Predictors of dementia among the oldest old: longitudinal findings from the representative "survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)".

BACKGROUND/AIMS: Our current study aimed to investigate the determinants of dementia among the oldest old using longitudinal data from a representative sample covering both community-dwelling and institutionalized individuals. METHODS/DESIGN: Longitudinal representative data were taken from the "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" that surveyed community-dwelling and institutionalized individuals aged 80 years and above (n = 1,296 observations in the analytic sample), living in North Rhine-Westphalia (most populous state of Germany). The established DemTect was used to measure cognitive impairment (i.e., probable dementia). A logistic random effects model was used to examine the determinants of probable dementia. RESULTS: The mean age was 86.3 years (SD: 4.2 years). Multiple logistic regressions revealed that a higher likelihood of probable dementia was positively associated with lower education (e.g., low education compared to medium education: OR: 3.31 [95% CI: 1.10-9.98]), a smaller network size (OR: 0.87 [95% CI: 0.79-0.96]), lower health literacy (OR: 0.29 [95% CI: 0.14-0.60]), and higher functional impairment (OR: 13.45 [3.86-46.92]), whereas it was not significantly associated with sex, age, marital status, loneliness, and depressive symptoms in the total sample. Regressions stratified by sex were also reported. DISCUSSION: Our study identified factors associated with dementia among the oldest old. This study extends current knowledge by using data from the oldest old; and by presenting findings based on longitudinal, representative data (also including individuals residing in institutionalized settings). CONCLUSIONS: Efforts to increase, among other things, formal education, network size, and health literacy may be fruitful in postponing dementia, particularly among older women. Developing health literacy programs, for example, may be beneficial to reduce the burden associated with dementia.

Understanding resilience: Lifestyle-based behavioral predictors of mental health and well-being in community-dwelling older adults during the COVID-19 pandemic.

BACKGROUND: Changes in sleep, physical activity and mental health were observed in older adults during early stages of the COVID-19 pandemic. Here we describe effects of the COVID-19 pandemic on older adult mental health, wellbeing, and lifestyle behaviors and explore predictors of better mid-pandemic mental health and wellbeing. METHODS: Participants in the Adult Changes in Thought study completed measures of lifestyle behaviors (e.g., sleep, physical activity) and mental health and wellbeing both pre-pandemic during regular study visits and mid-pandemic via a one-time survey. We used paired t-tests to compare differences in these measures pre- vs. mid-pandemic. Using multivariate linear regression, we further explored demographic, health, and lifestyle predictors of pandemic depressive symptoms, social support, and fatigue. We additionally qualitatively coded free text data from the mid-pandemic survey for related comments. RESULTS: Participants (N = 896) reported significant changes in mental health and lifestyle behaviors at pre-pandemic vs. mid-pandemic measurements (p < 0.0001). Qualitative findings supported these behavioral and wellbeing changes. Being male, never smoking, and lower pre-pandemic computer time and sleep disturbance were significantly associated with lower pandemic depressive symptoms. Being partnered, female, never smoking, and lower pre-pandemic sleep disturbance were associated with higher pandemic social support. Pre-pandemic employment, more walking, less computer time, and less sleep disturbance were associated with less pandemic fatigue. Participant comments supported these quantitative findings, highlighting gender differences in pandemic mental health, changes in computer usage and physical activity during the pandemic, the value of spousal social support, and links between sleep disturbance and mental health and wellbeing. Qualitative findings also revealed additional factors, such as stresses from personal and family health situations and the country's concurrent political environment, that impacted mental health and wellbeing. CONCLUSIONS: Several demographic, health, and lifestyle behaviors appeared to buffer the effects of the COVID-19 pandemic and may be key sources of resilience. Interventions and public health measures targeting men and unpartnered individuals could promote social support resilience, and intervening on modifiable behaviors like sleep quality, physical activity and sedentary activities like computer time may promote resilience to fatigue and depressive symptoms during future community stressor events. Further research into these relationships is warranted.

Does Escalating Violence and Associated Fear of Crime Worsen Psychological Well-Being in Community Dwellers Living in a Rural Setting? Results From the Atahualpa Project Cohort.

