Literature can be a fruitful source of inspiration for rethinking ageing. Two literary short stories, one by Thomas Mann, the other by Stefan Zweig, offer two original portraits of an old man, which may lead some to reconsider the relationship between old age and passion, and to restore the humanity of the figure of the old man.

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OBJECTIVE: Although the model of successful aging is already well discussed and has received considerable critical responses, its intersection with the growing enthusiasm for creative engagement among older adults needs further exploration. This article contributes to the growing literature on later-life creativity by examining its relationship with the discourse of successful aging.
METHODS: The study employs critical humanities-based perspectives and the literature on later-life to address creativity in older age within contemporary neoliberal imperatives.
RESULTS: While successful aging is as an antithesis to the narrative of decline, it often fails to capture alternative meanings of aging and the creative engagement in later life. The commercialization and commodification of creativity often function to discipline individuals towards a culture of productivity, optimization, and innovation. However, many older individuals challenge these notions as they create their own models of aging well and authentically that do not align with the ideals of successful aging.
CONCLUSIONS: Reductionist, individualistic, and capital-driven understandings of later-life creativity can be broadened by employing critical interdisciplinary approaches, which also help rethink the current meanings of old age and aging. The article will be of interest to scholars, policymakers, artists, and practitioners in gerontological scholarship and the humanities.

UNASSIGNED: Detection and management of late-life depression largely relies on primary care. Yet in Singapore, older adults are unlikely to seek help for their mental health from their primary care providers. This qualitative descriptive study explores how late-life depression manifests to general practitioners (GPs) in the Singaporean primary care setting.
UNASSIGNED: Twenty-eight private GPs practicing in Singapore were asked about their clinical experience with late-life depression during semi-structured group and individual discussions conducted online. Participants were purposively sampled across age, gender, and ethnicity (Chinese, Malay, Indian). Transcripts were analysed with reflexive thematic analysis.
UNASSIGNED: To GPs, depression in older patients often manifests through somatic symptoms or subtle behavioural changes, only detectable through follow-ups or collateral history. GPs reported that older patients attribute depressive symptoms to normal ageing or do not mention them, particularly within an Asian culture encouraging stoic endurance. GPs perceived late-life depression as reactions to ageing-related stressors, with male, low-income, or institutionalised patients being at particular risk of insidious, severe depression. GPs noted ethnic differences regarding families\' involvement in care, which they described as helpful, but sometimes stress-provoking for patients. Fear of burdensomeness or loss of autonomy/social role could prompt rejection of diagnosis and treatment in patients. GPs considered good patient-doctor rapport as a facilitator at every step of the care process, noting more favourable prognosis in care-concordant patients.
UNASSIGNED: Depression in older adults in Singapore can be covert, with favourable outcomes relying on GPs\' ability to pick up on subtle changes, assess patients holistically, and build rapport with patients and families.
UNASSIGNED: This work was funded by the Division of Family Medicine Research Capabilities Building Budget under the project \"Technology and Compassion: Improving Patient Outcomes Through Data Analytics and Patients\' Voice in Primary Care\" [NUHSRO/2022/049/NUSMed/DFM].

Patients with persistent somatic symptoms (PSS) often receive either somatic or psychiatric care, depending on whether symptoms are respectively medically explained (MES) or unexplained (MUS). This separation may not be as clinically relevant as previously assumed; however, research on data-driven subgroups within cohorts of older patients with PSS is not available. Our goal is to identify more clinically relevant homogeneous subgroups beyond the distinction of MUS and MES among older patients with PSS by using a data-driven approach. We performed two Latent Profile Analyses (LPAs), one focused on 6 somatic health measures, the other on 6 psychosocial measures, using data from a case-control study with participants (>60 years) with MUS (N = 118) or MES (N = 154), recruited from the general public, general practices and secondary healthcare. We identified two somatic-health based (strong, vulnerable) and four mental-health based (strong, vulnerable, lonely, non-acceptance) profiles. We found no statistically significant overlap between the somatic - and mental health profiles (κ = 0.019). Health related quality of life negatively associated with the mentally - and somatically vulnerable profiles. We conclude that singular focus on MUS/MES distinction in the care for older PSS patients may lead to undertreatment of the most vulnerable patients. Integrated care is recommended when treating persistent somatic symptoms in later life, regardless of the (un)explained origin of the symptoms.

Although long-term survival in Rett syndrome (RTT) has been observed, limited information on older people with RTT exists. We hypothesized that increased longevity in RTT would be associated with genetic variants in MECP2 associated with milder severity, and that clinical features would not be static in older individuals. To address these hypotheses, we compared the distribution of MECP2 variants and clinical severity between younger individuals with Classic RTT (under 30 years old) and older individuals (over 30 years old). Contrary to expectation, enrichment of a severe MECP2 variant (R106W) was observed in the older cohort. Overall severity was not different between the cohorts, but specific clinical features varied between the cohorts. Overall severity from first to last visit increased in the younger cohort but not in the older cohort. While some specific clinical features in the older cohort were stable from the first to the last visit, others showed improvement or worsening. These data do not support the hypothesis that mild MECP2 variants or less overall severity leads to increased longevity in RTT but demonstrate that clinical features change with increasing age in adults with RTT. Additional work is needed to understand disease progression in adults with RTT.

