BMC Geriatrics

Background: Older adults living with mild cognitive impairment (MCI) or Alzheimer's disease and related dementias (AD/ADRD) and their care partners face substantial daily challenges that evolve with disease progression and extend far beyond the clinical setting, including symptom management, care coordination, healthcare navigation, and planning for future care needs. Understanding these challenges is essential for developing innovative solutions to provide ongoing and targeted support. In this study, we explored questions, challenges, and support needs experienced by dementia dyads following diagnosis to inform the development of an artificial intelligence (AI)-based chatbot designed to provide ongoing support for dementia dyads. Methods: We recruited 11 community-dwelling dyads comprising persons living with MCI or mild AD/ADRD and their care partners, one additional care partner, and 12 dementia care experts from academic medical centers, clinics, and aging organizations in the U.S. We conducted semi-structured interviews and analyzed them using conventional content analysis. Results: Participants described interconnected questions, challenges, and support needs that evolved while navigating life with MCI or AD/ADRD. Questions centered around day-to-day care management, medical concerns, behavioral symptom management, diagnosis and prognosis, safety, and resources and services. Challenges included care partner overwhelm, limited dementia knowledge, condition-related uncertainty, healthcare system navigation difficulties, financial constraints, and technology-related barriers. Participants identified needs for ongoing education, personalized care planning, resource navigation, logistical support and follow-up, culturally responsive care, and social and emotional support. Conclusions: Dementia dyads experience substantial informational, emotional, and practical support needs in the early stages of MCI and AD/ADRD. Findings suggest that post-diagnostic support should extend beyond information provision alone to provide ongoing, personalized, and practical guidance that helps dyads navigate changing needs, resources, and everyday dementia care. These findings are informing the development of an AI-based chatbot intended to complement existing dementia care by extending access to education, practical guidance, and resource navigation between clinical encounters.

Background: Care home research often fails to address issues that matter most to residents, families, and staff. Priority-setting exercises can help reduce this lack of inclusivity, but few have received significant resident responses. Objectives: To identify research priorities of UK care home stakeholders (including residents; relatives; care staff, managers and owners; healthcare professionals; policymakers and researchers), and to assess whether these priorities can be addressed using existing research datasets. Methods: PREACH was an 18-month research priority-setting study involving 1063 stakeholders, across 50 care homes, including 381 residents. Participants submitted ideas of what care home research should focus on through 1) care home activity sessions or 2) an online survey. Responses underwent content analysis to identify themes, and these themes were mapped against a national repository of care home trial data. Results: Fifty-one themes were identified. The most frequent priority across all stakeholder groups was access to meaningful activities for residents (22%). Relatives and residents emphasised social connection and day-to-day experience, whereas staff more often highlighted system pressures. No stakeholder-prioritised topics were directly addressable using existing secondary datasets. Conclusions: Collaboration with care home teams to reach large numbers of residents offers a practical route to producing more relevant and timely care home research. Care home stakeholders consistently prioritise quality of life, meaningful activity and staffing over disease-specific or health-focused research. Existing research datasets measure relatively few of the priorities identified by residents, highlighting the need for resident-centred outcome measures and data collection.

Across the UK, older adults in deprived areas like Barnsley are spending more of their lives in poor health. Alongside increased loneliness, this creates barriers to leading active healthy lives that can lead to decreases in the quality of life of residents and increased pressure on healthcare services. To address these issues, Barnsley Council brought together over 80 providers of physical activity classes for adults aged 50 and over as part of a joined up partnership called the Barnsley Older People Physical Activity Alliance (BOPPAA). The evaluation will explore how effectively the joined up partnership (BOPPAA) works in helping older adults lead active health lives by collecting information on involvement in the classes, and speaking to residents and organisations to get their thoughts and opinions. The findings will be used to help understand how BOPPAA can be improved to better meet the needs of the local population.

