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The rapid evolution of warfare in the modern multi-domain battlespace necessitates a corresponding transformation in military training and education. The 21st-century battlefield is increasingly complex, with technology and the operational environment changing at an unprecedented pace across all domains—land, air, sea, cyber, and space—while major opponents of Western alliances continue to strengthen and coordinate their economic and military power to challenge the international order. The ongoing Russian war in Ukraine starkly illustrates the dynamic challenges of the modern battlespace and underscores the need for military instruction systems that are both resilient and adaptable. This article explores the “train while we fight” concept as a paradigm for addressing the challenges and opportunities in military education and training, emphasizing that learning must be continuous, adaptive, and integrated into operational activities. We analyze the growing role of Advanced Distributed Learning in education and training, highlight the need for multinational cooperation to build and sustain training resilience, and examine innovative instructional approaches inspired by fields such as lean manufacturing, mass customization, personalized learning, and on-demand content production. [ABSTRACT FROM AUTHOR]

Aim: This study explored the impact of different care modes on the outcome of hospitalized patients with acute ischaemic stroke (AIS) during hospitalization and 3 months after discharge. Methods: This was a prospective cohort study comparing the outcomes at hospitalization, at discharge, and at 3 months post discharge among AIS patients with different caregiving arrangements from 9, December 2022 to 20, August 2023. The general information questionnaire, Modified Barthel Index, Shortened General Comfort Questionnaire, Perceived Social Support scale, Herth Hope Index, modified Rankin scale and EQ‐5D‐5L were utilized for the investigation. Results: The psychological evaluation scores during hospitalization, including comfort, perceived social support, and hope, did not significantly differ between the two groups of AIS patients (p >.05). Moreover, there were no significant impacts observed in terms of length of stay (LOS) at the hospital or hospitalization expense (p >.05). The proportion of patients with intact functionality was greater in the family caregiver group 3 months after discharge (16.5%). However, when stratified based on prognosis, the difference in outcomes between the two groups of patients did not reach statistical significance (p >.05). The analysis of ADL, quality of life and stroke recurrence in 276 surviving ischaemic stroke patients 3 months post discharge indicated no differences between the two groups across all three aspects (p >.05). Conclusion: Older and divorced or widowed AIS patients tend to prefer professional caregivers. The psychological state during hospitalization, length of hospital stay and hospitalization expenses are not influenced by the caregiving model. Three months post discharge, a greater proportion of patients in the family caregiving group had intact mRS functionality, but this choice did not impact patient prognosis, stroke recurrence, quality of life or independence in ADL. [ABSTRACT FROM AUTHOR]

The nutritional value of green forage is a result of various pratotechnical practices, including fertilisation and harvest timing. Additionally, individual plant species present in natural grasslands may respond differently to those practices. The study aimed to investigate the effect of fertilisation type (farm yard manure (FYM) and NPK fertilisation) and the timing of the first regrowth harvest of meadow sward (ten harvest dates) on the lignin and structural carbohydrates of three dicotyledonous meadow plants: Taraxacum officinale F.H. Wigg., Achillea millefolium L. and Lotus corniculatus L. Plant material was harvested from 28 Apr until 26 Jun at 7-day intervals and analysed for cellulose (CL), hemicellulose (HCL), and acid detergent lignin (ADL). The levels of neutral detergent fibre (NDF), acid detergent fibre (ADF), and ADL were measured using near-infrared spectroscopy (NIRS) with a NIRFlex N-500 device. Cellulose was calculated as the difference between ADF and ADL, while HCL was calculated by subtracting ADF from NDF. T. officinale had the lowest HCL (average 65.5 g∙kg−1 DM) and ADL content (47.1 g∙kg−1 DM) while A. millefolium had the highest CL content (266.5 g∙kg−1 DM) and ADL (52.3 g∙kg−1 DM). In contrast, L. corniculatus accumulated the highest HCL (104.5 g∙kg−1 DM) and the lowest CL content (246.1 g∙kg−1 DM). An increase in all studied parameters content was observed with later harvest dates. On average, plants fertilised with FYM contained lower amounts of structural carbohydrates and ADL compared to those fertilised with NPK.

Aim: Our study aims to assess the effectiveness of horticultural therapy in improving outcomes in older patients with dementia. Design: A systematic review and meta‐analysis. Methods: The included studies comprised randomised controlled trials (RCTs) that aimed to assess the effectiveness of horticultural therapy on cognitive function in older patients with dementia. The study design and data extraction were independently conducted by two investigators, who also evaluated the risk of bias using RoB 2.0. The meta‐analysis was carried out using Stata 15.1 software. Data Sources: On November 2023, we searched relevant English and Chinese publications in PubMed, Web of Science, Cochrane Library, Embase, CNKI and Wanfang databases. Results: The meta‐analysis included a total of 9 RCTs, involving 655 older patients diagnosed with dementia. The findings from these studies demonstrated that horticultural therapy had a significant positive impact on various aspects of the patients' well‐being when compared to conventional care. Specifically, it was found to improve cognitive function scores, alleviate symptoms of depression, enhance daily activities and enhance overall quality of life. When conducting a subgroup analysis, it was observed that horticultural therapy had a statistically significant effect on cognitive function in older patients with dementia when the intervention frequency was at least two times per week. Furthermore, interventions with a duration of less than 6 months were found to be more effective than those lasting 6 months or longer. Additionally, outdoor horticultural therapy was found to be superior to indoor interventions. Moreover, structured interventions were observed to yield better outcomes compared to non‐structured interventions. Conclusion: More high‐quality studies are needed to further corroborate these findings due to the low quality of the included studies. Horticultural therapy has been found to have a significantly positive impact on the cognitive function, depression status, ADL, and quality of life of older patients with dementia. Implications for the Profession and/or Patient Care: We provide references for non‐pharmacologic treatment of older patients with dementia. What Problem Did the Study Address?: This study aimed to measure the efficacy of horticultural therapy in older patients with dementia across four dimensions: cognitive function, depression levels, daily living activities and overall quality of life. What Were the Main Findings?: In older patients with dementia, horticultural therapy has been proven to have a significant positive impact on cognitive function, depressive status, activities of daily living and quality of life. Where and on Whom Will the Research Have an Impact?: This study will inform non‐pharmacological interventions for older patients with dementia worldwide. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Background: In Denmark, stroke represents a leading disability cause. While people with difficulties in performing activities of daily living (ADL) due to poststroke cognitive impairments are often referred to occupational therapy, limited knowledge is available on the nature of these services. Aim/Objective: To explore how Danish occupational therapists describe their practice when addressing decreased ADL ability in people with poststroke cognitive impairments in hospital and municipality settings. Material and Methods: National, cross-sectorial, web-based public survey. Results: 244 occupational therapists accessed the survey; 172 were included in the analysis. Most respondents could indicate the theory guiding their reasoning; half used standardised assessments. Regarding intervention, restorative and acquisitional models were preferred; specific strategies were identified. Intensity: 30-45 min 3-4 times/week in hospitals; 30-60 min 1-2 times/week in municipalities. Conclusions: Therapists report to be guided by theory in their reasoning. Standardised assessments are used to a higher extend than previously reported. Still, the results invite critical reflections on correct use of assessment instruments, content and intensity of interventions, and how therapists keep themselves updated. Significance: The results document the need for practice improvements and may inform the definition of standard care in future trials. [ABSTRACT FROM AUTHOR]

