveling further distances to medical services. Participants with limited activity (p<0.001), those from urban counties (p=0.017), and those who traveled further (p=0.030) were more likely to attend a chronic disease program. CONCLUSION: While further distances to healthcare providers was found to be a protective factor based on the utilization of community-based resources, rural residents were less likely to attend a program to better manage their chronic conditions, potentially choosing to use long distance travel to address urgent medical needs rather than focusing on prevention and management of their conditions. Important policy and programmatic efforts are needed to increase reach of chronic disease self-management programs and other community services and resources in rural areas and to reduce rural inequities.

Integrated care for older populations and its implementation facilitators and barriers: A rapid scoping review.

PURPOSE: Inform health system improvements by summarizing components of integrated care in older populations. Identify key implementation barriers and facilitators. DATA SOURCES: A scoping review was undertaken for evidence from MEDLINE, the Cochrane Library, organizational websites and internet searches. Eligible publications included reviews, reports, individual studies and policy documents published from 2005 to February 2017. STUDY SELECTION: Initial eligible documents were reviews or reports concerning integrated care approaches in older/frail populations. Other documents were later sourced to identify and contextualize implementation issues. DATA EXTRACTION: Study findings and implementation barriers and facilitators were charted and thematically synthesized. RESULTS OF DATA SYNTHESIS: Thematic synthesis using 30 publications identified 8 important components for integrated care in elderly and frail populations: (i) care continuity/transitions; (ii) enabling policies/governance; (iii) shared values/goals; (iv) person-centred care; (v) multi-/inter-disciplinary services; (vi) effective communication; (vii) case management; (viii) needs assessments for care and discharge planning. Intervention outcomes and implementation issues (barriers or facilitators) tend to depend heavily on the context and programme objectives. Implementation issues in four main areas were observed: (i) Macro-level contextual factors; (ii) Miso-level system organization (funding, leadership, service structure and culture); (iii) Miso-level intervention organization (characteristics, resources and credibility) and (iv) Micro-level factors (shared values, engagement and communication). CONCLUSION: Improving integration in care requires many components. However, local barriers and facilitators need to be considered. Changes are expected to occur slowly and are more likely to be successful where elements of integrated care are well incorporated into local settings.

Lean body mass change over 6 years is associated with dietary leucine intake in an older Danish population.

Higher protein intake, and particularly higher leucine intake, is associated with attenuated loss of lean body mass (LBM) over time in older individuals. Dietary leucine is thought to be a key mediator of anabolism. This study aimed to assess this relationship over 6 years among younger and older adult Danes. Dietary leucine intake was assessed at baseline and after 6 years in men and women, aged 35-65 years, participating in the Danish cohort of the WHO-MONICA (Multinational MONItoring of trends and determinants in CArdiovascular disease) study (n 368). Changes in LBM over the 6 years were measured by bioelectrical impedance using equations developed for this Danish population. The association between leucine and LBM changes was examined using multivariate linear regression and ANCOVA analyses adjusted for potential confounders. After adjustment for baseline LBM, sex, age, energy intake and physical activity, leucine intake was associated with LBM change in those older than 65 years (n 79), with no effect seen in those younger than 65 years. Older participants in the highest quartile of leucine intake (7·1 g/d) experienced LBM maintenance, whereas lower intakes were associated with LBM loss over 6 years (for trend: ß=0·434, P=0·03). Sensitivity analysis indicated no effect modification of sex or the presence of CVD. Greater leucine intake in conjunction with adequate total protein intake was associated with long-term LBM retention in a healthy older Danish population. This study corroborates findings from laboratory investigations in relation to protein and leucine intakes and LBM change. A more diverse and larger sample is needed for confirmation of these results.

Disparity in dental attendance among older adult populations: a comparative analysis across selected European countries and the USA.

