Dietary Sodium Restriction and Frailty among Middle-Aged and Older Adults: An 8-Year Longitudinal Study.

Frailty is a common geriatric syndrome. However, there is little information about the relationship between dietary sodium restriction (DSR) and frailty in later life. This study aimed to elucidate the relationship between DSR and frailty in middle-aged and older adults. The 8-year follow-up data from the Taiwan Longitudinal Study on Aging, including 5131 individuals aged ≥50 years, were analyzed using random-effects panel logit models. DSR was evaluated by assessing whether the participants were told by a physician to reduce or avoid sodium intake from food. Three indices were used to measure frailty: the Study of Osteoporotic Fractures (SOF) index, the Fried index, and the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) index. Individuals with DSR were more likely to report frailty compared with those with non-DSR (SOF: adjusted odds ratio [AOR] = 1.82, 95% confidence interval [CI] = 1.46-2.27; Fried: AOR = 2.55, 95% CI = 1.64-3.98; FRAIL: AOR = 2.66, 95% CI = 1.89-3.74). DSR was associated with a higher likelihood of SBF (AOR = 2.61, 95% CI = 1.61-4.22). We identified a temporal trajectory in our study, noting significant participant reactions to both short- and mid-term DSR. Future research should address the balance between frailty risk and cardiovascular risk related to DSR.

Impact of Residential Area Characteristics and Political Group Participation on Depression Among Middle-Aged and Older Adults: Results of an 11-Year Longitudinal Study.

Background and Objectives: The claim that political group attendance is associated with poor mental health among older adults may be conditioned on geographic conditions. This study examined the geographical context in which political group participation may be associated with depression. Research Design and Methods: The 11-year follow-up data from the Taiwan Longitudinal Study on Aging, covering 5,334 persons aged ≥50 years, were analyzed using random-effects panel logit models. Depression was assessed using 10 items on the Centre for Epidemiologic Studies Depression scale. Participants were asked to indicate whether they belonged to different social groups. We modeled depression as a function of political group participation (the independent variable) and geographical region (moderators), adjusting for individual-level characteristics. Results: Respondents in political groups were more likely to report depression than those in nonpolitical groups (adjusted odds ratio [AOR] = 1.90, 95% confidence interval [CI] = 1.34-2.68). Between urban and rural settlements, there were no statistically significant differences in mental health outcomes among older adults engaged in political groups (AOR = 1.72, 95% CI = 0.81-3.67). For those who remained politically engaged, living in areas with lower levels of electoral competition was associated with a lower likelihood of depression (AOR = 0.92, 95% CI = 0.86-0.98); this conditional effect was not prevalent among those who were solely engaged in nonpolitical groups (AOR = 1.02, 95% CI = 0.99-1.03). Discussion and Implications: Political group participation is associated with poor mental health among older adults living in politically competitive regions.

Impact of dietary sodium restriction on falls among middle-aged and older adults: Results of an 8-year longitudinal study.

AIM: This study aimed to understand the relationship between dietary sodium restriction (DSR) and falling experiences in middle-aged and older adults. METHODS: The 8-year follow-up data from the Taiwan Longitudinal Study on Aging, covering 5131 individuals aged ≥50 years, were analyzed using random-effects panel logit models. Participants were asked to indicate whether they were told by a physician to reduce or avoid sodium intake from food and whether they had had fall experiences during the past year. We modelled falling experiences as a function of DSR (independent variable), involuntary body weight loss and walking difficulty (mediators), and chronic diseases (moderator), adjusting for individual-level characteristics. RESULTS: Individuals with DSR were at a higher risk of falls compared with those with no DSR (adjusted odds ratio [AOR] = 1.30, 95% confidence interval [CI] = 1.11-1.53). This effect was more prevalent in individuals with a history of stroke (AOR = 1.85, 95% CI = 1.19-2.87). Those told to reduce sodium intake by a physician were likely to lose weight involuntarily (AOR = 1.20, 95% CI = 1.05-1.36) and had difficulty walking up two or three flights of stairs alone (AOR = 2.38, 95% CI = 1.73-3.27), which mediated the effect of DSR on increased fall risk (AOR = 1.15, 95% CI = 0.95-1.38). We found a temporal effect: participant reactions to short- and mid-term DSR were significant. CONCLUSIONS: DSR was associated with a greater likelihood of falls among middle-aged and older adults, particularly those with a history of stroke. Geriatr Gerontol Int 2024; 24: 292-299.

Predicting frailty in older adults using vocal biomarkers: a cross-sectional study.

