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Need for quantifying malnutrition awareness among community-dwelling older adults and identifying factors associated with malnutrition awareness.
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As the global population continues to age, maintaining the physical performance and independence of older adults has become a critical public health concern. Population ageing describes a simultaneous increase in the number of older adults and the growth of the oldest- old demographic, which poses substantial societal, economic, and health-related challenges. Worldwide, it has been estimated that by 2050, one in six people will be over the age of 65. In the Netherlands, the number of individuals aged 65 years and older has been predicted to increase from 19.2% in 2020 to 26.5% in 2050, with the number of individuals aged 80 years and older doubling. As a consequence, a growing number of individuals will experience a decline in physical function, which is a critical determinant of maintaining independence, autonomy, and active participation. Muscle strength and power, fundamental components of physical functioning, progressively deteriorate with advancing age, increasing the demand of healthcare systems and contributing to rising health care costs. However, engaging in regular physical activity can attenuate both the individual and societal impacts of ageing by preserving functional capacity, enhancing overall well-being, and promoting social participation. To improve physical functioning in older adults, targeted interventions should incorporate physical activity and emphasize physical functioning as a key determinant of maintaining independence.
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Introduction: Fall rates and fall-related injuries among community-dwelling older adults (≥65 years) are expected to increase rapidly, due to the aging population worldwide. Fall prevention programs (FPPs), consisting of strength and balance exercises, have been proven effective in reducing fall rates among older adults. However, these FPPs have not reached their full potential as most programs are under-enrolled. Therefore, this study aims to identify promising strategies that promote participation in FPPs among community-dwelling older adults. Methods: This is an exploratory qualitative study. Previously, barriers and facilitators for participation in FPPs by older adults had been identified. Next, six strategies had been designed using the Intervention Mapping approach: (1) reframing; (2) informing about benefits; (3) raising awareness of risks; (4) involving social environment; (5) offering tailored intervention; (6) arranging practicalities. Strategies were validated during semi-structured interviews with communitydwelling older adults (n = 12) at risk of falling. Interviews were audio-recorded, transcribed, and analyzed following a qualitative thematic methodology, with a hybrid approach. Results: All strategies were considered important by at least some of the respondents. However, two strategies stood out: (1) reframing ‘aging’ and ‘fall prevention’: respondents preferred to be approached differently, taking a ‘life course’ perspective about falls, and avoiding confronting words; and (2) ‘informing about benefits’ (e.g., ‘living independently for longer’); which was mentioned to improve the understanding of the relevance of participating in FPPs. Other strategies were considered important to take into account too, but opinions varied more strongly. Discussion: This study provides insight into potential strategies to stimulate older adults to participate in FPPs. Results suggest that reframing ‘aging’ and ‘fall prevention’ may facilitate the dialogue about fall prevention, by communicating differently about the topic, for example ‘staying fit and healthy’, while focusing on the benefits of participating in FPPs. Gaining insight into the strategies’ effectiveness and working mechanisms is an area for future research. This could lead to practical recommendations and help professionals to enhance older adults’ participation in FPPs. Currently, the strategies are further developed to be applied and evaluated for effectiveness in multiple field labs in a central Dutch region (Utrecht).
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Background: As the number of older adults increases worldwide, understanding their mental health is crucial, including the impact of traumatic experiences that can lead to posttraumatic stress disorder (PTSD). However, validated screening and diagnostic instruments for PTSD in older adults are limited. Objective: We sought to provide a comprehensive summary of the diagnostic accuracy of PTSD screening and diagnostic instruments used in older adults (Mage ≥ 60 years). Method: A systematic search of MEDLINE, EMBASE, PsycINFO and Web of Science databases was conducted for January 1980 through 10 January 2025. Studies that focused on the psychometric properties of PTSD instruments in older adults were included. Results: Out of 21,197 publications screened, only 40 studies including 24 instruments met the eligibility criteria. Only seven were conducted with participants from the general population or primary care patient samples. There were 14 relevant studies in the last ten years, with only six based on the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria. Validation studies conducted in non-Western and/or non-English speaking older adult samples are rare. Conclusions: There is a shortage of validation studies of PTSD screening and diagnostic tools in the general older adult population. We recommend using the Clinician-Administered PTSD Scale for DSM-5 in clinical practice. It is the gold standard for assessing current and lifetime PTSD in the general population. Further research is required to establish evidence-based clinical cut-off scores and cross-cultural validity for PTSD screening in different populations of older adults. Future studies should also assess measures that consider the multimorbidity in this population (e.g. cognitive impairment and other psychiatric or medical disorders) and are easy to administer in clinical practice.