BACKGROUND: The current study addresses the extent to which diversity in dental attendance across population subgroups exists within and between the USA and selected European countries. METHOD: The analyses relied on 2006/2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and 2004-2006 data from the Health and Retirement Study (HRS) in the USA for respondents≥51 years of age. Logistic regression models were estimated to identify impacts of dental-care coverage, and of oral and general health status, on dental-care use. RESULTS: We were unable to discern significant differences in dental attendance across population subgroups in countries with and without social health insurance, between the USA and European countries, and between European countries classified according to social welfare regime. Patterns of diverse dental use were found, but they did not appear predominately in countries classified according to welfare state regime or according to the presence or absence of social health insurance. CONCLUSIONS: The findings of this study suggest that income and education have a stronger, and more persistent, correlation with dental use than the correlation between dental insurance and dental use across European countries. We conclude that: (i) higher overall rates of coverage in most European countries, compared with relatively lower rates in the USA, contribute to this finding; and that (ii) policies targeted to improving the income of older persons and their awareness of the importance of oral health care in both Europe and the USA can contribute to improving the use of dental services.

Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients.

AIMS: This study aimed to determine the association between potentially inappropriate prescribing (PIP) and health related outcomes [adverse drug events (ADEs), health related quality of life (HRQOL) and hospital accident and emergency (A&E) visits] in older community dwelling patients. METHODS: A retrospective cohort study of 931 community dwelling patients aged ≥70 years in 15 general practices in Ireland in 2010. PIP was defined by the Screening Tool of Older Person's Prescriptions (STOPP). ADEs were measured by patient self-report and medical record for the previous 6 months and reviewed by two independent clinicians. HRQOL was measured by the EQ-5D. A&E visits were measured by patients' medical records and self-report. Multilevel logistic, linear and Poisson regression examined how ADEs, HRQOL and A&E visits varied by PIP after adjusting for patient and practice level covariates: socioeconomic status, co-morbidity, number of drug classes and adherence. RESULTS: The overall prevalence of PIP was 42% (n = 377). Patients with ≥2 PIP indicators were twice as likely to have an ADE (adjusted OR 2.21; 95% CI 1.02, 4.83, P < 0.05), have a significantly lower mean HRQOL utility (adjusted coefficient -0.09, SE 0.02, P < 0.001) and nearly a two-fold increased risk in the expected rate of A&E visits (adjusted IRR 1.85; 95% CI 1.32, 2.58, P < 0.001). The number of drug classes and adherence were also significantly associated with these same adverse health outcomes. CONCLUSIONS: Reducing PIP in primary care may help lower the burden of ADEs, its associated health care use and costs and enhance quality of life in older patients.

Potentially inappropriate prescribing and vulnerability and hospitalization in older community-dwelling patients.

BACKGROUND: The predictive validity of existing explicit process measures of potentially inappropriate prescribing (PIP) is not established. OBJECTIVE: To determine the association between PIP, and vulnerability and hospital visits in older community-dwelling patients. METHODS: This was a retrospective cohort study of 931 community-dwelling patients aged ≥70 years in 15 general practices in Ireland in 2010. PIP was defined by the Beers 2012 criteria and the Screening Tool of Older Person's Potentially Inappropriate Prescriptions (STOPP). Vulnerability was measured by the Vulnerable Elders Survey (score ≥3). The number of hospital visits was measured using patients' medical records and self-report for the previous 6 months. Multilevel logistic and Poisson regression was used to examine the association between PIP, and vulnerability and hospital visits after adjusting for patient and practice level covariates, socioeconomic status, comorbidity, number of drug classes, social support, and adherence. RESULTS: The prevalence of PIP determined by the Beers 2012 and STOPP criteria was 28% (n = 246) and 42% (n = 377), respectively. Patients with ≥2 PIP indicators were almost twice as likely to be classified as vulnerable (Beers adjusted odds ratio [OR] = 1.80; 95% CI = 1.08, 3.01; P < 0.05; STOPP adjusted OR = 1.86; 95% CI = 1.13, 3.04; P < 0.05). Patients with ≥2 STOPP indicators had an increased risk in the expected rate of hospital visits (adjusted incidence rate ratio = 1.32; 95% CI = 1.14, 1.54; P < 0.01). The Beers 2012 criteria were not associated with increased hospital visits. CONCLUSION: STOPP is a more sensitive measure of PIP than the Beers 2012 criteria and of clinical benefit in primary care settings.