Key Summary Points: Aim: To elucidate the relationship between dysphagia and ADL in older adults. Finding: Swallowing disorder in older adults was associated with a lower ability to perform ADL, and there was a negative association between the prevalence of dysphagia and ADLs in older adults. Message: The capacity to perform ADL is significantly associated with dysphagia. Purpose: Numerous epidemiological studies have suggested a possible association between dysphagia and the risk of decline in Activities of daily living (ADL) among older adults. This systematic review and meta-analysis aimed to elucidate the relationship between dysphagia and ADL in older adults. Methods: PubMed, Web of Science, Cochrane Library, Embase, Ebsco, MEDLINE, Wiley, CINAHL, and Ovid databases were comprehensively examined for relevant studies published up to October 31, 2022. Quantitative studies published in English were included to explore the relationship between dysphagia and ADL in people aged 65 years and older. The NIH Quality Assessment Tool was used to assess the study quality. R software was used to draw forest plots and I2 was employed to indicate study heterogeneity. Sensitivity analysis was performed using the one-by-one exclusion method. Publication bias was measured using funnel plots and Egger's test. Results: A total of 3,498 studies were retrieved from the database, 22 of which were eventually included in the systematic evaluation, and 14 of which were subjected to meta-analysis. Data from nine studies were categorical variables, and meta-analysis results showed that swallowing disorders in older adults were associated with a lower ability to perform ADL (OR = 3.39, 95% CI: 2.55–4.50, p < 0.001), with moderate heterogeneity (I2 = 62%, p = 0.006). Data from seven studies were continuous variables, resulting in a negative association between the prevalence of dysphagia and ADLs in older adults (SMD = −0.80, 95% CI: −1.08 to −0.51, p < 0.001), with high heterogeneity (I2 = 94%, p < 0.001). Sensitivity analysis showed robust results, funnel plots and Egger's test indicated no publication bias. Conclusion: Dysphagia is significantly associated with the capacity to perform ADL. Prevention and screening of dysphagia in older patients dependent on others for daily care are needed. Further long-term studies are needed in the future to prove causality. [ABSTRACT FROM AUTHOR]

AbstractAimMethodsResultsConclusionsTo investigate the influence of cognitive functions on the effectiveness of Lee Silverman Voice Treatment (LSVT)® BIG therapy on motor symptoms, gait speed, activities of daily living (ADLs), and quality of life (QOL) in people with Parkinson’s disease (PD).This retrospective, single-center cohort study included 20 people with PD (PwPD) with mild cognitive impairment (PD-MCI group) or without (PD-NC group) (n = 10 each).In the PD-NC group, all assessments improved significantly. Similarly, the PD-MCI group showed significant improvements in the total Movement Disorder Society‐sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III, 10-meter walking test, and total MDS-UPDRS Part II. However, the Parkinson’s Disease Questionnaire summary index showed a trend toward improvement that did not reach statistical significance.LSVT® BIG therapy may improve motor symptoms, gait speed, and ADLs in PwPD, regardless of the presence or absence of MCI. [ABSTRACT FROM AUTHOR]

• The elevated prevalence of disability among the elderly poses a multitude of challenges to their care. • Improving or maintaining ADL independence while meeting individual ADL care requirements proves to be an effective response to the challenges posed by disability. • Self-supporting care is an ideal model to maintain ADL independence for the elders with disability. To develop SSC program for promoting the independence of disabled elderly in Activities of Daily Living (ADL) care in nursing homes. This intervention aligns with the Medical Research Council (MRC) Framework for complex interventions. The following three steps were undertaken: (1) identifying the evidence base; (2) identifying/developing theory; (3) modeling processes and outcomes. We successfully developed the complex intervention program of self-supporting care (SSC). The program comprises two integral parts: (1) self-supporting care interventions (SSC-i); (2) self-supporting care implementation interventions (SSC-ii). Through adherence to the MRC framework, an evidence-based SSC program for managing ADL among disabled elderly individuals in nursing homes was developed. These findings offer a detailed specification of the SSC intervention protocol, which can serve as a valuable resource for healthcare professionals and researchers in subsequent phases, particularly in pilot testing the efficacy of the intervention and promote independence among disabled elderly individuals. [ABSTRACT FROM AUTHOR]

• This study is the first longitudinal study of the interaction among intrinsic capacity, social participation and family support on the trajectory of the daily activity ability of old people, in line with the development trend of active and healthy aging proposed by the WHO. The empirical results show that the interaction between intrinsic capacity and the environment can promote functional performance. • The latent growth curve model (LGCM) was used to examine the effect of the interaction between social support and intrinsic capacity on the ability of elderly people to perform activities of daily living. • The ADL score of the elderly participants showed a significant downward trend with time over 4 years. In the elderly population with high intrinsic capacity, the daily activity ability of individuals with low levels of social participation decreased significantly over time. In the elderly group with low intrinsic capacity, the daily activity ability of individuals with low levels of social participation and high levels of life care decreased significantly over time. • It is necessary to develop individualized interventions for older people with different characteristics. Attention should particularly be given to old people with impaired intrinsic capacity to improve their social participation, encourage them to actively participate in social activities, and call on their children to give older people more emotional comfort and material security in their lives. This can optimize older people's ability to perform daily activities and promote healthy aging. This study explored the effect of the interaction between intrinsic capacity and social support on the activities of daily living in the older adults. A total of 3,124 older adults participated in the study. Data on the assessment of intrinsic capacity as well as activities of daily living (ADL) and social support were collected. The latent growth curve model (LGCM) was used to examine the effect of the interaction between social support and intrinsic capacity on the activities of daily living in the older adults. A total of 3,730 older adults were included at baseline, and 3,124 older adults completed the 4-year follow-up. The ADL score of the older adults showed a significant downward trend with time over 4 years (β=-0.115, P<0.05). In the elderly population with high intrinsic capacity, the ADL of individuals with low levels of social participation decreased significantly over time (β=-0.114, P=0.012). In the elderly group with low intrinsic capacity, the ADL of individuals with low levels of social participation (β=-0.245, P=0.005) and high levels of life care (β=-0.167, P=0.001) decreased significantly over time. This is the first longitudinal study to explore the effects of interactions among intrinsic capacity, social participation and family support on the trajectory of ADL in the older adults from the perspective of the life course. Social participation can effectively improve functional ability of older adults with low intrinsic capacity. Life care is beneficial for maintaining the functional ability of older adults with intact intrinsic capacity, but it accelerates the deterioration of the functional ability of older adults with low intrinsic capacity. [ABSTRACT FROM AUTHOR]

Background: Neurocognitive disorders (NCDs) have a variable decline in cognitive function, while loneliness was associated with cognitive impairment and increased dementia risk. In the present study, we examined the associations of loneliness with functional and cognitive status in patients with minor (mild cognitive impairment) and major NCDs (dementia). Methods: We diagnosed mild NCD (n = 42) and major NCD (n = 164) through DSM-5 criteria on 206 participants aged > 65 years using the UCLA 3-Item Loneliness Scale (UCLA-3) to evaluate loneliness, the activities of daily living (ADL) and the instrumental activities of daily living (IADL) scales to measure functional status, and Mini-Mental State Examination (MMSE) to assess cognitive functions. Results: In a multivariate regression model, the effect of loneliness on cognitive functions was negative in major (β = −1.05, p < 0.0001) and minor NCD (β = −0.06, p < 0.01). In the fully adjusted multivariate regression model (sex–age–education–multimorbidity–depressive symptoms–antidementia drug treatment), the effect of loneliness remained negative for major NCD and became positive for minor NCD (β = 0.09, p < 0.001). The effect of loneliness on IADL (β = −0.26, p < 0.0001) and ADL (β = −0.24, p < 0.001) showed a negative effect for major NCD across the different models, while for minor NCD, the effect was positive (IADL: β = 0.26, p < 0.0001; ADL: β = 0.05, p = 0.01). Minor NCD displayed different levels of MMSE (β = 6.68, p < 0.001) but not ADL or IADL, compared to major NCD for the same levels of loneliness. MANOVA pill test suggested a statistically significant and different interactive effect of loneliness on functional and cognitive variables between minor and major NCDs. Conclusions: We confirmed the relationships between loneliness and cognitive and functional status in major NCD, observing a novel trend in minor NCD. [ABSTRACT FROM AUTHOR]

