The exploration of interventions to delay aging is an emerging topic that promotes healthy aging. The multidomain intervention has the potential to be applied in the field of aging because it concentrates on the functional ability of older adults. There is currently no literature reporting on a multidomain intervention involving cognition, exercise and nutrition for delaying aging.

The Multidomain Intervention for Delaying Aging in Community-dwelling Older Adults (MIDA) is a Zelen-design randomized controlled trial with a 6-month intervention duration. The multidomain intervention comprises cognitive training, exercise training, and nutritional guidance, delivered through both group sessions and individual family interventions. A total of 248 participants aged 60 to 85 years will be randomized to the intervention group or control group and followed up for 12 months. The primary outcome is the change in epigenetic age acceleration and pace of aging following the multidomain intervention. The secondary outcomes are the changes in frailty score and intrinsic capacity Z-score. Other outcomes include physical functions, body composition, aging biomarkers, inflammatory markers, haematology and biochemistry parameters, and lifestyle factors.

This study will explore the effects of the multidomain intervention on delaying aging in community-dwelling older adults. We aim to introduce a new approach to delaying aging and offer a practical multidomain intervention strategy for healthcare institutions.

We aimed to elucidate the role of Angiotensin II type 1 receptor (AT1R) blocker usage in muscle wasting and dysfunction related to HIV.

Appendicular skeletal muscle mass, higher and lower limb strength, and physical fitness were determined in people living with HIV (PWH) using AT1R blockers users (n = 33), angiotensin-converting enzyme (ACE) inhibitors (n = 28), or not using antihypertensive drugs (n = 33). Groups had similar age, sex, race, BMI, and time of HIV infection. Muscle biopsies were performed to determine the abundance of AT1R, the relative abundance of selected proteins related to proteolysis, antioxidant enzymes, and oxidative stress. Plasma angiotensin II, IL-6, and TNF-alpha were also determined.

PWH using AT1R blocker presented higher strength, physical fitness, and muscle mass than PWH using ACE inhibitors or not using antihypertensive drugs. Although both PWH using AT1R blockers and ACE inhibitors presented reduced angiotensin II plasma levels, only PWH using AT1R blockers presented lower skeletal muscle AT1R activation, lower plasma oxidative stress markers, lower skeletal muscle oxidative stress (4-HNE), and proteolysis markers (Atrogin-1, Murf-1).

AT1R blocker usage protects against oxidative stress and activated proteolysis, contributing to the prevention of muscle wasting and dysfunction among PWH.

BackgroundOlder adults with mobility dysfunction are at risk for falls, hospitalization, and death. In an earlier pilot study, individuals with asymptomatic carotid artery stenosis (ACAS) demonstrated mobility dysfunction when compared to individuals without ACAS. We tested whether carotid stenosis affected mobility function in a larger community-dwelling cohort using the Invecchaire in Chianti (InCHIANTI) database.MethodsWe analyzed data from participants in the InCHIANTI study who completed a medical history, carotid duplex testing, and mobility function testing (Short Physical Performance Battery- SPPB). Participants with a history of stroke, transient ischemic attack, or carotid endarterectomy were excluded. 709 participants met inclusion criteria (116 ACAS, 593 no ACAS). Our analytic approach sought to evaluate the impact of stenosis on mobility after accounting for age, sex and cardiovascular risk factors. Age was stratified into 2 age-groups (65-74 and 75-84 years). Two-way ANOVA was used to test the effect of stenosis-group, age-group, and their interactions on SPPB score with sex as a covariate.ResultsStenosis-group (P = 0.0002), age-group (P < 0.0001), and the interaction between stenosis-group and age-group (P = 0.0008) significantly affected SPPB. Post-hoc testing showed that participants with ACAS demonstrated worse performance on the SPPB (9.81 ± 0.37) compared to those with no ACAS (11.10 ± 0.11) in the 65-74 years age-group (P < 0.0001).Conclusions65-74-year-old adults with ACAS performed significantly worse on the SPPB than those without ACAS. These results lend further support that ACAS may be associated with mobility dysfunction in older adults.

To examine the relationship between body mass index (BMI), abdominal adiposity, handgrip strength and physical function in people with HIV (PWH), and to explore the potential influence of physical activity and diet on this relationship.

Cross-sectional analyses.

The PROSPER-HIV Study was conducted at four clinical sites across the United States. Eligible participants were on antiretroviral therapy and had a viral load less than 200 copies/ml. Measures included: handgrip strength; physical function, assessed with the Short Physical Performance Battery (SPPB); BMI; abdominal adiposity, estimated using waist circumference; physical activity levels, measured using accelerometers; and diet quality, measured using triple-pass 24-h recalls. Data were analyzed using quantile regression between covariates and median of the outcomes.

Among PWH [ n  = 409, 59 years old (51.0-65.0), 76.5% male], 71.4% were overweight or obese, 72.4% had high waist circumference, 12.7% had low handgrip strength, and 11.5% had low SPPB. After controlling for age and sex, there was a negative association between SPPB and waist circumference ( β  = -0.011, P  = 0.02). When physical activity and diet variables were considered in the model, moderate-to-vigorous physical activity (MVPA) and step count were significant ( P  < 0.05) and influenced the relationship between waist circumference and SPPB. Although there was a moderate negative correlation between waist circumference and SPPB for the lowest quartiles of MVPA and steps, this correlation weakens as the activity levels increase.

Increased abdominal adiposity is associated with poorer physical function among PWH. Participants with higher MVPA and steps presented higher physical function even in the presence of high waist circumference.

Recent research has explored frailty in systemic lupus erythematosus using multiple measures. We examined the agreement among frailty measures and the association of each with cross-sectional and longitudinal health outcomes.

We used data from the California Lupus Epidemiology Study to examine the following measures of frailty: Systemic Lupus International Collaborating Clinics (SLICC) Frailty Index (SLICC-FI), Short Physical Performance Battery (SPPB), and Fatigue, Resistance, Ambulation, Illness, and Loss of Weight (FRAIL) scale questionnaire. Patient-Reported Outcomes Measurement Information System Physical Function 10a (PF) was tested as a proxy measure of frailty. Agreement between frailty classifications by each measure was assessed. Cross-sectional associations of frailty classifications with hospitalization, valued life activities disability, cognitive impairment, six-minute walk test distance, self-reported disease damage, fatigue, and depressive symptoms were assessed with logistic and linear regression analyses. Associations with hospitalization, disease damage increase, and disability increase over the subsequent three years were assessed by Cox proportional hazards analyses.

Percentages of participants identified as frail varied among the measures, from 10.8% to 45.9%. Agreement among classifications ranged from slight to substantial (k from 0.17 to 0.63). Most of the frailty measures were associated with both cross-sectional and longitudinal health outcomes, with the notable exception of the SPPB. SLICC-FI had the most consistent association with outcomes, followed by FRAIL and PF.