BACKGROUND: Escalating street violence and criminal homicides have an adverse impact on psychological well-being. However, these consequences have been difficult to evaluate. Using a recently validated scale, we aimed to assess the impact of fear of crime on the psychological status of middle-aged and older adults living in a rural setting afflicted by endemic violence. METHODS: Participants were selected from Atahualpa residents included in previous studies targeting psychological distress in the population. A validated scale was used to objectively quantify fear of crime in participants. Differences in symptoms of depression and anxiety between baseline and follow-up were used as distinct dependent variables and the continuous score of the fear of crime scale was used as the independent variable. Linear regression models were fitted to assess the association between the exposure and the outcomes, after adjusting for relevant confounders. RESULTS: A total of 653 participants (mean age = 53.2 ± 11.5 years; 57% women) completed the requested tests. We found a 13% increase in symptoms of depression and anxiety during the peak of violence in the village compared with previous years. Linear regression models showed a significant association between the total score on the fear of crime questionnaire and worsening symptoms of depression (ß = .24; 95% CI = 0.14-0.35) and anxiety (ß = .31; 95% CI = 0.24-0.37), after adjustment for relevant confounders. CONCLUSIONS: This study shows a significant aggravating effect of fear of crime on pre-existing symptoms of depression and anxiety and a deleterious effect of these conditions on overall well-being.

Biopsychosocial factors of depression among community-dwelling geriatric population with low perceived social support; a population-based study.

BACKGROUND: Although significant and disabling consequences are presented due to geriatric population-related depression, an insufficient comprehension of various biological, psychological, and social factors affecting this issue has been observed. Notably, these factors can contribute to geriatric population-related depression with low social support. This study aimed to identify factors associated with depression among the community-dwelling geriatric population with low social support in Malaysia. METHODS: This study used secondary data from a population-based health survey in Malaysia, namely the National Health Morbidity Survey (NHMS) 2018: Elderly Health. The analysis included 926 community-dwelling geriatric population aged 60 and above with low social support. The primary data collection was from August to October 2018, using face-to-face interviews. This paper reported the analysis of depression as the dependent variable, while various biological, psychological and social factors, guided by established biopsychosocial models, were the independent variables. Multiple logistic regression was applied to identify the factors. Analysis was performed using the complex sampling module in the IBM SPSS version 29. RESULTS: The weighted prevalence of depression among the community-dwelling geriatric population aged 60 and above with low social support was 22.5% (95% CI: 17.3-28.7). This was significantly higher than depression among the general geriatric Malaysian population. The factors associated with depression were being single, as compared to those married (aOR 2.010, 95% CI: 1.063-3.803, p: 0.031), having dementia, as opposed to the absence of the disease (aOR 3.717, 95% CI: 1.544-8.888, p: 0.003), and having a visual disability, as compared to regular visions (aOR 3.462, 95% CI: 1.504-7.972, p: 0.004). The analysis also revealed that a one-unit increase in control in life and self-realisation scores were associated with a 32.6% (aOR: 0.674, 95% CI: 0.599-0.759, p < 0.001) and 24.7% (aOR: 0.753, 95% CI: 0.671-0.846, p < 0.001) decrease in the likelihood of developing depression, respectively. CONCLUSION: This study suggested that conducting depression screenings for the geriatric population with low social support could potentially prevent or improve the management of depression. The outcome could be achieved by considering the identified risk factors while implementing social activities, which enhanced control and self-fulfilment.

Learning From People With Dementia What Works Well for Well-Being: Interviews and Focus Groups.

BACKGROUND AND OBJECTIVES: Previous research has tended to prioritize the condition of dementia when investigating positive lived experiences, while there is no evidence that well-being becomes fundamentally different when living with dementia. The current exploratory qualitative study examined how people living with dementia describe how they realize their well-being, without treating dementia as a central concern, and specifically addressed people who are successful in maintaining their well-being. RESEARCH DESIGN AND METHODS: Semistructured face-to-face interviews (n = 16) and 2 focus groups (n = 13) were conducted with community-dwelling older people living with dementia, aged 65-93 years (68% male). Conversations covered contributors to experienced life satisfaction, and life enjoyment, and were analyzed using inductive thematic analysis. RESULTS: Two main themes described how people realize well-being. (1) To live a fulfilling life, participants engaged in activities in order to feel useful and relaxed, and they engaged with others, by interacting and sharing with others, and relying on others. (2) To have a positive attitude toward life, participants appreciated the good things in their current life, their lived life, and about their own person, and positively coped with difficulties by accepting them as part of life, not dwelling on the negative, and actively addressing difficulties. DISCUSSION AND IMPLICATIONS: The results appear to reflect universal ways of realizing well-being, justifying the use of universal models of well-being for people living with dementia. We can learn from people living with dementia that living a fulfilling life and having a positive attitude toward life are key to realizing their well-being.

