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Background: Pulmonary infection (PI) and urinary tract infection (UTI) have been the most common cause of hospitalization and most frequent infection respectively in older people with disability (OPWD). Long‐term care insurance (LTCI) policy, intending to provide services to reduce the disease burden of OPWD, it remains unclear whether LTCI could reduce PI‐, and UTI‐related hospitalizations. This quasi‐experimental study aimed to assess the influences of LTCI on all‐cause, especially PI‐ and UTI‐related hospitalizations among OPWD and the variation across sociodemographic characteristics. Methods: 32,120 participants in the Chengdu Long‐term Care Insurance cohort were considered the intervention group, and 2,704 not covered by the LTCI were in the control group. A total of 3,134,160 hospitalization records were collected between January 2014 and June 2021. A doubly robust difference‐in‐differences (DID) method was used to estimate the average treatment effect on the treated (ATT), indicating the average effect of LTCI on intervention group. Results: The average monthly all‐cause, PI‐, and UTI‐related hospitalization rates were 16.3%, 4.0% and 0.5% in the intervention group, respectively, and were 19.3%, 3.9% and 0.5% in the control group, respectively. Under LTCI, all‐cause (ATT [95% CI]: 7.15% [6.41%, 7.88%]), PI‐ (3.25% [2.76%, 3.74%]), and UTI‐related hospitalizations (0.46% [0.28%, 0.64%]) were decreased. The influences of LTCI became significant after 5 months since the LTCI implementation and remained stable over time. The impact was more pronounced among those with longer coverage. The overall reduction was stronger in those who were not married, lived alone, and resided in institutions. Conclusions: LTCI may reduce the occurrence of all‐cause, PI‐, and UTI‐related hospitalizations in OPWD, with stronger influences observed over an extended period of implementation. The implementation of LTCI can play a role in reducing the burden of infectious diseases in OPWD and the care burden of families and society. [ABSTRACT FROM AUTHOR]

Purpose: Aging is the primary risk factor for cognitive decline. Serum klotho, as an anti-aging protein, may be involved in cognitive decline. Thus, we aim to explorer the correlation between serum klotho and cognitive performance among an older adult population in the United States. Methods: We performed a cross-sectional study using data from NHANES 2011-2014. Serum klotho was analyzed by ELISA. Cognitive function was measured by Establish a Registry for Alzheimer's Disease (CERAD) test, Animal Fluency test and Digit Symbol Substitution Test (DSST) score. The relationship between serum klotho and cognition was analyzed by a multivariable regression model. Results: A total of 2,171 participants aged 60-79 years were included. Median serum klotho concentration was 851.52 pg./ml (SD = 294.07). We also categorized serum klotho concentrates into quartiles. After fully adjusting pertinent variables, compared to those with lowest klotho levels (206.3-658.4 pg./ml), individuals with highest klotho concentrates (983.3-3,456 pg./ml) had a higher CERAD score [ß (95%CI): 0.97 (0.25, 1.69) p = 0.008] and DSST score [ß (95%CI): 1.86 (0.25, 3.47), p = 0.024]. Conclusion: Our findings indicated that, among the general population of American older adults, serum klotho concentrates may serve as a marker of cognitive health. The benefits of klotho on aging process and neurodegenerative disorders should be paid more attention. [ABSTRACT FROM AUTHOR]

Background: The association between grip strength and depression in elderly individuals in low- and middle-income countries (LMICs) has rarely been studied. This study aims to explore the relevance of grip strength and depression in the elderly population using data from a national large-scale population. Methods: This study was conducted using data from seniors over 60 years old in wave 1 of the Longitudinal Aging Study in India (LASI). Grip strength is the maximum of three measurements by the dynamometer. Depression symptoms were assessed using 10 items on the Center for Epidemiologic Studies Depression Scale (CESD-10) with a 10-point boundary. Multivariate linear regression analysis, non-linear analysis, subgroup analysis, interaction tests and sensitivity analysis were performed. Results: There were 27,343 participants in this study, including 19,861 participants with low grip strength and 7,482 participants with normal grip strength. The results revealed that grip strength and depression were negatively correlated in elderly individuals after adequate adjustment for confounding factors [odds ratio (OR) = 1.237, 95% confidence interval (CI) 1.172–1.305, p < 0.00001]. The results remained stable after adjusting for all confounding factors (OR = 1.090, 95% CI 1.030–1.155, p = 0.00307). Regression analysis showed that physical activity (PA), comorbidities and cognition may have an impact on the correlation between grip strength and depression symptoms. Smooth curve fit suggested that grip strength and depressive symptoms were linearly related. The interaction test results of gender in the relationship between grip strength and depression were significant (p for interaction < 0.05). Conclusion: Grip strength and depression were negatively correlated in older Indians, and larger prospective studies are needed in the future to determine this association. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia is associated with cognitive impairment in older adults. However, the underlying mechanisms are not fully understood. Aim: To explore the mediating role of nutritional status in the relationship between sarcopenia and cognitive impairment. Methods: Three thousand eight hundred and ten participants (mean age 61.94 ± 8.01 years) from the West China Health and Aging Trend (WCHAT) study were included. We defined sarcopenia using the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Cognitive status and nutritional status were measured using the Short Portable Mental Status Questionnaire (SPMSQ) and the Mini Nutritional Assessment Short Form (MNA-SF). Relationships between sarcopenia, nutritional status, and cognitive function were explored using multiple linear regression. Two mediation models were generated to examine whether nutritional status mediates the association between sarcopenia and cognitive function using PROCESS macro version 3.5. Results: The study involved 3147 (82.6%) non-sarcopenic, 387 (10.2%) sarcopenic, and 276 (7.2%) severely sarcopenic individuals. In mediation model 1, sarcopenia (β = 0.208, 95% CI 0.072 to 0.344, P = 0.0028) was significantly associated with cognitive impairment, and nutritional status mediated this association (indirect effect = 0.162, bootstrap 95% CI 0.116 to 0.212). Mediation model 2 indicated that nutritional status exhibited a full mediating effect regarding the association between sarcopenia and cognitive impairment (indirect effect = 0.131, bootstrap 95% CI: 0.08 to 0.188; direct effect = 0.046, bootstrap 95% CI − 0.115 to 0.21) and a partial mediating effect regarding the association between severe sarcopenia and cognitive impairment (indirect effect = 0.21, bootstrap 95% CI: 0.143 to 0.283; direct effect = 0.476, bootstrap 95% CI: 0.234–0.724). Conclusions: The relationship between sarcopenia and cognitive impairment was significantly mediated by nutritional status. Early nutritional interventions may prevent cognitive decline in sarcopenic older adults. [ABSTRACT FROM AUTHOR]

