The Power of a Complex Systems Perspective to Elucidate Aging.

It is becoming highly accepted that aging, age-related diseases, and geriatric healthcare can move forward if reductionist research is complemented by integrative research uniting knowledge on specific aging mechanisms, multiple biomedical, social, psychological, lifestyle, and environmental factors and their interactions. In this special issue, we present exciting papers that illustrate how complexity science theory and practice can be applied to aging research and provide a better understanding and quantification of healthy aging and vulnerability to disease. Recent insights on biomarkers, clocks of aging, frailty, and resilience are covered and studied in interaction with a dynamic multiscale perspective. The editorial and closing viewpoint guide you through basic principles of gerontological complexity science and shed light on new research horizons, including innovative systems-based interventions.

Geriatric medicine and Olympic elite sports-parallels and philosophies.

The 30th Olympiad took place in July 2024. At first glance, sports science and training of elite athletes may appear to be of little relevance to geriatric medicine. However, there are important parallels between the practice of geriatric medicine and elite sports and lessons that we can learn from our sports science colleagues. Elite athletes and older people are operating at the margins of physiological capacity. Both benefit from tailored, scientifically informed training programmes delivered and monitored by a multidisciplinary team. There are parallels between the comprehensive geriatric assessment and the philosophy of marginal gains pioneered by British Cycling. Insights into the biology of skeletal muscle function are beginning to translate into the development of clinical interventions and substances that offer an unfair advantage in sport by improving muscle strength and physical performance may be of therapeutic benefit in sarcopenia. The 2024 Olympics provide an opportunity for us to learn lessons for excellence in our research and provide an opportunity to promote exercise across the life course-important for healthy ageing.

Online patient-provider communication and healthy ageing: the roles of health literacy and health self-efficacy.

eHealth involves using digital technologies, like electronic health records and telemedicine, to enhance healthcare delivery and outcomes. For older adults, eHealth helps manage chronic conditions, access services remotely, and engage in preventive health, improving physical and psychological well-being. This study investigates the association between online patient-provider communication (OPPC) and older adults' quality of life (QoL, i.e. sleep quality, exercise and psychological health). The study also explores how health literacy and health self-efficacy mediate the relationship between OPPC and QoL. This study utilized data from the National Cancer Institute's Health Information National Trends Survey, collected in 2019 (HINTS 5 Cycle 3), specifically targeting individuals aged ≥ 60 (N = 2587). The associations among variables were analysed using structural equation modelling. OPPC was positively and significantly associated with health literacy (ß = 0.53, p < 0.001). Health literacy was positively and significantly related to health self-efficacy (ß = 0.02, p < 0.001). Health self-efficacy was significantly related to five dimensions of QoL: sleep quality (ß = 0.20, p < 0.001), fruit and vegetable consumption (ß = 0.13, p < 0.010), exercise (ß = 0.59, p < 0.001), sedentariness (ß = -0.58, p < 0.001) and psychological health (ß = 0.24, p < 0.001). Besides, health literacy and health self-efficacy also mediated the influence of OPPC on QoL sequentially, being identificators as two serial mediators between OPPC and older adults' QoL. This study suggests that OPPC plays an important role in older adults' QoL.

The Influence of Structural Brain Changes on Cognition in the Context of Healthy Aging: Exploring Mediation Effects Through gBAT-The Graphical Brain Association Tool.

The contribution of age-related structural brain changes to the well-established link between aging and cognitive decline is not fully defined. While both age-related regional brain atrophy and cognitive decline have been extensively studied, the specific mediating role of age-related regional brain atrophy on cognitive functions is unclear. This study introduces an open-source software tool with a graphical user interface that streamlines advanced whole-brain mediation analyses, enabling researchers to systematically explore how the brain acts as a mediator in relationships between various behavioral and health outcomes. The tool is showcased by investigating regional brain volume as a mediator to determine the contribution of age-related brain volume loss toward cognition in healthy aging. We analyzed regional brain volumes and cognitive testing data (Montreal Cognitive Assessment [MoCA]) from a cohort of 131 neurologically healthy adult participants (mean age 50 ± 20.8 years, range 20-79, 73% females) drawn from the Aging Brain Cohort Study at the University of South Carolina. Using our open-source tool developed for evaluating brain-behavior associations across the brain and optimized for exploring mediation effects, we conducted a series of mediation analyses using participant age as the predictor variable, total MoCA and MoCA subtest scores as the outcome variables, and regional brain volume as potential mediators. Age-related atrophy within specific anatomical networks was found to mediate the relationship between age and cognition across multiple cognitive domains. Specifically, atrophy in bilateral frontal, parietal, and occipital areas, along with widespread subcortical regions mediated the effect of age on total MoCA scores. Various MoCA subscores were influenced by age through atrophy in distinct brain regions. These involved prefrontal regions, sensorimotor cortex, and parieto-occipital areas for executive function subscores, prefrontal and temporo-occipital regions, along with the caudate nucleus for attention and concentration subscores, frontal and parieto-occipital areas, alongside connecting subcortical areas such as the optic tract for visuospatial subscores and frontoparietal areas for language subscores. Brain-based mediation analysis offers a causal framework for evaluating the mediating role of brain structure on the relationship between age and cognition and provides a more nuanced understanding of cognitive aging than previously possible. By validating the applicability and effectiveness of this approach and making it openly available to the scientific community, we facilitate the exploration of causal mechanisms between variables mediated by the brain.

