BACKGROUND: The fear of falling is a common issue among older adults that negatively affects physical and psychological aspects of health-related quality of life, regardless of actual fall events. Interventions aimed at reducing fear of falling, independent of falls, may improve older adults\' quality of life. This study examined the moderated mediation effect of physical activity in how fear of falling affects health-related quality of life through depression in community-dwelling older adults.
METHODS: This study used secondary data from the Korea Centers for Disease Control and Prevention\'s 2019 Community Health Survey. The study included 73,738 adults aged 65 years or older. The researchers used the fear of falling scale, International Physical Activity Questionnaire, Patient Health Questionnaire-9, and EuroQol 5 Dimension as research tools, and performed descriptive statistics, Pearson\'s correlation coefficient, and SPSS PROCESS macro analysis. The study used the bootstrapping method to assess the adjusted mediating effect by resampling 5,000 times, and determined statistical significance with a 95% confidence interval.
RESULTS: In the model in which fear of falling affects health-related quality of life by mediating depression, the moderated mediation effect of physical activity was statistically significant, as the bootstrapping result did not include 0 in the 95% confidence interval (Index of moderated mediation [95% CI] = 0.006 [0.004-0.007], 0.008 [0.006-0.009]). Depression and health-related quality of life impairment decreased as the level of physical activity increased through inactivity, minimal activity, and health promotion activities, as the negative mediating effects decreased.
CONCLUSIONS: Physical activity reduces depression and improves health-related quality of life by influencing older adults\' fear of falling. Community-based programs are needed to encourage and support older adults in maintaining moderate physical activity to manage the depression caused by fear of falling, which is common among older adults, and to improve their health-related quality of life.

Carbonated drinks have been reported to increase muscle activity during swallowing compared with water. Older adults who habitually consume carbonated drinks may use their swallowing-related muscles to a greater extent, thereby preserving their swallowing function. This study investigated the relationship between habitual carbonated drink intake, amount of carbonated drink consumed, and subjective difficulty in swallowing in community-dwelling older adults. We administered a questionnaire to determine subjective difficulty in swallowing, nutritional status, presence of sarcopenia, and habitual intake of carbonated drinks. Statistical analysis of the subjective difficulty in swallowing was performed using logistic regression analysis with the presence or absence of suspected dysphagia, using the Eating Assessment Tool-10 as the dependent variable. The results showed that older age (odds ratio [OR]: 1.077; p = 0.011), nutritional status (OR: 0.807; p = 0.040), systemic sarcopenia (OR: 1.753, p < 0.001), and habitual intake of carbonated drinks (OR: 0.455; p = 0.039) were associated with subjective difficulty in swallowing. In conclusion, the daily habits of community-dwelling older adults impact their swallowing function.

UNASSIGNED: Cognitive reserve (CR) is a property of the brain that allows for better-than-expected cognitive performance relative to the degree of brain change over the course of life. However, neurophysiological markers of CR remain under-investigated. Electroencephalography (EEG) features may function as suitable neurophysiological markers of CR. To assess this, we investigated whether the dorsal attention network (DAN) and ventral attention network (VAN) activities, as measured during resting-state EEG, moderate the relationship between hippocampal volume and episodic memory.
UNASSIGNED: Participants were recruited as part of the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. Hippocampal volume was determined using magnetic MRI, and episodic memory was measured using word lists. After testing the effect of hippocampal volume on memory performance using multiple regression analysis, we evaluated the interactions between hippocampal volume and DAN and VAN network activities. We further used the Johnson-Neyman technique to quantify the moderating effects of DAN and VAN network activities on the relationship between hippocampal volume and word list memory, as well as to identify specific ranges of DAN and VAN network activity with significant hippocampal-memory association.
UNASSIGNED: A total of 449 participants were included in this study. Our analysis revealed significant moderation of DAN with a slope of β = -0.00012 (95% CI: -0.00024; -0.00001, p = 0.040), and VAN with a slope of β = 0.00014 (95% CI: 0.00001; 0.00026, p = 0.031). Further, we found that a larger hippocampal volume was associated with improved memory performance, and that this association became stronger as the DAN activity decreased until a limit of DAN activity of 944.9, after which the hippocampal volume was no longer significantly related to word-list memory performance. For the VAN, we found that a higher hippocampal volume was more strongly associated with better memory performance when VAN activity was higher. However, when VAN activity extended beyond -914.6, the hippocampal volume was no longer significantly associated with word-list memory.
UNASSIGNED: Our results suggest that attentional networks help to maintain memory performance in the face of age-related structural decline, meeting the criteria for the neural implementation of cognitive reserve.