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Introduction: Falls and fall-related injuries in community-dwelling older adults are a growing global health concern. Despite effective exercise-based fall prevention programs (FPPs), low enrollment rates persist due to negative connotations associated with falls and aging. This study aimed to investigate whether positive framing in communication leads to a higher intention to participate in an FPP among community-dwelling older adults. Methods: We conducted a twosequence randomized crossover study. We designed two flyers, a standard flyer containing standard terminology regarding FPPs for older adults, and a reframed flyer highlighting fitness and activity by reframing ‘fall prevention’ as an ‘exercise program’ and ‘old’ as ‘over 65 years’. With a Mann– Whitney U test, we investigated group differences regarding the intention to participate between the flyers. A sensitivity analysis and subgroup analyses were performed. We conducted qualitative thematic analysis on open-ended answers to gain a deeper understanding of participants’ intention to participate. Results: In total, we included 133 participants. Findings indicated a significantly higher intention to participate in the reframed flyer (median = 4; interquartile range = 1–6) compared to the standard flyer (median = 2; interquartile range = 1–4) (p = 0.038). Participants favored more general terms such as ‘over 65 years’ over ‘older adults’. Older adults who were female, not at high fall risk, perceived themselves as not at fall risk, and maintained a positive attitude to aging showed greater receptivity to positively-framed communications in the reframed flyer. Additionally, already being engaged in physical activities and a lack of practical information about the FPP appeared to discourage participation intentions. Discussion: The results in favor of the reframed flyer provide practical insights for designing and implementing effective (mass-)media campaigns on both (inter)national and local levels, as well as for interacting with this population on an individual basis. Aging-related terminology in promotional materials hinders engagement, underscoring the need for more positive messaging and leaving out terms such as ‘older’. Tailored positively framed messages and involving diverse older adults in message development are essential for promoting participation in FPPs across various population subgroups to promote participation in FPPs among community-dwelling older adults.
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Background To gain insight into the role of plantar intrinsic foot muscles in fall-related gait parameters in older adults, it is fundamental to assess foot muscles separately. Ultrasonography is considered a promising instrument to quantify the strength capacity of individual muscles by assessing their morphology. The main goal of this study was to investigate the intra-assessor reliability and measurement error for ultrasound measures for the morphology of selected foot muscles and the plantar fascia in older adults using a tablet-based device. The secondary aim was to compare the measurement error between older and younger adults and between two different ultrasound machines. Methods Ultrasound images of selected foot muscles and the plantar fascia were collected in younger and older adults by a single operator, intensively trained in scanning the foot muscles, on two occasions, 1–8 days apart, using a tablet-based and a mainframe system. The intra-assessor reliability and standard error of measurement for the cross-sectional area and/or thickness were assessed by analysis of variance. The error variance was statistically compared across age groups and machines. Results Eighteen physically active older adults (mean age 73.8 (SD: 4.9) years) and ten younger adults (mean age 21.9 (SD: 1.8) years) participated in the study. In older adults, the standard error of measurement ranged from 2.8 to 11.9%. The ICC ranged from 0.57 to 0.97, but was excellent in most cases. The error variance for six morphology measures was statistically smaller in younger adults, but was small in older adults as well. When different error variances were observed across machines, overall, the tablet-based device showed superior repeatability. Conclusions This intra-assessor reliability study showed that a tablet-based ultrasound machine can be reliably used to assess the morphology of selected foot muscles in older adults, with the exception of plantar fascia thickness. Although the measurement errors were sometimes smaller in younger adults, they seem adequate in older adults to detect group mean hypertrophy as a response to training. A tablet-based ultrasound device seems to be a reliable alternative to a mainframe system. This advocates its use when foot muscle morphology in older adults is of interest.