Multiple measures of frailty appear to identify the risk of poor health outcomes. The intended use, as well as the simplicity and practicality of implementing the measure, may be the most important considerations in choosing a frailty measure.

Sarcopenia is a syndrome of severe muscle wasting, associated with adverse outcomes related to liver transplantation (LT). There are several approaches used to identify sarcopenia. We aimed to investigate the prevalence of sarcopenia using 3 different criteria and determine how these performed in relation to clinical outcomes.

The cohort study included 237 adults with cirrhosis referred for LT. Sarcopenia was identified using (1) CT-defined; and the (2) original and (3) updated European Working Group on Sarcopenia in Older People criteria (EWGSOP1 and 2). Logistic regression was used to estimate OR and 95% CI for the relationships between sarcopenia and receiving an LT, unplanned admissions pre-LT, surgical complications, and length of stay for the LT admission. Fine-Gray competing risk analysis explored the impact of sarcopenia on receiving an LT and unplanned admissions. The AUC determined the predictive utility of the criteria.

The prevalence of CT-defined sarcopenia (52%) was more than twice and 4-fold that of EWGSOP1-defined (22%) and EWGSOP2-defined (11%) sarcopenia, respectively. No criteria demonstrated a significant association with time to LT nor the time to unplanned admissions pre-LT. Similarly, none of the 3 criteria had superior predictive utility for the clinical outcomes for unplanned hospital admissions pre-LT of receiving an LT, with all 3 criteria having identical moderate AUCs for unplanned admissions (0.70) and similar weak AUCs (≤0.55) for the likelihood of receiving an LT.

Sarcopenia in patients undergoing LT evaluation is prevalent. EWGSOP criteria appear to offer no advantage over CT-only criteria in identifying patients at increased risk of adverse LT outcomes. Bedside measures of muscle function may be of benefit in tracking the effectiveness of interventions targeting sarcopenia.

Cardiovascular disease (CVD) is associated with several risk and protective factors, including psychological variables, such as anxiety and depressive symptoms, stress and coping strategies. These factors may be either a cause or a consequence of CVD and are thought to influence the cardiac rehabilitation (CR) process after acute cardiac event, a multifaceted intervention that is crucial for reducing rehospitalisation and mortality. The main aim of this study was to correlate such psychological components with cardiac outcomes in a sample of 315 CVD referred to an in-hospital CR program.

Participants completed self-report questionnaires on perceived stress, anxiety and depressive symptoms, and coping styles.

Females (36.51 %) reported higher levels of depressive symptoms and turning to religion as a coping strategy compared to male. Perceived stress did not differ between male and female, but it was found to be significantly higher in heart failure patients, regardless of gender. Functional outcomes after a CR program were not predicted by any psychological variable, whereas clinical outcomes were predicted by depressive symptoms and coping strategies (social support and positive attitude). Finally, perceived health status was predicted by anxiety, depressive symptoms and avoidance.

These findings confirm the importance of conducting psychological screening in patients with CVD, as recommended by international guidelines, and highlight the need to provide them with adequate psychological support to reduce the adverse consequences of cardiac disease, and to promote protective attitudes and behaviours through tailored psychological interventions to improve outcomes after a CR program.

To date, most research investigating the influence of circulating sex hormones on ageing female skeletal muscle has been cross-sectional and focused only on dichotomised young and old, or pre- versus post-menopausal groups. This excludes an important transitional period from high to low circulating oestrogen. Using secondary data from the Baltimore Longitudinal Study of Aging, this study aimed to investigate cross-sectional and longitudinal associations between circulating sex hormones and skeletal muscle mass and function across a continuum of ages.

Multiple and binomial linear regression was used to map cross-sectional (n = 319) and longitudinal (n = 83) associations between circulating sex hormones (oestradiol (E2), free oestradiol index (FEI), total (TT) and bioavailable (BioT), testosterone, testosterone/oestradiol ratio (TT/E2)) and skeletal muscle mass and function in healthy females. Cross-sectional models analysed females across an ageing continuum (24-89 years) and longitudinal associations were tested across 4-6 years of ageing in females over 50 years old. Models were adjusted for age, height, physical activity, comorbidities, ethnicity, and follow-up time.

Cross-sectionally, serum E2 and FEI were positively associated with relative appendicular lean mass (ALM; β = 0.28 and 0.20, respectively, p < 0.05) and thigh muscle percentage (β = 0.19 and 0.15, respectively, p < 0.05). E2 and FEI were negatively associated with total body fat percentage (β = -0.30 and -0.21, respectively, p < 0.05). BioT was positively associated with absolute ALM (β = 0.13, p < 0.05) and total body fat percentage (β = 0.18, p < 0.05). TT was negatively associated with total body fat percentage (β = -0.14, p < 0.05). The TT/E2 ratio was negatively associated with thigh muscle CSA (β = -0.08, p < 0.05) and hamstring strength (β = -0.12, p < 0.05). Across 4-6 years, decreases in E2 and FEI were associated with a decrease in ALM (β = 0.27 and 0.41, respectively, p < 0.05), and a decrease in FEI was associated with a decrease in handgrip strength (β = 0.21, p < 0.05). Decreases in TT and BioT were associated with an increase in total body fat (β = -0.25 for both, p < 0.05) and a decrease in TT was associated with an increase in hamstring specific force (β = -0.11, p < 0.05).

This study demonstrates novel associations between sex hormone levels and skeletal muscle in females across a wide continuum of ages. We also demonstrate that longitudinal fluctuations in circulating sex hormones must be considered to gain a comprehensive understanding of female muscle ageing.

Exercise is an important tool which has been shown to help patients manage many of the side effects of their cancer treatment, reduce toxicities, and improve prognosis. The benefits of exercise have been well documented, however, performing regular exercise during treatment remains a challenge for most patients. The Flexible Individualised ExeRcise programme for cancer patients during ChEmotherapy (FIERCE) is an exercise programme that has been co-designed by healthcare professionals and people with a personal lived experience of chemotherapy. The primary aim of this study is to examine the feasibility of delivering the FIERCE programme for cancer patients during chemotherapy.

The FIERCE study is a randomised controlled feasibility trial which will include 50 participants who are scheduled to receive chemotherapy for the treatment of breast, colorectal, or ovarian cancer. Participants will be randomly allocated to Group 1: FIERCE programme, or Group 2: Self-managed pedometer programme in a 2:1 ratio. Participants will be enrolled in the study for the duration of their chemotherapy treatment. The primary outcome of feasibility will be measured using a mixed-methods approach. Secondary outcomes of cardiorespiratory fitness, muscular strength, skeletal muscle mass, physical function, fatigue, and quality of life will be measured at baseline (T0) and post-intervention (T1).