Background: Low lean mass and cognitive impairment are both age-related diseases. In addition, these conditions share many risk factors. However, the association between them has been controversial in recent years. Objective: To investigate the association between low lean mass and cognitive performance in U.S. adults using NHANES data from 1999 to 2002. Methods: A total of 2550 participants were identified in the National Health and Nutrition Examination Survey Database (1999–2002). The independent variable was low lean mass, and the dependent variable was cognitive performance. Men and women were classified as having low lean mass if appendicular lean mass (ALM) adjusted for BMI (ALMBMI) was < 0.789 and < 0.512, respectively. Cognitive performance was assessed using the Digit Symbol Substitution Test (DSST). Higher scores on the DSST indicated better cognitive performance. The covariates included sex, age, race, poverty income ratio, comorbidity index, educational level, physical activity and smoking status. Results: For the primary outcome, our multivariate linear regression analysis indicated that participants without low lean mass were associated with better cognitive performance (β = 1.50; 95% CI [0.12–2.89]). Subgroup analysis results indicated that the association was similar in sex, age, race, poverty income ratio, comorbidity index, educational level, physical activity and smoking status. Conclusions: Participants without low lean mass were associated with better cognitive performance. We might be able to improve cognitive performance by treating low lean mass, thus providing an opportunity for intervention at a younger age. [ABSTRACT FROM AUTHOR]

Objectives: Sarcopenia is a condition associated with progressive loss of skeletal muscle mass and function resulting in substantial negative health outcomes and disability in older adults. It is thus important that sarcopenia-related risk factors be explored. The present study was based upon the Asian Working Group on Sarcopenia 2019 (AWGS2019) criteria to assess whether vitamin D levels are a risk factor associated with sarcopenia in various ethnic groups in western China. Design: Cross-sectional study. Setting: Communities in Yunnan, Guizhou, Sichuan, and Xinjiang provinces. Participants: We included 4236 individuals that were 50 years of age or older from the West China Health and Aging Trend (WCHAT) study. Measurements: An InBody 770 instrument was used for bioimpedance-based analyses of muscle mass, while a digital grip strength dynamometer was used for handgrip strength-based measurements of muscle strength. Physical performance was assessed based upon gait speed over 4 m. Other secondary variables were additionally analyzed as potentially relevant risk factors. Results: Sarcopenia affected an estimated 22.45% of studied individuals who were 50 years of age or older, with respective prevalence rates in the < 60, 60–64, 65–79, and ≥80 age groups of 11.78%, 19.44%, 32.65%, and 67.97%. Rates in males and females were 26.66% and 20.05%, respectively. In males, a significant difference in vitamin D levels was detected when comparing individuals with and without sarcopenia, although no such relationship was detected in females. Following adjustment for confounding variables, binary logistic regression analyses revealed that inadequate vitamin D was able to independently predict sarcopenia risk only in males (OR=1.875,95%CI: 1.109–3.169, P=0.019). Conclusions: Among middle-aged and older adults of multiple ethnicities in western China, we found that inadequate vitamin D was an independent predictor of sarcopenia risk specifically in males. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the relationship between cognitive performance and obesity parameters, such as body mass index (BMI), visceral fat area (VFA), waist circumference (WC), and waist-to-hip ratio (WHR) in western China. Study Design: A cross-sectional study. Methods: 3914 participants, aged ≥50 years, were recruited in this study. Anthropometrics measurements, life-style factors, chronic disease comorbidities, and sleep qualities were recorded for each participant. Among the anthropometrics, BMI, WC, and WHR were assessed using standard procedures, while VFA was calculated using bioelectrical impedance analysis. Cognitive performance was estimated using the Short Portable Mental Status Questionnaire (SPMSQ). Finally, relationships between cognitive abilities and BMI, VFA, WC, and WHR were evaluated using univariate and multivariate regression analyses. Results: Cognitive decline (CD) occurred at a rate of 13.29% among the 3914 participants. A strong correlation was observed between cognitive abilities and BMI of male patients aged 50–59 yrs (OR 1.116,95% CI1.002–1.242), in the adjusted model. Alternately, WHR was shown to be significantly related to CD in females aged ≥70 years (OR 0.041, 95% CI0.002–0.671). WC was shown to have a strong association with CD in males (OR 1.023,95% CI1.003–1.024). Lastly, WHR was closely connected to CD in participants with BMI < 25 kg/m2 (OR 0.022,95% CI0.002–0.209). Conclusions: Our findings suggest that a higher middle age BMI is associated with CD, whereas, in the elderly population, a higher WHR is related to improved cognitive performance. Further investigation is warranted to elucidate a relationship between VFA and CD. [ABSTRACT FROM AUTHOR]

