Journal of the American Medical Directors Association

Background Falls are a major safety concern in healthcare. In palliative care, patients are particularly vulnerable due to complex symptom burdens and rapid physical decline. However, standard falls risk assessment tools, primarily designed for acute clinical environments, rely on static risk scores and lack efficacy in hospice settings. The Falls Early Warning Score (FEWS) is a observational tool developed to address the specific contributing factors and complex needs of palliative patients. Aims To explore and understand staff views regarding the implementation, utility, and benefits of the FEWS tool to identify people at risk of falling in a specialist palliative care inpatient unit. Methods A mixed-methods study was conducted at a UK hospice. Healthcare professionals with clinical experience using the FEWS chart completed an electronic questionnaire assessing their confidence, practice, and perceived barriers. Questionnaire outcomes informed subsequent face-to-face, semi-structured interviews. Qualitative data were evaluated using reflexive thematic analysis. Results Eleven staff completed the questionnaire, and five participated in interviews. Three major themes were identified: (1) Education, highlighting staff preferences for 1:1 training and the necessity of dedicated user guides; (2) Location and format of the FEWS tool, contrasting the data collection benefits of electronic formats against the bedside accessibility of paper charts; and (3) Recognised benefits of the FEWS tool, including its ability to prompt safe staffing levels, highlight variable patient presentation, and mitigate the emotional and physical impact of falls. Conclusions It is feasible and highly acceptable to integrate bespoke falls risk assessment tools into palliative care. By addressing the unique complexities of hospice patients, customised tools like FEWS can empower staff and support dynamic clinical decision-making. Further research is required to evaluate their clinical efficacy in reducing falls.

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.

Background: Sarcopenia and obesity often coexist in older adults and are associated with high-er functional decline, disability, and reduced quality of life. Although physical activity (PA) is protective, prescription and adherence to exercise programs remains low in this population. Pragmatic and scalable interventions are therefore needed. Thus, we evaluated the effects of a 12-week unsupervised PA prescription program on physical performance in overweight/obese frail geriatric outpatients. Methods: A single-arm interventional study was conducted among geriatric outpatients aged over 60 years. Thirty-seven overweight/obese participants (20 women) completed the 12-week home-based PACE prescription which included individualized functional and resistance exercises with walking. Physical performance [i.e. functional capacity (SPPB), walking speed, Timed Up and Go (TUG), lower-limb muscle endurance (30-STS) and function (5-STS)], clinical status (probable sarcopenia, fall risk, walking speed) and clinically meaningful changes were assessed. Results: Participants achieved 238 min/week of PA on average, with 65% meeting recommended PA guidelines. Significant improvements were observed in lower-limb muscle function (p=0.033) and endurance (p=0.006) and in absolute (p=0.038) or relative (p=0.045) estimated muscle power. The prevalence of probable sarcopenia decreased significantly following the intervention (p=0.011). Clinically meaningful improvements were observed in muscle endurance (p<0.001) and functional status (p=0.040). Conclusion: In overweight/obese frail geriatric outpatients, the prescription of PACE achieved high PA adherence and improved lower-limb muscle function. Integrating this pragmatic and personalized PA strategy into routine geriatric care may support healthy aging and help prevent sarcopenia-obesity related functional decline.

