Search Results (673)

Background: In recent years, electronic patient-reported outcome (ePRO) systems on electronic devices, such as smartphones, have been employed to collect patients’ self-assessments and symptom reports. However, these studies were limited to younger populations and patients with severe diseases. Objective: This study aimed to evaluate the ease of use and response continuity of an ePRO system used by healthy middle-aged and older adults. Methods: This prospective observational study included participants aged 40–74 years undergoing specific health checkups. The System Usability Scale (SUS) was used to assess ePRO usability. Response continuity was evaluated by assessing EuroQol 5-Dimensional 5-Level responses once a month for up to 3 months after the health checkup date. Results: Eleven participants, aged 47–73 years, participated in the study. The mean SUS on the screening date was 59.1 (95% CI: 50.0–68.1; a cut-off of 70 indicated “useful”). However, only one participant failed to complete the ePRO at one and two months post-examination, and responses were obtained from all participants at three months. Conclusions: Due to the small sample size, usability as measured by the SUS should be interpreted descriptively. While initial onboarding appeared to be a major implementation barrier, sustained monthly ePRO reporting over 3 months was achievable among participants who completed registration with support, suggesting the conditional feasibility of response continuity in this preventive health checkup setting. Full article

Background: Cognitive aging is a physiological process that involves gradual and mild changes in mental functions. When these changes significantly affect cognitive performance, it is considered cognitive decline. Objective: This analytical cross-sectional pilot study examined the association between periodontal status, systemic conditions, and cognitive performance in middle-aged and older adults. Methods: Forty adults aged 35–59 years (n = 20) and ≥60 years (n = 20) from northeastern Mexico were evaluated. Oral assessments included the Modified Gingival Index and detection of Porphyromonas gingivalis and Fusobacterium nucleatum using qPCR. Cognitive function was evaluated with the Mini-Mental State Examination (MMSE), and frailty with the Clinical Frailty Scale (CFS) and Oral Frailty Checklist (OF-5). Systemic medical history and oral hygiene habits were determined using a questionnaire. Results: MMSE scores were lower in older adults compared with middle-aged adults, and the magnitude of the difference was small. The presence of P. gingivalis or F. nucleatum was similar between groups. Frailty indicators were more prevalent in older adults. Logistic regression identified age and frailty-related variables as the strongest predictors of lower cognitive performance, whereas microbiological findings were not significant predictors. Conclusions: Age and frailty indicators, rather than bacterial presence alone, were associated with reduced cognitive performance in this pilot sample. Although no microbiological differences were observed, the findings highlight the need for larger analytical studies incorporating quantitative bacterial load and additional confounders to better understand the oral–systemic–cognitive interactions. Full article

Background: Socioeconomic factors significantly influence health outcomes in older adults, yet their impact on specific aspects of mobility remains unclear. This study investigates the relationship between area-level socioeconomic disadvantage and mobility health in older adults. Methods: We conducted a cross-sectional study of 110 community-dwelling older adults recruited and collected using voluntary response sampling at eight health fairs across rural Southeast Alabama in 2022–2024 (60 ± 16 years, 80% female). Area-level socioeconomic status was measured using the Area Deprivation Index (ADI), a validated composite measure of neighborhood disadvantage. Mobility was assessed using the Instrumented Timed Up and Go (iTUG) test and the Instrumented Five Times Sit-to-Stand (i5TSTS) test. Kruskal–Wallis tests and general linear models in SAS 9.4 analyzed the relationship between ADI and mobility measures. Results: Higher ADI scores were significantly associated with poorer performance on the i5TSTS test (p = 0.0004). While overall iTUG duration did not differ significantly across ADI groups, the sit-to-stand phase of the iTUG showed a significant relationship with ADI (p = 0.0026). These associations remained significant after adjusting for age, weight, race, and education level. Conclusions: These findings suggest that neighborhood context plays a crucial role in mobility health, particularly in functions related to postural transitions. Clinicians should consider area-level disadvantage when screening for mobility limitations and may need to prioritize sit-to-stand interventions for patients living in high-deprivation areas. Full article