Objectives: To determine the risk of poor health-related outcomes in older adults with cooccurring hearing impairment and cognitive impairment, and to compare the risk of hearing impairment only, cognitive impairment only, and multiple morbidities. Design: Cross-sectional study. Setting: Community-dwelling older adults aged 60 years and older were included. Participants: The data of missing hearing and cognitive status were excluded, and 3770 older people participated in the study. Measurements: The hearing function evaluation was conducted by questionnaire survey. Assessment of cognitive function was completed using the SPMSQ scale. The subjects were divided into hearing impairment and cognitive impairment group, hearing impairment only group, cognitive impairment only group and neither group. Multiple logistic regression was used to analyze the risks of hearing and cognitive impairment and health-related condition. Results: The prevalence of hearing impairment and cognitive impairment, hearing impairment only, cognitive impairment only, and neither were 9.4%, 8.3%, 29.9% and 52.4%, respectively. Compared with the control group, the individuals with hearing impairment and cognitive impairment were associated with depression (OR=3.48, 95% CI=2.66, 4.56), anxiety (OR=2.35, 95% CI=1.92, 3.33), frailty (OR=4.30, 95% CI=2.89, 6.40), and ADL impairment (OR=2.77, 95% CI=2.03, 3.77). Conclusion: The studies shows that hearing impairment combined with cognitive impairment is significantly associated with anxiety, depression, frailty, and ADL impairment. Comprehensive management and intervention should be provided for older people to reduce the occurrence of adverse health consequences. [ABSTRACT FROM AUTHOR]

Objective: To understand the prevalence of sarcopenia in the Chengdu community, analyze the risk factors of sarcopenia, and provide a theoretical basis for further development of strategies for sarcopenia prevention and treatment. Methods: A total of 938 individuals aged 60 years and above were recruited from the community of Chengdu. Skeletal muscle mass was measured by the bioelectrical impedance analysis (BIA), and sarcopenia was diagnosed according to the Asian Sarcopenia Working Group (AWGS) 2019 diagnostic criteria. A scale was generated to determine the age, living habits, and chronic diseases of enrolled subjects. The Mini Mental Examination Scale (MMSE) was used to assess their cognitive function, and the Geriatric Depression Scale (GDS-15) was used to identify depression. Results: Among the 938 residents enrolled in the study, 172 (18.34%) had sarcopenia, including 48 (5.12%) with severe sarcopenia. The prevalence of sarcopenia in males was 19.91% and 16.81% in females. According to the binary logistic regression, older age (OR = 1.104, 95%CI: 1.059–1.151) and impaired cognitive function (OR = 2.251, 95%CI: 1.145–4.424) were independent risk factors for sarcopenia in females. Among the males, older age (OR = 1.079, 95%CI: 1.037–1.124) was the independent risk factor for sarcopenia. A moderate increase in BMI reduced the prevalence of sarcopenia in both females and males. Multi-category logistic regression analysis documented that females of older age were more likely to develop severe sarcopenia (χ2 = 16.769, P < 0.01 vs. no sarcopenia), females with lower BMI were more likely to develop severe sarcopenia (χ2 = 13.654, P < 0.01 vs. no sarcopenia), females with heart disease were more likely to develop severe sarcopenia (χ2 = 5.786, P = 0.016 vs. no sarcopenia; χ2 = 5.791, P = 0.016 vs. non-severe sarcopenia), and females with impaired cognitive function were more likely to develop severe sarcopenia (χ2 = 13.381, P < 0.01 vs. no sarcopenia; χ2 = 7.529, P = 0.006 vs. non-severe sarcopenia). Males were more likely to develop severe sarcopenia with older age (χ2 = 18.435, P < 0.01 vs. no sarcopenia; χ2 = 9.8011, P=0.002 vs. non-severe sarcopenia), lower BMI (χ2 = 12.736, P < 0.01 vs. no sarcopenia), smoking (χ2 = 4.68, P = 0.031 vs. no sarcopenia; χ2 = 5.652, P = 0.017 vs. non-severe sarcopenia), and chronic obstructive pulmonary disease (COPD) (χ2 = 5.517, P = 0.019 vs. no sarcopenia). Conclusion: In the Chengdu community, the prevalence of sarcopenia among individuals 60 years of age or older was higher in males than in females. In elderly females, older age and impaired cognitive function were independent risk factors for sarcopenia. Women with more advanced age, decreased BMI, heart disease, and impaired cognitive function were more likely to develop severe sarcopenia. In elderly males, increased age was an independent risk factor for sarcopenia, and older age, decreased BMI, smoking, and COPD increased the probability of developing severe sarcopenia. [ABSTRACT FROM AUTHOR]

