Search Results (89)

Background/Objectives: Physical activity (PA) interventions have the potential to delay or reverse frailty in older people, and previous meta-analyses have shown that PA reduces frailty risk. However, introduction and maintenance of PA during midlife might be more impactful as a public health intervention to reduce frailty at the population level. This study aimed to evaluate the impact of longitudinal PA patterns on future frailty risk and to examine whether it is modified by age of onset before vs. after 60 years. Methods: We conducted a systematic review and meta-analysis of prospective population-based cohort studies evaluating the effect of longitudinal PA trajectories on frailty risk of community-dwelling adults below and above 60 years at baseline. Risk ratios (RRs) from studies eligible for quantitative synthesis were pooled using random-effects meta-analysis. Results: Ten studies involving 111,714 participants from Europe, Asia, and North America were included in the systematic review and six in the meta-analysis. Relative to long-term physical inactivity, persistent PA trajectory was associated with 44% reduced risk of frailty (RR = 0.56, 95% CI:0.42–0.76) with moderate certainty, while inclining trajectories were associated with a 38% reduced risk (RR = 0.62, 95% CI: 0.57–0.68) with low certainty. Results: were similar for populations > 60 and <60 years at baseline. Conclusions: Sustained or increasing PA patterns over time are associated with lower risk of future frailty. These findings warrant further implementation studies to quantify the impact of public health policies promoting physically active lifestyles in midlife on the burden of frailty in aging populations. Full article

AI literacy has become a pressing concern across disciplines, calling for comprehensive measurement tools applicable to diverse age groups. Building on existing research, we propose a six-facet model encompassing affective experiences, usage skills, cognitive evaluation, ethical norms, responsible use, and self-development. The present study aimed to develop and validate the Six-Facet Artificial Intelligence Literacy Questionnaire (SFAILQ) among 2443 Chinese participants aged 12 to 60 years, spanning adolescence to middle adulthood, with a disproportionately larger proportion falling within the 18-to-40 age range. An item reduction analysis was conducted using the first split-half sample (N₁ = 1217), and reliability and validity analyses were performed with the second split-half sample (N₂ = 1226). The final SFAILQ consists of 32 items assessing six dimensions: affective experiences (5 items), usage skills (5 items), cognitive evaluation (6 items), ethical norms (6 items), responsible use (4 items), and self-development (6 items). All six dimensions and the total score correlated significantly and positively with academic self-efficacy (usage skills showing the strongest correlation) and with academic engagement (responsible use demonstrating the highest correlation). The SFAILQ demonstrated high internal consistency, construct validity, convergent validity, discriminant validity, and criterion-related validity. It may serve as an effective tool for evaluating AI literacy among adolescents, young adults, and midlife adults. Full article

Background/Objectives: A multivariable prediction model was developed and externally validated to estimate an individual’s current need to visit a dentist among young to middle-aged adults. The objective was to provide an accessible, non-invasive screening tool for independent home self-assessment or integration within routine healthcare workflows. Methods: A cross-sectional study utilised data from two National Health and Nutrition Examination Survey (NHANES) cycles (2011–2014). Logistic regression was applied to develop the prediction model among 1870 dentate adults aged 30–50, a critical onset period for oral diseases. The primary outcome was derived from objective oral examinations conducted by licensed dentists. The resulting questionnaire-based tool provides two recommendations: a visit to a dentist or continuation of routine oral care. Results: External validation using the independent NHANES 2013–2014 cohort (n = 2024) demonstrated robust and clinically relevant predictive capacity, with an AUC of 0.822 (95% CI 0.803–0.842). The model exhibited acceptable calibration (slope 0.85; intercept 0.04) and stable operation. Decision-curve analysis showed net benefit across thresholds; at Pt = 0.33, 14/100 unnecessary screenings were avoided compared with treat-all. Internal validation using a 10% hold-out partition (n = 184) supported these findings, indicating similarly strong discrimination (AUC 0.817, 95% CI 0.751–0.884). Conclusions: Early midlife is a consistent and informative period for oral health intervention. A scalable 14-predictor architecture using accessible indicators established high clinical utility, supporting integration into digital health and primary care. This approach enables efficient population-level prevention. Large-scale, nationally representative NHANES data allowed for the investigation of less-studied factors, including intermittent smoking, metabolic dysregulation, and elevated cholesterol levels. Full article