Objectives: Lifestyle behaviors such as physical activity, cognitive engagement, social interaction, diet, sleep, and vascular risk management are increasingly recognized as contributors to cognitive aging and dementia risk. Although many middle-aged and older adults express interest in maintaining brain health, less is known about their beliefs about brain-healthy behaviors or their preferences for receiving multicomponent brain health interventions. This study examined adults’ ratings of the usefulness of a wide range of lifestyle activities for brain health and their preferred formats for receiving support. Methods: A 60-item online survey was administered to compensated volunteers aged 40 years and older through a commercial provider. The questionnaire assessed perceived usefulness of lifestyle-based brain health activities and preferred intervention delivery formats. The analytic sample included 761 respondents. Descriptive statistics were computed for all ratings and differences by age group and gender were tested using MANOVA with post hoc comparisons adjusted for multiple testing. Results: Participants endorsed many lifestyle activities as helpful for brain health. Mentally stimulating activities, good sleep, stress management, and creative activities received the highest ratings, whereas strength training, meditation, language learning, and computer-based cognitive training were rated lower. Aerobic exercise and mentally stimulating activities were most frequently selected as the single most important activity. Significant effects of age, gender, and their interaction were observed, with younger men and older women generally rating activities more favorably. With respect to desire for services, over half of participants preferred receiving a cognitive assessment, and many favored online education or app-based tools. Conclusions: Middle-aged and older adults recognize a wide range of lifestyle factors as potentially beneficial for brain health and express strong interest in structured support, particularly assessments and digital resources. These findings can inform the design of flexible, multicomponent brain health interventions aligned with adults’ preferences and priorities. Full article

Background: Ewing sarcoma (ES) is a rare, aggressive small round cell sarcoma (SRCS) that peaks in adolescence. Given its rarity, atypical age or site presentations increase the risk of misclassification. This study examines age-related clinicopathological patterns in molecularly confirmed canonical ES (FET::ETS-fused). Methods: Between 2016 and 2025, 90 tumors diagnosed as ES or Ewing-like SRCSs underwent targeted RNA sequencing and/or EWSR1 break-apart fluorescence in situ hybridization. Patients were stratified into three age groups: 0–18, 19–39, and ≥40 years. Clinical, anatomical, pathological, molecular, and treatment/outcome variables were compared across strata. Results: Canonical ES accounted for 84% (76/90) of SRCSs, dominated by EWSR1::FLI1 (89%). ES comprised 91% of SRCSs in children but declined to 75% in older adults. Tumors arose mainly in bone (63%), with a significant age association (p = 0.016): children and young adults were primarily skeletal (73% and 62%), whereas older adults were predominantly extraskeletal (78%). Renal ES clustered in adults ≥40 years (p = 0.003). Classic histology predominated; atypical patterns were more common in extraskeletal tumors but lacked age specificity. Ewing-like SRCSs (n = 14), with heterogeneous or absent fusions, displayed a broader age distribution—including infants and older adults—and a marked extraskeletal predominance (86%, p = 0.001). Metastatic presentation strongly predicted inferior survival (p = 0.025). Treatment was multimodal, with neoadjuvant chemotherapy more frequent in children (90%, p = 0.029). Conclusions: Age significantly influences anatomic presentation and certain treatment choices in ES, whereas histology and survival remain broadly similar across groups. Age-linked extraskeletal trends reinforce the importance of routine molecular testing, particularly in underreported Middle Eastern populations. Full article

Nutrition risk is prevalent in community-dwelling older adults, and leads to increased morbidity and mortality. Understanding the factors associated with the development of high nutrition risk is crucial for the development of appropriate programs and policies to address this problem. Therefore, our objective was to identify the psychosocial factors correlated with the development of high nutrition risk, as assessed by SCREEN-8, among Canadian adults categorized by ten-year age groups (45–54, 55–64, 65–74, and 75+). We used data from 17,051 participants in the tracking cohort of the Canadian Longitudinal Study on Aging and employed multivariable binomial logistic regression to identify the social and demographic factors associated with the emergence of high nutrition risk at follow-up, three years after the baseline. Baseline data were gathered between 2011 and 2015. At baseline, 34.4% of participants across all age groups were at high nutrition risk, while 40.0% were at high risk at follow-up. Factors consistently associated with the development of high nutrition risk across all age groups included lower levels of social support, lower self-rated social standing, infrequent participation in sports or physical activities, infrequent participation in cultural or educational activities, and lower household incomes. Programs and policies addressing these factors may reduce the prevalence of high nutrition risk and the development of high nutrition risk. Full article

Background: Cognitive and physical functions share certain age-related patterns of change, including slowed processing speed and movement. Both functions are multifaceted, and the association between them can be affected by the type of measurement considered. This study examined one-to-one relationships between cognitive and physical functions, using data from the Compostela Aging Study. Methods: A total of 267 middle-aged and older individuals without cognitive impairment were included in the study (mean age 65.57, 75.7% women). The relationship between cognitive and physical performance was examined using Spearman’s rho, adjusted for age and sex. Results: Standing up, sitting down and total times in the Timed-Up and Go test were significantly correlated with performance on the Trail-Making and phonological fluency tests. Turning time in the Timed-Up and Go test and self-reported physical activity were correlated with performance on the Spanish version of the California Verbal Learning Test. Grip strength was correlated with performance on the Counting Span task. Conclusions: This study adds evidence to the one-to-one relationship between cognitive and physical function in a subclinical cohort of middle-aged and older adults. Full article