Background: Length of hospital stay (LOS) and readmission are important outcomes for older inpatients. The association between functional status on admission and outcomes has not been well investigated in Chinese elderly. Objectives: To detect the impact of function impairments on LOS and 90-day readmission in a population of Chinese elderly inpatients. Methods: This is a prospective cohort study. All new patients over 60 years in geriatrics department of a university hospital in Western China from June to August 2016 were enrolled. Activities of daily living (ADL) and Instrumental ADL (IADL) on admission were evaluated with Barthel Index and Lawton IADL. Outcomes were LOS and 90-day readmission. LOS was calculated as the total days of hospital stay. Readmission was investigated through telephone interviews after discharge. Pearson Chi-square test was used to detect the associations. Binary logistic regression was used to detect the association of function status on admission with LOS and readmission. Results: A total of 225 patients were enrolled. Mean age 82.41 (± 7.316; 63–99), 31.1% were females. Overall, 64.9% of the patients were hospitalized longer than 14 days and 33.30% experienced a 90-day readmission. Following an adjustment for age, gender, marital status, education level, smoking, alcohol, nutrition status, and admission location, the binary logistic regression models showed that both ADL impairment (OR 2.03; 95% CI 1.06–3.87) and IADL impairment (OR 2.54; 95% CI 1.28–5.01) were independent predictors for LOS. ADL impairment was an independent predictor for 90-day readmission (OR 2.26; 95% CI 1.14–4.47), while IADL impairment was not associated with readmission (OR 1.43; 95% CI 0.68–3.02). Conclusion: Functional status on admission is the predictor of LOS and 90-day readmission in Chinese older inpatients from the geriatric department of a university hospital. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the prevalence of sarcopenia in different ethnic groups and the association with cultural life styles in west China. Design: A cross-sectional study. Settings: The communities in Yunnan, Guizhou, Sichuan, and Xinjiang provinces. Participants: 4500 participants aged 50 years or older in west China were enrolled in this study. Sarcopenia was defined according to the diagnostic algorithm of the Asia Working Group for Sarcopenia (AWGS). Measurements: We measured gait speed, handgrip strength and muscle mass by using bioelectrical impedance analysis (BIA) for all eligible participants. Life-style information were collected by reviewers. Relationships between sarcopenia and ethnic groups were analyzed using univariate and multivariate analyses. Results: We found 869 (19.31%) adults aged 50 years old or older were sarcopenia. The mean age is 62.4±8.3 years. The main ethnic groups enrolled in this study is Han, Tibetan, Qiang, Yi and Hui. The crude prevalence of sarcopenia is 22.3% in Han, 18.2% in Tibetan, 11.8% in Qiang, 34.7% in Yi and 26.7% in Hui. Compared to Han, after adjusting sex and age, Qiang has a lower prevalence of sarcopenia (odds ratio [OR]: 0.44, 95% CI 0.35–0.55), Yi has a higher prevalence of sarcopenia (OR: 1.78, 95% CI 1.29–2.43). While adding adjusting other potential cofounders, sarcopenia is still less prevalent in Qiang (OR: 0.44, 95% CI 0.34–0.57). Conclusions: The crude prevalence of sarcopenia is 22.3% in Han, 18.2% in Tibetan, 11.8% in Qiang, 34.7% in Yi and 26.7% in Hui. Sarcopenia was less prevalent in Qiang compared with Han. Further studies to determine related factors of sarcopenia among different ethnic groups are recommended. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between sensory impairment and all-cause mortality among the oldest-old (aged 80 and older) in China. Design: Prospective cohort study. Setting: Community-based setting in 22 provinces of China. Participants: A total of 8788 older adults aged 80 and over at baseline with complete hearing and vision function data were included as the study population. Measurements: Sensory impairment was categorized as no sensory impairment, hearing impairment (HI) only, vision impairment (VI) only and dual sensory impairment (DSI) according to hearing and vision function. Deaths were identified through interviews by close family members. Cox proportion hazards regression models were used to examine the association of sensory impairment with mortality, adjusting for socio-demographic data, life style factors and health status. Results: The mean age was 92.3 ± 7.6 years old, and 60.1% of participants were female. Among 8788 participants, 9.8% were recognized as DSI, 9.7% were HI only and 10.4% with VI only. Comparing with participants with no sensory impairment, those with VI only (HR=1.10, 95% CI=1.01-1.20) and DSI (HR=1.21, 95% CI=1.09-1.35) were significantly associated with higher risk of all-cause mortality in the fully adjusted model. Conclusion: Our results demonstrated that VI only and DSI were significantly associated with higher risk of mortality among Chinese older adults aged 80 and over. The finding advocated that it is necessary to identify and manage sensory impairments for the advanced ages to reduce mortality risks. [ABSTRACT FROM AUTHOR]

Objectives: The goal of the present study was to assess the relationship between sarcopenia and prealbumin levels among hospitalized patients ages 60 and older.Design: Cross-sectional study.Setting: The geriatric wards in Guizhou Provincial People's Hospital, Guiyang. Guizhou, China.Measurements: Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) criteria, which consist of three components: low muscle mass, assessed based on an index of appendicular skeletal mass/height2 <7.0kg/m2 for men and <5.4kg/m2 for women; low muscle strength, defined as handgrip strength <26kg for men and <18kg for women; and low physical performance, defined as gait speed <0.8m/s. Using these criteria, sarcopenia was defined as presence of low muscle mass in addition to low muscle strength and/or low physical performance. Prealbumin levels and other variables were considered as being independent variables in an effort to evaluate any potential associations between these factors and sarcopenia status using non-adjusted and multivariateadjusted regression models.Results: The overall prevalence of sarcopenia was 60.17%, affecting 65 (70.65%) men and 6 (23.08%) women in the present study. Age, body mass index (BMI), and prealbumin levels were each independently associated with sarcopenia (p<0.05). In a multivariate model, after adjusting for all potential covariates, prealbumin levels remained significantly associated with sarcopenia incidence, with an inflection point of 265.9mg/L. The effect sizes and the confidence intervals on the left and right sides of this inflection point were 0.94 (0.90 to 0.99) and 1.07 (0.93 to 1.23), respectively.Conclusion: Among older Chinese inpatients in the present study, prealbumin levels were negatively correlated with sarcopenia incidence, when prealbumin levels were below 265.9mg/L. [ABSTRACT FROM AUTHOR]