Aging in climate change: Unpacking residential mobility and changes of social determinants of health in southern United States.

The southern coastal states of the United States are susceptible to extreme weather and climate events. With growing move-in and -out older populations in the region, health implications of their residential mobility lack sufficient knowledge. Using 126,352 person-level records from 2012 to 2021, we examined geospatial and temporal patterns of older populations' residential mobility, considering the changing social determinants of health and disparities. We found the moves of older populations with socioeconomic or health disadvantages were related to increased exposure to environmental hazards and reduced access to health resources. The findings inform targeted strategies for climate adaptation that address the needs of vulnerable aging populations.

Exploring mHealth design opportunities for blind and visually impaired older users.

Background: Mobile health (mHealth) applications (apps) are crucial in delivering health information and services to older adults. Despite their importance, blind and visually impaired (BVI) older individuals often face significant challenges in app accessibility and usability. This study delves into the design preferences and expectations of BVI older users and underscores the necessity of user-centered design for inclusive mHealth apps. Methods: Conducted in September 2023, the study comprised six focus group interviews. Each session involved two to four participants who began with self-introductions, followed by discussions centered on three open-ended interview questions. Results: The study involved 14 participants: four with severe low vision and 10 totally blind. The primary design principles highlighted were "customizability" and "simplicity". The participants stressed the importance of intuitively designed main pages aligning with user patterns. Further, the participants articulated the following mHealth app feature or menu recommendations: editable profiles, emergency contact access, adaptable data presentation, data exportation, audible color details, customizable colors for varying visual needs, audible error feedback, feasible data input methods, toolbars, and habit-establishing reminders. Discussions also touched on the vital role of clear health data visualizations and comprehensible app-based health information. Conclusions: The findings illuminate paths for software developers and health scientists working towards more inclusive mHealth solutions. It is essential during the development phase to prioritize app learnability to accommodate a broad range of users, ensuring that even those with disabilities can effectively use technological innovations to address health disparities.

Potentially Inappropriate Prescribing and Potential Prescribing Omissions and Their Association with Adverse Drug Reaction-Related Hospital Admissions.

BACKGROUND: This study aimed to determine the prevalence of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) and their association with ADR-related hospital admissions in patients aged ≥ 65 years admitted acutely to the hospital. METHODS: Information on medications and morbidities was extracted from the Adverse Drug Reactions in an Ageing Population (ADAPT) cohort (N = 798: N = 361 ADR-related admissions; 437 non-ADR-related admissions). PIP and PPOs were assessed using Beers Criteria 2019 and STOPP/START version 2. Multivariable logistic regression (adjusted odds ratios (aOR), 95%CI) was used to examine the association between PIP, PPOs and ADR-related admissions, adjusting for covariates (age, gender, comorbidity, polypharmacy). RESULTS: In total, 715 (90%; 95% CI 87-92%) patients had ≥1 Beers Criteria, 555 (70%; 95% CI 66-73%) had ≥ 1 STOPP criteria and 666 patients (83%; 95% CI 81-86%) had ≥ 1 START criteria. Being prescribed at least one Beers (aOR = 1.66, 95% CI = 1.00-2.77), or meeting STOPP (aOR = 1.07, 95% CI = 0.79-1.45) or START (aOR = 0.72; 95%CI = 0.50-1.06) criteria or the number of PIP/PPO criteria met was not significantly associated with ADR-related admissions. Patients prescribed certain drug classes (e.g., antiplatelet agents, diuretics) per individual PIP criteria were more likely to have an ADR-related admission. CONCLUSION: There was a high prevalence of PIP and PPOs in this cohort but no association with ADR-related admissions.

Suboptimal diet quality is associated with the incidence of type 2 diabetes mellitus in middle-aged and older populations in China: evidence from a population-based cross-sectional study.