Background: Non-motor symptoms, including sleep and cognitive dysfunction, are major contributors to reduced quality of life in people with Parkinsons disease (PwPD). Dance has been proposed as a promising intervention to improve quality of life in PwPD. Previously, we reported longitudinal trajectories of global cognition following community-based dance; however, little is known about its long-term influence on sleep-related non-motor symptoms and their relationship with global cognitive performance. Objective: We examined the six-year trajectories of sleep and overall non-motor symptom severity among PwPD participating in weekly community-based dance classes compared to a sedentary Reference group. As a secondary objective, we evaluated their association with global cognitive performance as a functional outcome. Methods: This longitudinal observational study followed PwPD engaged in community dance participation as well as a matched sedentary control group from the Parkinsons Progression Markers Initiative database over six years. Generalized estimating equations (GEE) were used to model group-level trends, with sensitivity analyses conducted to assess the robustness of the findings. Results: Non-motor outcomes showed that insomnia worsened significantly within the Reference group (p = .003) but improved among dancers (p = .005), with daytime sleepiness remaining stable across both groups. When sleep was used as a predictor of cognition, global cognitive performance trended to improve in the Dance group (p = .078) and declined mid-period in the Reference group (p = .014). In addition, overall non-motor symptom severity worsened in the Reference group (p = .011) but remained stable in the Dance group. Constipation also worsened significantly in the Reference group (p = .012) compared to the Dance group. Conclusion: The present study demonstrates that community-based dance may support select non-motor symptoms, including insomnia, and cognitive resilience in PwPD. Findings reinforce dance as a valuable, real-world, non-pharmacological approach to slow functional decline in PD.

Background: Hearing loss (HL) may be a risk factor for poor psychosocial outcomes among older adults, but evidence remains mixed. We assessed associations of self-reported and objective HL with and without hearing aid use with social contact, loneliness, and depression pooled across 6 years of follow-up. Methods: We studied 2049 Black and White adults from the Health, Aging, and Body Composition study aged 70-79 at recruitment. Self-reported HL and audiometric HL with and without hearing aid use were assessed at analytic baseline (Year 5, 2001-2002). Outcomes were frequency of contact with family and friends (<weekly vs. at least weekly), depressive symptoms (CESD-10), and loneliness (CESD-10 item "I felt lonely") measured across 6 annual visits. Adjusted for demographic and clinical variables, we used generalized linear regression with generalized estimating equations to assess associations with outcomes pooled across six follow-up waves. Results: Self-reported HL (16%) was associated with more depressive symptoms ({beta}=0.13 SD; 95%CI:0.03,0.24), but no other outcome. Objective HL without hearing aid use (11%) was associated with infrequent contact with friends (OR=1.38; 95%CI:1.07,1.78) and more depressive symptoms ({beta}=0.19 SD; 95%CI:0.07,0.31); objective HL with hearing aid use (9%) was not associated with these outcomes. Objective HL, regardless of hearing aid use, was borderline associated with more frequent feelings of loneliness. Discussion: Objective HL without hearing aid use may be an important risk factor for isolation from friendship networks and depressive symptoms among older adults. Self-reported HL and objective HL with hearing aid use may also be linked to some adverse psychosocial outcomes.

Background: Fear of falling may limit mobility in older adults, particularly during winter. Pragmatic, community-based interventions are needed to support safe, sustainable walking. Objective: To assess the feasibility and acceptability of a co-created intervention (MABIDA) promoting utilitarian and recreational walking among older adults. Method: Fifty-two older adults with fear of falling participated in a 12-week group intervention (summer/winter) consisting of one 60-minute supervised walking session/week, incorporating exercises. Walking group level was assessed using a subjective decisional tree. Results: Forty-one participants (73.3{+/-}5.7years) completed the study (dropout: winter only). Retention and adherence exceeded 75%. Intervention settings were considered appropriate ([&ge;]81%). The decisional tree correctly classified 72% of participants. Participants reported satisfaction (82%) and enjoyment (81%). No differences were observed between seasons or walking groups (p>0.05). Group walking was the main facilitator (59%), while weather was the main barrier (17%). Conclusion: MABIDA appears feasible, acceptable, and adapted across seasons and walking speed profiles.

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.