Background: Atrial fibrillation (AF) contributes significantly to global mortality. Its burden is rising, but regional differences remain. We assessed AF prevalence, incidence, mortality, disability-adjusted life years (DALYs), and risk factors in the USA and EU from 1991 to 2021. Methods: AF data from GBD 2021 were extracted, stratified by sex and age. Absolute numbers, age-standardized rates (ASR), and estimated annual percentage change (EAPC) were calculated. DALYs and deaths attributable to common risk factors were also analyzed. Results: From 1991 to 2021, AF incidence increased by 111.6% in the USA (EAPC 2.48) and 47.0% in the EU (EAPC 1.14), with faster growth in males. ASR prevalence and incidence increased in the USA (EAPC 0.57 and 0.55) but were stable in the EU (EAPC −0.05 and −0.21). Mortality rose 161% in the USA (EAPC 3.19) and 124% in the EU (EAPC 3.04), with the sharpest increases in older EU adults and midlife USA adults. Systolic blood pressure (SBP) was the largest contributor to DALYs and deaths, while high body-mass index (BMI) and alcohol grew fastest. Conclusions: AF burden rose markedly in both regions, with steeper increases in the USA and greater impact on males and midlife adults. Hypertension remains the dominant contributor, but obesity and alcohol consumption are emerging challenges. Full article

Using a pattern-centered approach, this investigation sought to identify latent subgroups of family functioning and evaluate their associations with health outcomes. A latent profile analysis was conducted using data from the National Study of Midlife Development in the United States (MIDUS). The sample comprised 5923 married adults between 25 and 74 years old who responded to items measuring family support, family strain, spousal support, spousal strain, and spousal agreement. These aspects of family functioning were used to identify four latent classes: Low Functioning (5.0%), Moderate Support with Elevated Strain (31.7%), High Support with Elevated Strain (13.7%), and High Functioning (49.6%). Compared to the other classes, individuals in the High Functioning class had greater psychological well-being and were less likely to have a chronic physical condition. The findings of this study highlight the importance of the systemic context of families in understanding the role of close relationships in health. Full article

Objective: This study examined age- and sex-specific correlates of arterial stiffness, assessed by the cardio–ankle vascular index (CAVI), in apparently healthy Chinese adults using an anthropometric–metabolic–inflammatory framework, and descriptively compared subgroup association patterns across these domains. Methods: In this cross-sectional study, 525 apparently healthy Chinese adults aged 20–78 years were included. Regression models with age-by-indicator interaction terms were used to test whether the age–CAVI association varied across anthropometric, metabolic, and inflammatory indicators. Sex-adjusted analyses were applied to the overall sample, sex-stratified analyses were used to characterize sex-specific patterns, and the Benjamini–Hochberg false discovery rate correction was applied for multiple interaction tests. Results: CAVI increased progressively with age, with a steeper age–CAVI association after 50 years (p < 0.05). Notably, females showed a transient midlife elevation. Association patterns appeared to differ by sex. In the sex-stratified interaction analyses, anthropometric signals were more prominent in men, particularly for height (p < 0.01), whereas metabolic-related interaction signals were more evident in women, with triglycerides providing the clearest corresponding signal and low-density lipoprotein cholesterol (LDL-C) showing a weaker accompanying pattern; the C-reactive protein (CRP)-related contrast was not retained after additional adjustment for blood pressure and smoking. Conclusions: CAVI increased with age, with a steeper rise after midlife and a transient midlife elevation in women. The association patterns across anthropometric, metabolic, and inflammatory indicators appeared to differ by sex, with signals from the anthropometric domain appearing more evident in men and metabolic-related signals appearing more evident in women. These findings suggest that age- and sex-specific interpretation of CAVI may be informative in preventive health check-up settings. Full article

With global life expectancy steadily rising, promoting healthy aging is becoming a critical objective of public health. Physical function tends to decline gradually, often beginning in midlife, when subtle changes start to occur and accumulate undetected until later years. This study examines the feasibility of using DNA methylation-based epigenetic clocks as biomarkers for cumulative physical performance in 24 community-dwelling adults aged 39 years and older. Our findings reveal that several epigenetic age estimators, particularly DNAmAgeHannum, are significantly associated with a novel composite score criterion derived from standardized motor function assessments (DNAmAge: ρ = −0.48, p < 0.026; DNAmPhenoAge: ρ = −0.48, p < 0.026) with DNAmAgeHannum (ρ = −0.59, p < 0.005). These findings support the potential of using epigenetic aging markers to detect early physiological decline, even in relatively healthy, midlife populations, offering a promising tool for the early identification of age-related functional deterioration. Full article