Background: Ageing is a common and permanent process, which is affected by biological, psychological, social, and environmental factors. With the surge of globalization and industrialization, there was a migration of youth to the urban areas, which led to the disintegration of age old joint family system, thereby forcing the elderly to continue to work for their daily living. The elderly person’s functional dependence is an important public health issue. Objectives: To estimate the prevalence of Functional dependence in elderly people. To identify the factors associated with functional dependence in elderly people. Methodology: A Cross sectional study included All elderly population aged 60 years and above for the duration 6 months. 300 study sample estimated and data was collected by using pre test questionnaire and activities of daily living (ADL), instrumental activities of daily living (IADL) scale was used. Statistical analysis included simple descriptive analysis and tests of significance like Chi-square test. Results: The prevalence of functional dependence for basic activities of daily living among study population was 32.7% (95% CI 27.61-37.97) and for instrumental activities of dailyliving was 39.7% (95% CI 34.3-45.3). Conclusion: Among various risk factors studies, 7 factors for functional dependence for ADL. Advanced age, female gender, chronic illness, elderly who are not living with their spouse (widow/unmarried/separated), tobacco user, smoker and current alcoholics had significant associations for ADL functional dependency. [ABSTRACT FROM AUTHOR]

Problematic use of opioids by older adults is associated with adverse effects and has become a public health crisis worldwide. Ageing-related disabilities in activities of daily living (ADL) could promote unnecessary use of opioids in this population. This study evaluates the association between ADL disability and opioid consumption in Brazilian older adults. Study design- cross-sectional secondary data analysis of the second wave of the Brazil Longitudinal Study of Ageing (ELSI-Brazil). Data from the second wave of the Brazil Longitudinal Study of Ageing (ELSI-Brazil) were used. Older adults with chronic pain were included. ADL disability was measured using the Katz Index. The primary outcome was opioid consumption for chronic pain. The primary association was explored using logistic regression models adjusting for predetermined confounders. Sensitivity analyses evaluating model performance were done by calibrating and validating the model using randomly split equal sets. In those who reported presence of chronic pain (n = 2865), the prevalence of opioid use was 29% (95% CI:23.1%–35.6%). In adjusted models, participants with moderate and severe ADL disability had 1.6 (95% CI:1.13–2.32; P = 0.009) and 3.8 (95% CI: 1.80–7.90; P < 0.001) times higher odds of opioid consumption compared to no disability, respectively. Being female, alcohol consumption, higher pain intensity, history of dementia, fractures, and presence of ≥2 comorbidities were significantly associated with increased opioid use (P < 0.05). Nearly one-third of the Brazilian elderly population experiencing chronic pain reported using opioids. The functional decline during the process of ageing appears to be a risk factor for pain intolerance and opioid use. Multidisciplinary approaches to detect early ADL disabilities and improve mobility and access to assistive technologies need to be established to prevent opioid overuse and addiction in elderly populations. [ABSTRACT FROM AUTHOR]

The purpose of the rehabilitation program is to improve motor skills, coordination, sensory system, mobilization and other existing disorders to achieve activity of daily living (ADL). For a span of five months, beginning two months ago, the patient had been incapable of independent mobilization. Throughout this duration, he was confined to a bed and wheelchair, necessitating assistance from family members for movement, who would lift or carry him as necessary. Physical therapy as part of the multidisciplinary approach can provide core stability exercises, muscular facilitation and stimulation of motion of the upper and lower extremities, balance exercises and mobility exercises, as well as strengthening exercises with PNF facilitation and active stimulation techniques and using the patient's body weight as a training burden. Bobath approach and facilitation exercise can reduce spasticity by strengthening the antagonist muscles. This case report concludes that although physiotherapy is done late with strengthening exercise and core stability strengthening techniques, prone strengthening exercise, it can improve motor skills, coordination, which in turn will increase the patient's independence in carrying out functional activities and ADLs. [ABSTRACT FROM AUTHOR]

The nutritional value of green forage is a result of various pratotechnical practices, including fertilisation and harvest timing. Additionally, individual plant species present in natural grasslands may respond differently to those practices. The study aimed to investigate the effect of fertilisation type (farm yard manure (FYM) and NPK fertilisation) and the timing of the first regrowth harvest of meadow sward (ten harvest dates) on the lignin and structural carbohydrates of three dicotyledonous meadow plants: Taraxacum officinale F.H. Wigg., Achillea millefolium L. and Lotus corniculatus L. Plant material was harvested from 28 Apr until 26 Jun at 7-day intervals and analysed for cellulose (CL), hemicellulose (HCL), and acid detergent lignin (ADL). The levels of neutral detergent fibre (NDF), acid detergent fibre (ADF), and ADL were measured using near-infrared spectroscopy (NIRS) with a NIRFlex N-500 device. Cellulose was calculated as the difference between ADF and ADL, while HCL was calculated by subtracting ADF from NDF. T. officinale had the lowest HCL (average 65.5 g·kg-1 DM) and ADL content (47.1 g·kg-1 DM) while A. millefolium had the highest CL content (266.5 g·kg-1 DM) and ADL (52.3 g·kg-1 DM). In contrast, L. corniculatus accumulated the highest HCL (104.5 g·kg-1 DM) and the lowest CL content (246.1 g·kg-1 DM). An increase in all studied parameters content was observed with later harvest dates. On average, plants fertilised with FYM contained lower amounts of structural carbohydrates and ADL compared to those fertilised with NPK. [ABSTRACT FROM AUTHOR]

Background: A 27-year-old postnatal female presented with musculoskeletal pain, but on examination was found to also have migraines, problems with memory, energy and focus, anxiety, low energy and difficulty sleeping. She reported waking up feeling stiff, sore and unrested. Intervention: The patient was placed on a twelve-week care plan during which time she was checked and adjusted twice a week and adjusted using a Torque Release Technique analysis while vertebral subluxation correction was performed utilising an Integrator Instrument Assisted, manual methods (HVLA), SOT pelvic blocking, pelvic drop table drop piece and a toggle board techniques. Outcomes: The patient reported significant improvement outcomes across all measures, especially quality and quantity of sleep, focus, anxiety, and ability to handle stress. This was concomitant with a complete resolution of migraines and neck pain, and a significant reduction in headache and other musculoskeletal pain. Conclusion: Assisting new mothers in regaining adaptability postpartum may be a significant aspect of chiropractic care. An aspect of subluxation during this time may include poor sleep quality and quantity, which may impact other areas of life, including migraine, headache, energy, focus and mental health. [ABSTRACT FROM AUTHOR]

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Background: Functional disability in older adults, defined as the inability to perform essential daily activities, is categorized into Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Understanding these limitations is key for informing health policies and services. The aim was to estimate the prevalence and identify factors associated with functional disability among the elderly in rural Goa. Methodology: A community-based cross-sectional study was conducted among the elderly residing in the field practice area of the Rural Health and Training Centre, Mandur, Goa. Data were collected from 300 elderly participants using the Katz ADL Index and Lawton Brody’s IADL Scale. Participants were selected through systematic random sampling. Results: ADL disability prevalence was 13.7%, while IADL disability was 38.7%. ADL disability was associated with sex, education, financial dependence, co-morbidities, alcoholism, and sensory impairments. IADL disability was linked to age, sex, education, financial dependence, co-morbidities and visual impairment. Conclusions: The study emphasizes the need for comprehensive geriatric assessments in rural communities, highlighting the importance of evaluating functional status at the primary healthcare level to improve elderly care policies.