Psychosocial Problems in Community-dwelling Older Adults: A Cross-sectional Study.

BACKGROUND: Changing lifestyles, health care, growing age, and life expectancy have contributed to the occurrence of old age in communities. The elderly population are rising who are aged 60 or older in the present scenario. They are more prone to psychosocial problems such as stress, loneliness, low self-esteem, and anxiety. These problems impact their psychological health. MATERIALS AND METHODS: This cross-sectional study was conducted at selected communities of Amritsar, Punjab. A total of 200 older adults were involved using the purposive sampling technique. Data were collected using a predesigned sociodemographic pro forma and a five-point Likert scale to assess psychosocial problems among the elderly. The data collection method employed was interviewed. In the psychosocial problems assessment tool, a total of 35 items were included, which were further categorized as follows: no psychosocial problem (0-35), mild psychosocial problem (36-70), moderate psychosocial problem (71-105), and severe psychosocial problem (106-140). RESULTS: The average age of the older adults was 69.31 ± 6.63 years, 65.5% were males and 34.5% were females. Regarding psychosocial problems, 69% had moderate, 16% had mild, 10.5% severe, and 4.5% had no problems. The median score was 90 (18). The median score was 17.50 (7) for stress, 38 (17.75) for loneliness, 18 (7.75) for anxiety, and 14 (7) for self-esteem. All the four domains, stress, loneliness, anxiety, and self-esteem, had a statistically significant relationship (P < 0.01). A statistically significant association was found between self-esteem, type of family, and anxiety with educational level. CONCLUSION: The study concluded that older adults in communities have significant psychosocial problems such as stress, loneliness, self-esteem, and anxiety. Collaboratively, health professionals, local community leaders, and social workers can formulate and execute a health awareness campaign to avoid these issues that cause the aged much anguish.

RésuméLes modes de vie changeants, les soins de santé, le vieillissement et l'espérance de vie accrue ont contribué à l'occurrence du vieillissement dans les communautés. La population âgée de 60 ans ou plus est en augmentation dans le contexte actuel. Ils sont plus sujets à des problèmes psychosociaux tels que le stress, la solitude, la faible estime de soi et l'anxiété. Ces problèmes ont un impact sur leur santé psychologique.Matériel et Méthodes:Cette étude transversale a été menée dans des communautés sélectionnées d'Amritsar, au Pendjab. Au total, 200 personnes âgées ont été incluses en utilisant la technique d'échantillonnage raisonné. Les données ont été collectées à l'aide d'un formulaire sociodémographique préconçu et d'une échelle de Likert à cinq points pour évaluer les problèmes psychosociaux chez les personnes âgées. La méthode de collecte de données utilisée était l'entrevue. Dans l'outil d'évaluation des problèmes psychosociaux, un total de 35 items ont été inclus, qui ont été ensuite catégorisés comme suit: aucun problème psychosocial (0­35), problème psychosocial léger (36­70), problème psychosocial modéré (71­105) et problème psychosocial sévère (106­140).Résultats:L'âge moyen des personnes âgées était de 69,31 ± 6,63 ans, 65,5 % étaient des hommes et 34,5 % étaient des femmes. En ce qui concerne les problèmes psychosociaux, 69 % avaient un problème modéré, 16 % un problème léger, 10,5 % un problème sévère et 4,5 % n'avaient aucun problème. Le score médian était de 90 (18). Le score médian était de 17,50 (7) pour le stress, 38 (17,75) pour la solitude, 18 (7,75) pour l'anxiété et 14 (7) pour l'estime de soi. Les quatre domaines, le stress, la solitude, l'anxiété et l'estime de soi, avaient une relation statistiquement significative (P < 0,01). Une association statistiquement significative a été trouvée entre l'estime de soi, le type de famille et l'anxiété avec le niveau d'éducation.Conclusion:L'étude a conclu que les personnes âgées dans les communautés ont des problèmes psychosociaux significatifs tels que le stress, la solitude, l'estime de soi et l'anxiété. En collaboration, les professionnels de la santé, les leaders communautaires locaux et les travailleurs sociaux peuvent formuler et exécuter une campagne de sensibilisation à la santé pour éviter ces problèmes qui causent beaucoup de souffrance aux personnes âgées.