This study examined whether participants with poor activities of daily living (ADLs) at hospital discharge had increased weight loss after 6 months of follow-up and whether nutrition therapy can prevent this weight loss. This dietary randomized controlled trial (N = 104) examined community-dwelling older adults (66-95 years) discharged from hospital and at risk for malnutrition, receiving either 6 months of nutrition therapy (intervention) or only standard care (control). ADL was assessed using seven questions on self-care based on the Katz et al.\'s method. At discharge, 45 (43%), 36 (35%), and 23 (22%) had high, medium, and poor ADL, respectively, with no differences between the control and intervention groups according to chi-square test. Participants in the control group with poor ADL had significantly higher weight loss than participants with high ADL (age- and sex-adjusted analysis of covariance: 3.6 kg; 95% confidence interval [1.0, 6.1] kg, p = .007). No such difference was observed in the intervention group. Participants with poor ADL at hospital discharge develop lower body weight by around 3.5 kg 6 months later when compared with participants with high ADL. Receiving nutrition therapy could help older adults with poor ADL to maintain body weight after hospital discharge.

This randomized controlled pilot study compared the efficiency of exercise on a vibration machine combined with needle therapy versus needle therapy alone in managing fibromyalgia symptoms and well-being among older adults. Conducted at King Khalid Hospital in Alkharj, Saudi Arabia, the study involved eighty-six patients aged 60 to 67 years. Participants were randomly assigned to either the VENT (Vibration Exercise Device) group or the NT (Needle Therapy) group. The VENT group underwent 10-minute vibration training sessions twice a week, paired with 30-minute needle acupuncture sessions once a week, while the NT group received needle therapy alone. Both interventions were carried out over 12 weeks. Pre- and post-intervention assessments measured disability, pain, balance, and quality of life. Data analysis showed that 94.1% of participants completed the study, with significant improvements in disability observed in the VENT group. Both groups demonstrated significant improvements in pain, balance, and well-being. However, post-intervention comparisons favored the VENT group, showing significantly better outcomes. The findings suggest that combining vibratory exercise with needle therapy offers enhanced benefits for older adults with fibromyalgia.

BACKGROUND: Frailty Index (FI) reflects health, functioning and well-being of older people. It is valuable to compare how frailty has changed over time in ageing cohorts. This study aims to examine trends in frailty among 75-95-year-old men and women over three decades.
METHODS: The Helsinki Ageing Study started in 1989 and includes repeated cross-sectional postal surveys every 10 years examining community-dwelling cohorts of older people (75, 80, 85, 90 and 95 years). FI comprises the same 36 items in each cohort.
RESULTS: The mean FI was 0.22 (SD 0.12), 0.25 (SD 0.15), 0.26 (SD 0.15) and 0.23 (SD 0.15) in 1989, 1999, 2009 and 2019, respectively (P for linearity for crude values .11). Adjusted for age and sex, the four cohorts differed in their frailty the 2019 cohort having the lowest FI. This sex-adjusted difference was seen among 75-, 80-, 85- and 90-year-olds but not among 95-year-olds. FI decreased more among men than women (P for cohort <.001, P for sex <.01, P for interaction = .19).
CONCLUSIONS: The prevalence of frailty among community-dwelling individuals aged 75, 80, 85 and 90 years-but not among those aged 95 years-has significantly decreased over the last decades. This positive trend may have important implications for health policies in societies with increasing longevity.

BACKGROUND: The use of wearable monitoring devices (WMDs), such as smartwatches, is advancing support and care for community-dwelling older adults across the globe. Despite existing evidence of the importance of WMDs in preventing problems and promoting health, significant concerns remain about the decline in use after a period of time, which warrant an understanding of how older adults experience the devices.
OBJECTIVE: This study aims to explore and describe the experiences of community-dwelling older adults after receiving our interventional program, which included the use of a smartwatch with support from a community health workers, nurses, and social workers, including the challenges that they experienced while using the device, the perceived benefits, and strategies to promote their sustained use of the device.
METHODS: We used a qualitative descriptive approach in this study. Older adults who had taken part in an interventional study involving the use of smartwatches and who were receiving regular health and social support were invited to participate in focus group discussions at the end of the trial. Purposive sampling was used to recruit potential participants. Older adults who agreed to participate were assigned to focus groups based on their community. The focus group discussions were facilitated and moderated by 2 members of the research team. All discussions were recorded and transcribed verbatim. We used the constant comparison analytical approach to analyze the focus group data.
RESULTS: A total of 22 participants assigned to 6 focus groups participated in the study. The experiences of community-dwelling older adults emerged as (1) challenges associated with the use of WMDs, (2) the perceived benefits of using the WMDs, and (3) strategies to promote the use of WMDs. In addition, the findings also demonstrate a hierarchical pattern of health-seeking behaviors by older adults: seeking assistance first from older adult volunteers, then from social workers, and finally from nurses.
CONCLUSIONS: Ongoing use of the WMDs is potentially possible, but it is important to ensure the availability of technical support, maintain active professional follow-ups by nurses and social workers, and include older adult volunteers to support other older adults in such programs.