Yi Fang,1 Yuqi Jiang,2 Linlin Ma,1 Huixian Chen,1 Zhi Li,1 Fen Luo,1 Wen Jiang,1 Shuya Cai,1 Qiaoqiao Guo,3 Zhiqin Yin1,4 1School of Nursing, Wenzhou Medical University, Wenzhou City, Zhejiang Province, People’s Republic of China; 2The First Hospital of Jiaxing City, Jiaxing City, Zhejiang Province, People’s Republic of China; 3College of Renji, Wenzhou Medical University, Wenzhou City, Zhejiang Province, People’s Republic of China; 4Wenzhou Health Promotion Research Center, Wenzhou City, Zhejiang Province, People’s Republic of ChinaCorrespondence: Zhiqin Yin; Qiaoqiao Guo, Email yzq@wmu.edu.cn; 1574612325@qq.comPurpose: While previous studies have extensively examined the impact of receiving positive social support during social support interactions on depressive symptoms among older adults, adverse effects experienced, such as being rejected or ignored, are often overlooked. Moreover, there has been limited discussion on the effects of giving social support to others. Thus, this study investigates the impacts of social support given by disabled older adults to others on their own depressive symptoms, as well as the mediating role of receiving social support (both positive and negative aspects) and the moderating effect of the activity of daily living (ADL).Patients and Methods: This cross-sectional, community-based study was conducted in Wenzhou and Jiaxing City, China, from September 2021 to September 2022, with a total of 255 disabled older adults meeting the inclusion and exclusion criteria. The data were collected face-to-face using a structured questionnaire. The participants were asked to complete the Barthel Index Scale, the Chinese version of the Positive and Negative Social Exchange Scale, the Giving Social Support questionnaire, and the Short Form Chinese Geriatric Depression Scale to measure disability, receiving positive and negative social support, giving social support, and depressive symptoms, respectively. Descriptive statistical analysis, correlation analysis, mediation effect tests, and moderation effect tests were used to analyse the questionnaire data.Results: The social support provided by disabled older adults to others primarily involved companionship and care. The positive aspect of social support received was largely emotional support, while the negative aspect was mainly characterised by failure to obtain help and unsympathetic behaviour. Providing social support was found to be associated with a potential beneficial effect on depressive symptoms, linked to lower severity, with this effect fully mediated by receiving social support. Specifically, receiving emotional support accounted for 56.63% of the effect size, while failure to obtain help and unsympathetic behaviour contributed 21.55%, and rejection and neglect collectively accounted for 21.83%. Additionally, the effect was partially moderated by ADL, with older adults exhibiting lower ADL scores showing a greater benefit from both giving and receiving social support compared to those with higher ADL scores.Conclusion: It is imperative to recognise and encourage disabled older adults to provide social support to others, especially emotional support, while reducing negative feedback, such as neglect and unnecessary blame. This could alleviate their depressive symptoms and promote psycho-social well-being.Keywords: disabled older adults, social support, social exchange, depressive symptoms, ADL

Abstract Objectives Frailty is a prevalent geriatric condition that significantly impacts the health of older adults. This study aimed to examine the prevalence of frailty among older Chinese adults aged ≥ 65 years and to assess its association with adverse geriatric outcomes. Method This study included 20,724 older adults aged ≥ 65 years in Jiangsu Province, China, utilizing a random, stratified, multistage cluster sampling approach. Frailty was assessed using the 5-item FRAIL scale. Geriatric outcomes, such as independence in activities of daily living (ADL), cognitive impairment, and frequent fall events (occurring four or more times in the preceding year), were evaluated. Logistic regression models were employed to evaluate the association between frailty and geriatric outcomes, with results presented as odds ratios (ORs) and 95% confidence intervals (CIs). Results The mean age of the participants was 73.4 ± 6.4 years. The standardized prevalence of prefrailty and frailty was 35.2% and 10.3%, respectively. Individuals identified as prefrail or frail tended to live in rural areas, have lower educational levels, be widowed, have lower incomes, and engage in less physical activity. Prefrailty and frailty were associated with an increased risk of limitations in BADL (OR: 9.62, 95% CI: 7.43–12.46; and OR: 29.25, 95% CI: 22.42–38.17, respectively) and IADL (OR: 2.54, 95% CI 2.35–2.74; and OR: 5.19, 95% CI 4.66–5.78, respectively), positive cognitive impairment screening (OR: 1.23, 95% CI: 1.16–1.31; and OR: 1.72, 95% CI: 1.56–1.91, respectively), and frequent falls (occurring four or more times in the preceding year) (OR: 3.38, 95% CI: 2.50–4.56; and OR: 8.37, 95% CI: 6.01–11.65). The association between frailty and both limitations in BADL and falls was notably more pronounced among the younger age groups (p for interaction

Abstract Background The fact that most older people do not live long means that they do not have more time to pursue self-actualization and contribute value to society. Although there are many studies on the longevity of the elderly, the limitations of traditional statistics lack the good ability to study together the important influencing factors and build a simple and effective prediction model. Methods Based on the the data of Chinese Longitudinal Healthy Longevity Survey (CLHLS), 2008–2018 cohort and 2014–2018 cohort were selected and 16 features were filtered and integrated. Five machine learning algorithms, Elastic-Net Regression (ENR), Decision Tree (DT), Random Forest (RF), K-Nearest Neighbor (KNN), and eXtreme Gradient Boosting (XGBoost), were used to develop models and assessed by internal validation with CLHLS 2008–2018 cohort and temporal validation with CLHLS 2014–2018 cohort. Besides, the best performing model was explained and according to the variable importance results, simpler models would be developed. Results The results showed that the model developed by XGBoost algorithm had the best performance with AUC of 0.788 in internal validation and 0.806 in temporal validation. Instrumental activity of daily living (IADL), leisure activity, marital status, sex, activity of daily living (ADL), cognitive function, overall plant-based diet index (PDI) and psychological resilience, 8 features were more important in the model. Finally, with these 8 features simpler models were developed, it was found that the model performance did not decrease in both internal and temporal validation. Conclusions The study indicated that the importance of these 8 factors for predicting the death of elderly people in China and built a simple machine learning model with good predictive performance. It can inspire future key research directions to promote longevity of the elderly, as well as in practical life to make the elderly healthy longevity, or timely end-of-life care for the elderly, and can use predictive model to aid decision-making.

ObjectivesMethodsResultsConclusionsClinical ImplicationsThis study was conducted to determine the relationships between activities of daily living (ADL), depression, and quality of life. Specifically, the study aimed to evaluate the potential mediating role of depression in the relationship between activities of daily living and quality of life in a sample of Iranian older adults.This cross-sectional study recruited 118 older adult adults with multiple chronic conditions in Iran from December 2022 to September 2023. Data were collected using a demographic and health information questionnaire, the Katz Index, the Lawton scale, Old-World Health Organization Quality of Life, and the Geriatric Depression Scale. Path analysis was used to test the hypothesis.Participants’ average age was 70.15 ± 6.91 years. BADL (B = 0.2, p = .02), and depression (B = −0.25, p = .004) were significantly related to the quality of life. The standardized indirect effect of BADL on quality of life was 0.08 (p = .006).According to the results of this study, functional status can directly and also, indirectly affect the quality of life of older adults with multiple chronic conditions through depression.Health care providers are advised to carefully assess older adults’ mental health and functional status and consider their relationships to quality of life. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite the explosive increase in interest regarding Robot-Assisted Walking Training (RAWT) for stroke patients, very few studies have divided groups according to the severity levels of patients and conducted studies on the effects of RAWT. OBJECTIVE: The purpose of this study was to present a definite basis for physical therapy using the robot-assisted walking device through a more detailed comparison and analysis and to select the optimal target of RAWT. METHODS: This study was designed as a prospective and randomized controlled trial to investigate the effect of RAWT on balance, motor function, and Activities of Daily Living (ADL) depending on severity levels in stroke patients. 100 participants were randomly divided into study and control groups in equal numbers. The study group was 49 and the control group was 47. One from the study group and three from the control group were eliminated. The study period is four weeks in total, and RAWT is performed five times a week for 40 minutes only for study group. During the same period, all group members had 30 minutes of Conventional Physiotherapy (CP) five times a week. RESULTS: The results of this study clearly confirmed that RAWT combined with CP produces more significant improvement in patients with stroke than the CP alone. And they indicated that RAWT had a more considerable effect in the poor or fair trunk control group for trunk balance and in the high fall risk group for balance. In motor function, RAWT showed its value in the severe and marked motor impairment group. The total or severe dependence group in ADL experienced more improvements for RAWT. CONCLUSION: This study can be concluded that the lower the level of physical functions, the more effective it responds to RAWT. As demonstrated in the results of this study, the potential of current robotic technology appears to be greatest at very low functional levels of stroke patients. Patients with low functional levels among stroke patients may benefit from robot rehabilitation. [ABSTRACT FROM AUTHOR]