Background Falls in hospitals are associated with injuries, deaths and poor patient outcomes. Although clinical guidelines recommend educating hospital patients about how to prevent falls, not all hospitals systematically deliver evidence-based patient falls education. The primary aim of this study is to implement and evaluate the effectiveness of delivering a research-informed education program called the Safe Recovery Program with ward support on rates of falls and falls-related injuries in hospitals. The secondary aims include measuring changes in patient and staff knowledge and awareness about falls prevention and identifying barriers and facilitators to staff and patients taking action to reduce hospital falls. Methods The trial will adhere to the Consolidated Standards of Reporting Trials guidelines. Twelve wards will be recruited from five Australian hospitals over a 65-week period. A stepped-wedge cluster randomised controlled trial design will be used with unidirectional crossover from control to experimental conditions together with randomisation of when each cluster makes the transition. The crossovers will occur at 12 timepoints, each five weeks apart. Alongside the trial, patients and staff on participating wards will be recruited for interviews and qualitative data analyses will be conducted to understand how to optimise implementation. The experimental condition involves usual care plus delivery of the Safe Recovery Program. For the Safe Recovery Program, supervised allied health assistants will deliver brief falls education programs to all suitable patients in designated wards, reinforced by all ward staff. Falls champions, who are registered nurses and allied health professionals, will provide Safe Recovery Program training for staff, using a train-the-trainer model. The ward staff will also be trained in how to support hospital patients to adopt safe behaviours. The primary outcome will be falls per 1000 patient bed days. The secondary outcomes will be: (i) injurious falls per 1000 patient bed days (ii) patient and staff changes in falls awareness, knowledge and motivation; and (iii) barriers and enablers to hospital staff engaging in behaviour change and program implementation. An economic evaluation will also be conducted to estimate the incremental cost effectiveness of implementing the Safe Recovery intervention. Ethics and Dissemination Ethics approvals have been obtained from The Royal Melbourne Hospital Human Research Ethics Committee (HREC/113864/MH-2024). The findings will be disseminated through peer-reviewed journals, workshops and conferences. Consumer team investigators will guide the communication of findings to the target audiences, including older patients, hospital staff, healthcare managers and policy makers. Trial Registration Number: ACTRN12624001469505

Background: Non-pharmacological interventions may enhance motor-cognitive integration in prodromal Alzheimer's disease (pAD). Partnered Rhythmic Rehabilitation (PRR), an adapted dance-based intervention, is designed to engage the motor, cognitive, and social domains. However, no randomized trial has evaluated its feasibility or efficacy in pAD. This study evaluated the feasibility, safety, and preliminary efficacy of PRR compared to group walking (WALK) in adults with pAD and amnestic mild cognitive impairment (aMCI). Methods: In this single-blind, randomized controlled pilot trial (NCT04029623), 68 adults with pAD and aMCI were randomized to PRR or WALK. Prespecified feasibility criteria were attrition [&le;]15% and no injurious falls during interventions. Preliminary efficacy was examined on the primary outcome, the Four-Square Step Test (FSST). Secondary cognitive, motor, and psychosocial outcomes were also assessed to inform future definitive trials. Several modifications were made to the original protocol to ensure compliance with safety measures associated with the COVID-19 pandemic. Results: Attrition in the PRR group (15.2%) did not significantly exceed the prespecified threshold (P = .848), and 0 injurious falls were reported during the supervised sessions, meeting both feasibility and safety criteria. No significant group-by-time interactions were observed for FSST, but significant group-by-time interactions favoring PRR were identified for Timed Up-and-Go (TUG; P = .021) and jump distance (P = .014). Conclusion: PRR was feasible and safe in adults with aMCI consistent with pAD but did not meet the prespecified efficacy endpoint on FSST. Our results showed that TUG and standing board jump distance may serve as potential outcomes in future definitive trials.

