Poor sleep quality is linked to increased frailty in middle-aged people living with HIV in Botswana.

This work aims to evaluate associations between self-reported sleep health and frailty in Botswana, a sub-Saharan Africa setting. Fifty persons living with HIV (PLWH) on suppressive antiretroviral therapy (ART) and fifty HIV seronegative control participants are enrolled in Botswana. Sleep quality is scored subjectively as "good" or "poor" based on self-report. A frailty index (FI) is constructed based on thirty-three health deficits related to body mass index, waist circumference, physical activity, emotional status, and fatigue, and scored ranging between 0 (no deficit present) and 1 (all deficits present). Sleep quality between PLWH and controls is compared using logistic regression; linear regression is performed to compare the FI between them. Linear regressions are performed to examine the association between the FI and sleep quality stratified by HIV serostatus. Age, sex, and comorbidities are adjusted; when relevant, CD4 cell and ART duration are controlled. PLWH display 2.88 (95% CI: 1.22-6.79, p = 0.02) higher odds of having poor sleep than controls. Having poor sleep is associated with increased FI in PLWH but not in controls. Specifically, compared with PLWH who have good sleep, PLWH who report poor sleep have a > 1 standard deviation (p < 0.0001) increase in their FI score.

Associations Between Depression Symptom Burden and Delirium Risk: A Prospective Cohort Study.

Background and Objectives: Delirium and depression are prevalent in aging. There is considerable clinical overlap, including shared symptoms and comorbid conditions, including Alzheimer's disease, functional decline, and mortality. Despite this, the long-term relationship between depression and delirium remains unclear. This study assessed the associations of depression symptom burden and its trajectory with delirium risk in a 12-year prospective study of older hospitalized individuals. Research Design and Methods: A total of 319 141 UK Biobank participants between 2006 and 2010 (mean age 58 years [range 37-74, SD = 8], 54% women) reported frequency (0-3) of 4 depressive symptoms (mood, disinterest, tenseness, or lethargy) in the preceding 2 weeks prior to initial assessment visit and aggregated into a depressive symptom burden score (0-12). New-onset delirium was obtained from hospitalization records during 12 years of median follow-up. 40 451 (mean age 57 ±â€…8; range 40-74 years) had repeat assessment on average 8 years after their first visit. Cox proportional hazard models examined whether depression symptom burden and trajectory predicted incident delirium. Results: A total of 5 753 (15 per 1 000) newly developed delirium during follow-up. Increased risk for delirium was seen for mild (aggregated scores 1-2, hazards ratio, HR = 1.16, [95% confidence interval (CI): 1.08-1.25], p < .001), modest (scores 3-5, 1.30 [CI: 1.19-1.43], p < .001), and severe (scores ≥ 5, 1.38 [CI: 1.24-1.55], p < .001) depressive symptoms, versus none in the fully adjusted model. These findings were independent of the number of hospitalizations and consistent across settings (eg, surgical, medical, or critical care) and specialty (eg, neuropsychiatric, cardiorespiratory, or other). Worsening depression symptoms (≥1 point increase), compared to no change/improved score, were associated with an additional 39% increased risk (1.39 [1.03-1.88], p = .03) independent of baseline depression burden. The association was strongest in those over 65 years at baseline (p for interaction <.001). Discussion and Implications: Depression symptom burden and worsening trajectory predicted delirium risk during hospitalization. Increased awareness of subclinical depression symptoms may aid delirium prevention.

Delineating cognitive resilience using fractal regulation: Cross-sectional and longitudinal evidence from the Rush Memory and Aging Project.