The FIERCE feasibility study aims to explore if a flexible, individualised exercise programme will support individuals to be active during chemotherapy treatment. If proven to be feasible, a large-scale randomised controlled trial will be undertaken focusing on the efficacy of the FIERCE programme on different health outcomes.

The study is registered with ClinicalTrials.gov, registration number: NCT06280885.

Standard assessment of physical function commonly involves evaluation of gait speed, balance, duration of repetitive sit-to-stand movements using the 5-times chair-rise test (CRT-5), and handgrip strength (HGS). However, reports involving longer versions of stand-alone sit-to-stand tests to evaluate functional fitness in older adults are hard to find in literature.

To investigate the strength of within-group relationships between duration, power and velocity using a 30-s chair-rise test (CRT-30) and physical performance, and to assess between-group differences in these relationships, in a large cohort of older adults.

Study participants (n = 73; age-range: 28-93 years; females: 50 males: 23) performed a longer protocol (CRT-30) at maximum voluntary speed. Chair-rise power (CRP), sit-to-stand (concentric) and stand-to-sit (eccentric) velocities were measured during trials. Anthropometric, Short Physical Performance Battery (SPPB) and HGS data collected with CRT-30 variables were analyzed in participants divided into three subsets (<50, 50-70 & >70 years).

Between-group differences significantly varied between CRT-30 measurements. CRT-30 duration, power and velocities demonstrated strong within-group correlations with SPPB and HGS measures, especially in the >70-year age-group (p < 0.01). CRT-30 and physical performance variables also showed significant between-group differences, especially for the >70 years age group.

CRT variables such as duration, power, sit-to-stand and stand-to-sit velocities exhibit stronger relationships with markers of physical function, especially in older adults.

Gout is the most common form of inflammatory arthritis. It is predominantly managed with pharmacological interventions, and physical impairments in people with gout have seldom been studied. We aimed to identify gout-related physical impairments that may be targeted by physical interventions.

Five electronic databases (Medline, AMED, EMBASE, APA PsycInfo, CINAHL) were searched from inception to April 2024, together with reference lists of all included articles. We included all study designs, except for singular case reports, conducted in people with gout, where at least one objective physical impairment outcome was reported. All title, abstract and full-text article eligibility screening was performed independently by two reviewers. Independent data extraction included design and setting, participant demographics, baseline characteristics, disease duration, physical impairment investigated, and method of assessment. Data synthesis was summarised descriptively.

Twenty-four articles were included. Most studies were cross-sectional designs in secondary care settings, 11 were performed in New Zealand. Participants' mean ages ranged from 41.3 (standard deviation (SD) not calculated) to 75.8 (SD 5.2) years. Participants were predominantly male. Gout duration ranged from 24 h to a mean of 28 years. Five broad categories of physical impairment were identified: lower extremity function, joint range of motion, strength, deformity, and Achilles tendon stiffness.

Based on limited evidence, the most commonly observed physical impairments are related to lower extremity function and joint range of motion. Our review identifies the need to better understand and quantify gout-related physical impairments before developing targeted physical interventions.

Chronic dizziness is common in older adults, yet frequently occurs without a clear cause ('idiopathic dizziness'). Patients experience subjective unsteadiness with minimal objective imbalance, potentially related to small vessel disease. Here we examine the hypothesis that this syndrome is associated with disrupted cortical processing of postural instability.

EEG and postural sway were recorded in 33 older adults with chronic, idiopathic dizziness (Age, Mean = 77.3 years, SD = 6.4, 61 % female) and 25 matched controls (Age, Mean = 76.9 years, SD = 6.0, 56 % female). EEG was time-locked to spontaneous instances of postural instability and analysed via time-frequency decomposition.

Significant between-group differences in EEG were observed during the early phase of postural instability (p < 0.05, cluster-corrected). Whilst controls exhibited broadband increase in EEG power across sensorimotor areas, dizzy patients displayed suppressed beta activity (19-24 Hz). Contrary to predictions, these differences did not relate to small vessel disease markers (rs < 0.05, ps > 0.720) but to fear of falling (r = -0.44, p = 0.001).

Previous work implies that suppressing cortical beta enhances the relay of sensory information. We therefore propose that the modulation in beta EEG observed in patients reflects an anxious, top-down strategy to increase sensitivity to instability, which paradoxically causes persistent feelings of subjective imbalance.

These results identify associations between idiopathic dizziness and disrupted sensorimotor beta activation during postural instability. Cortical beta during imbalance may be a possible biomarker of chronic, idiopathic dizziness in older adults and/or fear of falling.

This prospective cohort study assessed the impact of intrinsic capacity on hospital admissions among older adults after an Emergency Department (ED) visit. Assessing 1132 patients according to WHO's Integrated Care for Older People guidelines between March 1 and August 30, 2022, we found that 784 (69.26%) were admitted. The admission group demonstrated significantly lower intrinsic capacity scores (mean ± SD, 2.92 ± 1.29) compared to the discharge group (3.44 ± 1.23; p < .001). Multivariable logistic regression showed that higher intrinsic capacity scores were associated with lower odds of admission (adjusted odds ratio [aOR] = 0.81; 95% CI: 0.71-0.92; p < .001). Notably, patients with malnutrition had significantly higher odds of admission (OR = 3.12; 95% CI: 2.16-4.50; p < .001). These findings underscore the importance of integrating the intrinsic capacity assessment with traditional clinical indicators in the emergency care of older adults.

Shear wave elastography (SWE) can quantify muscle stiffness to reflect the muscle quality, and we explored the application of SWE in assessing physical performance. In this work, a total of 98 older adults, including 55 men and 43 women, were recruited in this cross-sectional study. Short physical performance battery (SPPB) and time-up-and-go (TUG) test were used to evaluate physical performance, and a dynamic SWE imaging for the flexor digitorum superficialis in the process of using grip strength meter was documented. The peak strength and peak shear wave velocities (SWV) were recorded, and the ratio of peak SWV to peak strength was defined as the standardized muscle contractive stiffness. For men, the peak SWV was negatively correlated to SPPB scores (r = -0.351 to -0.448, all P < 0.01) and positively correlated to TUG time (r = 0.299-0.369, all P < 0.05), and the standardized muscle contractive stiffness was significantly negatively correlated to SPPB scores (r = -0.501 to -0.532, all P < 0.01) and positively correlated to TUG time (r = 0.424-0.462, all P < 0.01). For women, the peak SWV was not correlated to physical performance, and the standardized muscle contractive stiffness was correlated to the TUG time (r = 0.312 for Cmax and 0.310 for Cmean, both P < 0.05). Those participants with decreased physical performance had significant higher standardized muscle contractive stiffness in both men and women (all P < 0.05). We proved that SWE can be applied in evaluating muscle function and the flexor digitorum superficialis contractive stiffness standardized by grip strength can be a potential indicator.