Self-perceptions of aging, physical activity, and depressive symptoms in older community residents with varied neighborhood walkability in Taiwan.

BACKGROUND: Prior research has identified the mediating effect of physical activity in the relationship between self-perceptions of aging and physical health. However, this impact on mental health is unknown, and the influence of environmental contexts proposed by ecological models in this regard remains largely unexplored. Therefore, this study aimed to investigate the role of physical activity in the relationship between self-perceptions of aging and depressive symptoms in older adults, and compare the impact across four levels of neighborhood walkability. METHODS: A sample of 1,055 community-dwelling older adults aged 65 or above was obtained through random-digit-dialing computer-assisted telephone interviewing. The individual's neighborhood walkability was calculated using Walk Score®, and categorized into four levels: car-dependent, somewhat walkable, very walkable, and walker's paradise. Partial least squares structural equation modelling was employed. RESULTS: We found that more positive self-perceptions of aging were associated with fewer depressive symptoms and a mediation effect of physical activity in this relationship. Among the four levels of neighborhood walkability, the mediation effect of physical activity was only statistically significant in the lowest level (car-dependent). The findings supported our hypotheses regarding the mediating effect of self-perceptions of aging on depressive symptoms via physical activity. Neighborhood walkability might potentially influence the mediating role of physical activity. CONCLUSIONS: This study emphasizes key areas on intervention programs and policy formulation to promote mental health in older adults.

Development and Validation of the Dementia Caregiver Burden Scale: A Tool for Community-Dwelling Dementia Caregiver.

BACKGROUND: The number of patients with dementia increases rapidly in aging populations. Dementia is an irreversible disease that causes a patient to be dependent on others' care and also causes family caregivers to experience difficulties in multiple domains. PURPOSE: In this study, a dementia caregiver's burden scale that addresses family caregivers' characteristics and caring environments was developed and validated. METHODS: In-depth interviews with nine caregivers were conducted to identify the attributes of perceived burden and establish preliminary questions. Content validity was confirmed by seven experts using the item content validity index and scale content validity index/average. Construct validity, criterion-related validity, and reliability were verified using data from 205 primary caregivers of patients with dementia. RESULTS: Exploratory factor analysis revealed that five factors, including physical health deterioration, responsibility and role of caregiver, emotional distress, medical expense concerns, and family conflict, and 24 items explained 68.6% of the total variance. The calculated Cronbach's α for the overall scale was .96. CONCLUSIONS: The scale developed in this study may be used to measure the burden perceived by family caregivers of patients with dementia in the physical, emotional, social, financial, and situational domains. Also, the scale may be used to guide the development of tailored interventions that take into consideration different family caregiver and caring situation-related characteristics.

Immigrant Older Adults' Experiences of Aging in Place and Their Neighborhoods: A Qualitative Systematic Review.

Engaging in one's neighborhood fosters independence, promotes social connectedness, improves quality of life, and increases life expectancy in older adults. There is a lack of evidence synthesis on immigrant older adults' neighborhood perceptions and experiences, essential for addressing neighborhood-level influences on aging in place. This study systematically synthesizes qualitative evidence on immigrant older adults' perceptions and experiences of their neighborhoods. A comprehensive search was conducted from inception to 5 April 2023, in multiple databases. This review considered studies including immigrant older adults aged ≥60 years, included studies from any country where the neighborhood was the focus, and only considered qualitative data while excluding review studies, theoretical publications, and protocols. Eligible studies were appraised using the JBI critical appraisal checklist for qualitative research. The Joanna Briggs Institute meta-aggregation approach was used to synthesize findings, and the ConQual approach established confidence in the synthesis. A total of 30 studies were included. Most studies were conducted in North America and explored phenomena such as aging in place, social capital, social cohesion, sense of community, and life satisfaction. Key contextual factors were walkable safe access to social spaces, accessible transportation to amenities, social cohesion with neighbors, and pre-migration neighborhood experiences. Immigrant older adults have varied experiences related to their sense of belonging and social cohesion. Factors such as racial discrimination, feeling unsafe, and social isolation contributed to negative perceptions. This review highlights the need for inclusive neighborhoods that align with the needs and values of immigrant older adults aging in place.