INTRODUCTION: Degradation of fractal patterns in actigraphy independently predicts dementia risk. Such observations motivated the study to understand the role of fractal regulation in the context of neuropathologies. METHODS: We examined associations of fractal regulation with neuropathologies and longitudinal cognitive changes in 533 older participants who were followed annually with actigraphy and cognitive assessments until death with brain autopsy performed. Two measures for fractal patterns were extracted from actigraphy, namely, α1 (representing the fractal regulation at time scales of <90 min) and α2 (for time scales 2 to 10 h). RESULTS: We found that larger α1 was associated with lower burdens of Lewy body disease or cerebrovascular disease pathologies; both α1 and α2 were associated with cognitive decline. They explained an additional significant portion of the variance in the rate of cognitive decline above and beyond neuropathologies. DISCUSSION: Fractal patterns may be used as a biomarker for cognitive resilience against dementia-related neuropathologies.

Circadian disturbances and frailty risk in older adults.

Frailty is characterized by diminished resilience to stressor events. It is associated with adverse future health outcomes and impedes healthy aging. The circadian system orchestrates ~24-h rhythms in bodily functions in synchrony with the day-night cycle, and disturbed circadian regulation plays an important role in many age-related health consequences. We investigated prospective associations of circadian disturbances with incident frailty in over 1000 older adults who had been followed annually for up to 16 years. We found that decreased rhythm strength, reduced stability, or increased variation were associated with a higher risk of incident frailty and faster progress of frailty over time. Perturbed circadian rest-activity rhythms may be an early sign or risk factor for frailty in older adults.

Circadian disturbances and frailty risk in older adults: a prospective cohort study.

Frailty is characterized by diminished resilience to stressor events. It associates with adverse future health outcomes and impedes healthy aging. The circadian system orchestrates a ~24-h rhythm in bodily functions in synchrony with the day-night cycle, and disturbed circadian regulation plays an important role in many age-related health consequences. We investigated prospective associations of circadian disturbances with incident frailty in over 1,000 older adults who had been followed annually for up to 16 years. We found that decreased rhythm strength, reduced stability, or increased variation, were associated with a higher risk of incident frailty, and faster worsening of the overall frailty symptoms over time. Perturbed circadian rest-activity rhythms may be an early sign or risk factor for frailty in older adults.

The association between longitudinal changes in depressive symptoms and cognitive decline among middle-aged and older Chinese adults.

OBJECTIVE: Depression is associated with cognitive impairment and dementia, but few studies have been done on Chinese adults. This study evaluates the relationship between depressive symptoms status and cognitive function in middle-aged and elderly Chinese adults. METHODS: We included 7,968 participants from the Chinese Health and Retirement Longitudinal Survey (CHRALS) with a follow-up of 4 years. Using the Center for Epidemiological Studies Depression Scale to measure depressive symptoms, with a score of 12 or more indicating elevated depressive symptoms. Adjust covariance analysis and generalized linear analysis were used to investigate the relationship between depressive symptoms status (never, new-onset, remission and persistence) and cognitive decline. Restricted cubic spline regression was used to performed the potential nonlinear associations between depressive symptoms and the change scores of cognitive functions. RESULTS: During the 4-year follow-up, 1148 participants (14.41%) reported persistent depressive symptoms. The participants who have persistent depressive symptoms with more declines in total cognitive scores (least-square mean = -1.99, 95% CI: -3.70 to -0.27). Compared with never depressive symptoms, participants with persistent depressive symptoms experienced a faster decline in cognitive scores (ß = -0.68, 95%CI: -0.98 to -0.38), and small difference (d=0.29) at follow-up. But females with new-onset depression had more cognitive decline than those with persistent depression (least-square mean new-onset - least-square mean persistent=-0.10), its differences in males (least-square mean new-onset - least-square mean persistent=0.03). CONCLUSIONS: Participants with persistent depressive symptoms experienced a faster decline in cognitive function, but differently in men and women.

Longitudinal association between muscle strength and depression in middle-aged and older adults: A 7-year prospective cohort study in China.