Gait analysis is crucial for diagnosing and monitoring various healthcare conditions, but traditional marker-based motion capture (MoCap) systems require expensive equipment, extensive setup, and trained personnel, limiting their accessibility in clinical and home settings. Markerless systems reduce setup complexity but often require multiple cameras, fixed calibration, and are not designed for widespread clinical adoption. This study introduces 3DGait, an artificial intelligence-enhanced markerless 3-Dimensional gait analysis system that operates with a single consumer-grade depth camera, providing a streamlined, accessible alternative. The system integrates advanced machine learning algorithms to produce 49 angular, spatial, and temporal gait biomarkers commonly used in mobility analysis. We validated 3DGait against a marker-based MoCap (OptiTrack) using 16 trials from 8 healthy adults performing the Timed Up and Go (TUG) test. The system achieved an overall average mean absolute error (MAE) of 2.3°, with all MAE under 5.2°, and a Pearson's correlation coefficient (PCC) of 0.75 for angular biomarkers. All spatiotemporal biomarkers had errors no greater than 15 %. Temporal biomarkers (excluding TUG time) had errors under 0.03 s, corresponding to one video frame at 30 frames per second. These results demonstrate that 3DGait provides clinically acceptable gait metrics relative to marker-based MoCap, while eliminating the need for markers, calibration, or fixed camera placement. 3DGait's accessible, non-invasive and single camera design makes it practical for use in non-specialist clinics and home settings, supporting patient monitoring and chronic disease management. Future research will focus on validating 3DGait with diverse populations, including individuals with gait abnormalities, to broaden its clinical applications.

Physical inactivity exacerbates muscle function and mass loss, increasing the risk of falls in older adults. Regular exercise can prevent muscle loss, cognitive decline, and comorbidities, potentially reducing fall risk. Given the multifactorial nature of fall risk, a comprehensive assessment is required.

To investigate the effects of a 40-week intervention, including a long-term exercise program (16-weeks), detraining (8-weeks), and retraining (16-weeks), on fall risk and cognitive status in older adults with mild cognitive impairment.

Participants (≥70 years old) were divided into two groups: Elastic Band Resistance Training (EBRT, n = 22) and a control group with no treatment (n = 20). Cognitive profile, body composition, muscle power, and multifactorial fall risk assessments (Timed Up-and-Go Test (TUG), Falls Efficacy Scale (FES), Fall Risk Assessment Tool (FRAT), and sensorimotor platform) were evaluated at four time points.

Significant correlations between muscle power, fat-free mass, and cognitive status with fall risk assessments were observed at baseline. Both phases of the exercise intervention improved muscle power, body composition, cognitive profile, and fall risk status. The EBRT group showed significant improvements in muscle power (p ≤ 0.01), fall risk (FRAT, p ≤ 0.01), FES (p ≤ 0.05), sensorimotor performance (p ≤ 0.001), TUG (p ≤ 0.001), and cognitive status (MoCA, p ≤ 0.05). Protective effects persisted during the detraining phase.

This study highlights significant improvements in fall risk assessment induced by EBRT, demonstrating its protective effects. The findings suggest that EBRT can enhance aspects related to fall risk, offering promising avenues for improving independence and quality of life in older adults prone to falls.

To explore the effectiveness of a NMES device in improving pain and function for individuals with KOA.

This was a randomised, sham-controlled, superiority trial recruiting individuals with symptomatic KOA, with both participants and outcome assessors blinded to the treatment allocation. Participants were randomised to receive either self-administered NMES, consisting of quadriceps (5 times a week) and footplate stimulation (7 times a week), or a sham device for 8 weeks. The primary outcome was the change in Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain domain at week 8.

179 participants were randomised; 50.8 ​% female, mean (SD) age 66.9 (8.7) years. 164 attended the follow up visit. No difference in the WOMAC pain domain was seen between groups (-0.7; 95 ​% CI: -1.5, 0.1; P ​= ​0.10), though within group improvements were reported in both groups (NMES: -1.5; 95 ​% CI: -2.0, 0.8; P ​< ​0.01, sham: -0.8; 95 ​% CI: -1.4, 0.2; P ​< ​0.01). There were no differences in strength, exercise and functional capacity, swelling, health related quality of life or anxiety and depression between groups. Sub-group analysis for NMES compliance or recruitment source did not change response in primary outcome.

Use of an NMES device on the quadriceps and plantar flexors did not enhance pain relief or improve function over the sham control in people with KOA.

Deconditioning is a complex process of physiological change following a period of inactivity. This can be observed in a clinical setting when hospital patients have prolonged periods of bed rest. Prolonged bed rest negatively affects health-related outcomes such as cardiovascular, respiratory and musculoskeletal function, and is linked to increased mortality. To combat deconditioning in patients, a functional resistance exercise intervention may be suitable to employ. Exercise interventions can successfully prevent and reverse muscle loss and functional decline, the main component of deconditioning.

This service evaluation investigates functional resistance training (FRT) as a preventive measure against inpatient deconditioning, conducted from September 2023 to January 2024 with 146 inpatients admitted to medical or orthopaedic wards. Inclusion criteria were age 65 years or older, ability to follow instructions, no baseline hoisting, and sufficient medical fitness. FRT was delivered by sport and exercise professionals. Outcome measures were strength and function-based and were completed pre- and post-intervention. Statistical analysis was conducted using IBM SPSS Statistics 29 (Windows). Normality was assessed via the Shapiro-Wilk test, with statistical significance set at p ≤ 0.05. Paired t-tests compared admission and discharge outcomes to evaluate the intervention's effectiveness. Spearman's ρ was used to assess correlations between engagement rate and each outcome measure. As this is an evaluation of a current service, with no additional interventions carried out, or additional data collected, ethics approval was not required.

Preliminary findings reveal high engagement (average 80%) and significant improvements (p ≤ 0.001) in muscle strength, grip strength, 30-s sit-to-stand test (30STS), and DeMorton's Mobility Index (DEMMI) post-FRT. Handheld dynamometry indicates a notable 30%-50% increase in muscle strength, while grip strength improved by 11%. However, a 20% reduction occurred in patients with < 50% engagement, suggesting deconditioning without FRT. The 30STS observed a 100% increase in repetitions, indicating improved lower limb strength. DEMMI scores showed a statistically significant enhancement in overall mobility post-intervention. Notably, 26 pathways were downgraded with over 80% engagement, suggesting FRT-engaged patients are more likely to downgrade.

The positive effects on muscle and grip strength, lower limb function, and overall mobility underscore FRT's potential as a valuable clinical intervention. Downgrades in discharge pathways suggest positive financial implications of FRT. Further research with larger samples and controlled designs is crucial for validating these findings and determining optimal FRT protocols in healthcare settings.