Objective To examine the association between patient-reported shared decision-making (SDM) and documented advance care planning (ACP) among adults with Alzheimer disease and related dementias (ADRD), and to assess whether this association differed between adults with and without ADRD. Design Retrospective observational study using linked survey and electronic health record (EHR) data. Setting and Participants Participants aged [≥]50 years in the All of Us Research Program who completed a patient-reported SDM measure and had linked EHR records. The primary analytic cohort included 3,635 adults with ADRD; 123,681 adults without ADRD comprised a secondary comparison cohort. Methods SDM was measured by how often clinicians asked participants about their opinions or preferences regarding medical care or treatment and was categorized as high (always/most of the time) or low (some of the time/ None of the time). Documented ACP was identified within 3 years before or after the SDM assessment. Modified Poisson regression with robust variance estimated prevalence ratios (PRs) and adjusted PRs (aPRs). Results Among adults with ADRD, 60.6% reported high SDM. Documented ACP prevalence was 5.1% among participants with high SDM and 3.6% among those with low SDM (P=0.027). High SDM was associated with greater ACP prevalence in the unadjusted model (PR, 1.44; 95% CI, 1.04-1.99); the association remained positive but was attenuated after full adjustment (aPR, 1.28; 95% CI, 0.93-1.77). Among adults without ADRD, high SDM was associated with documented ACP (aPR, 1.17; 95% CI, 1.03-1.33). Conclusions and Implications Among adults with ADRD, high SDM was associated with greater ACP prevalence in unadjusted analyses, although the fully adjusted association was not statistically significant. In contrast, higher SDM remained significantly associated with ACP among those without ADRD. The low prevalence of ACP highlights an important opportunity to expand discussions of current and future care preferences as a routine component of patient-centered care.

Background: Safely walking through complex environments requires the use of visual information to plan and regulate steps, while managing competing cognitive demands. Age-related changes in visual control of gait and executive function may contribute to unsafe stepping behaviour, particularly under cognitive load. Route previewing may support visual motor planning, but its effects under dual task conditions in older adults are not well understood. Research Question: Does cognitive dual tasking influence gait and gaze behaviour during adaptive walking in older adults, and does previewing the walking route before gait initiation mitigate these effects? Methods: Thirty nine community dwelling older adults (Mage=73.4 years, SD=8.1; 14 male) completed four adaptive walking conditions, combining single and dual-task walking with and without previewing. Per condition, participants completed six trials across different 8-m long coloured walking routes. Gait characteristics were assessed using an instrumented walkway and video-analysis, while gaze behaviour was recorded using mobile eye tracking. Cognitive load was manipulated using a serial subtraction task. Gait and gaze outcomes were evaluated using linear mixed effects models. Results: Dual task performance significantly increased stepping errors, cross-steps, and double limb support, while reducing stride length (p < .001). It also significantly increased the number and duration of task irrelevant fixations (p < .001). After previewing, participants exhibited more efficient gaze behaviour, as evidenced by looking further ahead (larger forward gaze transitions) and fewer irrelevant gaze fixations (p < .002). Significant Task-by-Preview interactions revealed that previewing mitigated the negative effects of dual-tasking on stepping errors and cross steps (p < .001). Significance: Route previewing prior to gait initiation attenuates negative effects of cognitive load on adaptive gait in older adults, likely by supporting visual motor planning. These findings highlight the potential value of simple visual planning interventions for improving adaptive gait in older adults.