BACKGROUND: Evidence regarding the associations between muscle strength in different parts of the body and depression is lacking. This study examined whether poor muscle strength is associated with a higher incidence of depression in a large cohort of middle-aged and older adults. METHODS: In total, 5,228 middle-aged and older adults from the China Health and Retirement Longitudinal Study without depression at baseline were followed for 7 years. Their demographic characteristics, chronic diseases and lifestyle behaviors were assessed. After adjusting for relevant variables, a Cox regression was used to determine the relationship between muscle strength and incident depression. RESULTS: Over 32,544 person-years of follow-up, 1,490 participants developed depression. Low muscle strength at baseline was associated with a higher 7-year incident of depression, even after excluding those who developed depression within 2 years. After adjusting for confounding factors, it was found that a higher baseline relative handgrip strength was a protective factor against depression (HR [95% CI]=0.575 [0.430-0.768] for the lowest quartile vs. the highest quartile; p<0.001). Longer times on the 5TSTS test were a risk factor for depression (HR [95% CI]=1.321 [1.077-1.621] for the lowest quartile vs. the highest quartile; p = 0.007). When the strengths of the upper and lower limbs were considered together, the hazard ratio for depression in people with relatively greater muscle strength was 0.463 (95% CI=0.307-0.699; p<0.001). CONCLUSIONS: Muscle strength could be predictive of depression, and the combined measurement of upper and lower limb muscle strength can improve the predictive ability.

The association between pulmonary function and depression in middle-aged and elderly people in China: The role of cognitive ability and sleep time.

BACKGROUND: Depression is a common mental disorder in middle-aged and elderly people, which seriously affects their physical health and life quality.So far, whether pulmonary function is a factor in depression has not been tested.The purpose of this study was to test whether pulmonary function was independently associated with depression and to assess the effects of cognitive ability and sleep time on this association. METHODS: In this analysis, 5,235 participants from the Chinese Longitudinal Study of Health and Retirement were included. Participants were registered in 2015 and followed up in 2018. The relationship between pulmonary function and depression was estimated by binary logistic regression model. The mediated role of cognitive ability was examined by intermediary analysis, and the interaction between pulmonary function and sleep time on depression was discussed. RESULTS: After adjusting for confounding factors, it was found that higher baseline pulmonary function was the protective factor of depression (OR [95%CI]=0.524 [0.394-0.697] for the lowest quantile vs the highest quantile). Cognitive ability explained 14.55% of the association between pulmonary function and depression, pulmonary function and sleep time on the effects of depression have a combined interaction, RERI (95%CI) = 0.545 (0.053-1.038). CONCLUSIONS: High baseline pulmonary function is independently associated with a lower risk of depression, which is partly mediated by cognitive ability. Pulmonary function and sleep time have synergy with the effects of depression. These findings show that pulmonary function, cognitive ability and sleep time are reliable predictors of depression.

The relationships between step count and all-cause mortality and cardiovascular events: A dose-response meta-analysis.

BACKGROUND: A goal of 10,000 steps per day is widely advocated, but there is little evidence to support that goal. Our purpose was to examine the dose-response relationships between step count and all-cause mortality and cardiovascular disease risk. METHODS: Cochrane Central Register of Controlled Trials, EMBASE, OVID, PubMed, Scopus, and Web of Science databases were systematically searched for studies published before July 9, 2021, that evaluated the association between daily steps and at least 1 outcome. RESULTS: Sixteen publications (12 related to all-cause mortality, 5 related to cardiovascular disease; and 1 article contained 2 outcomes: both all-cause death and cardiovascular events) were eligible for inclusion in the meta-analysis. There was evidence of a nonlinear dose-response relationship between step count and risk of all-cause mortality or cardiovascular disease (p = 0.002 and p = 0.014 for nonlinearity, respectively). When we restricted the analyses to accelerometer-based studies, the third quartile had a 40.36% lower risk of all-cause mortality and a 35.05% lower risk of cardiovascular event than the first quartile (all-cause mortality: Q1 = 4183 steps/day, Q3 = 8959 steps/day; cardiovascular event: Q1 = 3500 steps/day, Q3 = 9500 steps/day; respectively). CONCLUSION: Our meta-analysis suggests inverse associations between higher step count and risk of premature death and cardiovascular events in middle-aged and older adults, with nonlinear dose-response patterns.