Aim: This systematic review was conducted to explore the associations between sarcopenia, hospitalization and length of stay in the old people.Methods: Pubmed, Embase, Medline and Cochrane Central Register of Controlled Trails from January 2009 to October 2017 were searched in this review. We included prospective studies, which had the clear definition of sarcopenia and reported the hospitalization or length of stay as one of outcomes. Adjusted Odd ratios (aORs), hazard ratios (aHRs) or relative risks (aRRs) extracted from the studies were combined to synthesize pooled effect measures. Heterogeneity, and methodological quality were assessed using I² statistic and Newcastle-Ottawa scale, respectively.Results: Nine studies were included in this review. Of these, 8 studies with 4174 individuals reported results for hospitalization, 3 studies involving 6276 old people in the community reported results for length of stay. Sarcopenia was significantly associated with future hospitalization (RR 1.40, 95% CI 1.04-1.89, p = 0.029; data from 8 studies). A subgroup analysis showed the associations between sarcopenia and readmission in hospitalized old patients that were statistically significant (RR 1.75, 95% CI 1.01-3.03, p = 0.044; data from 8 studies). However, this association were not found in the community-dwelling older subjects (RR 1.08, 95% CI 0.74-1.57, p = 0.688; data from 8 studies), uncertain in nursing home residents. The association of sarcopenia and length of stay was not statistically significant (OR 1.21, 95% CI 0.90-1.63, p = 0.20; data from 8 studies) in community-dwelling residents.Conclusions: This systematic review demonstrates that sarcopenia is a significant predictor of readmission in old inpatients, but not associated with hospitalization or length of stay in community-dwelling old adults. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to estimate the prevalence of sarcopenic obesity (SO) and the association between cognitive impairment and SO in a cohort of elderly Chinese community-dwelling individuals.Methods: A total of 948 elderly Chinese community-dwelling individuals aged 60-92 years were recruited. The participants were categorized into the following four groups according to their sarcopenia and obesity status: sarcopenic obese, sarcopenic, obese and non-sarcopenic, and non-obese group. Sarcopenia was defined as appendicular skeletal muscle index of <7.0 kg/m2 in men and <5.7 kg/m2 in women; obesity was defined as values greater than the upper two quintiles for body fat percentage stratified by gender of the study population; cognitive impairment was measured using the Mini-Mental State Examination and defined as a score of <24.Results: A total of 945 participants were included in the statistical analyses with a mean age of 68.76 ± 6.50 years. The prevalence of SO was 6.0% (7.3% in men and 4.8% in women). The sarcopenic obese (odds ratio [OR]: 2.550, 95% confidence interval [CI], 1.196-5.435) and obese (ORs: 2.141, 95% CI, 1.230-3.728) groups had significantly increased risk for cognitive impairment in fully adjusted model, respectively.Conclusion: The SO prevalence in elderly Chinese community-dwelling individuals was relatively low (6.0%). The present study suggested SO was independently associated with cognitive impairment. [ABSTRACT FROM AUTHOR]

Aim: Procalcitonin (PCT) has predictive value for patients with infectious diseases, but has not been studied in frailty. The purpose of this study was to compare PCT to two other inflammatory biomarkers [interleukin-6 (IL-6)] and C-reactive protein (CRP) in their association with frailty among older hospitalized patients.Methods: Retrospective study of inpatients (June-December, 2016), who had all three biomarkers measured within 24 h of admission. Frailty was defined according to the Chinese version of a validated frailty scale. Due to the association of biomarkers with infection, we divided patients into “non-infected” (no pneumonia or other infections) and “pneumonia” (using standard criteria) groups.Results: Of 435 patients (mean age 81.6 ± 8.6 years), 181 (41.6%) were designated the non-infected group and 254 (58.4%) the pneumonia group. Prevalence of frailty in the non-infected group was 32.0% (58/181) and frailty (univariate analysis) was associated with higher PCT and IL-6 levels but not CRP. Prevalence of frailty in the pneumonia group was 40.2% (102/254) and frailty was associated with all three biomarkers. In multivariable analysis adjusting for age, gender, smoking, alcohol use, hemoglobin, albumin, neutrophils and creatinine, PCT (not IL-6 and CRP) was associated with frailty in the non-infected group (OR = 5.244; 95% CI, 1.622-16.947; P = 0.006) and none of the biomarkers were associated with frailty in the pneumonia group.Conclusions: Although the study is limited due to the retrospective methods, PCT but not IL-6 or CRP, was associated with frailty among older inpatients without infection. None of these biomarkers were associated with frailty among patients with pneumonia. [ABSTRACT FROM AUTHOR]

Background: Little is known about the relationship between metabolic syndrome (MetS) and disability in the oldest old.Aims: To investigate the possible association between MetS and disability among community-dwelling older adults aged ≥ 90 years.Methods: This was a secondary analysis of a cross-sectional study. MetS was defined by the International Diabetes Federation Criteria. Activities of daily living (ADL) and instrumental activities of daily living (IADL) disabilities were evaluated using the physical self-maintenance scale and the Lawton-Brody IADL scale, respectively.Results: We included 725 participants (mean age: 93.8 ± 3.1 years). The prevalence of MetS was 13.0% in women and 9.8% in men, respectively. In women, ADL and IADL disabilities were more prevalent in the MetS group compared with the non-MetS group (ADL: 43.1 vs. 30.6%, p = 0.044; IADL: 73.8 vs. 59.8%, p = 0.030). After adjusting for relevant confounders, participants with MetS was associated with an increased risk of either ADL (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.22-3.45) or IADL disability (OR 2.12, 95% CI 1.31-4.78) compared with those without MetS. In men, similar results were found with respect to the prevalence of ADL or IADL disability and the adjusted ORs, but the results were not statistically significant.Conclusion: MetS is associated with an increased risk of either ADL or IADL disability in a study population of long-lived adults, especially in women. [ABSTRACT FROM AUTHOR]