Objectives: To evaluate change in physical function and probable sarcopenia following a 36-week community multicomponent exercise programme (Vivifrail model) across two consecutive cycles, and to assess the consistency of this change between cohorts. Study design: Quasi-experimental, single-arm, repeated-measures service evaluation. Ninety-two older adults (2025-2026 cohort; mean age 75.9 years, 88.0% women) completed baseline and post-intervention assessments; an independent 2024-2025 cohort (n = 86) was analysed jointly for replication (n = 178). Main outcome measures: Short Physical Performance Battery (SPPB) score (primary); Timed Up and Go (TUG), handgrip strength, 6-metre walk time and Mini-Mental State Examination (MMSE) (secondary); probable sarcopenia (EWGSOP2), SPPB-based frailty category, and a fall-risk indicator computed identically in both cohorts. Results: SPPB improved by a mean of 1.33 points (Cohen's d = 0.96; p < .001), with concordant improvement in all four secondary outcomes (all q < .005). 72.8% reached the substantial minimal clinically important difference. Probable sarcopenia fell from 17.4% to 5.4% (p = .006), and frailty category shifted toward higher functional levels (p < .001). Effect sizes were consistent between cohorts for SPPB, handgrip and 6-metre walk; the Time x Cohort interaction was significant for TUG only. In the pooled sample, elevated fall risk fell from 19.7% to 11.2% (p = .002). Conclusions: A 36-week multicomponent exercise programme was associated with clinically meaningful, reproducible improvement in physical function and a reduction in probable sarcopenia across two independent cohorts. The single-arm design precludes causal inference.

INTRODUCTIONThe number of people living with dementia in many African countries is anticipated to treble by 2050. However, data from Uganda are scarce, with no published prevalence studies using a comprehensive approach to dementia diagnosis. We used methods developed by the 10/66 Dementia Research Group to estimate dementia prevalence in rural South-West Uganda, and its association with socio-demographics and functional status. METHODSThe cross-sectional study was nested within the General Population Cohort. In Phase 1, all cohort participants aged 60+ underwent cognitive screening. In Phase 2, we invited all those with impaired cognition, 50% with mildly impaired cognition, and 15% with unimpaired cognition for assessment. We also assessed functional status using WHODAS-12, IDEA-IADL and reported care needs. RESULTSOver 80% of eligible participants underwent screening, and of those sampled, over 90% were assessed. Dementia prevalence was 18.6%, and most cases were mild or very mild. Dementia was associated with increased age and lower educational attainment. People with dementia had lower performance at IADLs, but similar levels of disability and care needs. DISCUSSIONDementia prevalence in Uganda is high, affecting nearly 1 in 5 people aged 60 and over. This is higher than most other estimates from the region, particularly others that have used two-phase approaches and clinical DSM diagnoses, which may under-estimate dementia prevalence due to attrition between study phases and cultural variations in reporting functional impairment by informants. Any planned health and social care services for older people should include support for people with dementia and their families.

BackgroundMultimorbidity is common among U.S. skilled nursing facilities (SNFs) residents and complicates pharmacologic management, yet real-world evidence on treatment patterns in this population remains limited. This study evaluated medication order rates and identified resident- and facility-level factors among SNF residents with multimorbidity. MethodsRetrospective, observational study using electronic health record (EHR) data from PointClickCares Life Sciences database. Participants were 728,222 residents active in a U.S. SNF on April 30, 2025 with at least one documented diagnosis of hypertension, hyperlipidaemia, type 2 diabetes (T2D), depression, or Alzheimers disease and related dementias (ADRD). The outcome was presence of guideline-recommended medication order for each condition, modelled with modified Poisson regression to estimate adjusted prevalence risk ratios (RRs) and 95% confidence intervals. ResultsMedication order rates were 79% for ADRD, 79.1% for T2D, 87.7% for hypertension, 83.3% for hyperlipidaemia, and 90.8% for depression. Rates varied across comorbidity combinations: ADRD was associated with lower medication order prevalence, while cardiometabolic multimorbidity profiles associated with higher prevalence. Black/African American identity had the lowest likelihoods of a medication order for 3 of 5 conditions (RRs of 0.93 to 0.92), while having hypertension or hyperlipidaemia medication order was associated with higher likelihood of having orders for 3 of remaining 4 conditions (RRs of 1.02 to 1.19). ConclusionsMost SNF residents with multimorbidity had a medication order for common chronic conditions, although important variability and disparities remain. Differences by comorbidity profile and social context underscore the need for targeted strategies supporting equitable, integrated prescribing and person-centred care in SNFs.