Arsenic is among the most important environmental toxicants contributing to the global prevalence of hypertension. Multiple studies have reported a greater burden of hypertension among people of African ancestry, yet the contribution of environmental factors to this burden is unclear. Therefore, we investigated the association of arsenic exposure with increased risk of hypertension and high blood pressure in 965 Afro-Caribbean adults in the Tobago Health Study. Linear and logistic regression analyses were conducted for the total cohort and stratified by sex and age separately. We also examined potential effect modification by sex. Each unit (μg/L) increase in ΣAs was associated with 2% higher odds of hypertension in the total cohort and 4% higher odds among women. Higher ΣAs was associated with higher diastolic blood pressure and mean arterial pressure (MAP) among men. The associations of higher ΣAs with hypertension among women and with higher MAP among men were significant only in mid-life but not in older age. The data suggest effect modification by sex for the relationship between ΣAs and MAP in men. The findings suggest that exposure to inorganic arsenic contributes to age- and sex-specific patterns for greater risks of hypertension and high blood pressure among Afro-Caribbean adults. Full article

Background: Sjögren’s disease (SjD) is a chronic systemic autoimmune disorder characterized by persistent exocrine gland inflammation, possible multi-organ involvement and a marked predominance of mid-life women. Beyond dryness and fatigue, patients report mood disturbances and cognitive complaints such as “brain fog”, which affect daily functioning and quality of life. Objective: To summarize and critically synthesize the literature on depression, anxiety, cognitive function, personality traits and quality of life assessment in adults with SjD and to highlight clinically relevant gaps. Methods: We performed a narrative review (PubMed, Cochrane, Embase through June 2025) of studies on psychological outcomes, cognitive function and quality of life in adults with SjD. Results: Depression and anxiety were frequently observed: depressive symptoms were present in roughly one-third to nearly half of patients, while anxiety symptoms were reported by about one-third. Cognitive impairment (affecting memory, attention and executive function) was also frequently described, often alongside severe fatigue and sleep disturbance. Overall, quality of life was reduced in SjD, driven mainly by fatigue and emotional distress rather than by classic disease activity. Neuroimmune mechanisms (e.g., chronic systemic inflammation and cytokine signalling such as IL-6 and TNF-α) may contribute to affective and cognitive symptoms. Overall, the evidence base remains largely cross-sectional and heterogeneous. Conclusions: Psychiatric symptoms and cognitive complaints represent a substantial and clinically relevant burden in SjD. Routine screening and multidisciplinary management that includes psychological assessment and support may improve well-being, adherence and quality of life. Full article

People in midlife interact with several different environments during their daily life including employment, leisure, commuting, and various family responsibilities, a concept defined as activity space. However, little is known about how these activity spaces contribute to individuals’ daily health behavior choices. The Everyday Environments and Experiences (E3) study was conducted to explore these relationships. In this paper, we provide a reproducible GPS processing workflow to generate time-weighted exposure measures (activity spaces) inferred from 21 days of continuous GPS monitoring among 340 midlife adults in Cook County, Illinois (n = 340) from the E3 study. Data from waist-mounted GPS devices that recorded one-minute location epochs were aggregated after excluding time spent within an 800 m buffer around the home. For each epoch, we derived proximity and kernel density measures for eleven food and physical-activity-related location types (e.g., supermarkets, fitness facilities), along with twenty-six environmental context variables (e.g., land use, crime, population density). Time-weighted averages characterized each participant’s typical non-home environmental exposure. After adjustment for environmental context, age and gender were generally unrelated to activity-space measures. However, Black and Hispanic participants (as compared to White participants) spent less time near both food and physical-activity resources, suggesting systemic inequities in access beyond neighborhood composition. These findings highlight the need to move beyond static residential measures toward time-weighted, dynamic assessments of environmental exposure. They also indicate that racial and ethnic disparities in routine activity space may reflect structural inequities shaping daily physical activity and access to healthy food. Future research is needed to explore how these observed disparities translate into differences into disease risk, using longer exposure periods and different geographic settings to identify causal pathways and inform multi-level interventions. Full article