Cross-sectional studies demonstrate an association between low serum levels of vitamin D and slower gait speed in older individuals. However, longitudinal studies remain inconclusive. This study investigates whether vitamin D deficiency and insufficiency are risk factors for the incidence of slowness.

A total of 2815 participants from the English Longitudinal Study of Ageing (ELSA), aged ≥60 years and with a baseline gait speed >0.8 m/s, were followed for six years. Baseline serum levels of vitamin D [25(OH)D] were categorized as "sufficiency" (>50 nmol/L), "insufficiency" (>30 and ≤50 nmol/L) or "deficiency" (≤30 nmol/L). Gait speed was reassessed at four and six years of follow-up to identify incident cases of slowness (walking speed ≤0.8 m/s). A Poisson regression model, adjusted for sociodemographic, behavioural and clinical characteristics at baseline, was conducted to determine the association between serum 25(OH)D levels and the risk of slowness.

The incidence densities of slowness per 1000 person-years were 67.4 (95% CI: 60.93-74.64) for sufficiency, 76.7 (95% CI: 68.30-86.22) for insufficiency and 90.7 (95% CI: 78.46-104.92) for deficiency. Serum 25(OH)D deficiency was associated with a 22% increase in the risk of slowness (IRR: 1.22; 95% CI: 1.01-1.49) compared with serum 25(OH)D sufficiency. No significant association was observed for serum 25(OH)D insufficiency.

Serum 25(OH)D deficiency is a risk factor for the incidence of slowness in older individuals, suggesting that maintaining sufficient 25(OH)D levels could be a strategic approach to minimise long-term mobility impairment.

Major knowledge and practice gaps exist in aged care home services to support independence of older people with dementia. This research evaluates an adaptation of a community-based rehabilitation model for care homes, namely Interdisciplinary Care Home-bAsed Reablement Program (I-CHARP), by examining whether (and, if so, how) I-CHARP produces its intended effects and how this programme can be practicably implemented, sustained and scaled up across care homes in Australia.

I-CHARP is a 4-month bio-behavioural-environmental rehabilitation model of care, integrated in care home services, supported through the deployment of an implementation strategy, the Research Enabled Aged Care Homes (REACH) network. It consists of (1) 8-12 full individual sessions and additional eight brief follow-ups per resident, tailored to the resident's needs, delivered primarily by a team of an occupational therapist, registered nurse and other allied health staff; (2) environmental modifications/assistive devices up to the value of $400 per resident; and (3) engagement of intervention care home staff, managers and regular visitors. An overarching evaluation approach is participatory action research using a cluster quasi-experimental design and mixed methods. It involves testing of the implementation strategy (REACH network and other approaches) while observing/gathering information on the intervention (I-CHARP) and related outcomes in three cycles. Participants include residents (aged ≥ 60 years with early stages of dementia) and care staff from 16 care homes. Care quality indicators, health care costs, field notes and semi-structured interviews/focus groups with intervention site staff, regular visitors and managers will provide further insights into I-CHARP processes and implementation issues.

In the final phase of the project, an Agile Implementation Playbook will be developed for the delivery of reablement care that can be used in routine practice across care homes in Australia. The study findings will also inform future policy development and strategic directions for dementia care in care homes.

Australian New Zealand Clinical Trial Registry, ACTRN12623000885695 Registered 16 August 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386088.

1.0 dated 20 July 2023.

The association between peripheral arterial disease (PAD) as one of the chronic vascular diseases with decreased muscle endurance of the lower limbs has been reported in many studies. This study evaluated the correlation between calf strength measures with disease severity and its outcomes in patients with chronic limb ischemia.

This study was conducted on 53 patients with chronic limb ischemia referred to the Department of Vascular Surgery Taleghani Hospital, affiliated to Shahid Beheshti University of Medical Sciences between October 2020 and November 2021.

The strength measurements included the dorsiflexion strength (DFS) and plantar flexion strength (PFS) of the affected limbs, which were measured using a newly developed dynamometer. Disease severity evaluated with angiography and outcomes were evaluated in all patients for three months.

The mean age was 64.51 ± 9.3 years. The mean DFS and PFS were 13.55 ± 4.24 kg and 20.1 ± 8.29 kg, respectively. The need for invasive intervention was required in 42 (79.2%) patients. Amputation was performed in 21(39.6%). The multivariate analysis showed chronic limb ischemia severity (B: 7.11, 95% CI: 11.74, -2.46, P: 0.001), involvement level (B: 2.53, 95% CI: 4.03, -1.02, P: 0.042) and outcome type (B: 2.66, 95%CI: 4.22, -1.08, P: 0.039) were significantly related to DFS. The chronic limb ischemia severity (B: 3.89, 95%CI: 6.14, -1.64, P: 0.002) and level of involvement (B: 2.11, 95%CI: 3, -1.01, P:0.047) were significantly associated with PFS.

Our study showed that PFS and DFS were lower in patients with severe forms of chronic limb ischemia and those with simultaneous involvement of both above and below knee. DFS in patients requiring amputation was significantly lower than patients who did not require amputation during three months follow-up.

This study aimed to investigate the impact of nutritional status and frailty phenotype and the predictors of temporal changes on health-related quality of life (HRQoL) of patients with bladder or kidney cancer.

Frailty phenotype, Patient-Generated Subjective Global Assessment, and Quality-of-life questionnaire Core-30 were applied twice to patients diagnosed with bladder or kidney cancer. Patients also completed a sociodemographic questionnaire, and clinical data were collected from records.

Sixty-two individuals completed the study, mostly male, with a mean age of 62.5 (± 11.4) years. The median time of follow-up was 14.5 months. Role functioning, emotional functioning, and fatigue improved over time (p < 0.05). The factors that negatively affected the long-term quality of life summary score were being female, malnourished, pre-frail and frail, cancer treatment, performance status, and lower income. Using the multivariate model, being malnourished (β =  - 7.25; 95% CI, - 10.78 to - 3.71; p < 0.001), frail (β =  - 7.25; 95% CI, - 13.39 to - 1.11; p = 0.021), and each one-point increase in performance status (β =  - 6.9; 95% CI, - 9.54 to - 4.26; p < 0.001), were the ones that most negatively impacted the HRQoL between the two assessments.

This study confirmed that frailty, nutritional status, and performance status are the main predictors of HRQoL of patients with bladder or kidney cancer over time.

These findings may be the first step towards highlighting the importance of preventing malnutrition and frailty, in favor of a better long-term QoL for cancer patients.

Admission to hospital with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with a high risk of morbidity and mortality. Biologic treatment reduces COPD exacerbations in patients with eosinophilic inflammation. Mepolizumab, a monoclonal antibody to interleukin 5, reduces eosinophilic inflammation, but its effects on future hospitalization and mortality are uncertain.