Background: Frailty is a common geriatric syndrome in old people. It remains controversial whether Mediterranean diet could prevent old people from developing into frailty. The aim of this study is to summarize the relevant studies and assess the effectiveness of adherence to Mediterranean diet on frailty in old people.Method: A systematic search of MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials was conducted to identify all relevant studies up to Oct 2017. We included studies regarding the associations between adherence to Mediterranean diet and risk of frailty among elders. A meta-analysis was performed to explore the effects of Mediterranean diet on frailty.Results: Six studies matched the inclusion criteria, of which five were prospective and one was cross-sectional. A total of 10,210 participants from the five prospective cohort studies were included to perform the meta-analyses. In comparison with lowest adherence to Mediterranean diet, elders with highest adherence to Mediterranean diet were significantly associated with lower risk of frailty in the future (RR= 0.56, 95% CI=0.36-0.89, p=0.015). Furthermore, the pooled estimates from four studies performed among participants in western countries (European and North American) showed that higher adherence to Mediterranean diet was associated with a 52% reduced risk of frailty (RR= 0.48, 95% CI=0.32-0.72, p<0.001). However, one study showed no association between Mediterranean diet and frailty among Asian elders (RR=1.06, 95% CI=0.83-1.36, p=0.638).Conclusion: A higher adherence to Mediterranean diet is associated with a lower risk of frailty in old people. Meanwhile, the benefits may be more obvious among elders from western countries. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence and factors associated with sarcopenia in a sample of older inpatients. Methods: A cross‐sectional study was conducted in three acute geriatric wards in 2012. Sarcopenia was defined according to the criteria of the Asian Working Group for Sarcopenia. Results: We included 407 patients aged 81.0 ± 8.0 years. The prevalence of sarcopenia was 31% in the whole study population. Multiple logistic regression showed that being a female (odds ratio (OR) 4.75, 95% confidence interval (CI) 2.45–9.20), smoking (OR 2.94, 95% CI 1.26–6.69), cognitive impairment (OR 2.08, 95% CI 1.10–3.95), polypharmacy (OR 2.36, 95% CI 1.28–4.34) and body mass index (OR 0.75, 95% CI 0.68–0.83) were independently associated with sarcopenia. Conclusion: Sarcopenia was highly prevalent in older inpatients. In addition to factors previously reported to be associated with sarcopenia, we found that polypharmacy was associated with sarcopenia. As the direction of causality remains uncertain, these relationships deserve further study. [ABSTRACT FROM AUTHOR]

Aim Aim The aim of the present study was to examine the association between sarcopenia and nutritional status and physical activity among community-dwelling Chinese people aged 60 years and older. Methods This study was carried out on 836 community-dwelling Chinese individuals aged ≥60 years to evaluate sarcopenia using the Asian Working Group for Sarcopenia criteria. Sociodemographic characteristics and lifestyle habits were collected using a general questionnaire. Nutritional status was assessed using the Mini Nutritional Assessment and biochemical parameters, whereas physical activity was assessed using the long form of the International Physical Activity Questionnaire. In addition, univariate and multivariate analysis was used to analyze the association between sarcopenia with nutritional status and physical activity. Results The total prevalence rate of sarcopenia was 10.5%, 47 (11.3%) men and 41 (9.7%) women who were classified as sarcopenia. The prevalence of sarcopenia was significantly lower among the participants of normal nutrition status. Compared with the participants with sarcopenia, those without sarcopenia had higher levels of prealbumin ( P < 0.05) and hemoglobin ( P < 0.05) for both sexes. In the multivariate model, after adjustment for all covariates, the Mini Nutritional Assessment score (adjusted OR 0.769, 95% CI 0.689-0.859, P < 0.05) was statistically significantly associated with sarcopenia, but the relationship between physical activity and sarcopenia was not significant. Conclusions The prevalence of sarcopenia in the Chinese community-dwelling population aged 60 years and older was high. There was a significant association between sarcopenia and nutritional status, but not with physical activity, based on a questionnaire. Further studies should evaluate whether maintaining a good nutritional status might be effective in lowering the risk of sarcopenia. Geriatr Gerontol Int 2017; 17: 1959-1966. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the relationship between frailty and the metabolic syndrome and to evaluate how these contribute to mortality in very old people. Design: Secondary analysis of data from the Project of Longevity and Aging in Dujiangyan. Setting: Community sample from Sichuan Province, China. Participants: People aged 90+ years (n=767; baseline age=93.7±3.4 years; 68.0% women. Measurements: After a baseline health assessment, participants were followed for four years (54.0% died). A frailty index (FI) was calculated as the sum of deficits present, divided by the 35 health-related deficits considered. Relationships between the FI and the metabolic syndrome were tested; their effect on death was examined. Results: The mean FI was 0.26 ±0.11. Higher FI scores were associated with a greater risk of death, adjusted for age, sex, education, and metabolic syndrome items. The hazard ratio was 1.03 (95% confidence interval 1.02, 1.04) for each 1% percent increase of the FI. The mortality risk did not change with the metabolic syndrome (odds ratio=0.99; 0.71-1.36). Conclusions: In the oldest old, frailty was a significant risk for near-term death, regardless of the metabolic syndrome. Even using age-adjusted models, the epidemiology of late life illness may need to account for frailty routinely. [ABSTRACT FROM AUTHOR]

• Regression discontinuity analysis provides a framework to assess the causal effects of implementing LTCI. • Implementation of LTCI significantly reduced mortality rate and extended survival time. • LTCI demonstrates greater benefits among specific subgroups, emphasizing the need for early intervention, collaboration with family members, and a balanced allocation of care resources. • This research marks the first comprehensive exploration of the potential health benefits associated with the implementation of LTCI, providing valuable perspectives that can inform policy making and enhance the development of robust long-term care systems in developing countries. The surge of disabled older people have brought enormous burdens to society. The aim of this study was to examine the impact of long-term care insurance (LTCI) implementation on mortality and changes in physical ability among disabled older adults. This was a prospective observational study based on data from the government-led LTCI program in a pilot city of China from 2017 to 2021. Administrative data included the application survey of activities of daily living (ADL), the baseline characteristics and all-cause mortality. Return visit surveys of ADL were conducted between August 2021 and December 2021. A regression discontinuity model was used to analyze the impact of LTCI on mortality. A total of 12,930 individuals older than 65 years were included in this study, and 10,572 individuals were identified with severe disability and participated in the LTCI program. LTCI implementation significantly reduced mortality by 5.10 % (95 % CI, -9.30 % to -0.90 %) and extended the survival time by 33.74 days (95 % CI, 13.501 to 53.970). The ADL scores of the LTCI group dropped by 2.5 points on average, while the ADL scores of those did not participated in LTCI dropped by 25.0 points. The heterogeneity analysis revealed that the impact of LTCI on mortality reduction was more significant among females, individuals of lower age, those who were married, cared for by family members, and who lived in districts with rich care resources. LTCI implementation had a favorable impact on the mortality and physical ability of participants. [ABSTRACT FROM AUTHOR]