Clinical indicators for pulmonary tuberculosis (PTB) among patients with community-acquired pneumonia (CAP) have been derived from studies on younger or middle-aged populations in high TB-burden countries. However, diagnostic clues specific to older adults remain insufficiently validated. This multicenter prospective observational study aimed to identify the clinical features that can help differentiate PTB from CAP among older patients. We enrolled patients aged ≥ 65 years who were diagnosed with PTB or non-TB CAP between September 2023 and September 2025. Clinical data—including demographics, symptoms, and laboratory findings, previously reported as potential discriminators of PTB—were compared between the two groups. Of 233 patients included, 57 (24%) were diagnosed with PTB. No significant difference in sex was observed between the PTB and non-TB CAP groups. The PTB group was older and had a poorer performance status than the CAP group. On multivariate logistic regression analysis, PTB was significantly and independently associated with weight loss (aOR 8.17, p < 0.001); symptoms lasting ≥ 2 weeks (aOR 5.79, p < 0.001); and absence of general fatigue (aOR 0.19, p < 0.001) and dyspnea (aOR 0.19, p = 0.002) but not with night sweats and hemoptysis. These clinical features may be valuable indicators of PTB in older adults and inform tuberculosis control strategies in regions expected to have accelerated population aging. Full article

Background/Objectives: Hearing impairment in middle-aged adults is a significant, modifiable risk factor for cognitive decline and dementia, and therapy with hearing aids or cochlear implants has been suggested to reduce this risk. However, most research on auditory rehabilitation and cognition has focused on older adults, and evidence regarding cognitive outcomes in middle-aged adults remains scarce despite this group being identified as critical for dementia prevention. Thus, this study aimed to assess cognitive skills in middle-aged hearing-impaired individuals 1 year after receiving a cochlear implant (CI) as part of auditory rehabilitation. Methods: Thirty-two patients with a mean age of 52.4 were enrolled in a prospective pre-post study. Hearing was tested using the Freiburg Monosyllable Test (FS) and the Oldenburg Inventory (OI). Cognitive performance was assessed using the WAIS-IV, operationalized through the Working Memory Index (Digit Span, Arithmetic) and Processing Speed Index (Symbol Search, Coding). Quality of life was assessed with the NCIQ, tinnitus-related distress with the Tinnitus Questionnaire (TQ), and depressive symptoms with the ADS-L. Results: After one year, speech intelligibility (FS) improved from a median of 0 to 70.0 (Wilcoxon Z = −4.864, p < 0.001, r = −0.61), and subjective hearing from a median of 2.55 to 3.18 (Wilcoxon Z = −3.072, p = 0.002). The NCIQ score increased from 52.3 to 60.6 (Z = −3.899, p < 0.001), and tinnitus-related distress decreased from 25 to 21 (Wilcoxon Z = −2.209, p = 0.027). Depressive symptoms declined numerically, although this change did not reach statistical significance. Working memory improved from 82.0 to 89.0 (Wilcoxon Z = −4.090, p < 0.001), and processing speed from 89.5 to 95.5 (Wilcoxon Z = −2.533, p = 0.011). Before CI, WMI and PSI showed a strong correlation (ρ = 0.533, p = 0.002), and WMI correlated moderately with education level (ρ = 0.452, p = 0.012). One year after CI, correlations strengthened between PSI and NCIQ (ρ = 0.510, p = 0.006), PSI and OI (ρ = 0.400, p = 0.039), and WMI and TQ (ρ = –0.459, p = 0.021), indicating emerging associations between cognitive outcomes and auditory or psychosocial measures. Conclusions: One year of CI-based auditory rehabilitation improves auditory function, quality of life, tinnitus distress, and—critically—working memory and processing speed in middle-aged adults. These findings address a previously unfilled research gap and support the relevance of CIs for preserving cognitive health during midlife. Full article