When great responsibility comes with limited options: experiences and needs of older community-dwelling adults regarding accessing, understanding, appraising and using health-related information.

BACKGROUND: In previous research, older adults have been associated with reduced levels of health literacy (HL) influenced by a range of contextual factors. To optimise HL, it is essential to better understand the interactions between the ageing process and both personal and environmental factors as perceived by older adults. This study aimed to explore the experiences and needs of older community-dwelling adults when accessing, understanding, appraising and using health-related information. METHODS: An explorative, qualitative design was used within the social constructivism framework. Semi-structured individual interviews were conducted with 20 adults aged 70-96 living at home in three areas in Northern Iceland. The transcribed interviews were constructed into categories and subcategories using qualitative content analysis. FINDINGS: Four categories emerged. "Expectations for responsibility" describes the experience that individuals are responsible for taking care of their health, including accessing, understanding, appraising and using information and services, showing initiative and keeping needed communications active. "A gap between expectancy and ability/context" includes experiences while taking responsibility for expectations not aligning with skills/situations, creating information gaps. "Finding one's own ways" comprises various adapted ways to access, understand, and use information and services. "Bridging the gap" describes experiences of needing shared responsibility and more manageable options to enable reasoned health-related decisions and navigation in the healthcare system. CONCLUSIONS: The participants valued and took full responsibility for accessing, understanding, appraising and using information and services as part of a social norm; however, they experience information gaps. They request shared responsibility by being provided with fundamental health-related information as a vital step in making reasoned health-related decisions and navigating the healthcare system. They also request more inclusive and accessible service opportunities to bridge the gaps and facilitate HL. It is necessary to critically address, at a systematic level, the conflict between expected individual responsibility and the existence of options to act upon this responsibility. In matters of health, health services and HL, the need to analyse and confront structural disadvantages experienced by older adults is highlighted.

The association between self-rated health, number of family members, and cognitive function in community-dwelling older adults: Mediating role of depression.

With the increasing number of older adults, research on cognitive function has expanded. However, studies examining the mediating effect of depression on the association between complex factors and cognitive function in older adults are still insufficient. Additionally, there is a lack of studies that have investigated these relationships by integrating multiple factors related to the cognitive function of older adults. Therefore, our study investigated the association between the number of family members, self-rated health, depression, and cognitive function in community-dwelling older adults and highlighted the mediating role of depression in these relationships. We used data from 218 older adults aged over 65 collected in a previous study. The independent variables were the number of family members and self-rated health, and the dependent variable was cognitive function measured by the cognitive impairment screening test (CIST). The mediation variable was depression measured by the Patient Health Questionnaire-9 (PHQ-9). Structural equation modeling was used to examine the association between the independent, dependent, and mediation variable. The mean ages of the participants were 81.71 (standard deviation [SD] = 6.00) years, with 198 females (90.83%) and 20 males (9.17%). The structural equation model demonstrated a good model fit (chi-square value = 33.375; degrees of freedom = 24; p-value = 0.0964; RMSEA = 0.042; CFI = 0.970; TLI = 0.956; SRMR = 0.042). Self-rated health and the number of family members were not directly associated with cognitive function; however, depression had significant indirect effects (self-rated health to cognitive function: coefficient = -0.023, p-value = 0.017; number of family members and cognitive function: coefficient = 0.012, p-value = 0.030). Our findings indicated that depression plays a crucial mediating role between self-rated health, number of family members, and cognitive function. The results highlight the need for comprehensive strategies for mental health care to support cognitive health in older adults.

Responsibility endowing power: A theoretical framework of health empowerment for Chinese older people with chronic illness.

