Journal of the American Medical Directors Association

OBJECTIVE: Research on neighborhood context and cognitive health often relies on composite indices that collapse neighborhood socioeconomic status (SES) and aspects of the built environment into a single score. This study examined the extent to which neighborhood SES and built environment were associated with late-life cognitive impairment. METHOD: Participants were 281 predominantly Black older adults who completed the Self-Administered Gerocognitive Exam (SAGE), a brief cognitive screening measure. Participants also provided their home address to obtain four neighborhood metrics: Two composite measures of neighborhood disadvantage, the Environmental Justice Index (EJI) and the EJI Social-Environmental Rank, as well as the EJI Social Vulnerability Rank as a measure of neighborhood SES, and the EJI Environmental Burden Rank to measure exposure to hazardous aspects of the built environment. RESULTS: Lower neighborhood SES was associated with higher odds of cognitive impairment. In contrast, greater environmental burden was associated with lower odds of impairment, with years of education as a moderator; the association was strongest among individuals with high levels of education. The two composite scores were not associated with cognitive impairment. CONCLUSION: Composite measures of neighborhood features may obscure distinct pathways of their effects on cognition.

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: 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.

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.

. 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.

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.

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.

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.

Importance: Long-term exposure to higher average air pollutant concentrations is associated with poorer cognitive health, but annual averages can obscure substantial differences in day-to-day exposure. Whether recurrent high pollution days are associated with long-term cognitive aging trajectories among people with similar overall air pollution exposure is unclear. Objective: To determine whether the annual number of days exceeding World Health Organization daily guideline values for nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10) is associated with subsequent cognitive decline after accounting for annual mean air pollutant exposure. Design: Prospective cohort study using data from waves 1-10 (2002-03 to 2021-23) of the English Longitudinal Study of Ageing. Setting: Population-based cohort of community-dwelling adults in England. Participants: 12,235 adults aged 50+ years at analytic baseline. Exposures: Number of days exceeding World Health Organization daily guideline values ('exceedance days') for NO2, PM2.5, and PM10, derived from residence-linked environmental estimates during the calendar year preceding the analytic baseline. Main Outcomes and Measures: Baseline cognitive performance and model-estimated 14-year cognitive decline (corresponding to the 75th percentile of follow-up duration) in episodic memory and verbal fluency. Results: Exceedance days were not associated with baseline memory or verbal fluency after adjustment for annual mean air pollutant exposure. More NO2 exceedance days were associated with faster cognitive decline: comparing the 75th percentile with the median of NO2 exceedance days, the difference in 14-year decline was -0.09 SD (95% CI, -0.17 to -0.01; p = 0.02) for memory and -0.10 SD (95% CI, -0.19 to 0.00; p = 0.04) for fluency. PM2.5 and PM10 exceedance days were not associated with cognitive decline. Conclusions and Relevance: In this cohort study of older adults, a higher number of NO2 exceedance days was associated with faster subsequent cognitive decline after adjustment for annual mean air pollutant exposure. This suggests that daily exposure to high NO2 concentrations may be related to accelerated cognitive aging even when offset by lower exposure on other days, potentially providing a new rationale for identifying and prioritizing areas with recurrent high NO2 exposure and the local emission sources contributing to it.

Abstract Background: Heart failure (HF) is a major public health challenge in ageing populations and a leading cause of unplanned hospital readmissions. Biological, social, and economic factors contribute to recurrent hospitalisation, but gaps remain in understanding how these factors interact and patterns of healthcare use following hospitalisation. Methods: We conducted an explanatory sequential mixed-methods study of patients aged ?60 years with an HF hospital admission between 2016 and 2020 who completed the Sax Institute?s 45 and Up Study baseline questionnaire. Data were linked to Admitted Patient Data Collection, Medicare Benefits Schedule, and Pharmaceutical Benefits Scheme data. HF readmission within 30 days of the index admission was the outcome. Cox proportional hazards models estimated crude and adjusted hazard ratios (HRs and adjHRs) with 95% confidence intervals (CIs). Kaplan-Meier curves and log-rank tests compared survival between groups. Time-series plots mapped healthcare interactions over 1 year following the index admission. Results: Among 4,252 patients with HF, 409 were readmitted within 30 days. Significant predictors included age ?80 years (adjHR, 1.30; 95%CI, 1.01?1.67), 1 chronic condition (adjHR, 2.49; 95%CI, 1.41?4.40), ?2 chronic conditions (adjHR, 1.75; 95%CI, 1.04?2.95), and alcohol consumption above national guidelines (adjHR, 1.45; 95%CI, 1.06?1.98). Time-series analysis indicated that participants with readmission had more frequent out-of-hospital health service contact following their initial HF admission than those without readmission. Conclusions: Older age, chronic conditions, and high alcohol intake increased 30-day HF readmission risk. Differences in healthcare use after admission highlight opportunities for targeted and coordinated post-discharge care.