Background: The China Diet Balance Index 2022 (DBI-2022), released in 2024, is the latest dietary quality assessment tool developed in alignment with the updated Dietary Guidelines for Chinese Residents (2022). However, its association with hypertension in the Lingnan region—a geographic area distinguished by a unique dietary culture—has not been fully examined. Objective: This study aimed to systematically evaluate the dietary quality of Lingnan residents using DBI-2022 and explore its association with hypertension. Methods: We analyzed cross-sectional data from the 2015 China Adults Chronic Diseases and Nutrition Surveillance, focusing on 2982 Lingnan residents aged 45 years and older. Dietary information was collected via 3 consecutive days of 24-h dietary recalls and food frequency questionnaires, supplemented by standardized anthropometric measurements. We assessed the contribution of specific dietary components to overall quality and investigated the association between DBI-2022 indices and hypertension using multivariable regression models. Results: Among the 2982 participants, 821 (27.5%) were identified with hypertension. The primary dietary imbalances in the Lingnan population were characterized by moderate insufficient consumption (Low Bound Score [LBS] = 40.48) and moderate excessive intake (High Bound Score [HBS] = 22.58), with insufficient intake being the more prominent concern. Cereals, cooking oils, and salt emerged as key contributors to poor dietary quality, whereas soybeans, fruits, adequate water consumption, and dietary diversity were associated with better dietary quality. After adjusting for potential confounders, participants in the highest quartile of Diet Quality Distance (DQD) had significantly higher odds of hypertension (OR = 1.57, 95% CI: 1.05–2.35) compared to those in the lowest quartile. Similarly, the odds were elevated for those with high LBS (OR = 1.88, 95% CI: 1.24–2.87). Conclusions: Dietary insufficiency appears to be a more critical issue than excessive consumption among the Lingnan population. Poor dietary quality, particularly insufficient intake of protective foods, is significantly associated with elevated odds of hypertension. These findings support the applicability of DBI-2022 for regional dietary surveillance and highlight key priorities for targeted nutritional intervention strategies. Full article

Background: Hypertension is a leading modifiable risk factor for cardiovascular diseases globally, disproportionately affecting low- and middle-income countries (LMICs), including South Africa. Primordial prevention targeting normotensive individuals plays a key role in reducing lifetime risk. Aim: To assess knowledge, attitudes and practices (KAP) and social determinants of health related to primordial hypertension prevention among normotensive adults in OR Tambo District, Eastern Cape province. Methods: A community-based cross-sectional study was conducted among 245 randomly selected normotensive adults. A validated questionnaire captured socio-demographic characteristics and KAP levels. Data analysis included descriptive statistics, Cronbach’s alpha, and chi-square tests (p < 0.05). Results: Participants demonstrated moderate knowledge (53.9%), highly positive attitudes (86.1%), and fair preventive practices (59.6%), highlighting a clear knowledge–practice gap. Higher knowledge was significantly associated with female gender (p < 0.001), older age (p < 0.001), and family history of hypertension (p = 0.001). Positive attitudes correlated with older age (p = 0.018) and higher education (p = 0.008). Knowledge level significantly predicted both positive attitudes (p < 0.001) and preventive practices (p = 0.009). Conclusions: Despite moderate knowledge and positive attitudes, a clear knowledge–practice gap was evident, possibly influenced by social and structural constraints. Strengthening primordial hypertension prevention in rural South Africa requires integrated strategies combining context-specific health education with interventions addressing structural barriers to enable sustainable behaviour change. Full article

Background/Objectives: Excessive sugar, fat, and salt intake heighten susceptibility to metabolic syndrome and other chronic metabolic conditions. Biofortification (i.e., enhancing the nutritional content of crops) emerges as a sustainable new approach to address dietary deficiencies. Methods: This study evaluated the impact of an acute nutritional intervention in a controlled, randomized, single-blind trial involving healthy adults aged 50–79 years, in late middle age and early older adulthood utilizing biofortified vegetables enriched with iodine and molybdenum, aimed to explore short-term biochemical responses to the consumption of iodine- and molybdenum-biofortified lettuce. The study was designed as a controlled dietary intervention including both a biofortified and a non-biofortified lettuce group, matched for handling and composition. It was powered to detect short-term biochemical responses, providing initial insights into the physiological impact of micronutrient biofortification. Dietary intake was carefully monitored throughout the 12-day period to control for confounding dietary effects. Results: The intervention was associated with decreased plasma levels of triglycerides, AST, and ALT, and increased plasma levels of HDL-cholesterol and the satiety hormone PYY, suggesting enhanced metabolic regulation. Conclusions: These biochemical markers reflect early metabolic adaptations that may inform future research on the metabolic impact of micronutrient biofortification. This study also highlights the potential of crop biofortification as a sustainable, strategy to enhance the nutrient density of vegetables within controlled dietary patterns. Full article