Background Emerging evidence has linked frailty to individual chronic diseases, but whether it predicts a broad disease spectrum and accelerates multimorbidity accumulation over time remains unknown. This study aimed to systematically evaluate the associations of physical frailty with the burden of incident disease across a wide range of chronic conditions, and with the long-term rates of multimorbidity accumulation. Methods In this prospective cohort study of 466,864 UK Biobank participants , frailty status was assessed using the Fried frailty phenotype and categorized as robust, pre-frailty, or frailty. Chronic diseases were defined based on International Classification of Diseases (ICD)-10 codes, and disease patterns were identified using network analysis. Cox proportional hazards models were used to examine the associations of frailty status with incident chronic diseases, and linear mixed models were used to assess the annual rate of chronic disease accumulation. Results During a median follow-up of 13.8 years (IQR: 13.1-14.5), 536 incident chronic diseases across multiple systems were recorded. Physical frailty was associated with a significantly increased risk of 458 incident diseases (Bonferroni-corrected P < 0.05/536). In the overall cohort, compared with robust participants, those with pre-frailty ({beta} = 0.266, 95% confidence interval [CI]: 0.264-0.267) and frailty ({beta} = 0.941, 95% CI: 0.936-0.946) exhibited significantly faster rates of multimorbidity accumulation. This accelerated multimorbidity accumulation was consistently observed across strata of baseline disease burden, including participant with 0 ({beta} = 0.644, 95% CI: 0.635-0.653), 1 ({beta} =0.748, 95% CI: 0.727-0.768), [&ge;] 2 ({beta} =0.940, 95% CI: 0.933-0.947) chronic conditions at baseline. Similar associations were also found across distinct disease patterns, including neurodegenerative, metabolic, and psychiatric patterns. Conclusions Physical frailty predicts a broad range of incident diseases and is associated with accelerated multimorbidity accumulation. Incorporating frailty assessment into prevention strategies may help mitigate the growing burden of multimorbidity.

This study examined the prevalence of domestic elder abuse and examined factors in a province with a high aging index in Vietnam in 2025. Elder abuse was measured using the validated Vietnamese Domestic Elder Abuse Scale, covering psychological abuse, physical abuse, financial exploitation, neglect/abandonment. Logistic regressions identified factors associated with abuse. 29.44% of participants reported at least one abuse subtypes, with psychological abuse being the most common subtype (24.73%) and 9.82% experienced polyvictimization. Higher educational attainment was consistently associated with lower odds of all abuse subtypes. Having [&ge;]4 chronic conditions was associated with higher odds of psychological abuse compared with having none (OR= 2.79, 95%CI: 1.29-6.00). Difficulties in daily basic activities were associated with physical abuse (OR=5.42, 95%CI: 1.80-16.36), financial exploitation (OR=3.66, 95%CI: 1.34-10.01), and neglect/abandonment (OR=4.09, 95%CI: 1.72-9.70) compared with no difficulties. Findings highlight the need for stronger policy implementation and lifelong learning to prevent elder abuse in Vietnam.

Background: Frailty is a prominent risk factor for dementia. Early detection of at-risk individuals may enable intervention to prevent or slow dementia pathology. Blood-based biomarker discovery could offer a path for early detection of frailty and cognitive decline. Methods: Older adults at risk of dementia underwent comprehensive multi-disciplinary assessment at the Healthy Brain Ageing (HBA) clinic, including geriatric, neurophysiological and mood evaluations, in addition to providing a fasted blood sample. Clinical data were used to calculate a deficit accumulation frailty index (FI) score. Additional cohorts attended either one (n=118) or two (n=73) subsequent visits over an average period of 4 years. Untargeted metabolomics was performed on plasma samples, and metabolites were clustered by similarity. Linear regression was used to assess association of clusters with FI. Finally, change in plasma abundance over time was assessed. Results: At assessment, participants had a mean (SD) age of 68.10 (8.07) years; 72.2% were female. Hierarchical clustering identified 10 clusters of metabolites, of which 6 were significantly associated with FI (p<0.05) at baseline and contained similar classes of metabolite. Differential abundance analysis found unique temporal regulation of metabolite abundance in each cluster, but across clusters severity of frailty impacted direction of change in plasma abundance over time. Conclusions: Frailty index was associated with carboxylic acids and derivatives, fatty acyls and organooxygen compounds across multiple clusters, and a large number of lipids were linked to frailty score, potentially implicating dysregulation of energy metabolism in the pathophysiology of frailty and forming a panel of predictive biomarkers of at risk patients.

