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Digital technologies have the potential to contribute to health promotion and disease prevention in the aging world. This study aims to identify digital technologies for health promotion and disease prevention that could be used independently by older people in nonclinical settings using a scoping review. Through database (MEDLINE, PsycINFO, CINAHL, and SCOPUS; to March 3, 2022) and manual searches (to June 14, 2022), 90 primary studies and 8 systematic reviews were included in this scoping review. The eligibility was based on the PCC (Population, Concept, and Context) criteria: (1) people aged 50 years or older (population), (2) any digital (health) technology (eg, smartphone apps, websites, virtual reality; concept), and (3) health promotion and disease prevention in daily life in nonclinical and noninstitutional settings (context). Data items included study characteristics, PCC criteria, opportunities versus challenges, and evidence gaps. Data were synthesized using descriptive statistics or narratively described by identifying common themes. The studies were published in 2005-2022 and originated predominantly from North America and Europe. Most primary studies were nonrandomized, reported quantitative data, and investigated effectiveness or feasibility (eg, acceptance or usability) of digital technologies in older people. The participants were aged 50 years to 99 years, predominantly female, affluent (ie, with high income, education, and digital competence), and intended to use or used digital technologies for a median of 3 months independently at home or in community settings. The digital technologies included mobile or nonmobile technologies or virtual reality. The studies used \"modern devices\" (eg, smartphones, wearables, or gaming consoles) or modern and \"older devices\" (eg, computers or mobile phones). The users interacted with digital technologies via websites, emails, text messages, apps, or virtual reality. Health targets of digital technologies were mobility, mental health, nutrition, or cognition. The opportunities versus challenges of digital technologies were (1) potential health benefits versus unclear or no benefits for some outcomes, (2) monitoring of health versus ethical issues with data collection and management, (3) implications for functioning in daily life (ie, potential to prolong independent living) versus unclear application for clinical management or care, (4) tailoring of technical properties and content toward older users versus general use, (5) importance of human support for feasibility versus other factors required to improve feasibility, (6) reduction of social isolation versus access to digital technologies, and (7) improvement in digital competence versus digital divide. Various digital technologies were independently used by people aged 50 years or older for health promotion and disease prevention. Future studies should focus on (1) more diverse populations of older people, (2) new digital technologies, (3) other (clinical and care) settings, and (4) outcome evaluation to identify factors that could enhance any health benefits of digital technologies. RR2-10.2196/37729.

Background Dyslipidemia is a major risk factor for cardiovascular diseases (CVD). The prevalence of dyslipidemia varies by geographic location, often higher in urban populations. Our study aimed to assess the prevalence of dyslipidemia in the aging Indian population and compare the rural–urban differences in lipid abnormalities. Methods We analyzed baseline cross-sectional data from two longitudinal aging cohorts in rural and urban southern India- 2,797 participants from the rural (CBR-SANSCOG) cohort in Srinivaspura, Karnataka, and, 430 participants from the urban (CBR-TLSA) cohort in Bangalore, Karnataka. Participants aged ≥ 45 years were included, and those with dementia, severe psychiatric/medical illnesses, and severe visual/hearing impairments were excluded. Data on sociodemographic variables, physical activity, tobacco/alcohol use, BMI, diagnosis of diabetes, hypertension, and other medical comorbidities were collected. Lipid profiles were measured from fasting peripheral venous blood samples using standard laboratory techniques and lipid abnormalities were classified based on the NCEP ATP-III criteria. Proportions of lipid abnormalities were compared between the two populations using the two-proportions Z-test, and risk factors associated with dyslipidemia were analyzed using multivariate logistic regression models. Results The prevalence of high total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-c) was significantly greater in the urban than rural population (TC: 37.0% vs. 28.4% p < 0.001 and LDL-c: 33.5% vs. 26.8%, p < 0.01, respectively), while the prevalence of low high-density lipoprotein cholesterol (HDL-c: 72.4% vs. 44.2%, p <0.001), high triglycerides (TG: 45.7% vs. 38.6%, p <0.01) and lipid risk ratios (TC/HDL-c, TG/HDL-c and LDL-c/HDL-c) was higher in the rural than urban population. Females in both urban and rural populations were at a higher risk of having multiple lipid abnormalities. For the other risk factors assessed, while diabetes, overweight, obesity, and physical inactivity were associated with increased risks for certain lipid abnormalities, these associations were less pronounced in the urban population. Conclusions Aging Indians, both in rural and urban settings, have an alarmingly high prevalence of lipid abnormalities. Considering an elevated cardiovascular disease risk associated with lipid abnormalities, targeted interventions towards these communities are necessary to reduce the disease burden.

\"This Element focuses on the demographic dread arising from the relative shift in younger and older populations: not of a world lacking children, but of one catastrophized by the overabundance of the old and aging\"-- Provided by publisher.