This study aims to investigate what causes persons with self-reported visual impairment in Thailand to have different levels of functional disability. The study sample included 6327 older persons aged 60 and above, extracted from the '2021 Survey of Older Persons in Thailand' project. A multinomial logistic model was employed to investigate the relationship between demographic characteristics, living arrangements, and household conditions with the level of functional disability. The study found that gender had only a mild effect on functional disability level, while age had a high influence on every functional disability category. Interestingly, older persons living with their children were more likely to lose their functional ability than those living with other family members. This pattern indicates the dependency of older persons with visual impairment in Thailand on their children. In addition, older persons with self-reported visual impairment with a bedroom on the upper floor and those who had no rails in the house to support their movement were less likely to have a high level of functional disability than other groups of older persons. This may be a strategy for a family to help older persons with visual impairment to be able to perform activities of daily living (ADL) by arranging for them to live in a location in the house that is easy for them to be mobile and perform ADL as recommended in the social model of disability. [ABSTRACT FROM AUTHOR]

Background: Falls in older adults significantly impact overall health and healthcare costs. Intrinsic capacity (IC) reflects functional reserve and is an indicator of healthy aging. Aims: To explore the association between IC and recent falls (≤ 90 days) in community-dwelling octogenarians from the Aging and Longevity in the Sirente geographic area (IlSIRENTE) study. Methods: The Minimum Data Set for Home Care (MDS−HC) and supplementary questionnaires and tests were used to assess the five IC domains: locomotion, cognition, vitality, psychology, and sensory. Scores in each domain were rescaled using the percent of maximum possible score method and averaged to obtain an overall IC score (range 0−100). Results: The study included 319 participants (mean age 85.5 ± 4.8 years, 67.1% women). Mean IC score was 80.5 ± 14.2. The optimal IC score cut-off for predicting the two-year risk of incident loss of at least one activity of daily living (ADL) was determined and validated in a subset of 240 individuals without ADL disability at baseline (mean age 84.7 ± 4.4 years, 67.1% women). Participants were then stratified into low (< 77.6) and high (≥ 77.6) IC categories. Those with high IC (63.9%) were younger, more often males, and had lower prevalence of recent falls, disability, multimorbidity, and polypharmacy. Logistic regression models including IC as a continuous variable revealed a significant association between higher IC and lower odds of falls. This association was significant in the unadjusted (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94–0.98, p < 0.001), age- and sex-adjusted (OR 0.96, 95% CI 0.94–0.98, p < 0.001), and fully adjusted models (OR 0.96, 95% CI 0.93–0.99, p = 0.003). When considering IC as a categorical variable, unadjusted logistic regression showed a strong association between high IC and lower odds of falls (OR 0.31, 95% CI 0.16–0.60, p < 0.001). This association remained significant in both the age- and sex-adjusted (OR 0.30, 95% CI 0.15–0.59, p < 0.001) and fully adjusted models (OR 0.33, 95% CI 0.16–0.82, p = 0.007). The locomotion domain was independently associated with falls in the unadjusted (OR 0.98, 95% CI 0.97–0.99, p < 0.001), age- and sex-adjusted (OR 0.97, 95% CI 0.96–0.99, p < 0.001), and fully adjusted model (OR 0.98, 95% CI 0.96–0.99, p < 0.001). Discussion: This is the first study using an MDS−HC-derived instrument to assess IC. Individuals with higher IC were less likely to report recent falls, with locomotion being an independently associated domain. Conclusions: Lower IC is linked to increased odds of falls. Interventions to maintain and improve IC, especially the locomotion domain, may reduce fall risk in community-dwelling octogenarians. [ABSTRACT FROM AUTHOR]

This paper aims to map the daily functional characteristics of people diagnosed with essential tremor (ET) based on their subjective self-reports. In addition, we provide objective measurements of a cup-drinking task. This study involved 20 participants diagnosed with ET who completed the Columbia University Assessment of Disability in Essential Tremor (CADET) questionnaire that included five additional tasks related to digital equipment operation we wrote. Participants also described task-performance modifications they implemented. To create objective personal performance profiles, they performed a cup-drinking task while being monitored using a sensor measurement system. The CADET's subjective self-report results indicate that the most prevalent tasks participants reported as having difficulty with or requiring modifications were writing, threading a needle, carrying a cup, using a spoon, pouring, and taking a photo or video on a mobile phone. Analysis of participants' modifications revealed that holding the object with two hands or with one hand supporting the other were the most prevalent types. No significant correlation was found between the CADET total scores and the cup drinking objective measures. Capturing patients' perspectives on their functional disability, alongside objective performance measures, is envisioned to contribute to the development of custom-tailored interventions aligned with individual profiles, i.e., patient-based/smart healthcare. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the impact of depression, fear of falling, and activities of daily living (ADL) on the quality of life (QoL) among patients with spinal cord injuries (SCIs) in South Korea. Methods: This study adopted a prospective cross-sectional design. Data were collected using self-reported questionnaires from 70 SCI patients who visited the outpatient department of rehabilitation medicine. The data collection period was from October 16, 2017 to February 2, 2018. Participants' American Spinal Injury Association Impairment Scale classifications were C and D. Results: The study found that QoL correlated with self-rated health (Spearman rho=.41, p<.001), SCI duration (Spearman rho=-.26, p=.030), depressive symptoms (Spearman rho=-.43, p<001), and fear of falling (Spearman rho=-.75, p<.001). Additionally, QoL was associated with fear of falling (β=-.68, p<.001) and SCI duration (β=-.18, p=.025) in the regression analyses. These results were significant and accounted for 59.5% of the variance in QoL. Conclusion: Interventions targeting the QoL of patients with SCI can help reduce the fear of falling. [ABSTRACT FROM AUTHOR]

Background: The fact that most older people do not live long means that they do not have more time to pursue self-actualization and contribute value to society. Although there are many studies on the longevity of the elderly, the limitations of traditional statistics lack the good ability to study together the important influencing factors and build a simple and effective prediction model. Methods: Based on the the data of Chinese Longitudinal Healthy Longevity Survey (CLHLS), 2008–2018 cohort and 2014–2018 cohort were selected and 16 features were filtered and integrated. Five machine learning algorithms, Elastic-Net Regression (ENR), Decision Tree (DT), Random Forest (RF), K-Nearest Neighbor (KNN), and eXtreme Gradient Boosting (XGBoost), were used to develop models and assessed by internal validation with CLHLS 2008–2018 cohort and temporal validation with CLHLS 2014–2018 cohort. Besides, the best performing model was explained and according to the variable importance results, simpler models would be developed. Results: The results showed that the model developed by XGBoost algorithm had the best performance with AUC of 0.788 in internal validation and 0.806 in temporal validation. Instrumental activity of daily living (IADL), leisure activity, marital status, sex, activity of daily living (ADL), cognitive function, overall plant-based diet index (PDI) and psychological resilience, 8 features were more important in the model. Finally, with these 8 features simpler models were developed, it was found that the model performance did not decrease in both internal and temporal validation. Conclusions: The study indicated that the importance of these 8 factors for predicting the death of elderly people in China and built a simple machine learning model with good predictive performance. It can inspire future key research directions to promote longevity of the elderly, as well as in practical life to make the elderly healthy longevity, or timely end-of-life care for the elderly, and can use predictive model to aid decision-making. [ABSTRACT FROM AUTHOR]