The association between dietary quality and type 2 diabetes mellitus (T2DM) based on the Chinese Dietary Balance Index (DBI-16) is seldom reported. We hypothesized that poor dietary quality might increase the risk of T2DM in the middle-aged and older populations. A total of 1816 individuals (≥50 years) were included in the study. Demographic characteristics and dietary intake data were collected. Logistic regression and restricted cubic spline (RCS) analyses were conducted to explore the association between DBI-16 indexes and the risk of T2DM. The insufficient intake of vegetables and dairy might decrease the risk of T2DM (ORVegetable = 0.77, 95% CI = 0.60-0.97; ORDairy = 0.58, 95% CI = 0.35-0.96), but the individuals with insufficient intake of fruit were more likely to have a higher risk of T2DM (ORfruit = 2.26, 95% CI = 1.69-3.06). Compared with the subjects with the lowest quartile of Low Bound Score (LBS) or Diet Quality Distance (DQD), the individuals with Q2 and Q3 level of LBS (ORQ2 = 1.40, 95% CI = 1.03-1.90, P = .033; ORQ3 = 1.52, 95% CI = 1.11-2.08, P < .01) or DQD (ORQ2 = 1.45, 95% CI = 1.06-1.99, P = .021; ORQ3 = 1.64, 95% CI = 1.20-2.24, P < .01) showed increased risk of T2DM with a nonlinear association observed by RCS analysis. We concluded that imbalanced dietary intake, especially insufficient daily fruit intake, might predict an increased risk of T2DM in the middle-aged and elderly Chinese.

Bed flow priorities and the spatial and temporal dimensions of rural older adult care.

Despite prior research that examines the spatial and temporal dimensions of older adult care, there is disparate research on the influence of patient flow priorities on older adult care over time and place. Drawing on a qualitative case study of rural older adult transitions in care in the Canadian context we examine how patient flow prioritization undervalues older patients' needs and the local contexts in which care is provided. Certainly, accounting for the spatial and temporal dimensions of older adult care has broader implications that will enhance future research, policy and practice. Policy makers, researchers and clinicians may then use these recommendations as a stepping stone to align the health care system with the older populations that they serve.

Valuing indigenous quality of life: A review of preference-based quality of life instruments and elicitation techniques with global older indigenous populations.

Indigenous perspectives of quality of life (QoL) are different to that of non-Indigenous populations. Determining how to identify and value what is important to QoL for people from diverse cultural backgrounds is crucial for assessing effective outcomes for quality assessment and health economic evaluation to guide evidence-based decision making. This is particularly important for older Indigenous people who have complex care and support needs within health and aged-care systems. This scoping review aims to assess the existing literature in this field by firstly identifying preference based instruments that have been applied with older Indigenous peoples and secondly, exploring the extent to which existing preference based instruments applied with older Indigenous peoples encompass older Indigenous peoples QoL perspectives in their design and application. The inclusion criteria for the review were studies using preference based QoL instruments with an Indigenous population where the cohort was aged 50 years or over. This resulted in the critical analysis of 12 studies. The review identified that preference based QoL instruments have rarely been applied to date with older Indigenous populations with most instruments found to be designed for non-Indigenous adults. Typically, instruments have not incorporated Indigenous worldviews of QoL into either the content of the descriptive system or the elicitation techniques and corresponding value sets generated. To encapsulate Indigenous cultural perspectives accurately in economic evaluation, further research is required as to how QoL domains in preference based instruments for Indigenous peoples can be reflective of Indigenous perspectives. It is imperative that the QoL preferences of older Indigenous peoples are adequately captured within preference based QoL instruments applied with this population.

Early-Life Circumstances and Cross-Country Disparities in Cognition Among Older Populations - China, the US, and the EU, 2008-2018.

What is already known about this topic?: Many health challenges have emerged due to rapid population aging, including declined cognitive ability among older adults. What is added by this report?: Childhood circumstances have significant and lasting impacts on cognition in old age. This study compared cognition data from China with both the United States (U.S.) and the European Union (EU) during 2008-2018, finding that childhood circumstances could respectively explain 65.4% [95% confidence interval (CI): 59.4%, 71.4%] (China vs. the U.S.) and 38.2% (95% CI: 35.1%, 41.2%) (China vs. the EU) of the overall differences in cognition among older adults. Family socioeconomic status explained the largest share of differences among all considered childhood circumstances. What are the implications for public health practice?: Large disparities in cognition should be addressed by mitigating childhood disadvantages.