BackgroundPolypharmacy and use of inappropriate medications have been linked to increased risk of falls, hospitalizations, cognitive impairment, and death. The primary objective of this review was to evaluate the effectiveness, comparative effectiveness, and harms of deprescribing interventions among community-dwelling older adults.MethodsWe searched OVID MEDLINE Embase, CINAHL, and the Cochrane Library from 1990 through February 2019 for controlled clinical trials comparing any deprescribing intervention to usual care or another intervention. Primary outcomes were all-cause mortality, hospitalizations, health-related quality of life, and falls. The secondary outcome was use of potentially inappropriate medications (PIMs). Interventions were categorized as comprehensive medication review, educational initiatives, and computerized decision support. Data abstracted by one investigator were verified by another. We used the Cochrane criteria to rate risk of bias for each study and the GRADE system to determine certainty of evidence (COE) for primary outcomes.ResultsThirty-eight low and medium risk of bias clinical trials were included. Comprehensive medication review may have reduced all-cause mortality (OR 0.74, 95% CI: 0.58 to 0.95, I2 = 0, k = 12, low COE) but probably had little to no effect on falls, health-related quality of life, or hospitalizations (low to moderate COE). Nine of thirteen trials reported fewer PIMs in the intervention group. Educational interventions probably had little to no effect on all-cause mortality, hospitalizations, or health-related quality of life (low to moderate COE). The effect on falls was uncertain (very low COE). All 11 education trials that included PIMs reported fewer in the intervention than in the control groups. Two of 4 computerized decision support trials reported fewer PIMs in the intervention arms; none included any primary outcomes.DiscussionIn community-dwelling people aged 65 years and older, medication deprescribing interventions may provide small reductions in mortality and use of potentially inappropriate medications.Registry InformationPROSPERO - CRD42019132420.

Background: The absolute number of older individuals needing medical care and long-term care (LTC) is increasing globally due to the growing ageing population. However, it is uncertain who and what proportion of the population has access to care. Therefore, a systematic review and meta-analysis of the prevalence and reasons for unmet needs for healthcare and long-term care among older people, 65 years old and above, across countries was conducted. Methods: An information specialist performed a comprehensive search of four major databases (PubMed, EMBASE, Web of Science, and CINAHL) from inception to June 2020 without restrictions on language and date. We did random-efects meta-analysis to obtain pooled prevalence. We stratifed the meta-analysis by reasons for unmet need categorized by barrier dimension (availability, accessibility, afordability, and acceptability), survey year, geographic location, and socio-demographic characteristics of the older individual. Results: After screening 3912 articles, we included 101 studies published between 1996 and 2020. Of the 101 studies, 87 studies reported unmet healthcare needs and 14 studies reported unmet LTC needs. Overall, 10.4% (95% CI, 7.3-13.9) of the older population had unmet needs for healthcare. The common reasons for unmet healthcare needs were cost of treatment, lack of health facilities, lack of/conficting time, health problem not viewed as serious, and mistrust/fear of provider. A signifcant variation in pooled prevalence of unmet healthcare needs due to cost was found by gender (male [10.9, 95% CI, 8.9-13.1] vs female [14.4, 95% CI, 11.8-17.3]), educational level (primary or less [13.3, 95% CI, 9.6-17.6] vs higher [7.5, 95% CI, 5.9-9.3]), self-reported health (poor [23.2, 95% CI, 18.8-27.8] vs good [4.4, 95% CI, 3.4-5.5]), insurance status (insured [9.0, 95% CI, 7.5-10.6] vs uninsured [27.7, 95% CI, 24.0-31.5]), and economic status of population (poorest [28.2, 95% CI, 14.1-44.9] vs richest [7.1, 95% CI, 3.8-11.3]). One in four (25.1, 95% CI, 17.1-34.2) older people had unmet needs in LTC. Rural residents had a higher prevalence of unmet needs in LTC compared to their urban counterparts. Conclusion: With the population ageing globally, it is necessary to improve access to health care and LTC for older people. Ensuring afordability of health services, reducing geographical barriers, and improving acceptability, will be critical in reducing unmet need. Unmet needs for healthcare were concentrated in population with no education, poor economic group, outpatient health facility user, and uninsured group. With education and economic-based inequalities at the forefront, all countries should focus on improving access to health services by reducing the burden related to healthcare costs.

Background There were a few studies that examined the longitudinal association between living alone and depressive symptoms, and the vast majority of them were conducted in patients with certain diseases, such as heart failure, cancer, and glaucoma. This study aimed to examine the association between living alone and depressive symptoms in a large representative older Chinese population. Methods The China Health and Retirement Longitudinal Study (CHARLS) data from 2015 to 2018 were used. Living alone was defined as participants who did not live with others ever or more than 11 months in the past year at baseline. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression Scale (CES-D10). The multivariate logistic regression was used to estimate the relationship between living alone and depressive symptoms. Results There were 5,311 and 2,696 participants ≥ 60 years old included in the cross-sectional and cohort analysis, respectively. The risk of depressive symptoms in participants who lived alone was significantly higher than those who lived with others in both cross-sectional (OR:1.33; 95%CI:1.14,1.54) and cohort analysis (OR:1.23; 95%CI:0.97,1.55). There was a significant interaction between financial support and living alone ( P interaction = 0.008) on the risk of depressive symptoms. Stratified analyses showed that, compared to those who lived with others, the risk of depressive symptoms in participants who lived alone increased by 83% (OR:1.83; 95%CI:1.26,2.65) in participants receiving lower financial support. However, we did not find statistically significant associations in participants with medium (OR:1.10; 95%CI: 0.74,1.63) and higher financial support (OR: 0.87; 95%CI: 0.53,1.41). Conclusion Living alone was associated with a higher risk of depressive symptoms in the Chinese older population, and this association was moderated by the receipt of financial support. Living alone may be an effective and easy predictor for early identification of high-risk populations of depression in the older population.