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Background Psychiatric comorbidity is high in adults with posttraumatic stress disorder (PTSD), with up to 90% having at least one additional condition, and two-thirds having two or more other diagnoses. With an increasing aging population in industrialized counties, knowing which psychiatric disorders frequently co-occur in older adults with PTSD can have implications to improve diagnosis and treatment. This systematic literature review explores the current empirical literature on psychiatric comorbidity in older adults with PTSD. Method Literature databases PubMed, Embase, PsycINFO, and CINAHL were searched. The following inclusion criteria were applied: research done since 2013, PTSD diagnosis based on diagnostic criteria according to Diagnostic and Statistics Manual-Fifth Edition, International Classification of Diseases—10th Revision (ICD-10), or ICD-11, and studies include individuals aged 60 years or older. Results Of 2068 potentially relevant papers identified, 246 articles were examined based on titles and abstracts. Five papers met the inclusion criteria and were included. Major depressive disorder and alcohol use disorder were the most frequently studied and diagnosed psychiatric comorbidities in older adults with PTSD. Conclusions and implications Screening for depression and substance use in older adults should include an assessment of trauma and PTSD. Additional studies in the general older adult population with PTSD and a broader range of comorbid psychiatric disorders are needed.
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Post-traumatic stress disorder (PTSD) is a disabling mental health disorder affecting psychosocial functioning and quality of life. This systematic review is the first to summarize existing global literature on the relationship between PTSD and specific domains of cognitive function in the general population of older adults. We searched PsycINFO, Medline and CINAHL up until November 1st 2024. Studies were included if they were longitudinal cohort or cross-sectional studies of adults aged 60 years and over with a clinical diagnosis of PTSD or subthreshold PTSD symptoms, reporting on any domain of cognitive functioning using a standardised measure. Eighteen good or satisfactory quality articles met criteria for this review, of which three were longitudinal cohort studies and fifteen were cross-sectional studies. PTSD was associated with significant accelerated general cognitive decline and possible accelerated decline in attention and memory over time. Older adults with PTSD additionally performed significantly worse on measures of global cognitive function and memory compared to those without PTSD. For executive function results were mixed; two studies showed significant negative associations, whereas four other studies showed no significant differences between individuals with and without PTSD. Proactive screening of individuals with PTSD for cognitive decline and an additional focus of PTSD treatment on cognitive functioning are needed.
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Background: Most studies on older adults' vitality focus on linear connections between determinants and outcomes. To design more comprehensive and impactful approaches to support the vitality of older adults, a better understanding of the interplay among elements that shape their vitality is necessary. Objective: To uncover the underlying dynamic system that drives vitality in older adults, drawing directly from older adults' perspectives. Methods: During three group model-building sessions with 10–12 older adults (≥ 55 years old), a causal loop diagram with relevant feedback loops was developed through co-creation with older adults. The construction and analysis of the causal loop diagram were facilitated using the online modelling tools Vensim and Kumu. The group model-building sessions were guided by Scriptapedia, an online guide to conducting group model-building practices. Results: The final CLD consisted of 15 elements contributing to older adults' vitality, organised into three themes: ‘Psychological and emotional elements’, ‘Social connections and support’ and ‘Lifestyle and habits’. A total of 41 reinforcing feedback loops were identified, with 21 involving all three themes, 15 connecting two themes and 5 within a single theme. Conclusions: This study displays the complex interplay of elements influencing older adults' vitality, highlighting the critical roles of psychological, social and lifestyle-related elements. The participatory-led approach yielded co-produced insights that inform public health strategies, underscoring the need for comprehensive, multidisciplinary approaches to promote older adults' vitality. Such approaches must offer social opportunities and foster individuals' capacity and motivation to engage in meaningful social relationships. Patient or Public Contribution: The study was conducted in collaboration with a municipal policymaker and a coordinator of local community centres, who provided input on participant recruitment, materials, data interpretation, ethical considerations and result dissemination. During data collection, twelve older adults participated in three group model-building sessions, collaboratively developing a causal loop diagram to explore elements of vitality and their interconnections. Ongoing member checking with participants throughout the process ensured the analysis was refined and the researchers' interpretations were validated.
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Previous research shows that power training can increase power output in older adults and may also improve physical performance, physical functioning, and independence. However, power training interventions have not been optimized for older adults. The aim of this study was to assess the feasibility and preliminary effectiveness of a power training program called Powerful Ageing in older adults. A total of 28 older adults participated in a 12-week power training intervention at an intensity of 20-30% 1RM. The primary outcome, feasibility, was assessed through intervention retention, adherence (attendance and compliance), and safety. Secondary outcomes were measured in health domains of the ICF. In the function domain, muscle power and anaerobic power were assessed using a weighted squat and Wingate test, respectively. In the activities domain, physical performance was measured using the 6-minute walk test, and in the participation domain, physical activity in daily life and health status were evaluated using an accelerometer and the SF-36 questionnaire, respectively.
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