Background: Regular and consistent disease assessment could provide a clearer picture of burden in generalised myasthenia gravis (gMG) and improve patient care; however, the use of assessment tools in practice lacks standardisation. This modified Delphi approach was taken to review current evidence on assessment tool use in gMG and develop expert‐derived consensus recommendations for good practice. Methods: A European expert panel of 15 experienced gMG neurologists contributed to development of this consensus, four of whom formed a lead Sub‐committee. The PICO (Population, Intervention, Control, Outcomes) framework was used to define six clinical questions on gMG assessment tools, a systematic literature review was conducted, and evidence‐based statements were developed. According to a modified Delphi voting process, consensus was reached when ≥70% of the experts rated agreement with a statement as ≥8 on a scale of 1–10. Results: Eighteen expert‐ and evidence‐based consensus statements based on six themes were developed. Key recommendations include: consistent use of the Myasthenia Gravis Activities of Daily Living score (MG‐ADL) across clinical settings, followed by a simple question (e.g., Patient Acceptable Symptom State [PASS]) or scale to determine patient satisfaction in clinical practice; use of a Quantitative Myasthenia Gravis [QMG] or quality of life [QoL] assessment when the MG‐ADL indicates disease worsening; and consideration of symptom state to determine the timing and frequency of recommended assessments. Expert panel consensus was reached on all 18 statements after two voting rounds. Conclusions: This process provided evidence‐ and expert consensus‐based recommendations for the use of objective and subjective assessment tools across gMG research and care to improve management and outcomes for patients. [ABSTRACT FROM AUTHOR]

Background and Objective: Osteoarthritis is a degenerative joint disease that leads to biomechanical and morphological alterations in the joint. There are various physiotherapeutic interventions available for treating osteoarthritis but there is lack of literature regarding comparison of effectiveness of Forward walking and Retro walking in subjects with Osteoarthritis of knee, hence the need of the study arises. The purpose of this study was to determine the effectiveness between the Forward Walking and Retro-Walking in improving Strength and Function in subjects with Osteoarthritis of Knee. Methods: Prospective Cohort study design. 150 subjects who were clinically diagnosed of Osteoarthritis of Knee were assessed and only 66 were recruited who are willing to be in the study and they were randomly allocated into two Groups. In Group I (n = 33) subjects were treated with Conventional Physiotherapy and Forward Walking for 8 weeks, whereas in Group II (n = 33) subjects were treated with Conventional Physiotherapy and Retro Walking for 8 weeks. The outcome of this intervention Function (KOOS) and lower limb strength (knee flexion and extension). Results: Statistical analysis of this study data revealed that in between-group comparison showed there is a STATISTICAL significant difference in KOOS and knee flexors and extensors strength. Conclusion: This study concluded that Retro Walking is a suitable adjunct to Conventional Physiotherapy in Subject with knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Objectives: Frailty is a prevalent geriatric condition that significantly impacts the health of older adults. This study aimed to examine the prevalence of frailty among older Chinese adults aged ≥ 65 years and to assess its association with adverse geriatric outcomes. Method: This study included 20,724 older adults aged ≥ 65 years in Jiangsu Province, China, utilizing a random, stratified, multistage cluster sampling approach. Frailty was assessed using the 5-item FRAIL scale. Geriatric outcomes, such as independence in activities of daily living (ADL), cognitive impairment, and frequent fall events (occurring four or more times in the preceding year), were evaluated. Logistic regression models were employed to evaluate the association between frailty and geriatric outcomes, with results presented as odds ratios (ORs) and 95% confidence intervals (CIs). Results: The mean age of the participants was 73.4 ± 6.4 years. The standardized prevalence of prefrailty and frailty was 35.2% and 10.3%, respectively. Individuals identified as prefrail or frail tended to live in rural areas, have lower educational levels, be widowed, have lower incomes, and engage in less physical activity. Prefrailty and frailty were associated with an increased risk of limitations in BADL (OR: 9.62, 95% CI: 7.43–12.46; and OR: 29.25, 95% CI: 22.42–38.17, respectively) and IADL (OR: 2.54, 95% CI 2.35–2.74; and OR: 5.19, 95% CI 4.66–5.78, respectively), positive cognitive impairment screening (OR: 1.23, 95% CI: 1.16–1.31; and OR: 1.72, 95% CI: 1.56–1.91, respectively), and frequent falls (occurring four or more times in the preceding year) (OR: 3.38, 95% CI: 2.50–4.56; and OR: 8.37, 95% CI: 6.01–11.65). The association between frailty and both limitations in BADL and falls was notably more pronounced among the younger age groups (p for interaction < 0.001). Conclusions: According to the 5-item FRAIL scale, frailty was associated with limitations in BADLs and IADLs, positive cognitive impairment screening, and recent falls among older adults living in the community. Screening for frailty in younger age groups has the potential to prevent declines in physical function and falls. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the determinants of decline in activities of daily living (ADL) among people with dementia following the onset of the coronavirus disease of 2019 (COVID-19). Methods: A retrospective analysis was performed, including 37 individuals with dementia residing in group and nursing homes. The study cohort experienced a resurgence in facility admissions following COVID-19 outbreak, spanning from September to December 2022. Multivariate generalized linear mixed-effects models were employed to assess the Barthel Index at the time of readmission, which served as the dependent variable. Demographic variables before contracting COVID-19 were considered independent predictors if they were significantly associated with the Barthel Index at the time of readmission. Random intercepts were applied to account for variations among facilities in which individuals resided before contracting COVID-19. Results: Care level, degree of independent living for disabled older adults, and the ability to perform daily ambulatory movements were significantly associated with the Barthel Index at the time of readmission. When used as independent variables, both daily ambulatory movement (beta = 0.350) and care level (beta = -0.347) showed significant associations with the Barthel Index at the time of readmission. Whereas using daily ambulatory movements and the degree of independent living for disabled older adults as independent variables, only the degree of independent living for disabled older adults (beta = -0.757) was significantly associated with the Barthel Index at the time of readmission. Conclusion: The ability to engage in daily ambulatory movement affects the decline in ADLs due to COVID-19.

Abstract This study aimed to explore the mediating effects of ADL and depression on the relationship between sleep quality and HRQOL among older people in rural China, while also exploring the moderating impact of loneliness. The study gathered data from a household survey conducted among 1587 Chinese rural older adults (mean age = 73.63 years). The collected data was analyzed using SPSS version 23.0 software (IBM, New York, USA) and the PROCESS macro version 4.0 program. The findings indicated a significant correlation between sleep quality, ADL, depression, loneliness and HRQOL. ADL and depression exhibited a chain mediation effect on the relationship between sleep quality and HRQOL. Notably, the association between sleep quality and HRQOL was entirely mediated by ADL and depression. Additionally, loneliness acted as a moderator in the relationship between ADL and HRQOL. The findings of this study suggest that interventions focusing on sleep quality should prioritize strategies for enhancing older adults’ ADL and depression as integral components of promoting older adults’ HRQOL.

Lana Alhalaseh,1,&ast; Hala Makahleh,1,&ast; Bashayer Al-Saleem,1,&ast; Farah Al-Omran,1,&ast; Birgitte Schoenmakers2,&ast; 1Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan; 2Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium&ast;These authors contributed equally to this workCorrespondence: Lana Alhalaseh, P O Box 851182 Sweifieh, Amman, 11185, Jordan, Tel +962-798506513, Fax +962-6-5355 522, Email l.halaseh@ju.edu.joPurpose: Geriatric syndromes (GS) are prevalent in the older population, with an impact on morbidity and disability. This study aimed to investigate the prevalence of functional dependence and ten GS in community older adults and to examine the different associations between these syndromes and sociodemographic variables and their impact on functional dependence.Patients and Methods: A cross-sectional study of 342 outpatients seen at the geriatric clinic in the period 2015– 2023.Results: The mean age was 75± 7.4. One-third had functional dependence and 96.2% had at least one GS. The mean number of GS was 3.11± 1.74, ranging from 2.56± 1.67 in the 60s to 3.55± 1.70 in octogenarians. The most common GS found were polypharmacy (79.5%), musculoskeletal pain (49.7%), and Major Neurocognitive Disorder (MND) (32.7%). Polypharmacy was significantly associated with female sex and chronic pain, whereas sensory impairment was associated with male sex. MND, dizziness, and urinary incontinence were the only GS that significantly predicted functional dependence and were typically associated with increasing age.Conclusion: Functional dependence increases as individuals age, paralleled by increases in MND, urinary incontinence, dizziness, sensory impairment, and constipation. Notably, only MND, incontinence, depression, and dizziness were significant predictors of functional dependence. Consequently, it is imperative to screen older adults presenting with these syndromes for early signs of functional decline to optimize their function and avert subsequent dependence, morbidity, and mortality.Keywords: geriatric syndromes, functional dependence, elderly/older, ADL, Katz Index