Stvaranje okruženja prilagođenih dobi u Europi: alat za kreatore lokalnih politika i planova

Politike za stvaranje okruženja prilagođenih starijoj dobi, u kojima sudjeluje sve veći broj gradova i zajednica, lokalnih vlasti i regionalnih vlada, postale su snažan pokret u Europi i svijetu. Tim se politikama istražuju sinergije između poboljšanja fizičkog okruženja u četvrtima, prometa i stanovanja; povećanja poštovanja, društvene uključenosti i sudjelovanja zajednice; te ulaganja u javne usluge. Ova publikacija pruža komplet alata za usmjeravanje kreatora lokalnih politika i planova u procesu razvoja, provedbe i vrednovanja politika i intervencija prilagodbe dobi — politika koje podržavaju ljude da aktivno i zdravo stare, a time i da rade stvari koje su im važne i doprinose njihovim zajednicama. Na temelju lekcija iz postojećih inicijativa prilagodbe dobi u Europi, ova publikacija sažima ključne čimbenike za uspostavljanje i održavanje uspješnih inicijativa unutar četiri faze procesa politike: angažmana, planiranja, provedbe i vrednovanja. Velik broj primjera pokazuje kako su lokalne samouprave praktično primijenile načela djelovanja prilagođenog dobi.

Searching for Beauty and Health: Aging in Women, Nutrition, and the Secret in Telomeres.

Women typically outlive men, yet they often experience greater frailty and a higher incidence of chronic diseases as they age. By exploring the biological foundations of aging, with a particular focus on telomere dynamics, this manuscript aims to describe how dietary and lifestyle choices can significantly influence the aging process. The review comprehensively examines current research, underscoring the power of nutrition to counteract age-related changes, support healthy aging, and maintain vitality and beauty in women. The exploration of telomeres-the protective caps at the ends of chromosomes-reveals how they serve as markers of cellular aging and are potential targets for interventions aimed at enhancing women's longevity and quality of life. This study also emphasizes the importance of sex-specific approaches and precision medicine in understanding the unique health challenges women face as they age. By proposing targeted strategies, the review seeks to address these challenges, offering insights into preventive measures that can foster resilience, promote well-being, and extend healthy life expectancy in women. Ultimately, this work provides a sophisticated understanding of the aging process in women, highlighting the pivotal role of tailored interventions in preserving both health and beauty.

Promoting Geropsychology: A Memorandum for Research, Policies, Education Programs, and Practices for Healthy Aging.

BACKGROUND: This viewpoint paper reports the state of the art at a global level on research, practice and assessment, policies, and training in the clinical psychology of aging and, more specifically, in geropsychology. The main sources of information were as follows: (1) the most recent reviews of the literature available in the scientific literature; (2) the resources on the internet referable to professional and academic associations dealing with the topic; and (3) the laws, policy initiatives, and funded programs that are aimed at the diffusion and applications of mental health in aging. METHODS: The present study aims to provide an updated and comprehensive memorandum highlighting the importance of prioritizing mental health in older adults. It seeks to promote health in general and disease prevention strategies, ensuring equitable access to mental health services integrated into primary care and designed for aging. This paper also aims to shed light on the slow development process and lack of consolidation in the adaptation of academic training at master's and doctoral levels in most developed countries, despite the long-declared importance of enhancing resources for the promotion of geropsychology. RESULTS: The results of the present study are patchy. Although the importance of enhancing resources for the promotion of geropsychology has long been declared, the development process seems very slow, and the adaptation of academic training at master's and doctoral levels in most developed countries-those that, for demographic reasons and attitudes, should be more sensitive to the issue, does not yet seem to have consolidated. CONCLUSIONS: Collaboration among diverse professionals is crucial for providing integrated and comprehensive care to older adults that addresses their physical, psychological, and social needs.