Background/Objectives: The aim of this study is to describe sex- and age-specific patterns of HbA1c in adults with type 2 diabetes (T2D) mellitus across three temporal cohorts from Southern Italy (2012, 2017, and 2024), and to assess whether glycemic differences between men and women persist, narrow, or evolve over time. Methods: We analyzed three independent cohorts of adults with T2D, including 1249 patients in 2012 and 1125 patients in both 2017 and 2024. HbA1c values were summarized as medians and interquartile ranges within sex- and age-stratified groups. Temporal variation in cohort-specific median HbA1c was examined across timepoints within each sex and age category, and sex differences were assessed within each cohort year. Results: At the population level, median HbA1c values remained within a narrow range across all three cohorts, indicating overall temporal stability of glycemic control. No significant sex differences were observed in 2012 or 2024, and only one age stratum (≥80 years) showed a significant sex difference in 2017, with men exhibiting slightly higher median HbA1c. Age-stratified analyses revealed heterogeneous temporal patterns. In older adults (≥70 years), HbA1c medians were remarkably stable in both sexes (approximately 7.2–7.4% in women and 7.2–7.6% in men). In midlife (40–59 years), women tended to show modest increases or partial reversals in HbA1c, whereas men displayed worsening between 2012 and 2017 followed by stabilization thereafter. The youngest adults (18–29 and 30–39 years) showed the highest HbA1c levels in 2017 and the largest subsequent improvements between 2017 and 2024 in both sexes, with median values decreasing toward approximately 7.1–7.6%. Conclusions: Despite well-described biological and social sex differences in T2D, median HbA1c values in this real-world setting were broadly comparable between men and women and largely stable over a 12-year period. Sex differences were small, inconsistent, and age-dependent, with age, and not sex, emerging as the primary determinant of HbA1c over time. These findings suggest that sex-related disparities in glycemic control may be better understood through a dynamic, life-course perspective rather than static cross-sectional comparisons. Full article

Previous research found an inverse U-shaped association between age and different measures of wisdom, with the apex in late midlife. What might explain the negative relation between age and wisdom during the later years of life? This research investigated the impact of subjective physical health and mastery, using data from the Successful AGing Evaluation (SAGE) study of 976 adults between the ages of 51 and 99 years (M = 77.23, SD = 12.18). Physical health tends to decline with advancing years and, therefore, might reduce older adults’ sense of mastery and control over their lives, which might adversely affect their wisdom. Results showed that age correlated negatively with subjective health, wisdom, and mastery. In multivariate regression and path analyses, the negative relations of age and ill health on wisdom became non-significant after mastery was entered into the model. If wisdom declines in old age due to ill health that results in a perceived loss of mastery, enabling older adults to maintain their sense of control might preserve wisdom. Full article

Substance use, a significant public health concern, may be associated with worsening social connections and feelings of loneliness among adult populations. This study examined the associations between substance use (i.e., binge alcohol, e-cigarette, and traditional cigarette use) and loneliness among adults aged ≥50 years residing in the US. We conducted a secondary analysis of cross-sectional data from the 2023 Behavioral Risk Factor Surveillance System Social Determinant of Health Equity module. The sample included 138,614 adults aged ≥50 years, representing approximately 55.4 million individuals in this age group. Substance use was the key independent variable and categorized into two groups: no substance use and substance use—participants who reported current use of ≥1 of three substances (i.e., binge alcohol, e-cigarette, and traditional cigarette use). Overall, 19.0% of participants reported using ≥1 substance use, 21.0% reported feeling lonely sometimes, and 5.1% feeling lonely always/usually. Participants who reported using ≥1 substance had a 17.0% higher relative risk of feeling lonely always/usually (compared to feeling never/rarely lonely) than adults who did not report substance use, after adjusting for all covariates (RRR 1.17; 95% CI 1.10–1.35; p = 0.029). These findings underscore the strong link between substance use and loneliness among midlife and older adults. 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/Objective: Perimenopause, the final years of a woman’s reproductive life, may be symptomatic, affecting health and wellbeing. Lifestyle factors, such as diet, may alleviate these symptoms and improve health. Understanding nutrient intake at this stage of life is critical for tailoring dietary recommendations. This study investigated the nutrient intake of perimenopausal women in relation to adult guidelines and explored the associations between nutrients and symptoms. Methods: Irish perimenopausal women were recruited (>40 years old). Participants reported symptom severity via the Menopause Rating Scale (MRS). They completed a 4-day food diary along with a physical activity (PA) and demographic questionnaire. Hierarchal multiple regression was used to test the relationship between MRS and nutrients. A one-sample t-test or Wilcoxon signed-rank test was used to compare nutrient intake to the guidelines. Results: Participants (n = 63) had a mean age of 47.8 ± 3.5 years, a body mass index (BMI) of 27.0 ± 3.9 kg/m² and an overall MRS score of 13.5 ± 6.9. Participants were not meeting dietary reference values (DRVs) for most nutrients, with intakes significantly below guidelines for fibre (p < 0.001), total vitamin D (p = 0.031), calcium (p < 0.001), and iron (p < 0.001), and exceeding guidelines for saturated fat (p < 0.001). Hierarchal multiple regression models (adjusted for BMI, age, marital status, and PA) showed that Vitamin E intake was a predictor of a higher urogenital sub-score (β = 0.405, p < 0.001). Conclusions: There was variable adherence amongst midlife women to dietary guidelines, which may impact on both current and future health status. Public health initiatives are required to address this. Full article