UNASSIGNED: The aging society in Japan is progressing rapidly compared with that in the United States and European countries. Aging limits activities of daily living (ADL) in older adults, declining their lives and functions at home. Therefore, improving their ADL to effectively support their functioning at home for as long as possible is vital. Consequently, supporters need to have a common understanding, be promptly aware of the decline in ADL, and quickly introduce rehabilitation. The Functional Independence Measure (FIM) and Barthel Index (BI) are the main scales used to quantitatively assess ADL. However, previous studies have reported that FIM requires specialized knowledge for evaluation, and BI does not appropriately capture changes in ADL. The Self-Assessment Burden Scale-Motor (SAB-M) was developed as a scale for family caregivers to appropriately assess changes in ADL in older adults. Previous studies using the SAB-M have confirmed its reliability and validity in hospitalized patients as assessed by their family caregivers. Therefore, this study aimed to investigate the reliability and validity of the SAB-M among community-dwelling older adults as assessed by their family caregivers.
UNASSIGNED: This study included community-dwelling older adults who received home-visit rehabilitation at the first author\'s facility between October 2020 and December 2020 in Japan. Following previous studies, the SAB-M was used by family caregivers to assess 20 older adults twice for intra-rater reliability. Furthermore, 168 older adults were evaluated by family caregivers for internal consistency using the SAB-M. For criterion validity, the SAB-M was used for the assessment by family caregivers, and therapists used the FIM-Motor (FIM-M). This study used the weighted kappa, Cronbach\'s alpha, and Spearman\'s rank correlation coefficients for the statistical analysis of intra-rater reliability, internal consistency, and criterion validity, respectively.
UNASSIGNED: The weighted kappa coefficient for the total score was 0.98 (p < 0.01) and individual item, it was 0.93 for feeding (p < 0.01), 0.91 for bathing (p < 0.01), 0.98 for dressing (p < 0.01), 0.94 for transfer (p < 0.01), 0.94 for walking/wheelchair (p < 0.01), 0.95 for stairs (p < 0.01), and 0.96 for bladder management (p < 0.01). The Cronbach\'s alpha was 0.93 for the seven items. The Spearman\'s rank correlation coefficient between the SAB-M and FIM-M scores was 0.91 (p < 0.01).
UNASSIGNED: The SAB-M has sufficient reliability and validity among community-dwelling older adults. Family caregivers can routinely assess changes in the ADL of community-dwelling older adults using the SAB-M, enabling them to promptly consider introducing rehabilitation when older adults\' ADL declines. Therefore, implementing SAB-M helps older adults live and function at home for as long as possible.

OBJECTIVE: To develop a Screening for Oral Frailty Tool (SOFT) and evaluate its reliability and validity among Chinese community-dwelling older adults.
METHODS: Cross-sectional analysis.
METHODS: The study was conducted as part of an ongoing community-based prospective study in Shanghai. A total of 307 older adults, aged between 60 and 96 years, participated in the study.
METHODS: This study was conducted in 3 stages: item development, scale development, and scale evaluation. This study was based on a visual model depicting the deterioration of oral function, and a draft scale was generated based on a literature review, existing scales, expert consultations, and cognitive interviews. Between December 2023 and February 2024, the validity and reliability of the SOFT were evaluated using a questionnaire administered to 307 community-dwelling older adults. Data including demographics, frailty, and sarcopenia were collected.
RESULTS: The oral frailty scale comprises 6 items, including number of teeth, difficulty in swallowing, difficulty in chewing, difficulty in articulatory oral motor, dry mouth, and oral pain, and is assessed using a yes or no question. The correlations ranged from 0.40 to 0.66 when correlating each item with the total score of the scale. Using frailty and sarcopenia as criteria, the area under the curve for the SOFT was 0.71. The optimal cutoff for the SOFT was 2, using frailty as a criterion, with a higher Youden index and a high negative predictive value (94.9%), but a low positive predictive value (19.3%). The SOFT showed low internal consistency (Kuder-Richardson formula 20 coefficients 0.50) and good test-retest reliability (intraclass correlation coefficients 0.86).
CONCLUSIONS: The SOFT does not require specialized equipment and is not affected by cultural differences. It can be used for oral frailty screening in Chinese community-dwelling older adults and is simple and rapid.