AIM: To construct a health empowerment framework for the Chinese older people with chronic conditions. DESIGN: A Strussian grounded theory design was selected to generate the theoretical framework. METHODS: Data were collected from 53 community-dwelling older people with chronic conditions in China between November 2017 and August 2019, via semi-structured interviews and with participating observation. The constant comparative method identified the key categories. RESULTS: 'Responsibility endowing power', the health empowerment core theme, was defined as initiating, performing and realizing responsibility towards health through the interaction between the self, family and society. The framework enriches the meaning of health empowerment, changing older people's nursing practice.

"How difficult it is to change dietary behaviour" experience of older people with sarcopenic obesity: a qualitative study.

BACKGROUND: Dietary intervention is an important method to manage sarcopenic obesity, but the implementation in real world is difficult to achieve an ideal condition. This study aimed to the experiences of older people with sarcopenic obesity during the implementation of dietary behavioural change (DBC) intervention. METHODS: This study is a semi-structured individual interview embedded within a pilot randomized controlled trial on community-dwelling older people with sarcopenic obesity. Purposive sampling was applied to invite 21 participants who had received a 15-week DBC intervention. The interviews were audio-recorded and transcribed verbatim. Content analysis was performed to analyze the data. RESULTS: The themes for facilitators included: (a) Attach importance to self's health; (b) Family's support; (c) Concern self's body shape; (d) Instructor's support; (e) Regular food diary taken. The themes for barriers included: (a) Difficulties of taking food diary; (b) Difficulties of calculating the food amount; (c) Yield to offspring's appetite; (d) Misjudging self's or family's appetite. CONCLUSION: Support from family members and instructor, caring about self's health and body image facilitated the intervention implementation. The complication of food amount estimation and diary record, personal sacrifice for next generations, and previous living experience were barriers for implementing the intervention. Overall, the older people with sarcopenic obesity can accept the design of DBC intervention program and have great willing to join.

Listening to the voices of adolescents with intellectual disabilities: Exploring perception of post-school transition.

BACKGROUND: Life skills play a key role in the transition of a child with intellectual disabilities into a young adult. According to previous research, students with intellectual disabilities often lack such skills. However, most studies on this topic have been conducted on teachers or parents. Limited studies are available on adolescents with intellectual disabilities. Therefore, this study investigates how adolescents with disabilities perceive their competence in life skills post-school. METHOD: The sample consisted of 201 adolescents with disabilities (67 % with mild intellectual disabilities and 33 % with other disabilities). RESULTS: The results revealed that adolescents with intellectual disabilities' perception of their life skills in all areas (independent living, personal money management, community involvement and usage, leisure activities, health, and social/interpersonal relationships) was significantly lower compared to adolescents with other disabilities. In four out of the six sub-scales, female respondents reported that their competence level in life skills was lower compared to males. In addition, adolescents with disabilities in daycare centers stated that they could establish better social and personal relationships when compared to adolescents from other schools.

Perceived but not objective measures of neighborhood safety and food environments are associated with longitudinal changes in processing speed among urban older adults.

BACKGROUND: Although a growing body of literature documents the importance of neighborhood effects on late-life cognition, little is known about the relative strength of objective and subjective neighborhood measures on late-life cognitive changes. This study examined effects of objective and subjective neighborhood measures in three neighborhood domains (neighborhood safety, physical disorder, food environments) on longitudinal changes in processing speed, an early marker of cognitive aging and impairment. METHODS: The analysis sample included 306 community-dwelling older adults enrolled in the Einstein Aging Study (mean age = 77, age range = 70 to 91; female = 67.7%; non-Hispanic White: 45.1%, non-Hispanic Black: 40.9%). Objective and subjective measures of neighborhood included three neighborhood domains (i.e., neighborhood safety, physical disorder, food environments). Processing speed was assessed using a brief Symbol Match task (unit: second), administered on a smartphone device six times a day for 16 days and repeated annually for up to five years. Years from baseline was used as the within-person time index. RESULTS: Results from mixed effects models showed that subjective neighborhood safety (ß= -0.028) and subjective availability of healthy foods (ß= -0.028) were significantly associated with less cognitive slowing over time. When objective and subjective neighborhood measures were simultaneously examined, subjective availability of healthy foods remained significant (ß= -0.028) after controlling for objective availability of healthy foods. Associations of objective neighborhood crime and physical disorder with processing speed seemed to be confounded by individual-level race and socioeconomic status; after controlling for these confounders, none of objective neighborhood measures showed significant associations with processing speed. CONCLUSION: Subjective neighborhood safety and subjective availability of healthy foods, rather than objective measures, were associated with less cognitive slowing over time over a five-year period. Perception of one's neighborhood may be a more proximal predictor of cognitive health outcomes as it may reflect one's experiences in the environment. It would be important to improve our understanding of both objective and subjective neighborhood factors to improve cognitive health among older adults.