Abstract Background During hospitalisation, older patients spend most of their time passive in bed, which increases the risk of functional decline and negative adverse outcomes. Our aim is to examine the impact of robot-assisted physical training on functional status in older geriatric patients during acute hospitalisation. Methods This is a single-centre investigator-blinded placebo-controlled randomised controlled trial including geriatric patients aged ≥ 65 years, able to ambulate before hospitalisation, and with expected length of stay ≥ 2 days. In addition to standard physiotherapy treatment, the intervention group receive active robot-assisted resistance training and the control group passive robot-assisted sham training. Exclusion criteria are as follows: ambulation without assistance at the time of inclusion, known severe dementia, delirium, patients who have received less than three training sessions at discharge, terminal illness, recent major surgery/lower extremity fracture, conditions contradicting the use of training robot, lower extremity metastases, deemed unsuitable for robot-assisted training by a healthcare professional, or weight > 165 kg. The primary outcome is functional status assessed by change in Barthel Index-100 and 30-s chair stand test between inclusion and day of discharge. Secondary outcomes include functional status at 1- and 3-month follow-up, quality of life, depression, concern about falling, falls, cognition, qualitative interviews, need of homecare, discharge destination, readmissions, healthcare costs, sarcopenia, muscle quantity (bioimpedance), and mortality. Clinical meaningful change of the Barthel Index is 5 points. A recent study in geriatric patients reported a 6.9-point change following exercise. With a significance level of 5%, 80% power, and a drop-out rate of 20%, 244 participants per group (n = 488) are needed to detect the same mean difference. With a significance level of 5%, 80% power, and a drop-out rate of 20%, 74 participants per group (n = 148) are needed to detect a minimum clinical change of 2.6 repetitions for 30-s chair stand test. Recruitment started in January 2023 and is expected to continue for 19 months including follow-up. Discussion If our study shows that in-hospital robot-assisted training prevents functional decline in older patients, this may have a major impact on the individual patient due to increased wellbeing and a higher level of independency. In addition, society will benefit due to potential decrease in the need of municipality-delivered homecare following discharge. Trial registration ClinicalTrials.gov NCT05782855. Registration date: March 24, 2023.

Background and Objectives: Changes in activities of daily living (ADL) and quality of life (QOL) of patients with bone metastasis who underwent surgical treatment through Bone Metastasis Cancer Boards (BMCBs), a recent multidisciplinary approach for managing bone metastases, have been reported; however, no reports exist on patients who undergo conservative treatment. In this study, we aimed to evaluate these patients' ADL and QOL and examine the factors influencing changes in these parameters. Materials and Methods: We retrospectively reviewed 200 patients with bone metastases who underwent conservative therapy through BMCBs between 2013 and 2021. A reassessment was conducted within 2–8 weeks after the initial assessment. Patients' background and changes in performance status (PS), Barthel Index (BI), EuroQol five-dimension (EQ-5D) scores, and Numerical Rating Scale (NRS) scores were initially assessed. Furthermore, we categorized patients into two groups based on improvements or deteriorations in ADL and QOL and performed comparative analyses. Results: Significant improvements in EQ-5D (0.57 ± 0.02 versus [vs.] 0.64 ± 0.02), NRS max (5.21 ± 0.24 vs. 3.56 ± 0.21), and NRS average (2.98 ± 0.18 vs. 1.85 ± 0.13) scores were observed between the initial assessment and reassessment (all p < 0.001). PS (1.84 ± 0.08 vs. 1.72 ± 0.08) and BI (83.15 ± 1.68 vs. 84.42 ± 1.73) also showed improvements (p = 0.06, and 0.054, respectively). In addition, spinal cord paralysis (odds ratio [OR]: 3.69, p = 0.049; OR: 8.42, p < 0.001), chemotherapy (OR: 0.43, p = 0.02; OR: 0.25, p = 0.007), and NRS average scores (OR: 0.38, p = 0.02; OR: 0.14, p < 0.001) were independent factors associated with ADL and QOL. Conclusions: Patients with bone metastases who underwent conservative treatment through BMCBs exhibited an increase in QOL without a decline in ADL. The presence of spinal cord paralysis, absence of chemotherapy, and poor pain control were associated with a higher risk of deterioration in ADL and QOL. [ABSTRACT FROM AUTHOR]

Background & objectives Frailty is a geriatric syndrome with clinical and public health implications. It represents the state of increased vulnerability. This study aimed to estimate the prevalence of frailty and pre-frailty by demographic characteristics and geographical regions in India. Furthermore, it also aimed to examine the association of this prevalence with selected health outcomes using data from the Longitudinal Ageing Study of India (LASI). Methods This is a secondary analysis of LASI wave-1 data. A total of 26,058 respondents aged ≥60 yr were included for analysis. Frailty was assessed using Fried's frailty phenotype, including slowness, shrinking, low physical activity, weakness, and low endurance. Descriptive statistics were used to study frailty distribution. The odds ratio (OR) of health events across the frailty categories was computed using ordinal logistic regression. Results The findings of this study suggest that the prevalence of frailty and pre-frailty was 29.2 and 58.8 per cent, respectively. The prevalence of frailty was higher among women (37.3%), illiterate (37%) and rural residents (31%). It ranged between 14.5 per cent in Uttarakhand and 41.3 per cent in Arunachal Pradesh. Frailty was strongly associated with depression [OR: 2.09, Confidence Interval (CI): 1.98–2.21] and activities of daily living (ADL) difficulty (OR: 1.75, CI: 1.64–1.86). Higher odds were reported for fracture (OR: 1.24, CI: 1.01–1.51) and multimorbidity (OR: 1.18, CI: 1.04–1.33) among frailty. Interpretation & conclusions The heterogeneity of frailty prevalence across States indicates the need for population-specific strategies. A sharp age-related increase in prevalence highlights the need for preventive measures. Furthermore, the high prevalence of frailty among women, illiterate and rural residents indicates the target population for receiving preventive interventions. Lastly, a heterogeneity in frailty prevalence across different States indicates the scope for region-specific programmes. [ABSTRACT FROM AUTHOR]

Background : During hospitalisation, older patients spend most of their time passive in bed, which increases the risk of functional decline and negative adverse outcomes. Our aim is to examine the impact of robot-assisted physical training on functional status in older geriatric patients during acute hospitalisation. Methods: This is a single-centre investigator-blinded placebo-controlled randomised controlled trial including geriatric patients aged ≥ 65 years, able to ambulate before hospitalisation, and with expected length of stay ≥ 2 days. In addition to standard physiotherapy treatment, the intervention group receive active robot-assisted resistance training and the control group passive robot-assisted sham training. Exclusion criteria are as follows: ambulation without assistance at the time of inclusion, known severe dementia, delirium, patients who have received less than three training sessions at discharge, terminal illness, recent major surgery/lower extremity fracture, conditions contradicting the use of training robot, lower extremity metastases, deemed unsuitable for robot-assisted training by a healthcare professional, or weight > 165 kg. The primary outcome is functional status assessed by change in Barthel Index-100 and 30-s chair stand test between inclusion and day of discharge. Secondary outcomes include functional status at 1- and 3-month follow-up, quality of life, depression, concern about falling, falls, cognition, qualitative interviews, need of homecare, discharge destination, readmissions, healthcare costs, sarcopenia, muscle quantity (bioimpedance), and mortality. Clinical meaningful change of the Barthel Index is 5 points. A recent study in geriatric patients reported a 6.9-point change following exercise. With a significance level of 5%, 80% power, and a drop-out rate of 20%, 244 participants per group (n = 488) are needed to detect the same mean difference. With a significance level of 5%, 80% power, and a drop-out rate of 20%, 74 participants per group (n = 148) are needed to detect a minimum clinical change of 2.6 repetitions for 30-s chair stand test. Recruitment started in January 2023 and is expected to continue for 19 months including follow-up. Discussion: If our study shows that in-hospital robot-assisted training prevents functional decline in older patients, this may have a major impact on the individual patient due to increased wellbeing and a higher level of independency. In addition, society will benefit due to potential decrease in the need of municipality-delivered homecare following discharge. Trial registration: ClinicalTrials.gov NCT05782855. Registration date: March 24, 2023. [ABSTRACT FROM AUTHOR]