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

Objective: To determine whether plasma neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) are elevated in hospitalised patients with delirium relative to patients with dementia and primary psychiatric disorders (PPD). Methods and analysis: This was a cross-sectional observational study conducted at the Royal Melbourne Hospital, Melbourne, Australia, between April and October 2024, with comparator samples from a research biobank. In Phase 1 (Delirium Discovery Cohort), we measured plasma NfL and GFAP using the Single molecule array (Simoa) platform in hospitalised patients with delirium and compared them with dementia and PPD groups. Biomarker concentrations were the primary outcome and were compared using general linear models adjusted for age, sex, and estimated glomerular filtration rate, with bootstrapped confidence intervals. Discriminative performance was assessed as a secondary outcome using receiver operating characteristic (ROC) curve analysis. In Phase 2, we applied this threshold to independent dementia and PPD groups. Results: In Phase 1 (n =176), inpatients with delirium showed higher concentrations of both NfL and GFAP than patients with dementia ({beta} = 0.78; 95% CI [0.37, 1.20] and {beta} = 0.39 [0.07, 0.73] respectively) or PPD groups ({beta} = 1.17; [0.69, 1.66] and {beta} = 0.83 [0.51, 1.24] respectively). ROC curve analysis for differentiating delirium from dementia and PPD groups yielded an optimal NfL threshold of 24.1 pg/mL (AUC = 0.89, 96% sensitivity, 70% specificity). In comparison, GFAP showed lower accuracy (AUC = 0.85), and combining NfL with GFAP (AUC = 0.90) did not significantly improve performance. In Phase 2 (n = 154), the NfL threshold of > 24 pg/ml maintained strong performance (AUC = 0.95, 96% sensitivity, and 77% specificity). Conclusions: Plasma NfL shows promise as a biomarker for delirium in hospitalised patients, distinguishing it with high sensitivity from patients with dementia and PPD. Larger multicentre studies are needed to refine cut-offs, evaluate temporal dynamics, and determine integration into acute hospital delirium pathways.

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.

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: 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.

IntroductionFalls are a major cause of injury-related morbidity, mortality, and healthcare utilisation among older adults, with the greatest burden occurring in those aged [&ge;]80 years. Multicomponent exercise programmes that include balance and resistance exercises reduce falls, whereas the effect of resistance training delivered as a standalone fall-prevention intervention remains uncertain. Existing resistance-training trials have generally been small, underpowered for fall outcomes, and have produced inconsistent findings, despite reduced muscle strength being an important modifiable risk factor in the oldest old. The resistance training prescription used in these studies has not always aligned with recommendations for optimal strength adaptations in terms of intensity or progressive overload, which may explain this uncertain efficacy. Therefore, this study aims to determine whether 12 months of high-intensity progressive resistance training reduces fall rates in community-dwelling adults aged [&ge;]80 years with reduced muscle strength. Methods and analysisThis single-centre, randomised controlled trial conducted in Trondheim, Norway, includes 241 community-dwelling adults aged [&ge;]80 years with reduced muscle strength. Participants are randomly assigned (1:1) to either standard care with written physical activity guidance or a twice-weekly high-intensity progressive resistance training intervention for 12 months. The primary outcome is the rate of falls over 12 months. Secondary outcomes include time to first fall, fall-related injuries, muscular function, physical performance, balance, body composition, cardiometabolic health, cognition, and participant-reported outcomes. Cost-effectiveness is assessed from a healthcare perspective over the 12-month intervention period using costs and quality-adjusted life years. Analyses follow the intention-to-treat principle, using negative binomial regression for the primary outcome. The first participant was included on 30 March 2023, and the last participant was included on 29 September 2025. The 12-month intervention period is expected to be completed by September 2026. Ethics and disseminationThe study has received approval from the Regional Committee for Medical and Health Research Ethics in Norway (REK; reference number 462261). All participants provided written informed consent before participating. Findings will be shared via peer-reviewed publications, conference presentations, and communication with stakeholders and the public. Trial registration numberClinicalTrials.gov (NCT05691166), registered 11 January 2023. Available at: https://clinicaltrials.gov/study/NCT05691166

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 [&ge;]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.

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.

Objectives: The rising prevalence of financial exploitation among older adults has prompted research on the cognitive mechanisms underlying financial decision making in later life. Prior work has demonstrated a link between cognitive impairment and financial vulnerability. The present study examined the unique contributions of composite measures of memory and executive functioning to scam susceptibility in middle-aged to older adults without dementia. Methods: One hundred and fifty-one participants (age= 68.2 {+/-} 8.0 years, 72.2% female, years of education= 16.4 {+/-} 2.2) completed standard neuropsychological measures from the Uniform Data Set (UDS), Version 3, and the California Verbal Learning Test, Second Edition, and a self-report scam susceptibility measure. Psychometrically robust composite scores, the UDS-M+ and UDS3-EF, were computed to represent memory and executive functioning domains. Linear regression models examined independent associations between UDS-M+ and UDS3-EF performance and scam susceptibility. Nested model comparisons evaluated unique contributions of the UDS-M+ and UDS3-EF when included in a joint model. Results: Lower UDS-M+ (b= -0.25, 95% CI [-0.45, -0.04], p= .018) and lower UDS3-EF (b= -0.33, 95% CI [-0.54, -0.12], p= .002) scores were independently associated with greater scam susceptibility after adjusting for age, sex, years of education, and income. However, only UDS3-EF remained significant in a joint model. Post hoc analyses revealed that only memory was associated with scam susceptibility in middle-aged adults whereas only executive functioning was significant in older adults. Conclusions: These findings highlight the importance of monitoring memory and executive functioning across middle to older adulthood when considering susceptibility to scams.

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.