Although physical activity is associated with better physical functioning, the effects of initiating regular physical activity among older adults with persistent inactivity remain unclear. We conducted a sequential target trial emulation using Health and Retirement Study (HRS) data to estimate the effect of physical activity initiation versus noninitiation on incident mobility difficulty. Participants were included in the analysis if they were aged [&ge;]65 years at the previous wave, reported no regular physical activity at the previous two waves, and had no mobility, activities of daily living (ADL), or instrumental activities of daily living (IADL) difficulties at baseline. Stabilized inverse probability of treatment weighting was applied to adjust for measured confounding. Weighted cumulative incidence was then estimated with death treated as a competing event, and risk differences were calculated at approximately 2, 4, and 6 years. At 2 years, the cumulative incidence of mobility difficulty was 32.75% among initiators and 39.73% among noninitiators, with a risk difference of -6.98 percentage points (95% CI, -13.11 to -0.88). At 4 and 6 years, risk differences were -2.90 percentage points (95% CI, -9.77 to 4.29) and -5.44 percentage points (95% CI, -12.27 to 1.99), respectively. Initiating regular moderate or vigorous physical activity was associated with a lower risk of incident mobility difficulty at approximately 2 years among older adults with persistent inactivity. This difference was less evident at later follow-up, and no clear differences were observed for incident ADL or IADL difficulty.

Background: Retirement is a major life transition that may influence cognitive aging. Retirement pathways are becoming increasingly diversified, yet evidence on how heterogeneous retirement trajectories relate to dementia risk remains limited. This study used sequence and cluster analysis to characterize thousands of transition-to-retirement trajectories, including retirement timing and work intensity, to estimate associations with dementia risk. Methods: We used data from 13,879 participants in the U.S. Health and Retirement Study. Our exposure was transition-to-retirement trajectories between ages 51 and 75 identified using sequence and cluster analysis. Our outcome was a validated algorithmically derived dementia probability measure. We estimated associations between trajectory clusters and dementia risk beginning at age 76 using generalized estimating equations, adjusting for sociodemographic characteristics. Inverse probability weights were used to account for attrition. Results: We identified ten distinct transition-to-retirement trajectories characterized by differences in timing of retirement, part-time work, disability, and labor force attachment. Compared with individuals retiring after full-time work in their early-to-mid 60s, dementia risk was similar among those retiring earlier or later from full-time work. In contrast, individuals with sustained part-time employment between ages 51 and 75 had lower odds of dementia (OR: 0.62, 95% CI: 0.48, 0.80), while trajectories characterized by prolonged disability were associated with higher odds of dementia (OR: 1.53, 95% CI: 1.22, 1.91). Conclusions: Retirement timing alone showed limited association with later-life dementia risk, whereas sustained part-time employment and disability-related trajectories were more strongly associated with dementia risk. These findings suggest that employment intensity and health-related exit from the labor force may be more relevant for dementia risk than retirement timing, and that gradual and flexible work-to-retirement transitions may benefit brain health. Background: Retirement is a major life transition that may influence cognitive aging. Retirement pathways are becoming increasingly diversified, yet evidence on how heterogeneous retirement trajectories relate to dementia risk remains limited. This study used sequence and cluster analysis to characterize thousands of transition-to-retirement trajectories, including retirement timing and work intensity, to estimate associations with dementia risk. Methods: We used data from 13,879 participants in the U.S. Health and Retirement Study. Our exposure was transition-to-retirement trajectories between ages 51 and 75 identified using sequence and cluster analysis. Our outcome was a validated algorithmically derived dementia probability measure. We estimated associations between trajectory clusters and dementia risk beginning at age 76 using generalized estimating equations, adjusting for sociodemographic characteristics. Inverse probability weights were used to account for attrition. Results: We identified ten distinct transition-to-retirement trajectories characterized by differences in timing of retirement, part-time work, disability, and labor force attachment. Compared with individuals retiring after full-time work in their early-to-mid 60s, dementia risk was similar among those retiring earlier or later from full-time work. In contrast, individuals with sustained part-time employment between ages 51 and 75 had lower odds of dementia (OR: 0.62, 95% CI: 0.48, 0.80), while trajectories characterized by prolonged disability were associated with higher odds of dementia (OR: 1.53, 95% CI: 1.22, 1.91). Conclusions: Retirement timing alone showed limited association with later-life dementia risk, whereas sustained part-time employment and disability-related trajectories were more strongly associated with dementia risk. These findings suggest that employment intensity and health-related exit from the labor force may be more relevant for dementia risk than retirement timing, and that gradual and flexible work-to-retirement transitions may benefit brain health.