Interventions to Promote Physical Activity and Healthy Ageing: An Editorial.

The Healthy Ageing Challenge aims for people to enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experiences of the richest and poorest [...].

Healthy Aging in Colombia 2018 and Its Variation in Relation to Social Conditions.

The population aging in the region is occurring under scenarios of inequality, raising concerns about how the increase in life expectancy is experienced and what factors affect the quality of life of older adults. This research quantified the differentials of healthy aging in Colombia in 2018 and its association with social indicators through a cross-sectional, descriptive, and correlational observational study. Healthy aging was quantified using the Disability-Free Life Expectancy (DFLE) indicator and later correlated with social indicators and subjected to a Multiple Factor Analysis (MFA). The results showed a healthy life expectancy of 71.5 years for women and 66.9 years for men, with a disability expectancy of 8.3 and 6.4 years, respectively. Negative associations emerged with health problems, disability, lack of medical care, illiteracy, school absenteeism, and poverty, while higher education levels and retirement showed positive associations. The factor analysis by area of residence highlighted urban areas as conducive to healthy aging. In conclusion, the accelerated aging of the Colombian population faces health disparities that policies must address by improving education, economic security, and health services, especially for women and rural areas.

Plasma markers of neurodegeneration, latent cognitive abilities and physical activity in healthy aging.

Blood-based biomarkers of neurodegeneration demonstrate great promise for the diagnosis and prognosis of Alzheimer's disease. Ultra-sensitive plasma assays now allow for quantification of the lower concentrations in cognitively unimpaired older adults, making it possible to investigate whether these markers can provide insight also into the early neurodegenerative processes that affect cognitive function and whether the markers are influenced by modifiable risk factors. Adopting an exploratory approach in 93 healthy older adults (65-75 years), we used structural equation modelling to investigate cross-sectional associations between multiple latent cognitive abilities (working memory, episodic memory, spatial and verbal reasoning) and plasma amyloid beta (Aß42/Aß40 ratio), phosphorylated-tau 181 (ptau-181), glial fibrillary acidic protein (GFAP), and neurofilament light (NfL), as well as the influence of device-measured habitual physical activity on these associations. The results showed that NfL was negatively associated with working memory, and that NfL interacted with moderate-to-vigorous physical activity in its association with episodic memory. The study has thereby demonstrated the potential of neurodegenerative plasma markers for improving understanding of normative cognitive aging and encourages future research to test the hypothesis that high levels of NfL, indicative of white matter pathology, limit the beneficial effect of physical activity on episodic memory in healthy aging.

Regional differences in the Association of Healthy Aging with the incidence of falls: an analysis based on the China Health and Retirement Longitudinal Study from 2011 to 2020.

Background: Falls frequently occur among the older adult population. In this study, we examined the variations in fall incidence across different regions over time, focusing on the disparities between urban and rural areas among older adult Chinese individuals, Healthy aging is comprised of five dimensions: (1) absence of chronic diseases, (2) good physical functioning, (3) normal cognitive function, (4) active social participation, and (5) absence of depression. Additionally, we explored the relationship between healthy aging and the occurrence of falls in middle-aged and older adults. Falls are defined as events that occurred within the past two years. Results: Among 9,918 participants, 33.8% lived in urban areas and 23.0% achieved healthy aging. In contrast, 66.2% resided in rural areas with 16.5% achieving healthy aging. In 2011, rural residents had a higher fall incidence rate (17% in rural vs. 13.5% in urban); by 2020, the fall rate remained higher in rural areas (19.5% in rural vs. 17.3% in urban). Unhealthy aging (HR = 1.08, 95%CI: 1.00-1.16) were risk factors for falls. Subgroup analysis revealed that in rural areas, unhealthy aging increased the risk of falls. In urban areas, the increased risk of falls associated with unhealthy aging was not significant (Rural HR = 1.11, 95%CI:1.01-1.22; Urban HR = 1.05, 95%CI: 0.93-1.18). Conclusion: Healthy aging may be more strongly associated with a lower risk of falls in rural areas, while this association might be less pronounced in urban areas due to different environmental and social factors. This highlights the need for environment-specific fall prevention strategies and targeted measures for the older adult.

Utilizing the determinants of healthy aging to guide the choice of social prescriptions for older adults. / Utilisation des déterminants du vieillissement en bonne santé pour guider le choix des prescriptions sociales pour les aînés.