In this phase 2b, double-blind, placebo-controlled trial, we randomly assigned patients hospitalized with an AECOPD and a blood eosinophil count greater than or equal to 300 cells/μl any time in the preceding 12 months to receive either mepolizumab 100 mg or placebo every 4 weeks for 48 weeks, with treatment initiated at hospital discharge. The primary end point was the time to readmission or death from any cause. Key secondary end points included the number of hospital readmissions, exacerbations, and health-related quality of life.

A total of 238 patients were randomly assigned. The median time to hospitalization or death due to any cause was 25.4 weeks and 26.1 weeks in the mepolizumab and placebo groups, respectively, with Kaplan-Meier estimates of 33.9% and 31.0%, respectively (hazard ratio, 0.96; 95% confidence interval [CI], 0.70 to 1.32; P=0.811). The adjusted mean number of hospital readmissions was 1.65 (95% CI, 1.25 to 2.05) with mepolizumab and 1.85 (95% CI, 1.42 to 2.29) with placebo (risk ratio, 0.89; 95% CI, 0.64 to 1.25). The adjusted mean number of moderate or severe exacerbations was 2.80 (95% CI, 2.36 to 3.23) with mepolizumab and 3.45 (95% CI, 2.94 to 3.95) with placebo (risk ratio 0.81; 95% CI, 0.66 to 1.00). The numbers of adverse events and serious adverse events were similar between groups. No serious adverse event was attributed to the intervention.

Patients hospitalized with an AECOPD and eosinophilic inflammation of greater than 300 cells/μl of blood within the prior 12 months, had no benefit in risk of time to readmission or death following treatment with mepolizumab for 48 weeks. The observed change in moderate or severe exacerbations, which included the null in the upper bound of the 95% confidence interval, was in the direction observed in previous trials. (Funded by GSK plc; ClinicalTrials.gov number, NCT04075331.).

Physical performance is crucial for healthy aging. Body composition has gained particular attention. Anthropometric measurements, specifically the waist-to-hip ratio (WHR) and the waist-to-height ratio (WHtR), have emerged as valuable indicators. This study aims to investigate the correlation between abnormal WHR and waist-to-height ratios with physical performance.

Data from the Longevity Check-up 8+ project were analyzed. Anthropometric measurements were used to calculate WHR and WHtR. Physical performance was evaluated through the chair stand test. ANCOVA assessed the impact of WHR and WHtR on physical performance, while Cox proportional-hazards models were used to assess the relation between WHR, WHtR and physical performance. ROC curves analyzed their predictive capability.

Among 10690 participants (mean age 57.0 ± 14.8 y; 54% females), men exhibited higher WHR and WHtR and a higher prevalence of abnormal values (61% and 71%). Women took longer to complete the chair stand test (7.9 ± 2.7 vs. 7.6 ± 2.4 seconds, p < 0.01). Abnormal WHR and WHtR were associated with poorer physical performance after adjusting for confounders (HR: 1.28; 95% CI: 1.08-1.53; HR: 1.32; 95% CI: 1.04-1.66). ROC curve analysis showed that WHtR had superior predictive capability to identify lower physical performance across age and gender groups.

Individuals with higher WHR and WHtR values demonstrated poorer physical performance, underscoring the importance of monitoring abdominal fat distribution as a predictor of functional health and aging-related outcomes.

Orthogeriatric units have demonstrated improvements in functional recovery and survival in older adults hospitalised for hip fracture. The aim of this study is to present preliminary results of the interdisciplinary orthogeriatric activity at the Surgical Specialty Centre, Hamad Medical Corporation (Doha, Qatar).

A prospective observational study was designed to evaluate the activity of the orthogeriatric unit in hip fracture patients between 2022 and 2024.

100 patients were recruited with a mean age of 74.2 (SD 7.8) years, 57% were men, and a mean age-adjusted Charlson comorbidity index (CCI) of 4.4 (SD 1.7). Surgical delay was 1.8 (SD 3.4) days, with only 16% of the total undergoing surgery in more than 48h. The length of stay (LOS) of the enrolled sample was 15.8 (SD 23.1) days. In terms of functional recovery, the Barthel Index (BI) score increased significantly from 34.8 (SD 14.8) points on the first day of hospital admission to 55.7 (20.5) points at discharge, p<0.001; with a relative functional gain of 38.5 (SD 34.3) % and a rehabilitation efficiency (Heinemann Index above 50%) of 34.5%. The Heinemann Index calculated six months after discharge showed a rehabilitation efficiency of 60% of the total sample. Only one patient (1%) died in hospital and 3 (6%) had died at 6 months. Cox regression showed that CCI and LOS increased the risk of mortality, whereas BI score decreased it.

The introduction of an interdisciplinary orthogeriatric team in Qatar led to improvements in nutritional status, functional recovery and survival.

Severe falls in older individuals are a leading cause of emergency department (ED) visits and often result in long-term impairments that reduce physical activity (PA). Limited information exists on the characteristics of individuals who suffer from physical inactivity after such falls and the factors that influence it. This study investigates the association between potential moderators and changes in PA in older adults six months after a severe fall.

Participants were recruited from the SeFallED study (German Clinical Trials Register ID: 00025949). Moderators were evaluated through a home-based geriatric assessment conducted within four weeks of a severe fall with presentation to the ED. PA was quantified using both sensor-based (n = 72 men (75 years), n = 106 women (74 years) and self-reported (n = 105 men (74 years), n = 174 women (73 years) assessments. A Linear Mixed Model was used for analysis.

Sensor-based PA revealed a significant time effect for step count (p = 0.006), indicating an increase in PA six months after a severe fall. Fall history (95% CI: -1,009.5 - (-207.4), p = 0.003) and age (95% CI: -315.8 - (-82.5), p < 0.01) were significant negative moderators for changes in PA, only in women. No significant changes in self-reported PA were observed after six months (p = 0.109).

Participants showed an increase in sensor-based PA six months after a severe fall, though this was negatively associated with age and fall history. Early identification of factors that affect PA recovery may help stratify individuals by risk and target those in need of secondary prevention.

DRKS (Deutsches Register für klinische Studien, DRKS0 00259 49). Prospectively registered on 4th November, 2021.

To identify differences in characteristics between mobility-limited older adults with a history of falls and those at risk of falling but who have not yet fallen.

Frailty and muscle strength were characteristics distinguishing between older adults with a history of falls and those absent of falls despite an increased risk of falling.

Frailty should be incorporated alongside handgrip strength (HGS) and sit-to-stand (STS) tests into routine evaluations of mobility-limited older adults referred for fall assessment.