Prediction models for cardiovascular disease risk in the hypertensive population: a systematic review.

OBJECTIVE: The aim of this study was to identify, describe, and evaluate the available cardiovascular disease risk prediction models developed or validated in the hypertensive population. METHODS: MEDLINE and the Web of Science were searched from database inception to March 2019, and all reference lists of included articles were reviewed. RESULTS: A total of 4766 references were screened, of which 18 articles were included in the review, presenting 17 prediction models specifically developed for hypertensive populations and 25 external validations. Among the 17 prediction models, most were constructed based on randomized trials in Europe or North America to predict the risk of fatal or nonfatal cardiovascular events. The most common predictors were classic cardiovascular risk factors such as age, diabetes, sex, smoking, and SBP. Of the 17 models, only one model was externally validated. Among the 25 external validations, C-statistics ranged from 0.58 to 0.83, 0.56 to 0.75, and 0.64 to 0.78 for models developed in the hypertensive population, the general population and other specific populations, respectively. Most of the development studies and validation studies had an overall high risk of bias according to PROBAST. CONCLUSION: There are a certain number of cardiovascular risk prediction models in patients with hypertension. The risk of bias assessment showed several shortcomings in the methodological quality and reporting in both the development and validation studies. Most models developed in the hypertensive population have not been externally validated. Compared with models developed for the general population and other specific populations, models developed for the hypertensive population do not display a better performance when validated among patients with hypertension. Research is needed to validate and improve the existing cardiovascular disease risk prediction models in hypertensive populations rather than developing completely new models.

Effect of community-based lifestyle interventions on weight loss and cardiometabolic risk factors in obese elderly in China: A randomized controlled trial.

PURPOSE: We aimed to assess the effect of community-based lifestyle interventions on weight loss and cardiometabolic risk factors among obese older adults, and to explore the potential factors that impede weight loss during lifestyle interventions. MATERIALS AND METHODS: A 2-arm parallel randomized controlled trial was conducted from 2013 through 2016 in the community health service centers in Nanjing, China. Four hundred and eighty obese older adults were randomly assigned to receive a 24-month lifestyle intervention (242 participants) or usual care (238 participants). The intervention group received a community-based behavioral lifestyle intervention program, which targeted weight loss through dietary changes and increased physical activity, with a combination mode of intervention delivery. RESULTS: Weight loss was statistically significant at the end of the intervention with a mean reduction of 0.03 ±â€¯2.51 kg in the control group and 3.22 ±â€¯3.43 kg in the intervention group (p < .001). In the intervention group, 41.1% of participants achieved the target of 5% weight loss significantly (p < .001). Participants in the intervention group had significantly greater improvements in cardiometabolic risk factors. Multivariable logistic regression showed that female, living alone, and having more comorbidities were barriers to weight loss during the intervention. CONCLUSIONS: This study demonstrated that community-based lifestyle interventions are effective for managing weight and improving cardiometabolic risk factors in obese older adults.

Development and Validation of the Chinese Modesty Scale (CMS).

This paper describes the development and method of validation of the Chinese Modesty Scale (CMS). Based on Wang's dualistic model for value and instrumental modesty, our study employed a review of the literature, in-depth interviews, open-ended investigations, and feedback from experts. An initial 14-item scale for analyzing the issue of "Chinese modesty" was developed. Then we explored the dimensions and final items of this CMS using item analysis and exploratory factor analysis (EFA) with sample 1 (n = 406). After that, we conducted a confirmatory factor analysis (CFA) to replicate the factor structure obtained through EFA with a refined, independent, 12-item scale (n = 662). Results confirmed the dualistic model (for value and instrumental modesty) on which this scale was based. That is, we found that there are two kinds of "Chinese modesty": value modesty and instrumental modesty. As a valid, reliable scale, the CMS can therefore be used to measure the "Chinese modesty" of/in different age groups.