Executive summary: The age of Canada's population is increasing, necessitating innovative methods and tools for assessing the needs of older adults and identifying effective health and social prescriptions. In Alberta, a community-based, senior-serving organization undertook the development and piloting of the Healthy Aging Asset Index, an assessment tool and social prescribing guide for use by a variety of professionals within the community. Tool development was rooted in medical complexity assessment and social work practice, and adhered to the determinants of healthy aging established by Alberta's Healthy Aging Framework, which is based on the determinants of healthy aging published by the World Health Organization. Results from the pilot showed improvement in the functionality of older adults within the determinants over time, as they were supported in addressing areas of personal vulnerability. Adopting tools such as the Healthy Aging Asset Index can bring cohesiveness to the support that older adults receive across the care continuum and has the potential to shift the balance of care away from the health system and towards the community, thus improving the capacity of health systems and government to meet the needs of Canada's older adults.

The Healthy Aging Asset Index (HAAI) is an assessment tool that can be used to guide social prescribing by a variety of professionals in the community. The determinants of healthy aging can be used to inform social prescriptions in different domains. The HAAI can support shifting care away from the health system and into the community, and improve the capacity of health systems. Further investment is needed to support the implementation of the HAAI and social prescribing pathways within community-based organizations.

L'indice des ressources pour un vieillissement en bonne santé (HAAI) est un outil d'évaluation de la prescription sociale utilisable par divers professionnels de la collectivité. Utiliser les déterminants du vieillissement en bonne santé peut éclairer la pratique de la prescription sociale dans différents domaines. L'outil HAAI peut aider à offrir certains soins en milieu communautaire plutôt qu'au sein du système de santé, améliorant ainsi la capacité des systèmes de santé à fournir des soins. Des investissements supplémentaires sont nécessaires pour soutenir la mise en oeuvre de l'outil HAAI et les parcours de prescription sociale au sein des organisations communautaires.

Integrating social prescribing in a Canadian regional health system to support healthy aging. / Intégration de la prescription sociale dans un système de santé régional canadien pour favoriser le vieillissement en santé.

INTRODUCTION: Social prescribing (SP) is a rapidly growing health and social model of care. The concept of social prescribing is based on well-known clinical practices such as community referrals, integrated health and social care, and navigator models. Although SP began in the United Kingdom's mental health and social care field, there are many examples of different models of SP foci and pathways. Here in Canada, SP is emerging at several provincial locations, with differences in its delivery reflecting the local context of people and places.

British Columbia (BC) has developed a province-wide social prescribing model supporting older adults through close partnerships between health care and community organizations. A regional health authority, Fraser Health, has a specific regional team focussing on integrating social prescribing into the health system through meaningful engagement and continuous co-creation with multisectoral partners, using strategies such as change management and Plan-Do-Study-Act cycles. Environmental and organizational support are big facilitators that have supported the continuation of the designated integration effort. Long-term funding and more partnerships between health care and community organizations will be critical to sustaining the social prescribing model in BC.

La Colombie-Britannique a élaboré un modèle de prescription sociale à l'échelle de la province pour soutenir les aînés grâce à des partenariats étroits entre les établissements de soins de santé et les organismes communautaires. Une régie régionale de santé, Fraser Health, a une équipe régionale spécialisée qui travaille à intégrer la prescription sociale au système de santé par des interactions significatives avec des partenaires multisectoriels et l'élaboration conjointe continue de programmes, au moyen de stratégies comme la gestion du changement et les cycles de planification, d'exécution, d'étude et d'action (de Plan-Do-Study-Act, soit Planification-Exécution-Étude-Action). Les ressources du milieu et le soutien des organismes sont des facteurs importants qui ont facilité la poursuite de ces travaux d'intégration. Un financement à long terme et une hausse des partenariats entre les établissements de soins de santé et les organismes communautaires seront essentiels à la pérennisation du modèle de prescription sociale en Colombie-Britannique.

Relationship between participation in projects of incentives to promote walking and healthy aging among the older population: A four-year longitudinal study.

OBJECTIVE: This study aimed to evaluate the association between the Yokohama Walking Point Program, which promotes walking through feedback on step counts and incentives, and the extension of healthy life expectancy. METHODS: A total of 4298 individuals aged over 65 years who responded to the 2013 and 2016 surveys and who were not certified as needing long-term care in 2016 were included in this study. The participants were categorized into "non-participation," "participation without uploading," and "participation with uploading" groups based on their involvement and uploading of pedometer data. The objective variable was the occurrence of long-term care certification and deaths over the subsequent four years. A modified Poisson regression model was applied, adjusting for 15 variables before project initiation. RESULTS: A total of 440 participants (10.2 %) were included in the "participation with uploading" group and 206 (4.8 %) in the "participation without uploading" group. Compared with "non-participation," the risk ratio was 0.77 (95 % confidence interval (CI): 0.59-0.99) for "participation with uploading" and 1.02 (95 % CI: 0.75-1.38) for "participation without uploading". In the sensitivity analysis censoring death as an inapplicable outcome and considering functional decline, participation with uploading showed a risk ratio of 0.79 (95 % CI: 0.60-1.04) for the likelihood of functional decline. CONCLUSIONS: The use of pedometers and health point programs based on walking activity is associated with enhancing the health of older individuals participating in the program, representing a population-centric strategy targeting all citizens.