Background: Associations of sleep duration and insomnia symptoms with cognitive decline are inconsistent, and whether they represent modifiable risk factors or early manifestations of neurodegeneration may depend on life stage. We examined how sleep-cognition associations vary with age (44 to >90 years). Methods: We studied 16,884 participants from three cohorts with harmonised measures. In the English Longitudinal Study of Ageing (ELSA: n=9,473, median age 64, range 50 to >=90), linear mixed-effects models examined age-specific differences in cognitive change (recall and fluency) associated with sleep duration, difficulty falling asleep, nocturnal awakenings, incorporating sleep-by-age-by-time interactions, with initial adjustment for sociodemographic factors and further adjustment for health and lifestyle factors. Sleep characteristics showing consistent age-dependent associations in ELSA were further evaluated in Whitehall II (n=5,580, median age 55, range 44 to 68) and the Rush Memory and Aging Project (MAP: n=1,831, median age 80, range 53 to 102). Findings: In ELSA, difficulty falling asleep >=1 time/week (vs <1 time/week) was associated with less favourable 5-year change in recall at age 50 (difference -0.12 SD, 95% CI -0.20 to -0.04), with the association attenuating and reversing towards more favourable change at older ages (p-interaction=0.009 [linear], 0.016 [quadratic]). These persisted after further adjustment for health and lifestyle factors. Short sleep (<=6 h) showed similar patterns that attenuated after further adjustment. Similar age gradients were observed for difficulty falling asleep in Whitehall II and MAP. There was no evidence of age modification on long sleep and nocturnal awakenings. Interpretation: The cognitive implications of sleep disturbances vary by life stage. In midlife, difficulty falling asleep was associated with faster cognitive decline, supporting its role as a modifiable risk factor. In advanced age, the reversal is consistent with diminished arousal capacity accompanying prodromal dementia. Funding: US National Institute on Aging

. Abstract Objectives. Prior research has identified associations between sleep health and cognitive function. Our aim was to investigate multiple domains of sleep health and their associations with cognitive function in a diverse sample of older adults. Methods. These data are from an observational study in Chicago, USA, that enrolled adults aged 55 years and older without cognitive impairment at baseline and followed a subset for up to 2 years. Sleep was measured with 7 days of wrist actigraphy and we examined sleep duration (amount), sleep fragmentation (an index of restlessness and sleep quality), sleep start time and sleep regularity (based on the within-subject standard deviation of sleep start time). . Participants also completed tasks from the NIH Toolbox to estimate fluid cognition and the Trail Making Test (Trails B) to assess attention and processing speed. A subset of participants was examined at a follow-up visit that included only the NIH Toolbox assessment. Results. Our sample included 324 participants (63.6% women, 37.3% African American/Black, 13.6% Hispanic/Latino). Greater sleep fragmentation and less sleep regularity were associated with worse fluid cognition and Trails B scores (all p<.01). Longer sleep duration and earlier sleep start times were associated with better performance on Trails B. No sleep measures were associated with change in the fluid cognition score over an average of 1.9 years (n=133). Discussion. These findings support a cross-sectional association between cognitive function and multiple domains of sleep health, including duration, quality, timing and regularity, in a diverse sample of older adults.