BACKGROUND: Frailty is a common issue in the aging population. Given that frailty syndrome is little discussed in the literature on the aging voice, the current study aims to examine the relationship between frailty and vocal biomarkers in older people. METHODS: Participants aged ≥ 60 years visiting geriatric outpatient clinics were recruited. They underwent frailty assessment (Cardiovascular Health Study [CHS] index; Study of Osteoporotic Fractures [SOF] index; and Fatigue, Resistance, Ambulation, Illness, and Loss of weight [FRAIL] index) and were asked to pronounce a sustained vowel /a/ for approximately 1 s. Four voice parameters were assessed: average number of zero crossings (A1), variations in local peaks and valleys (A2), variations in first and second formant frequencies (A3), and spectral energy ratio (A4). RESULTS: Among 277 older adults, increased A1 was associated with a lower likelihood of frailty as defined by SOF (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.74-0.96). Participants with larger A2 values were more likely to be frail, as defined by FRAIL and CHS (FRAIL: OR 1.41, 95% CI 1.12-1.79; CHS: OR 1.38, 95% CI 1.10-1.75). Sex differences were observed across the three frailty indices. In male participants, an increase in A3 by 10 points increased the odds of frailty by almost 7% (SOF: OR 1.07, 95% CI 1.02-1.12), 6% (FRAIL: OR 1.06, 95% CI 1.02-1.11), or 6% (CHS: OR 1.06, 95% CI 1.01-1.11). In female participants, an increase in A4 by 0.1 conferred a significant 2.8-fold (SOF: OR 2.81, 95% CI 1.71-4.62), 2.3-fold (FRAIL: OR 2.31, 95% CI 1.45-3.68), or 2.8-fold (CHS: OR 2.82, 95% CI 1.76-4.51, CHS) increased odds of frailty. CONCLUSIONS: Vocal biomarkers, especially spectral-domain voice parameters, might have potential for estimating frailty, as a non-invasive, instantaneous, objective, and cost-effective estimation tool, and demonstrating sex differences for individualised treatment of frailty.

The Power of Women: Does increasing women's parliamentary representation reduce intake of sugar-sweetened beverages among children and adolescents?

OBJECTIVE: Consumption of sugar-sweetened beverages (SSBs) is associated with overweight and obesity in children and adolescents. Although existing research confirms the significance of economic and social factors as determinants of SSB intake, comparative studies on political factors and cross-national analyses are lacking. Research indicates that including women in the process of political decision-making promotes healthcare and child protection. This study examined how women's parliamentary representation influences children's and adolescents' SSB intake compared to adults. DESIGN: The study used cross-national food and beverage intake data from the Global Dietary Database. The outcome measurement was SSB consumption (g/day) for different population groups. We modeled SSB intake as a function of age groups, women's parliamentary representation at the national level (the independent variable), regime types (the contextual factor), and import tariffs on SSBs (the mediator) using country and time fixed effects regression models. SETTING: 185 countries across three waves from 2005 to 2015. PARTICIPANTS: Different population groups. RESULTS: The impact of female representation on reducing SSB consumption is more prevalent in children and adolescents than in adults. Furthermore, the effect of women's parliamentary representation on SSB consumption among children and adolescents is conditional on a country's democratic status. Finally, the marginal effect decreases when import tariffs on SSBs are considered a link in a causal chain. No changes in adult SSB intake are statistically significant. CONCLUSIONS: The findings suggest that the presence of women in the legislature can have a substantial impact on child and adolescent health.

Association between political group participation and depressive symptoms among older adults: an 11-year longitudinal study in Taiwan.

BACKGROUND: Given the speculation that political participation is causing an epidemic of depression, this study examined how participation in political and non-political groups influenced depressive symptoms among older adults in Taiwan. METHODS: The 11-year follow-up data from the Taiwan Longitudinal Study on Ageing, covering 5334 persons aged 50 years and older, were analysed using random-effects panel logit models. RESULTS: Engagement in social groups reduced the likelihood of depression (adjusted odds ratio [AOR]: 0.71, 95% confidence interval [CI]: 0.64-0.80). However, there was a greater likelihood of depressive symptoms among older adults who were engaged in political groups when compared with those who were engaged in non-political groups (AOR: 1.87, 95% CI: 1.31-2.65). For older adults who remained politically engaged, participation in a greater number of non-political group types was associated with a lower likelihood of depression (e.g. at 1: AOR: 0.53, 95% CI: 0.30-0.91; at 2+: AOR: 0.35, 95% CI: 0.18-0.67); this numbers-based effect was not prevalent among those who were solely engaged in non-political groups. CONCLUSIONS: Political group attendance can result in negative mental health outcomes among older adults. Our findings suggest that reducing the prevalence of depression through social participation is conditional to the engagement type.