We aimed to identify differences in characteristics between mobility-limited older adults with a history of falls and those at risk of falling, and to identify the parameter with the strongest predictive value on the risk of falling.

Data included anthropometry, HGS, 30-s and 5-reps STS tests, maximal isometric knee extensor strength, gait speed (6 m), postural balance (tandem test), and muscle mass (BIA). Frailty was assessed using the Clinical Frailty Scale (CFS) and sarcopenia was evaluated according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines. Outcomes of falls (past year), and depression (Geriatric Depression Scale 15) were self-reported.

Totally, 505 mobility-limited older adults (mean age 79.7 ± 6.3 years, 64.8% females) were included. Of these, 400 (79.2%) had experienced one or more falls within the past year (fallers), while 105 (20.8%) had not experienced a fall (at risk). Patients with experienced falls were more likely to feel depressed, had reduced handgrip strength, and reduced performance in both STS tests compared to those who had not fallen. Frailty was the strongest individual parameter associated with a history of prior falls, even after adjusting for covariates such as depression and 30-s STS (aOR 3.80; 95% CI 1.70-8.50).

Present study identified frailty as a key factor independently associated with a history of falls in this population. Additionally, handgrip strength and STS performance were key characteristics distinguishing between older adults with a history of falls within the past 12 months and those at risk of falling.

NCT05795556.

Two-thirds of people aged 65 years and older may require help with daily activities such as eating, bathing, and getting in and out of bed or a chair. Walking-assist wearable robots have shown significant improvements in physical function in controlled settings for patients.

In this study, we aimed to assess the feasibility and the effect of a gait assistance and gait resistance training program using a walking-assist wearable robot for community-dwelling older adults.

A total of 23 community-dwelling older adults aged 65 years and older (30 participants recruited, 7 dropped out) enrolled in a 12-session, 6-week gait assistance and gait resistance training program using a walking-assist wearable robot. A single-group, pre- and posttest design was employed to evaluate the feasibility based on program adherence and effectiveness. The primary and secondary outcomes for evaluating effectiveness were walking speed and functional performance, respectively.

Regarding the feasibility, the average number of sessions attended was 11.7 out of 12, indicating a mean adherence rate of 97.8%. Linear mixed model analysis revealed significant improvements in walking speed and functional performance at the end of the program compared with baseline. Specifically, the walking speed measured using the 10-Meter Walk Test, which includes self-selected velocity and fastest safe velocity, improved by a mean of 0.15  (SD 0.13) m/s (P<.001) and 0.15 (SD 0.17) m/s (P<.001), respectively. Functional performance also improved, with faster performance in Timed Up-and-Go (mean -0.63, SD 0.92 s; P=.003) and Four Square Step Test (mean -1.71, SD 1.64 s; P≤.001). Leg muscle strength increased across all measured domains, including plantarflexion (mean +7.29, SD 4.92; P=.004), hip adduction (mean +3.03, SD 2.73; P≤.001), hip extension (mean +2.63, SD 2.50; P≤.001), knee extension (mean +2.33, SD 3.12; P≤.001), knee flexion (mean +2.19, SD 2.17; P≤.001), dorsiflexion (mean +2.10, SD 3.06; P≤.001), hip abduction (mean +1.59, SD 1.92; P=.002), and hip flexion (mean +0.90, SD 1.56; P≤.001).

This study stands out for applying gait assistance and resistance training across various terrains, unlike previous studies that only tested gait assistance in controlled environments. The results demonstrated significant improvements in walking speed and functional performance in older adults, suggesting the effectiveness of preventive health care services using a walking-assist wearable robot as an intervention that can contribute to improving independent functioning and frailty among community-dwelling older adults.

Physical activity (PA) is crucial for older adults' well-being and mitigating health risks. Encouraging active lifestyles requires a deeper understanding of the factors influencing PA, which conventional approaches often overlook by assuming stability in these determinants over time. However, individual-level determinants fluctuate over time in real-world settings. Digital phenotyping (DP), employing data from personal digital devices, enables continuous, real-time quantification of behaviour in natural settings. This approach offers ecological and dynamic assessments into factors shaping individual PA patterns within their real-world context. This paper presents a study protocol for the DP of PA behaviour among community-dwelling older adults aged 65 years and above.

This 2-week multidimensional assessment combines supervised (self-reported questionnaires, clinical assessments) and unsupervised methods (continuous wearable monitoring and ecological momentary assessment (EMA)). Participants will wear a Garmin Vivosmart V.5 watch, capturing 24/7 data on PA intensity, step count and heart rate. EMA will deliver randomised prompts four times a day via the Smartphone Ecological Momentary Assessment3 application, collecting real-time self-reports on physical and mental health, motivation, efficacy and contextual factors. All measurements align with the Behaviour Change Wheel framework, assessing capability, opportunity and motivation. Machine learning will analyse data, employing unsupervised learning (eg, hierarchical clustering) to identify PA behaviour patterns and supervised learning (eg, recurrent neural networks) to predict behavioural influences. Temporal patterns in PA and EMA responses will be explored for intraday and interday variability, with follow-up durations optimised through random sliding window analysis, with statistical significance evaluated in RStudio at a threshold of 0.05.

The study has been approved by the ethical committee of Hasselt University (B1152023000011). The findings will be presented at scientific conferences and published in a peer-reviewed journal.

NCT06094374.

To investigate the effects of a 12-week, web-based, combined cognitive and physical training intervention on cognitive performance among ICU delirium survivors.

Prospective, four-arm randomized controlled trial.

Four sites (academic, county, community ICUs).

ICU adults 50 years old or older with at least one instance of ICU delirium or subsyndromal delirium.

Patients were randomized to one of four groups: physical exercise-cognitive training (PE-CT), physical exercise-cognitive control (PE-CC), stretching control-cognitive training (SC-CT), or stretching control-cognitive control (SC-CC).

The primary outcome was cognitive function at 3 and 6 months after start of intervention, as assessed by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). One hundred fifty-three patients were randomized to either: PE-CT, n = 41; PE-CC, n = 41; SC-CT, n = 36; or SC-CC, n = 35. There was a significant difference on changes in RBANS z scores among the four arms (interaction term p = 0.012). The mean RBANS z scores ranged from -2.66 to +1.43 (change in RBANS z score of ± 0.5-0.6 may be clinically significant). The SC-CT group had statistically significant worsening in cognitive scores compared with the SC-CC group at 3 (mean estimated difference in change from baseline, -0.28; 95% CI, -0.53 to -0.02; p = 0.035) and 6 months (mean estimated difference in change from baseline, -0.29; 95% CI, -0.53 to -0.04; p = 0.021). Compared with the SC-CC group, the PE-CC group had statistically significant worsening in cognitive scores at 6 month (mean estimated difference in change from baseline, -0.26; 95% CI, -0.49 to -0.02; p = 0.035). There were no significant differences between groups in physical or mental quality of life, depression, or anxiety outcomes at any of the timepoints.