People from UK South Asian communities experience barriers to accessing dementia care. Evidence suggests that evidence-based psychosocial dementia interventions can be successfully adapted for different cultural contexts, but further evidence is needed on how adaptations are developed and refined in practice. We aimed to adapt GRACE-family (Goal diRected, Accessible and Evidence-based Care), an evidence-based, manualised post-diagnostic dementia intervention, comprising 4-8 sessions for family carers and where possible, people with dementia, for Bengali-speaking communities. In a theory-informed process, a co-adaptation group encompassing lived, academic and clinical/professional experience developed consensus regarding which intervention functions were core. They then explored how adaptation might, while retaining these, account for cultural and linguistic contexts, informed by focus groups with memory service and Bengali community organisation staff (n=14). We developed a prototype adaptation, then piloted it with four Bangladeshi families supporting a person with dementia. Post-intervention, participants were asked about goal attainment, intervention acceptability, and qualitatively interviewed. Pilot data and a focus group with Sylheti-speaking family carers informed further refinements (n=6). Across data sources, two themes informed adaptation: (1) stigma, trust and community networks shaped access to dementia support; (2) flexible delivery was needed to respond to diverse language, communication and cultural needs. 3/4 pilot families completed the prototype intervention, which was in English as initial consultation cautioned against developing a written manual in a predominantly spoken language. Participants reported improvement on 7/8 personalised goals set, and all considered the intervention acceptable. Pilot delivery identified challenges using English-language materials during interpreter-mediated sessions. Iterative refinements added standard Bengali materials and spoken Sylheti audiovisual resources to broaden delivery options and facilitator training for culturally responsive and interpreter-mediated delivery. Our co-adaptation approach enabled stakeholders to advise from different, including experiential perspectives. It may inform future approaches to cultural and linguistically adaptations of psychological interventions for minoritised communities.

Frailty assessment is increasingly recommended for risk stratification in chronic disease management, but systematic clinical screening for frailty remains difficult to implement because it is resource-intensive. We investigated whether routinely collected clinical measures could be repurposed to prioritize adults with chronic diseases for clinical frailty assessment. We conducted a prediction study using UK Biobank data. A stacked ensemble model was developed using 12 routinely and low cost measured clinical variables to predict frailty. Gain metrics were used to quantify the proportion of frailty cases identified when screening was restricted to individuals with the highest predicted risk of frailty. We compared health profiles (mortality, polypharmacy, self-rated health, falls) of frail and non-frail individuals across different levels of predicted risk. The robustness of this screening strategy was evaluated across 3,284 modelling settings. Among 281,729 participants (mean age 57.9; 54.7% women) with at least one chronic condition, 5.8% were frail. In the validation sample (N validation=93,910, N training=187,819), screening only the 20% of participants with the highest predicted risk of frailty identified 55.6% of all frailty cases, corresponding to a 2.78-fold improvement compared to random screening. Overall, the model recovered 53.4% of the maximum achievable improvement over random screening. Frailty remained always associated with poor outcomes. Screening performance remained consistent across alternative modelling settings. Routinely collected clinical measures can improve the efficiency of frailty screening among adults living with chronic diseases by prioritizing individuals based on their level of risk. Since these data are already gathered during routine care, this risk-prioritization strategy could support scalable screening without increasing testing burden or clinical workload.