Community-dwelling older adults' perspectives on health risks: a qualitative study exploring anxieties, priorities, and expectations in ageing.

BACKGROUND: With the conflict between the promise of ageing in health and longevity and the limited availability of health resources and social support, older adults in China inevitably experience anxieties surrounding health risks. This study aims to investigate how older adults perceive the health risks that come with getting older, explore the degree to which health risks affect older adults, and advocate for active engagement in practices for managing health risks. METHODS: Using purposive sampling, three districts of Beijing (Xicheng District, Fengtai District, and Daxing District, respectively) were selected for the research. Qualitative semi-structured and in-depth interviews were conducted with 70 community-dwelling older adults who participated in the study. Data were extracted and analyzed based on a thematic framework approach. RESULTS: Three main themes were identified: (i) the anxieties of older adults concerning health risks in ageing; (ii) the priorities of older adults for health risk management in ageing; (iii) the expectations of older adults for health risk management in ageing. The primary health concerns among older adults included disease incidence and function decline. It was found that basic health management emerged as a critical need for older adults to mitigate health risks. Moreover, it was observed that healthcare support for older adults from familial, institutional, and governmental levels exhibited varying degrees of inadequacy. CONCLUSIONS: The primary source of anxieties among older adults regarding health risks predominantly stems from a perceived sense of health deprivation. It is often compounded by persistent barriers to primary care of priorities in managing health risks among older adults. In addition, the expectations of older adults for health risk management emphasize the necessity for integrated care approaches. Therefore, further research should give priority to the prevention and management of health risks, aim to reduce anxieties, provide integrated care to meet the primary needs and expectations of older adults, and ultimately strive toward the overarching goal of promoting health and longevity.

'It's where I belong': what does it mean to age in place from the perspective of people aged 80 and above? A longitudinal qualitative study (wave one).

BACKGROUND: Most people want to remain at home as they age. Ageing in place - remaining at home and connected to the community - is a national and international policy priority; however, to better understand how policy might be implemented, a more nuanced understanding is required about older adults' lived experiences of ageing in place, especially the experiences of those aged 80 and above. OBJECTIVE: To describe and explore the social processes which enable ageing in place from the perspective of community-dwelling older people (80+). METHODS: Forty-six respondents (80-100+ years) participated in the first wave of a longitudinal qualitative study set in North East England. Semi-structured interviews were conducted in participants' homes between June 2022 and January 2023. Interviews were analysed using reflexive thematic analysis. RESULTS: Participants positioned their homes as a place of freedom and as the antithesis of a 'care home'. Remaining in place was important for all participants; a key priority for them was to remain physically active to enable this. However, many participants faced significant hurdles to remaining in place. These were primarily related to health and mobility issues. Some participants were able to overcome such barriers by drawing on financial resources and available social networks. CONCLUSION: The home is central to understanding older peoples' (80+) experiences of ageing. In a socio-political context which promotes ageing in place, the social factors shaping experiences of ageing in place must be considered. This involves attending to the challenges of later life, particularly health and especially mobility and physical function. Currently, those with resources (social and economic) are better equipped to respond to such challenges, thus potentially exacerbating widening inequalities in ageing. By foregrounding the perspectives of those ageing in place alongside social factors shaping their experiences, our study has important implications for policy and health and social care. We show that a more equitable allocation of resources is vital to fulfil the ageing in place policy agenda. Furthermore, we highlight a need to recognise commitments to ageing in place displayed by people aged 80 and above, especially when remaining in place becomes difficult to achieve.

Determinants of sedentary behavior in community-dwelling older adults with type 2 diabetes based on the behavioral change wheel: a path analysis.