Fitness vs Fatness as Determinants of Survival in Noninstitutionalized Older Adults: The EXERNET Multicenter Study.

BACKGROUND: Physical fitness and body composition are important health indicators; nevertheless, their combined pattern interrelationships and their association with mortality are poorly investigated. METHODS: This longitudinal study is part of the Spanish EXERNET-Elder project. Person-months of follow-up were calculated from the interview date, performed between June 2008 and November 2009, until the date of death or censoring on March 2018 (whichever came first). In order to be included, participants had to fulfill the following criteria: (a) be older than 65 years, (b) live independently at home, (c) not suffer dementia and/or cancer, and (d) have a body mass index above 18.5. Body fat and weight were assessed by a bioelectrical impedance analyzer. Fitness was measured with the Senior Fitness and the one-leg static balance tests. The Spanish Death Index was consulted for the death's identification. Cluster analysis was performed to identify Fat-Fit patterns and traditional cut-points and percentiles to create the Fat-Fit groups. Cox proportional hazards regression models were used to calculate the hazard ratios (HRs) of death in clustered Fat-Fit patterns and in traditional Fat-Fit groups. RESULTS: A total of 2299 older adults (76.8% of women) were included with a baseline mean age of 71.9 ± 5.2 years. A total of 196 deaths (8.7% of the sample) were identified during the 8 years of follow-up. Four clustered Fat-Fit patterns (Low fat-Fit, Medium fat-Fit, High fat-Unfit, and Low fat-Unfit) and 9 traditional Fat-Fit groups emerged. Using the Low fat-Fit pattern as the reference, significantly increased mortality was noted in High fat-Unfit (HR: 1.68, CI: 1.06-2.66) and Low fat-Unfit (HR: 2.01, CI: 1.28-3.16) groups. All the traditional Fit groups showed lower mortality risk when compared to the reference group (obese-unfit group). CONCLUSION: Physical fitness is a determinant factor in terms of survival in community-dwelling older adults, independently of adiposity levels.

Prevalence of Metabolic Syndrome and Association with Physical Activity and Frailty Status in Spanish Older Adults with Decreased Functional Capacity: A Cross-Sectional Study.

Metabolic syndrome (MetS) is a cluster of medical conditions associated with several health disorders. MetS and frailty can be related to prolonged physical deconditioning. There is a need to know whether there is concordance between the different ways of diagnosing it and to know their prevalence in Spanish older adults. Thus, the aims of this study were to describe the prevalence of MetS; to analyse the concordance between different definitions to diagnose MetS; and to study the associations between MetS, frailty status, and physical activity (PA) in older adults with decreased functional capacity. This report is a cross-sectional study involving 110 Spanish older adults of ages ≥65 years with decreased functional capacity. Clinical criteria to diagnose MetS was defined by different expert groups. Anthropometric measurements, blood biochemical analysis, frailty status, functional capacity, and PA were assessed. The Kappa statistic was used to determine the agreement between the five MetS definitions used. Student's t-test and the Pearson chi-square test were used to examine differences between sex, frailty, and PA groups. The sex-adjusted prevalence of MetS assessed by the National Cholesterol Education Program-Third Adult Treatment Panel was 39.4% in men and 32.5% in women. The International Diabetes Federation and the Harmonized definitions had the best agreement (k = 1.000). The highest odds ratios (ORs) of cardiometabolic risk factors to develop MetS were elevated triglycerides (37.5) and reduced high-density lipoprotein cholesterol (27.3). Central obesity and hypertension prevalence were significantly higher in the non-active group (70.7% and 26.8%, respectively), compared to the active group (50.0% and 7.7%, respectively). Moreover, the active group (OR = 0.85, 95% CI = 0.35, 2.04) and active women group (OR = 0.77, 95% CI = 0.27, 2.20) appeared to show a lower risk of developing this syndrome. MetS is highly prevalent in this sample and changes according to the definition used. It seems that sex and frailty do not influence the development of MetS. However, PA appears to decrease central obesity, hypertension, and the risk of developing MetS.