Is trade a blessing or a curse? A panel data analysis of the determinants of depressive disorders.

OBJECTIVES: Given the speculation of the market economy causing an epidemic of depression, this study aimed to examine the influence of international trade on the prevalence of depressive disorders. METHODS: We used panel data from 1993 to 2015 covering 170 countries (n = 3787) and applied fixed effects regression models. We modeled the prevalence of depressive disorders as a function of international trade, adjusting for economic development, economic growth, and population size. Regime types, media freedom, and capital-labor ratio were included as moderators. RESULTS: A 100% point increase in the value of international trade indicated a 0.09% point decrease in the prevalence of depressive disorders (- 0.09, confidence interval [CI] - 0.01 to - 0.18). However, this effect existed only for democratic countries (- 0.15, CI - 0.03 to - 0.28). The effect was more prevalent when the governments allowed the media more freedom (score of 100, - 0.31, CI - 0.17 to - 0.45) or when a country's capital-labor ratio of endowments was high (50,000, - 0.22, CI - 0.08 to - 0.35). CONCLUSIONS: Trade brings about positive mental health outcomes in democracies, countries having free media, or capital-abundant economies.

How time horizons of autocrats impact health expenditure: a mixed methods research.

BACKGROUND: A country's spending on healthcare significantly improves its population health status. No comparative study has examined how the threat perceived by leaders influences health expenditure and cross-national analyses of authoritarian regimes. The objectives of this study are to examine how time horizons of autocrats influence health expenditure. METHODS: We designed a mixed methods research approach. First, the study used panel data from 1995 to 2010 covering 95 countries (n = 1208) and applied fixed effects regression models. As a proxy for time horizons, the study generated the predicted survival time for each regime-year using parametric survival analysis and the predictors to model regime failure. Second, we chose Chad, Rwanda and Ivory Coast to apply synthetic control methods for comparative case studies. Armed conflict had significant effects on regime duration and was used for an intervention. We constructed a synthetic version of each country, combining counties that did not or did experience armed conflict to resemble the values of health expenditure predictors for the actual country prior to the intervention. RESULTS: We found that an increase in the natural log form of survival time by 1 resulted in a 1.14 percentage point increase in health expenditure (% of GDP) (1.14, 95% CI = 0.60-1.69). Furthermore, we found that the difference in health expenditure between the actual Chad and its synthetic version starts to grow following the civil war in 2004 (in 2004, actual: 5.72%, synthetic: 5.91%; in 2005, actual: 3.91%, synthetic: 6.74%). Similarly, a large health expenditure gap between the actual Rwanda and its synthetic control resulted after the peace deal was signed in 2002 (in 2002, actual: 4.18%, synthetic: 4.77%; in 2003, actual: 6.34%, synthetic: 5.03%). In Ivory Coast, the two series diverge substantially during the civil war from 1999 to 2005 (in 1998, actual: 7.30%, synthetic: 7.11%; in 2002, actual: 4.47%, synthetic: 7.43%; in 2007, actual: 6.35%, synthetic: 6.50%). CONCLUSIONS: The findings suggest that health expenditure decreases as regime time horizons shrink, and reducing armed conflict is a way to promote regime stability.

A Dictator's Gift: Dominant party regimes and health expenditures.

BACKGROUND: A country's health expenditure significantly improves its population health status. This study aims to examine the determinants of health expenditure in dictatorships. METHODS: We designed a mixed methods research approach. First, we used panel data from 1995 to 2014 covering 99 countries (n = 1488). Fixed effects regression models were fitted to determine how different types of authoritarianism relate to health expenditure. Second, we chose Ivory Coast to apply the synthetic control methods for a case study. We constructed a synthetic Ivory Coast, combining other dominant party regimes to resemble the values of health expenditure predictors for Ivory Coast prior to a regime change from a dominant party system to personalist dictatorships in 2000. RESULTS: We found that dominant party autocracies, compared with non-dominant party regimes, increased health expenditure (% of GDP) (1.36 percentage point increase, CI = 0.59-2.12). The marginal effect, however, decreased when an autocrat in this type of regime held elections (0.86 percentage point decrease, CI = 0.20-1.52). Furthermore, we found the difference in health expenditure between the actual Ivory Coast and its synthetic version starts to grow following the regime change in 2000 (in 2000, actual: 6.00%, synthetic: 6.04%; in 2001, actual: 4.85%, synthetic: 5.99%), suggesting a pronounced negative effect of the government transition on Ivory Coast health expenditure. CONCLUSION: The findings suggest that different forms of dictatorship are associated with varying levels of health expenditure. Where dictatorships rely on popular support, as is the case with dominant party dictatorships, health expenditure is generally greater.