BACKGROUND: Sedentary behavior (SB) is deeply ingrained in the daily lives of community-dwelling older adults with type 2 diabetes mellitus (T2DM). However, the specific underlying mechanisms of the determinants associated with SB remain elusive. We aimed to explore the determinants of SB based on the behavior change wheel framework as well as a literature review. METHODS: This cross-sectional study recruited 489 community-dwelling older adults with T2DM in Jinan City, Shandong Province, China. Convenience sampling was used to select participants from relevant communities. This study used the Measure of Older Adults' Sedentary Time-T2DM, the Abbreviated-Neighborhood Environment Walkability Scale, the Social Support Rating Scale, the Lubben Social Network Scale 6, the Subjective Social Norms Questionnaire for Sedentary Behavior, the Functional Activities Questionnaire, the Numerical Rating Scale, the Short Physical Performance Battery, and the Montreal Cognitive Assessment Text to assess the levels of and the determinants of SB. Descriptive statistical analysis and path analysis were conducted to analyze and interpret the data. RESULTS: Pain, cognitive function, social isolation, and social support had direct and indirect effects on SB in community-dwelling older adults with T2DM (total effects: ß = 0.426, ß = -0.171, ß = -0.209, and ß = -0.128, respectively), and physical function, walking environment, and social function had direct effects on patients' SB (total effects: ß = -0.180, ß = -0.163, and ß = 0.127, respectively). All the above pathways were statistically significant (P < 0.05). The path analysis showed that the model had acceptable fit indices: RMSEA = 0.014, χ 2/df = 1.100, GFI = 0.999, AGFI = 0.980, NFI = 0.997, RFI = 0.954, IFI = 1.000, TLI = 0.996, CFI = 1.000. CONCLUSION: Capability (physical function, pain, and cognitive function), opportunity (social isolation, walking environment, and social support), and motivation (social function) were effective predictors of SB in community-dwelling older adults with T2DM. Deeper knowledge regarding these associations may help healthcare providers design targeted intervention strategies to decrease levels of SB in this specific population.

Factors associated with health-related quality of life among community-dwelling older adults: the APPCARE study.

This study aimed to identify the factors associated with health-related quality of life (HRQOL) among community-dwelling older adults. Physical and mental HRQOL were measured by the 12-item Short Form Health Survey (SF-12) at baseline and follow-up. Linear regression models were used to evaluate associations between socio-demographic, health, and lifestyle factors and HRQOL. The sample included 661 participants (mean age = 77.4 years). Frailty was negatively associated with physical HRQOL (B = - 5.56; P < 0.001) and mental HRQOL (B = - 6.65; P < 0.001). Participants with a higher score on activities of daily living (ADL) limitations had lower physical HRQOL (B = - 0.63; P < 0.001) and mental HRQOL (B = - 0.18; P = 0.001). Female sex (B = - 2.38; P < 0.001), multi-morbidity (B = - 2.59; P = 0.001), and a high risk of medication-related problems (B = - 2.84; P < 0.001) were associated with lower physical HRQOL, and loneliness (B = - 3.64; P < 0.001) with lower mental HRQOL. In contrast, higher age (B = 2.07; P = 0.011) and living alone (B = 3.43; P < 0.001) were associated with better mental HRQOL in the multivariate models. Future interventions could be tailored to subpopulations with relatively poor self-reported HRQOL, such as frail or lonely older adults to improve their HRQOL.

Effects of Qigong Therapy on the Psychological Well-Being, Physical Health State, Sleep State, and Life Satisfaction of Older Adults Living in Community.

Older adults living in a community are looking for alternative and complementary methods to improve their healthy longevity and quality of life. This study aimed to examine the effects of the Qigong therapy on psychological well-being, physical health state, sleep state, and life satisfaction of older adults living in community. This study used a quasi-experimental pretest-posttest control group design. The study samples were 69 older adults (intervention, n = 34; control, n = 35) over 65 years old in community in South Korea. Qigong therapy was performed 50 minutes per session, twice a week for a total of 20 times over a 10-week period in a comfortable and quiet environment without external noise. Measures were the study participant's general characteristics survey, psychological well-being scale, Cornell Medical Index-Korean version, sleep scale, and life satisfaction scale standardized for the elderly. Effects of Qigong therapy according to interaction effect over time and the group showed statistically significant differences in psychological well-being, physical health state, sleep state, and life satisfaction. This study suggests that Qigong therapy was an effective nursing intervention for improving the psychological well-being, physical health state, sleep state, and life satisfaction of older adults living in community.