BACKGROUND: Out-of-home mobility, defined as active and passive movement through external environments, is a resource for autonomy, quality of life, and self-realization in older age. Various factors influence out-of-home mobility, primarily studied in urban settings. The study aims to examine associated factors in a study population aged 75 and above in rural areas.
METHODS: Baseline data from the MOBILE trial involving 212 participants aged 75 and above and collected between June 2021 and October 2022 were analyzed. Out-of-home mobility was measured temporally as time out of home (TOH) and spatially as convex hull (CHull) using GPS over seven days. Mixed models considered outpatient care parameters as well as personal, social, and environmental factors along with covariates such as age and gender.
RESULTS: Participants in the MOBILE study (average age 81.5; SD: 4.1; 56.1% female) exhibited average out-of-home mobility of TOH: 319.3 min (SD: 196.3) and CHull: 41.3 (SD: 132.8). Significant associations were found for age (TOH: ß = -0.039, p < 0.001), social network (TOH: ß = 0.123, p < 0.001), living arrangement (CHull: ß = 0.689, p = 0.035), health literacy (CHull: ß = 0.077, p = 0.008), sidewalk quality (ß = 0.366, p = 0.003), green space ratio (TOH: ß = 0.005, p = 0.047), outpatient care utilization (TOH: ß = -0.637, p < 0.001, CHull: ß = 1.532; p = 0.025), and active driving (TOH: ß = -0.361, p = 0.004).
CONCLUSIONS: Previously known multifactorial associations related to objectively measured out-of-home mobility in old age could be confirmed in rural areas. Novel and relevant for research and practice is the significant correlation between out-of-home mobility and outpatient care utilization.
UNASSIGNED: HINTERGRUND: Außerhäusliche Mobilität, definiert als aktives und passives Bewegen durch außerhäusliche Umwelten, ist eine Ressource für Autonomie, Lebensqualität und Selbstverwirklichung im Alter. Beeinflusst wird diese multifaktoriell, was bisher vor allem im urbanen Raum untersucht wurde. Ziel der Studie ist es, assoziierte Faktoren in einer ländlichen Studienpopulation ab 75 Jahren zu untersuchen.
METHODS: Baseline-Daten der MOBILE-Studie von 212 Personen ab 75 Jahren erhoben zwischen Juni 2021 und Oktober 2022 gingen in die Analysen ein. Außerhäusliche Mobilität (GPS-basiert an 7 aufeinanderfolgenden Tagen) wurde zeitlich als Time out of Home (TOH) sowie räumlich als Convex Hull (CHull) gemessen. Gemischte Modelle berücksichtigten neben ambulanten Versorgungsparametern persönliche, soziale und umweltbezogene Faktoren sowie Kovariaten wie Alter und Geschlecht.
UNASSIGNED: Die Teilnehmenden der MOBILE-Studie (MAlter 81,5, SD: 4,1, davon 56,1 % weiblich) zeigten eine tägliche außerhäusliche Mobilität von MTOH: 319,3 min; SD: 196,3 und MCHull: 41,3; SD: 132,8. Signifikante Assoziationen wurden für Alter (TOH: ß = −0,039; p < 0,001), soziales Netzwerk (TOH: ß = 0,123; p < 0,001), Zusammenleben (CHull: ß = 0,689; p = 0,035), Gesundheitskompetenz (CHull: ß = 0,077; p = 0,008), Gehwegqualität (ß = 0,366; p = 0,003), Grünflächenanteil (TOH: ß = 0,005; p = 0,047), ambulante Versorgungsinanspruchnahme (TOH: ß = −0,637; p < 0,001, CHull: ß = 1,532; p = 0,025) und aktives Autofahren (TOH: ß = −0,361; p = 0,004) gefunden.
CONCLUSIONS: Bereits bekannte multifaktorielle Assoziationen mit objektiv gemessener außerhäuslicher Mobilität konnten im ländlichen Raum bestätigt werden. Neuartig und für Forschung und Praxis relevant ist der signifikante Zusammenhang außerhäuslicher Mobilität mit der Versorgungsinanspruchnahme.