INTRODUCTION: Individual lifestyle, behavioural and health-related factors are associated with the risk of developing dementia. However, the co-occurrence of these factors, which are likely to form distinct patterns, in relation to dementia risk has been understudied. METHODS: The sample included 151,832 UK Biobank participants aged 60-69 years. Latent class analysis was used to identify patterns among participants with two or more of the following risk factors: high alcohol consumption, high body weight, depression, diabetes, poor diet, hypertension, physical inactivity, visual impairment, hearing impairment, sleep disturbance, smoking, social isolation, traumatic brain injury, and vitamin D deficiency. Multivariate Cox proportional hazards models were used to determine the associations between identified risk factor patterns and incident dementia ascertained through hospital and death records. RESULTS: Over a median follow-up of 13 years, 5,304 participants developed dementia. Six risk factor classes were identified. Compared to participants with zero or one risk factor, all classes were associated with dementia risk: 'multiple risk factors' (hazard ratio [HR] 2.38, 95% confidence interval [CI] 2.11-2.68), 'hearing loss and unhealthy lifestyle' (HR=1.37, 95% CI 1.22-1.55), 'sleep and psychosocial factors' (HR=1.34, 95% CI 1.20-1.49), 'poor cardiometabolic health' (HR=1.32, 95% CI 1.19-1.46), 'heavy drinking and unhealthy lifestyle' (HR=1.20, 95% CI 1.07-1.35), and 'vitamin D deficiency, sedentary and psychosocial factors' (HR=1.18, 95% CI 1.03-1.35). DISCUSSION: We identified risk factor patterns that were differentially associated with dementia risk. These findings suggest that accounting for the co-occurrence of risk factors might be an effective approach for risk stratification and developing effective dementia prevention strategies.

Despite the numerous benefits associated with higher dietary quality, many older Veterans do not meet national dietary recommendations. Existing programs are not typically tailored for older Veterans who may experience physical and environmental limitations that hinder their ability to access and prepare healthy foods. This project piloted the incorporation of age-friendly, tailored, virtual nutrition education into an existing health promotion program for older Veterans. Programming followed an iterative design process over two years. Year 1 included 14 weeks of virtual nutrition education on healthy aging paired with weekly produce bags and recipe suggestions. In Year 2, virtual nutrition education shifted to more hands-on learning emphasizing basic meal preparation and adaptive cooking strategies for mobility limitations. Produce distribution in Year 2 shifted to a farmer's market model, based on feedback from year 1, allowing participants to self-select items. Primary outcomes included program satisfaction, dietary intake assessed via 24-hour recall to calculate the Healthy Eating Index (HEI-2015), and health-related quality of life (PROMIS Global Health). Findings demonstrate the feasibility and acceptability of a virtual nutrition program incorporating age-friendly cooking instruction and adaptive strategies to improve dietary quality among older Veterans.

Study objectives: Aging is associated with increased sleep complaints and changes in sleep architecture, microstructure and rest-activity rhythms. Meditation-based interventions have shown benefits on subjective sleep quality, but their effects on objective sleep parameters remain largely underexplored. This study investigated the effects of an 18-month meditation intervention on sleep combining subjective (questionnaires) and objective (polysomnography and actigraphy) measures in older adults. Methods: A total of 120 cognitively unimpaired older adults ([&ge;]65 y) with minimal sleep complaint completed questionnaires, one week of actigraphy and in-home polysomnography at baseline, and again 18 months later. Following the baseline visit, participants were randomly assigned to one of 3 groups: meditation training, non-native language training (active control), or passive control. Group-by-visit interactions were examined using mixed-effects models for sleep questionnaires, actigraphy-derived metrics, sleep architecture and microstructure, including slow waves, spindles, and spectral power. Results: Compared to the passive control group only, meditation training was associated with greater ease of morning awakening (p=0.04). No significant intervention effects were observed for any other sleep parameter, including actigraphy- and polysomnography-derived measures. These findings remained unchanged after adjustment for depressive symptoms and trait anxiety. Conclusion: In cognitively unimpaired older adults, this 18-month meditation intervention yielded only limited improvements in subjective sleep assessment. Meditation may therefore have subtle effects on self-reported sleep quality in this healthy older population, although no effects on objective sleep measures were detected. Future studies should examine whether adapting the content, intensity, or timing of meditation practice and enrolling populations with clinically meaningful sleep disturbances or psychoaffective symptoms may yield greater benefits.