Background: Polypharmacy is an escalating global health challenge, yet longitudinal evidence regarding its impact on mortality in Latin American aging populations remains limited. This study evaluated the association between medication burden and all cause mortality among community dwelling older adults in a rapidly aging region of Colombia. Methods: A longitudinal analysis was conducted using a sub-cohort of 4,110 participants (aged 60 years or more) from the SABE Colombia survey (Antioquia, Caldas, Risaralda, and Quindio). Vital status was adjudicated via the National Health System Resources Administrator (ADRES) database over a mean follow-up of 79 months. Polypharmacy was defined as the concurrent use of 5 9 medications and excessive polypharmacy as 10 or more. Extended Cox proportional hazards models were employed to estimate hazard ratios (HR), adjusting for sociodemographic factors, multimorbidity, and functional dependency. Results: At baseline, 20.2% of participants presented polypharmacy and 2.1% excessive polypharmacy. A total of 1,092 deaths (26.6%) were recorded during follow-up. After multivariable adjustment, both moderate polypharmacy (HR 1.17; 95% CI 1.02 - 1.31; p=0.029) and excessive polypharmacy (HR 1.82; 95% CI 1.34 - 2.47; p<0.001) were identified as independent predictors of mortality. Notably, the risk was markedly higher at the 10 or more medication threshold, suggesting a non-linear relationship between pharmacological burden and survival. Conclusions: Polypharmacy is a significant and independent predictor of mortality in Colombian older adults, with the risk nearly doubling in cases of excessive medication use. These findings underscore the urgent need for structured medication review and deprescribing interventions tailored to resource-constrained healthcare systems to mitigate the risks associated with high pharmacological accumulation. Keywords: Polypharmacy, Aged, Mortality, Longitudinal, Colombia.

Background Population aging is rapidly increasing the burden of multimorbidity and frailty, yet there is limited evidence on how healthy aging policies are implemented across different demographic and health system contexts. Methods We conducted a mixed-methods comparative case study in Spain, Italy, Chile, and Colombia, integrating a Targeted review of policy documents and relevant literature, quantitative indicators, and expert interviews. Results Chile and Colombia showed faster aging dynamics (compound annual growth rates of 4.18% and 4.21%) than Italy (1.96%) and Spain (1.39%), with estimated doubling times of 17 versus 36-50 years. All four countries have established policy frameworks; implementation remains uneven. Key barriers included fragmented services, limited community care, workforce constraints, and misaligned financing. Conclusions The central challenge lies not in the absence of policy frameworks but in their effective implementation. Strengthening primary care, embedding frailty assessment, and improving health-social care integration are key priorities for systems facing rapid demographic transition.

. 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.

Objectives: The 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) has been used in cohort studies with scores of >= 8 and >= 10 used to indicate clinically significant symptoms or probable depression. We examined whether observations crossing these thresholds displayed core affective features expected in individuals who might be suffering with a clinically significant major depressive episode. Methods: This was a descriptive analysis of repeated CES-D-10 assessments in the ASPirin in Reducing Events in the Elderly eXTension (ASPREE-XT) longitudinal cohort study of 19,114 participants. We identified observations of 'probable depression', defined as a CES-D-10 score >= 8 and then examined scores on item 3 ("I felt depressed") and item 8 ("I was happy"). The primary outcome was the proportion of threshold-positive CES-D-10 observations with minimally depressed mood and preserved happiness. Results: Over 13 years, 27,417 observations met the threshold of CES-D-10 >= 8. Of these, 13,356 observations (48.7%) had minimally depressed mood and preserved happiness. Conclusion: A substantial proportion of observations considered 'probable depression' had little or no depressed mood, together with preserved happiness. CES-D-10 sum scores should be used with caution as a proxy for major depressive disorder in 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.

Background: Limited evidence motivated us to examine risk of suicide after partner loss among older adults in Austria. Methods: All married older adults aged [&ge;]65 years and living in Austria (N=1,293,557) were followed during 2014-2023. Risk ratios (aRRs) for partner loss were calculated based on adjusted cumulative incidence functions. Results: A total of 357 suicides occurred among widowed older adults. Incidence rates among widowed and not widowed were 56.9 and 29.4 per 100,000 person-years, respectively. High rates were found among widowed males (170.8/100,000) and widowers aged [&ge;]85 (94.1/100,000). Suicide risk was highest in the first month (aRR, 13.6; 95%-CI: 8.7,22.4) but remained elevated up to five years after partner loss (aRR, 2.5; 95%-CI: 2.1, 2.8). Conclusion: Recently bereaved older adults had elevated risks of suicide suggesting monitoring and psychosocial support may be beneficial when bereaved.

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.