The Improving Recovery and Outcomes Every Day After the ICU (IMPROVE) trial did not result in improved cognitive, physical, mental health, or quality of life measures at 3 or 6 months. We found a drop in cognitive performance among patients receiving cognitive training from baseline to 3 months postintervention.

Falls in older adults increase the risk of mortality and hospitalization, particularly when physical function is low. This study aimed to determine whether low physical function and muscle mass, are also valuable for predicting falls within one year in older patients who visited an outpatient clinic for frailty.

This prospective cohort study analyzed the registry data of 624 outpatients aged > 65 years (mean age: 77.9 ± 6.0 years; female 368, male 256). The endpoint was the incidence of falls within one year. These included the five-chair standing test (5CS), usual gait speed, short physical performance battery, handgrip strength, and skeletal muscle mass index. All of these tests were performed during the first clinic appointment. The question about fall history was asked one year after the examination, and the history of falls during the period of one year from the date of the examination. We analyzed the relationship between whether these assessments were below the cutoff values and falls within one year using multiple logistic regression analysis.

A total of 154 (25%) patients fell within one year. Those with a low result on the 5CS or usual gait speed had significantly higher rates of falls within one year, even after adjustment for covariates, with odds ratios [95% confidence interval] of 2.07 [1.37-3.13] and 1.68 [1.09-2.60], respectively.

Low physical function, particularly in the lower limbs, was associated with near-term fall risk. The 5CS is helpful in fall risk assessment.

Accurate assessment of performance status (PS) in oncology care is crucial for improving clinical decisions, therapy selection and anticipated risks of treatment toxicity. While physical function is traditionally assessed in the clinic, in-clinic instruments do not capture the full spectrum of daily functioning. Digital health technologies (DHTs) can address this limitation by passively monitoring patients in their daily environment. Our study showed at-home physical activity and gait metrics from DHTs were associated with self-reported PS in participants with cancer, and these metrics had greater discriminatory power than in-clinic measures among this cohort. The DHT-derived metrics were also significantly correlated with patient-reported-outcomes, and used of the devices was broadly acceptable to study participants. Therefore, integrating DHTs into oncological practice could significantly refine how PS is measured and utilized, ultimately enhancing treatment decision-making and clinical outcomes. (ClinicalTrials.gov NCT03952767).

Impaired contrast sensitivity (CS) commonly occurs in older adults but has been largely overlooked as a contributing factor to functional impairment and decline. We examined if CS impairment predicts decline in performance on the expanded short physical performance battery (eSPPB) over 30 months of follow-up in cognitively healthy older adults.

Single center prospective cohort study of 192 cognitively unimpaired older adults with good visual acuity and self-reported visual function. Linear mixed models examined the difference in the association of moderately impaired baseline CS (logCS < 1.55) with performance on the eSPPB and its components-balance, 4 m gait speed, narrow walk, and chair pace-over 30 months. Multivariable models adjusted for the effect of age, race, and sex on the slopes over time.

At baseline, the mean participant age was 76.5 ± 4.7 years, with 56.5% (N = 108) female and 9.4% (N = 18) black. Participants with moderately impaired CS at baseline had a significantly faster decline in eSPPB over a 30-month period (Beta: -0.115, 95% CI (-0.180, -0.050), p < 0.001) compared with those with normal CS (Beta: -0.022, 95% CI (-0.044, -0.001), p = 0.042). There was a difference in slopes of -0.093 units/year ((95% CI, -0.161, -0.024), p = 0.009) between groups. This difference in slopes remained significant after adjusting for the effect of age, sex, and race (difference in slopes -0.086, 95% CI (-0.155, -0.016), p = 0.016). Impaired CS predicted significantly greater declines in balance over 30 months (difference in slopes -3.512 (-6.826, -0.199), p = 0.0378), but the differences in gait speed, narrow walk, and chair pace were not significant.

In cognitively intact older adults with good visual acuity, moderately impaired CS was associated with a significantly faster decline in eSPPB, especially balance, over 30 months of follow-up. A relatively simple test of vision may identify a subset of older adults without cognitive dysfunction who are at risk for mobility decline.

Algorithms estimating real-world digital mobility outcomes (DMOs) are increasingly validated in healthy adults and various disease cohorts. However, their accuracy and reliability in older adults after hip fracture, who often walk slowly for short durations, is underexplored.

This study examined DMO accuracy and reliability in a hip fracture cohort considering walking bout (WB) duration, physical function, days since surgery, and walking aid use.

In total, 19 community-dwelling participants were real-world monitored for 2.5 hours using a lower back wearable device and a reference system combining inertial modules, distance sensors, and pressure insoles. A total of 6 DMO estimates from 164 WBs from 58% (11/19) of the participants (aged 71-90 years; assessed 32-390 days after surgery; Short Physical Performance Battery [SPPB] scores of 3-12; gait speed range 0.39-1.34 m/s) were assessed against the reference system at the WB and participant level. We stratified by WB duration (all WBs, WBs of >10 seconds, WBs of 10-30 seconds, and WBs of >30 seconds) and lower versus higher SPPB scores and observed whether days since surgery and walking aid use affected DMO accuracy and reliability.

Across WBs, walking speed and distance ranged from 0.25 to 1.29 m/s and from 1.7 to 436.5 m, respectively. Estimation of walking speed, cadence, stride duration, number of steps, and distance stratified by WB duration showed intraclass correlation coefficients (ICCs) ranging from 0.50 to 0.99 and mean relative errors (MREs) from -6.9% to 12.8%. Stride length estimation showed poor reliability, with ICCs ranging from 0.30 to 0.49 and MREs from 6.1% to 13.2%. Walking speed and distance ICCs in the higher-SPPB score group ranged from 0.85 to 0.99, and MREs ranged from -10.1% to -1.7%. In the lower-SPPB score group, walking speed and distance ICCs ranged from 0.17 to 0.99, and MREs ranged from 13.5% to 32.6%. There was no discernible effect of time since surgery or walking aid use.

In total, 5 accurate and reliable real-world DMOs were identified in older adults after hip fracture: walking speed, cadence, stride duration, number of steps, and distance. Accuracy and reliability of most DMOs improved when excluding WBs of <10 seconds and were higher for WBs of >30 seconds than for WBs of 10 to 30 seconds and for participants with higher physical function. DMOs capture daily gait as early as 1 month after surgery also in people using walking aids. However, as most WBs in this cohort were short, there was a trade-off between improving accuracy and reliability by excluding short WBs and losing a substantial amount of data. These results have important implications for establishing the clinical validity of DMOs and evaluating the effects of interventions on daily-life gait, thereby facilitating the design of optimal care pathways.