BACKGROUND: Non-pharmacological interventions have proven effective at alleviating depression and anxiety symptoms in older adults. Methodological refinement and testing of these interventions in new contexts are needed on a small scale before their effectiveness and implementation can be evaluated. The purpose of this pilot study is to assess the feasibility of a future large-scale trial comparing an adapted mental health multi-component evidence-based intervention (VIDACTIVA) versus standard care for older adults experiencing depression symptoms in urban, resource-limited settings in Lima, Peru. Furthermore, this study will explore the acceptability, feasibility, and fidelity of implementing the intervention.
METHODS: We will conduct an open-label, mixed methods pilot feasibility study with two parallel groups. A total of 64 older adults, stratified by sex, will be randomized at a 1:1 ratio to either the \"intervention\" or \"control.\" Participants will be followed for 22 weeks after enrollment. Those in the intervention group will receive eight VIDACTIVA sessions administered by community health workers (CHWs) over 14 weeks, with an additional eight weeks of follow-up. Participants in the control group will receive two psychoeducation sessions from a study fieldworker and will be directed to health care centers. Standard care does not involve CHWs. We will evaluate screening rates, recruitment strategies, retention rates, the acceptability of randomization, and assessments. Additionally, we will assess preliminary implementation outcomes-acceptability, feasibility, and fidelity-from the perspectives of CHWs (interventionists), older adults (main participants), older adults\' relatives, and healthcare professionals.
CONCLUSIONS: If the findings from this feasibility trial are favorable, a fully powered randomized controlled trial will be conducted to evaluate `both the effectiveness and implementation of the intervention. This research will make a substantial contribution to the field of mental health in older adults, particularly by emphasizing a meticulous examination and documentation of the implementation process. By doing so, this study will offer valuable methodologies and metrics for adapting and assessing mental health interventions tailored to the unique needs of older adults in resource-constrained contexts and diverse cultural settings.
BACKGROUND: The current trial registration number is NCT06065020, which was registered on 26th September 2023.

This ethnographic exploration of death in the Peruvian context draws on fieldwork among abandoned-both by their families and the state-older adults in a shelter for the homeless in Lima, Peru. I examine the conditions and local forces that shape the ways people at this institution socially and physically die. My argument is that people in this long-term care facility who have lived entire lives on the margins, usually, end up having irrelevant deaths to their families, other residents of the institution, and the Peruvian state. At this shelter, dying in an irrelevant way means dying without companionship from family members and receiving poor and flawed care from the institution that shelters them.

Comorbidities in the elderly not only make them more susceptible to kidney disease, but also increase the risk of drug interactions due to polypharmacy. Such patients require regular kidney function tests when treated with renally excreted drugs. We conducted a retrospective study of post-mortem cases over a five- year period. Of 3040 toxicologically investigated cases, 3.8% had a history of renal failure. Thirteen deaths were directly attributable to inadequate drug dosing, 46% of which were related to lactic acidosis due to metformin accumulation. Appropriate dose adjustment could prevent fatal drug toxicity in patients with renal insufficiency.

OBJECTIVE: To determine the impact of PM2.5 exposure in old age and its interactive effect with smoking on incident diabetes.
METHODS: A total of 2766 participants aged ≥60 years in China were interviewed at baseline for disease risk factors in 2001-03 and were then followed up for 10 years to document incident diabetes. They were assessed for daily PM2.5 exposure in 2005. Multivariate Cox regression models were used to examine the association of PM2.5 exposure with incident diabetes and interactive effect between PM2.5 and smoking on incident diabetes.
RESULTS: During the cohort follow-up, 176 participants developed diabetes. The incidence of diabetes increased with PM2.5 exposure; the multiple-adjusted hazard ratio (HR) of diabetes was 2.27 (95 % CI 1.36-3.77) in participants with PM2.5 at ≥62.0 μg/m3 compared to those with <62.0 μg/m3. There was a significant interaction effect of PM2.5 with smoking on increased risk of diabetes. The adjusted HR for participants exposed to PM2.5 levels ≥62.0 μg/m3 who smoked was 4.39 (95 % CI 1.72-11.21), while for non-smokers it was 1.65 (95 % CI 0.88-3.09), compared to those with <62.0 μg/m3.
CONCLUSIONS: Exposure to PM2.5 in old age was associated with an increased incidence of diabetes and smoking enhanced the impact of PM2.5 on diabetic risk. These findings underscore the urgent need for air quality improvement measures and smoking cessation programs to mitigate the risk of diabetes in aging populations.