Background/Objective: Spinal cord injury (SCI) is a life-altering condition representing a major cause of long-term disability and substantial health burden worldwide. In the Middle East, including Saudi Arabia, rapid urbanization and evolving injury patterns may have influenced SCI trends; however, national data remain limited. This study aimed to examine age-standardized trends in SCI incidence, prevalence, and years lived with disability (YLDs) in Saudi Arabia from 1990 to 2021, comparing transport-related and non-transport unintentional injuries, and describing age- and sex-specific SCI patterns in 2021. Methods: Using data from the Global Burden of Diseases (GBD) 2021 study, we conducted a population-based trend analysis for Saudi Arabia from 1990 to 2021, stratified by age, sex, and injury cause. Outcomes included age-standardized incidence, prevalence, and YLD rates per 100,000 population, along with percentage changes, average annual percentage changes, and rate ratios with 95% uncertainty intervals (UIs). Results: Between 1990 and 2021, age-standardized SCI showed a point estimate increase in incidence (25.0%; 95% UI: −28.3 to 116.8) and prevalence (24.3%; 95% UI: 0.8 to 53.4), while YLDs showed a modest rise (1.4%; 95% UI: −44.5 to 83.9). Males experienced greater increases in incidence (31.9%) and prevalence (32.3%) than females. Non-transport unintentional injuries surpassed transport-related causes, accounting for nearly 75% of SCI-related YLDs in 2021. The highest burden occurred among young adult males (highest incidence) and older adults (peak prevalence). Conclusions: The burden of SCI in Saudi Arabia has increased over the past three decades, with a shift toward non-transport unintentional injuries. Because wide uncertainty intervals limit definitive conclusions on trend direction, strengthening injury prevention, rehabilitation, and surveillance programs is crucial to mitigate this growing burden. Full article

Background: Individuals with untreated hearing loss often experience cognitive decline as a result of increased cognitive load and reduced sensory stimulation. Despite the well-established link between untreated hearing loss and cognitive decline in older adults, its impact on cognition in young and middle-aged adults has not been systematically examined. Given the Lancet Commission’s identification of midlife hearing loss as the leading modifiable risk factor for dementia, early identification of cognitive decline is essential. This review explored the cognitive impact of untreated hearing loss in adults. Method: A comprehensive search was conducted in PubMed, Scopus, Web of Science, and EMBASE to include studies comparing cognitive function between adults with normal hearing and those with untreated hearing loss aged 18–65 years. The methodological quality of the included studies was examined via the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Pooled mean differences and heterogeneity were analysed for each domain. Results: Seven studies included in the qualitative synthesis had “moderate” to “strong” methodological quality. The cognitive domains assessed in these studies were global cognitive function, memory, attention, and executive function. Of these, six were eligible for meta-analysis, which revealed a small but statistically significant decline in overall cognitive performance and memory and executive function among adults with untreated hearing loss. Conclusions: Cognitive vulnerabilities exist in young and middle-aged adults with untreated hearing loss. Hence, incorporating cognitive assessment into routine audiological evaluation may enable earlier intervention and delay the future burden of Alzheimer’s disease and related dementias in such a population. Full article

Background/Objectives: Hypertension (HTN) is highly prevalent among middle-aged and older adults in Saudi Arabia, affecting nearly half of those attending primary care clinics. This growing burden contributes not only to cardiovascular disease, but also to functional decline and reduced mobility in aging Saudis. The objective of this paper was to examine the relationship between HTN and objective measures of mobility and endurance in Saudi adults aged ≥50 years, and to assess whether any associations differ by sex. Methods: In a cross-sectional study, 47 hypertensive and 53 non-hypertensive (no chronic disease) community-dwelling adults were recruited from various regions of Saudi Arabia. Participants completed mobility tests (five repetitions of sit-to-stand (5×STS) and timed up-and-go (TUG)) and an endurance test (6 min walk test (6MWT)). Multivariable linear regressions adjusted for age, body mass index, and sociodemographic factors were used to evaluate the association of HTN with each performance measure in men and women separately. Results: Participants with HTN were older (mean 63 vs. 57 years) and had higher BMI than controls (p < 0.05), as well as performing worse on all functional tests: they required more time for 5×STS and TUG, and walked a shorter distance during the 6MWT (all p ≤ 0.003). In sex-stratified analyses, HTN was associated with slower TUG in men (≈2 s longer, p = 0.027), while among women, HTN predicted significantly slower 5×STS (+8.4 s) and TUG (+2.8 s) times, and a 114 m-shorter 6MWT distance (p < 0.05 each). Conclusion: HTN is linked to impaired mobility and endurance in middle-aged and older Saudi adults, with hypertensive women exhibiting particularly pronounced deficits. Future research is needed to determine whether incorporating routine functional assessments and exercise-based counseling into HTN care may help identify and address early declines in physical independence among aging adults. Full article