Little is known about the relationship between falls and various physical activities in the oldest old people. This study was conducted to observe the association of fall with various exercise habits and farm work in very old people. In this cross-sectional study of a Chinese cohort of men and women aged 90–108 years, we observed the association of fall with habitual (current and former) farm work and exercise in very old people. The population included 805 unrelated Chinese nonagenarians and centenarians (68.94% of the subjects were women, with a mean age of 93.70 years). In the women, the subjects with a continuing exercise habit had a significantly lower prevalence of fall than those without an exercise habit; the subjects who had never exercised had a significantly higher prevalence of fall than those who exercised. In men, there was no significant difference in the prevalence of these habits between the subjects with and without fall. After adjusting for age, gender, body mass index, educational levels, life styles, vision levels and temperament, we found that current habitual farm work (OR = 1.755 95% CI (1.107, 2.780)) and exercise OR = 0.666 95% CI (0.445, 0.997) had a significant odds ratio for fall; among the females, continuing exercise (vs. having never exercised) had a significant odds ratio for fall (OR = 0.620 95% CI (0.395, 0.973)). Habitual farm work might be positively associated with fall; however, habitual exercise might be negatively associated with fall in Chinese long-lived old people. [ABSTRACT FROM AUTHOR]

The aim of this study is to explore the differences among older adults who are rural or urban residents with respects to their socioeconomic position, chronic health conditions and medication use. This cross-sectional study included 887 community-dwelling older adults (≥60 years) from western China. Trained interviewers collected data from all of the study subjects through face-to-face interviews. Polypharmacy was defined as the concomitant use of five or more medications. A total of 717 participants were included in the study analyses. Compared with their urban counterparts, the older adults in rural China were more likely to have more chronic health conditions, and a lower education level, annual income and insurance coverage rate. In addition, the rural inhabitants were less likely to use medications (58.7% vs. 75.7%, p < 0.001). The intensity of medication use (the mean number of drugs) was 1.7 for rural residents and 2.3 for urban residents ( p < 0.001). The prevalence of polypharmacy was significantly lower in rural residents than urban residents (11.5% vs. 17.5%, p = 0.021). Urban residence (odds ratios (OR) 1.89, 95% confidence intervals (CI) 1.03–3.48), number of chronic conditions (OR 1.95, 95% CI 1.16–3.30), diabetes (OR 4.14, 95% CI 2.33–7.37), and cardiovascular disease (CVD) (OR 2.09, 95% CI 1.25–3.51) were positively associated with polypharmacy, whereas good self-rated health (OR 0.32, 95% CI 0.16–0.65) was negatively associated with polypharmacy. In conclusion, urban residence is independently associated with polypharmacy in Chinese elders regardless of chronic health conditions and socioeconomic status. [ABSTRACT FROM AUTHOR]

Objectives Little is known about the relationship between dynapenic obesity and physical function in older Asian populations. This study aimed to examine the relationship of dynapenic obesity and lower extremity function in Chinese elderly adults. Methods Data were from a cross-sectional study (n = 616). Based on the World Health Organization Asian Criteria of Obesity and handgrip strength tertiles, 4 independent groups were classified as follows: nondynapenia/nonobesity, dynapenia-alone, obesity-alone, and dynapenic obesity. Lower extremity function was evaluated with a 20-meter gait speed test, balance test, and self-reported mobility disability. Results Compared with the dynapenic obesity group, the adjusted odds ratios (ORs) and 95% confidential intervals (CIs) for slow gait speed in men were 0.55 (0.27–0.86) in the nondynapenia/nonobesity group, 0.78 (0.31–0.96) in the dynapenia-alone group, and 0.86 (0.16–0.95) in the obesity-alone group. The corresponding ORs (95% CIs) in women were 0.46 (0.27–0.71), 0.80 (0.17–0.93), and 0.73 (0.15–0.91), respectively. Compared with the dynapenic obesity group, the adjusted ORs (95% CIs) for mobility disability in men were 0.41 (0.26–0.62) in the nondynapenia/nonobesity group, 0.61 (0.16–0.85) in the dynapenia-alone group, and 0.72 (0.28–0.88) in the obesity-alone group. The corresponding ORs (95% CIs) in women were 0.37 (0.17–0.81), 0.51 (0.27–0.96), and 0.53 (0.26–0.83), respectively. No significant difference was observed among the 4 groups with respect to the balance test score in both sexes ( P < .01). Conclusions Dynapenic obesity was associated with a greater risk of slow gait speed and mobility disability compared with dynapenia-alone or obesity-alone. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Metabolic syndrome (MetS), which includes obesity, hypertension, dyslipidemia, and insulin resistance, has been shown to predispose people to cognitive impairment and dementia. In this study, we aimed to examine the relationship between MetS and cognitive impairment among the oldest-old people using a cohort of Chinese individuals aged 90 to 108 years. Methods: The Project of Longevity and Aging in Dujiangyan is a population-based study of 870 people aged 90 years and older. Cognitive function was evaluated using Mini-Mental State Examination, and venous blood samples were collected after an overnight fast to measure the biochemistry indicators. Results: Among the 767 participants for this analysis, the mean age was 93.6 ± 3.3 years (range 90–108 years), 516 (67.3%) were women, and 53 were centenarians. The mean Mini-Mental State Examination score was 15.0 ± 5.9. The total prevalence rate of MetS was 9.3%. After adjusting for age, sex, educational levels, smoking, drinking, and exercise, MetS was associated with a lower odds ratio (OR) of having cognitive impairment (OR = 0.443, 95% CI, 0.255–0.769) among the total population. Among men, a high triglyceride level was also associated with a lower OR of having cognitive impairment (OR = 0.434, 95% CI, 0.191–0.989). Conclusion: MetS may be associated with better cognitive function among the oldest old. Among male nonagenarians and centenarians, high triglyceride level and systolic blood pressure, which are parts of MetS, are also associated with better cognitive function. [Copyright &y& Elsevier]