Serum Selenium and Incident Cardiovascular Disease in the PREvención con DIeta MEDiterránea (PREDIMED) Trial: Nested Case-Control Study.

Background: Selenium is an essential trace mineral with potential interest for cardiovascular disease (CVD) prevention owing to its antioxidant properties. Epidemiological data on selenium status and CVD remain inconsistent. The objective of this study was to ascertain whether low serum selenium (SSe) concentrations are related to an increased risk of a first CVD event in a population at high cardiovascular risk. Methods: We undertook a case-control study nested within the "PREvención con DIeta MEDiterránea" (PREDIMED) trial. A total of 207 participants diagnosed with CVD (myocardial infarction, stroke, or cardiovascular death) during the follow-up period (2003−2010) were matched by sex, age, and intervention group to 436 controls by incidence density sampling. Median time between serum sample collection and subsequent CVD event occurrence was 0.94 years. SSe levels were determined using inductively coupled plasma mass spectrometry analysis. Covariates were assessed through validated questionnaires, in-person interviews, and medical record reviews. Conditional logistic regression was used to calculate multivariable-adjusted odds ratios (ORs). Results: Among women, the mean SSe concentration was lower in cases than in controls (98.5 µg/L vs. 103.8 µg/L; p = 0.016). In controls, SSe levels were directly associated with percentage of total energy intake from proteins and fish intake (p for linear trend < 0.001 and 0.049, respectively), whereas SSe concentrations were inversely associated with age, body mass index, and percentage of total energy intake from carbohydrates (p for linear trend < 0.001, 0.008 and 0.016 respectively). In the total group, we observed an inverse dose−response gradient between SSe levels and risk of CVD in the fully-adjusted model (highest vs. lowest quartile: OR = 0.47, 95% CI: 0.27−0.81; ptrend = 0.003). Conclusions: Among elderly individuals at high cardiovascular risk, high SSe concentrations within population reference values are associated with lower first CVD incidence.

Trends in prevalence, health disparities, and early detection of dementia: A 10-year nationally representative serial cross-sectional and cohort study.

Objective: To identify trends in the prevalence of mild cognitive impairment (MCI) and dementia, and to determine risk factors associated with the early detection of dementia among U.S. middle-aged and older adults. Methods: We used 10-year nationally representative longitudinal data from the Health and Retirement Study (HRS) (2006-2016). Adults aged 55 years or older were included to examine the trend. To identify the associated factors, adults aged 55 years or older in 2006 who developed MCI or dementia in subsequent waves until the 2016 wave were included. Early and late detection of dementia were identified using the Langa-Weir classification of cognitive function. Multivariate logistic regression models were used to identify factors associated with the early detection of dementia. Results: The sample size for the analysis of the prevalence of MCI and dementia ranged from 14,935 to 16,115 in the six survey years, and 3,729 individuals were identified to determine associated factors of the early detection of dementia. Among them, participants aged 65 years or older accounted for 77.9%, and male participants accounted for 37.2%. The 10-year prevalence of MCI and dementia was 14.5 and 6.6%, respectively. We also found decreasing prevalence trends in MCI (from 14.9 to 13.6%) and dementia (from 7.4 to 6.0%) overall in the past decade. Using logistic regression controlling for the year, non-Hispanic black (MCI: OR = 2.83, P < 0.001; dementia: OR = 2.53, P < 0.001) and Hispanic (MCI: OR = 2.52, P < 0.001; dementia: OR = 2.62, P < 0.001) had a higher prevalence of both MCI and dementia than non-Hispanic white participants. In addition, men had a lower prevalence of MCI (OR = 0.94, P = 0.035) and dementia (OR = 0.84, P < 0.001) compared to women. Associated factors of the early detection of dementia include age, gender, race, educational attainment, stroke, arthritis diseases, heart problems, and pensions. Conclusion: This study found a decreasing trend in the prevalence of MCI and dementia in the past decade and associated racial/ethnic and gender disparities among U.S. middle-aged and older adults. Healthcare policies and strategies may be needed to address health disparities in the prevalence and take the associated factors of the early detection of dementia into account in clinical settings.