Background: The global prevalence of mental disorders, including depression, has steadily increased. Objective: To identifying the prevalence rate of depression and the related predictors among old-age people in Iraq. Patients and Methods: A cross-sectional study was conducted from August to November 2021. A random sampling technique was employed to gather information from the old age patients during their routine visits to outpatient clinic of three public hospitals (Baquba, Ramadi, Samarra), in Iraq. Data collection involved the utilization of a semi-structured questionnaire incorporating the validated Geriatric Depression Scale (GDS-30) administered through face-to-face interviews. Descriptive, bivariate, and multivariate logistic regression analyses were employed to examine the relationships between variables in the study. SPSS version 16 was utilized for data analysis, with statistical significance set at a threshold below 0.05. Results: Data of 344 old-age respondents (range 60-81 years) with a mean age of 75.15 (± 7.52) years have undergone final analysis. More than half were males (50.6%), married (62.2%), ranked themselves as unhealthy (72.4%), physically inactive (70.6%), and financially dependent (71.8%). The overall prevalence of depression was 74.4%. Logistic regression revealed significant associations: elderly females had 3.805 times higher risk (P<0.001,95% CI: 1.999 to 5.241), unhealthy individuals had 2.379 times (P<0.001, 95% CI 1.657 to 3.415), limited activities of daily living (ADL) had 2.650 times (P =0.001, 95% CI: 1.076 to 3.902), and those lacking family support had1.799 times (P = 0.003, 95% CI: 1.040 to 3.746) than their counterparts. Conclusion: High depression rates and multiple risk factors necessitate the urgent need for health and political intervention to support patients and promote greater social participation. [ABSTRACT FROM AUTHOR]

BackgroundAnxiety and depression are serious psychological and public health issues among the older adults. Currently, there is a lack of understanding of the relationship between Body Mass Index (BMI) and anxiety or depression symptoms in the older adult population in China. Therefore, the purpose of this study is to investigate the impact of BMI on anxiety and depression through correlation analysis in different subgroups and to examine the potential chain mediating effects of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) between BMI and symptoms of anxiety and depression.MethodsFrom the CLHLS database conducted in 2017–2018, data regarding height, weight, anxiety symptoms, depression symptoms, as well as demographic, socioeconomic, behavioral, and health-related characteristics were collected. Multivariate logistic regression analysis was used to explore the impact of BMI on anxiety and depression symptoms. Finally, the SPSS macro process was utilized to test the multiple mediating effects of ADL and IADL between BMI and anxiety or depression symptoms.ResultsAfter screening, a final sample of 9,098 Chinese older adult individuals aged 65 and above was selected. Among them, 1,074 cases (11.8%) exhibited anxiety symptoms, 1,458 cases (16.0%) exhibited depressive symptoms. Compared to normal BMI, the adjusted analysis showed that underweight in Chinese older adult individuals was significantly associated with anxiety (OR = 1.316, p = 0.004) and depression (OR = 1.232, p = 0.013). This relationship was found to be more significant in males, individuals aged 80 and above, unmarried individuals, and those residing in town. ADL and IADL played a chain-mediated role between BMI and anxiety symptoms in the older adult. BMI not only had a direct effect on anxiety symptoms in the older adult (effect = −0.0159; SE = 0.0066; 95%CI: LL = −0.0288, UL = −0.0031), but also influenced them indirectly through two pathways: the independent mediating role of IADL (effect = −0.0010; SE = 0.0005; 95%CI: LL = −0.0018, UL = −0.0003) and the chain-mediated role of ADL and IADL (effect = −0.0012; SE = 0.0004; 95%CI: LL = −0.0020, UL = −0.0006).ConclusionIn the older adult individuals in China, underweight is associated with an increased risk of anxiety and depression symptoms. Improving the underweight condition of Chinese older adult individuals can reduce their ADL and IADL limitations, thereby benefiting their mental health.

Environmental conditions experienced early in the life of an animal can result in gene expression changes later in its life history. We have previously shown that C. elegans animals that experienced the developmentally arrested and stress resistant dauer stage (postdauers) retain a cellular memory of early-life stress that manifests during adulthood as genome-wide changes in gene expression, chromatin states, and altered life history traits. One consequence of developmental reprogramming in C. elegans postdauer adults is the downregulation of osm-9 TRPV channel gene expression in the ADL chemosensory neurons resulting in reduced avoidance to a pheromone component, ascr#3. This altered response to ascr#3 requires the principal effector of the somatic nuclear RNAi pathway, the Argonaute (AGO) NRDE-3. To investigate the role of the somatic nuclear RNAi pathway in regulating the developmental reprogramming of ADL due to early-life stress, we profiled the mRNA transcriptome of control and postdauer ADL in wild-type and nrde-3 mutant adults. We found 711 differentially expressed (DE) genes between control and postdauer ADL neurons, 90% of which are dependent upon NRDE-3. Additionally, we identified a conserved sequence that is enriched in the upstream regulatory sequences of the NRDE-3-dependent differentially expressed genes. Surprisingly, 214 of the ADL DE genes are considered “germline-expressed”, including 21 genes encoding the Major Sperm Proteins and two genes encoding the sperm-specific PP1 phosphatases, GSP-3 and GSP-4. Loss of function mutations in gsp-3 resulted in both aberrant avoidance and attraction behaviors. We also show that an AGO pseudogene, Y49F6A.1 (wago-11), is expressed in ADL and is required for ascr#3 avoidance. Overall, our results suggest that small RNAs and reproductive genes program the ADL mRNA transcriptome during their developmental history and highlight a nexus between neuronal and reproductive networks in calibrating animal neuroplasticity.

Background: The entire concept of aging gracefully involves maintaining the independence and quality of life among the older adults, with a particular emphasis on the ability to perform Activities of Daily Living (ADL). The number of older adults in the country has grown subsequently, with their dependence on care-givers which has also increased. Objectives: The study attempts to understand the prevalence and determinants of the limitations of Activities of Daily Living (ADL) among older adults aged 60 and over living in Indian state of Assam. Methods: The study use the Longitudinal Ageing Study in India (LASI, 2017–18) Assam data, and information was sought from 816 older adults aged 60 years and above. An index of ADL was created on a scale of two levels, having no levels of ADL and having ADL limitation. Results: Around 18 % of the older adults reported ADL disability. Females had higher prevalence of ADL than males (22 % v/s 14 %). Those aged 70 plus were also more likely to have ADL functional limitation (OR = 1.78, CI = 1.61–1.96) than those aged 60–69 years. Older adults not involved in any physical activity were more likely to report ADL limitation (OR = 1.50, CI = 1.34–1.68) than their counterparts. Conclusion: The findings of the study call for action to have geriatric care centres as the need of the hour, to promote exercise and other recreational activities that will help the old keep physically active and increase social-participation.

Abstract Background Evidence indicates frailty before intensive care unit (ICU) admission leads to poor outcomes. However, it is unclear whether quality of life (QOL) and activities of daily living (ADL) for survivors of critical illness admitted to the ICU via the emergency department remain consistent or deteriorate in the long-term compared to baseline. This study aimed to evaluate long-term QOL/ADL outcomes in these patients, categorized by the presence or absence of frailty according to Clinical Frailty Scale (CFS) score, as well as explore factors that influence these outcomes. Methods This was a post-hoc analysis of a prospective, multicenter, observational study conducted across Japan. It included survivors aged 65 years or older who were admitted to the ICU through the emergency department. Based on CFS scores, participants were categorized into either the not frail group or the frail group, using a threshold CFS score of