Objectives To compare the prevalence of sarcopenia in urban and rural Chinese elderly adults and to identify the risk factors related to sarcopenia. Design A cross-sectional study. Setting Urban and rural communities in western China. Participants A total of 887 community-dwelling elderly adults aged 60 years or older. Measurement Sarcopenia was defined according to the recommended algorithm of the Asian Working Group for Sarcopenia (AWGS). Cognitive function, depression, and nutrition status were assessed using the Chinese version of the Mini-Mental Status Examination (MMSE), the Chinese version of the 30-item Geriatric Depression Scale (GDS-30), and the revised Mini Nutritional Assessment short-form (MNA-SF), respectively. Results A total of 612 individuals aged 70.6 ± 6.7 years (range, 60–91 years) were included in this study. The prevalence of sarcopenia in the study population was 9.8% (women, 12.0%; men, 6.7%; P = .031). The prevalence of sarcopenia was 13.1% in rural elders and 7.0% in urban elders ( P = .012). Age (odds ratio [OR] 1.22; 95% confidence interval [CI] 1.15–1.29), women (OR 1.71; 95% CI 1.20–5.65), malnutrition or at risk for malnutrition (OR 3.53; 95% CI 1.68–7.41), rural residence (OR 2.15; 95% CI 1.33–4.51), and the number of medications (OR 1.23; 95% CI 1.06–1.44) were independently associated with sarcopenia. Conclusions Rural elders are more vulnerable to sarcopenia than urban elders in a sample of western China's elderly population. More attention should focus on rural populations in future sarcopenia studies. [ABSTRACT FROM AUTHOR]

Objectives Frailty involves complex mechanisms of cumulative decline in several physiological systems and is associated with adverse events that are determined by genetic and environmental factors. It has been reported that angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphisms are associated with human performance. However, the relationships between ACE polymorphisms and frailty are poorly understood. Therefore, we used a Chinese community-dwelling cohort to examine these relationships. Design and setting This study is a part of the Comprehensive Geriatric Assessment and Health Care Service Study, which is a cross-sectional study being conducted in Southwest China. Participants and measurements The participants were grouped into frail, pre-frail, and robust groups according to the revised Fried frailty criteria. Frailty scores were obtained based on the number of frailty items present and used to evaluate the levels of frailty. ACE I/D polymorphisms were detected by polymerase chain reaction using specific primer. Results After the exclusion of participants with missing data, we included 604 community-dwelling Han people (57.9% women, mean age = 70.6 ± 6.8 years). The frequencies of the I/I, I/D, and D/D genotypes were 45.0%, 45.0%, and 10.0%, respectively. The I/D + D/D genotype (D carriers) exhibited higher frailty scores than did the homozygous I/I group (t = −2.07, P = .039). A greater proportion of the D carriers were classified as frail compared with the homozygous I/I group, but this difference was not statistically significant (15.1% vs 9.9%; χ 2 = −4.57, P = .102). The I/I genotype was associated with a lower frailty score and was significantly associated with reduced risk of prevalent frailty compared with the D-carrying genotypes (adjusted odds ratio 0.689, 95% confidence interval 0.493–0.965; P = .030). Conclusions The I/I ACE genotype is associated with a lower risk of frailty and a lower frailty level relative to the D-carrying genotypes among older Han people. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Whether the combination of obesity and low muscle strength (dynapenic-obesity) would cause greater impairment of the activities of daily living (ADL)/instrumental activities of daily living (IADL) than obesity alone and low muscle strength alone (dynapenia) remains unclear. The aim of this study was to reveal the possible independent and additive effects of dynapenia and obesity on ADL/IADL disability in an older Chinese population. Methods: A cross-sectional study, including 616 community-dwelling older adults, was conducted in China from 2010 to 2012. Based on the World Health Organization Asian Criteria of Obesity and handgrip strength tertiles, 4 independent groups were identified as follows: nondynapenia/nonobesity, dynapenia alone, obesity alone, and dynapenic-obesity. The Katz Index of Independence in ADL was used to assess ADL disability, whereas 6 IADL items of the Older Americans Resources and Services (OARS) multidimensional functional assessment questionnaire were used to assess IADL disability. Results: The prevalence of ADL and IADL disability was 21.1% and 28.9% in the dynapenic-obesity group, 15.5% and 22.6% in the dynapenia alone group, 13.1% and 19.6% in the obesity alone group, and 11.9% and 12.9% in the nondynapenia/nonobesity group, respectively. After adjusting for the covariates, in comparison with the dynapenic-obesity group, the adjusted odds ratios (95% confidence interval) for ADL disability were 0.36 (0.13–0.73) in the nondynapenia/nonobesity group, 0.51 (0.20–0.78) in the dynapenia-alone group, and 0.40 (0.11–0.61) in the obesity-alone group. The corresponding data for IADL disability were 0.55 (0.20–0.93), 0.82 (0.39–0.98), and 0.61 (0.30–0.91), respectively. Conclusion: Dynapenia, obesity, and dynapenic-obesity were associated with an increased risk of ADL/IADL disability. Dynapenic-obesity was associated with a greater risk of ADL/IADL disability in comparison with dynapenia or obesity alone. [Copyright &y& Elsevier]