A qualitative study of healthy ageing and co-production.

Europe's ageing population increases the demand for housing solutions targeting older citizens' needs and preferences. Establishing age-friendly communities fostering social participation is essential for healthy ageing and various housing options with shared facilities prioritizing social contact have emerged. While involving older people in public service delivery is emphasized, studies on co-production with older people in building age-friendly communities remain limited. This study explores a co-production initiative between older citizens, a municipality and a real estate company in a newly established senior village focusing on organizational settings and physical facilities. A qualitative study inspired by the BIKVA methodology was conducted using focus group interviews with citizens, frontline staff, and management. Through reflexive thematic analysis, the physical environment, organizational setting and other factors influencing the co-production process were analysed. Citizens expressed satisfaction with the unique physical environment, the different activities and being involved in the co-production process on development and building up the senior village. However, the co-production initiative was influenced by the lack of frontline staff involvement, how the physical facilities were organized for building inclusive communities as well as the level of information provided to align expectations among stakeholders. Involving older citizens in the co-production of age-friendly community initiatives has the potential to take the identified challenges into account. To understand what constitutes an optimal environment for healthy ageing further research in collaboration with older citizens is needed.

Information search under uncertainty across transdiagnostic psychopathology and healthy ageing.

When making decisions in everyday life, we often rely on an internally generated sense of confidence to help us revise and direct future behaviours. For instance, confidence directly informs whether further information should be sought prior to commitment to a final decision. Many studies have shown that aging and both clinical and sub-clinical symptoms of psychopathology are associated with systematic alterations in confidence. However, it remains unknown whether these confidence distortions influence information-seeking behaviour. We investigated this question in a large general population sample (N = 908). Participants completed a battery of psychiatric symptom questionnaires and performed a perceptual decision-making task with confidence ratings in which they were offered the option to seek helpful information (at a cost) before committing to a final decision. Replicating previous findings, an 'anxious-depression' (AD) symptom dimension was associated with systematically low confidence, despite no detriment in objective task accuracy. Conversely, a 'compulsive behaviour and intrusive thoughts' (CIT) dimension was associated with impaired task accuracy but paradoxical over-confidence. However, neither symptom dimension was significantly associated with an increased or decreased tendency to seek information. Hence, participants scoring highly for AD or CIT did not use the option to information seek any more than average to either increase their confidence (AD) or improve the accuracy of their decisions (CIT). In contrast, older age was associated with impaired accuracy and decreased confidence initially, but increased information seeking behaviour mediated increases in both accuracy and confidence for final decisions. Hence, older adults used the information seeking option to overcome initial deficits in objective performance and to increase their confidence accordingly. The results show an appropriate use of information seeking to overcome perceptual deficits and low confidence in healthy aging which was not present in transdiagnostic psychopathology.

Design, develop, and implement the strategic information system on health, dependence, and healthy aging: an analysis of the Mexican experience.

BACKGROUND: The Decade of Healthy Aging (2021-2030) emerges as a 10 years strategy to improve the lives of older adults, their families, and the communities in which they live. One of the actions defined in this framework is related to improving the measurement, monitoring, and understanding of characteristics, factors, and needs related to aging and health. The aim was to analyze and assess the process of construction and development of the Strategic Information System on Health, Funcional Dependence and Aging (SIESDE, for its acronym in Spanish). SIESDE will provide strategic information in Mexico at the municipal, state, and national levels that support the public policies on healthy aging. METHODS: The system processes and analyzes the data sources of the Health Information Systems and the National System of Statistical and Geographical Information. SIESDE comprises three components: (1) Design, construction, and evaluation of the indicators; (2) storage, management, and visualization, and (3) diffusion and translation of information. RESULTS: A total of 135 indicators were built on seven themes: (1) demographic, socioeconomic, and aging conditions, (2) health, (3) functional dependence, (4) healthy aging, (5) health services, (6) social and physical environments, and (7) complex indicators. CONCLUSIONS: SIESDE is an effective system for providing an overall view of health, aging, and functional dependence.