With the aging and longer survival of the population, comorbid chronic diseases is increasingly common. The variety and complexity of diseases pose challenges to the health management of the elderly. There is a relative lack of multimorbidity pattern researches in China, which are necessary issues for research.

To investigate the patterns of coexistence of common multiple chronic conditions among the elderly in China, in order to help policymakers, researchers, and clinicians better understand the current status of multimorbidity among Chinese elderly.

Data on the demographic characteristics and health status of 14 chronic diseases were extracted from the respondents aged 60 years and above in the China Health and Retirement Longitudinal Study (CHARLS) 2018, association rules, cluster analysis, principal component analysis, latent class analysis were used to explore the multimorbidity patterns of Chinese elderly, and the results of different methods were compared.

The data from a total of 10 800 respondents were eventually included, there were differences among the patterns obtained by four methods. However, the consistent multimorbidity patterns were identified: hypertension, diabetes or elevated blood glucose, dyslipidemia; chronic lung disease and asthma; arthritis or rheumatism, stomach diseases or digestive diseases; stroke, memory-related diseases.

The consistent patterns obtained by different methods contain chronic diseases with significant relationships of etiologies. The reasons of differences in results are complex etiologic relationships and different method principles.

The prevention and delay of disability is important for promoting healthy aging. Exercise intervention is an efficient strategy for disability prevention. Besides, exercise intervention presents significant therapeutic advantages and broad application prospects due to low cost, low implementation difficulty, high acceptance and wide application scenarios. Therefore, Nursing Group of Chinese Society of Geriatrics, Committee on Geriatric Nursing of Chinese Association of Geriatric Research, China Gerontological Nursing Alliance, National Center of Gerontology, Institute of Geriatric Medicine of Chinese Academy of Medical Sciences jointly developed and published Clinical Practice Guidelines for Exercise Interventions for the Prevention of Disability in Older Adults (2023). According to the methodologies specified in WHO Handbook for Guideline Development, the guidelines finally involve 32 recommendations and 18 clinical issues containing exercise principles, effectiveness and plans of different types of exercise, facilitators and barriers during exercise, aiming to provide a reference for the development and implementation of exercise programs for older adults at risk of disability and standardize clinical practice, thus promoting the gateway to improving physical function of the older adults, reducing the prevalence of disability, improving quality of life, contributing to healthy aging.

Along with the development of aging, much attention has been paid to geriatric health issues in China. Sleep disturbance is a common sleep problem endangering older people's health.

To systematically assess the prevalence of sleep disturbances in Chinese older people.

Studies about sleep disturbance in Chinese elderly were searched in database of CNKI, CQVIP, SinoMed, WanFang Data, PubMed, EmBase, The Cochrane Library, Web of Knowledge and PsycINFO from inception to 31st May, 2021. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies using the 11 criteria recommended by the Agency for Healthcare Research and Quality. Stata 16.0 was used for meta-analysis.

A total of 91 studies, with a sample of 81 354 cases were included. Meta-analysis showed that the overall prevalence rate of sleep disturbances among Chinese older people was 46.0%〔95%CI (41.7%, 50.4%) 〕. Further analysis indicated that the prevalence of sleep disturbances among men and women was 40.0%〔95%CI (30.9%, 49.2%) 〕and 49.4%〔95%CI (42.8%, 55.9%) 〕, respectively. And it was 35.1%〔95%CI (28.8%, 41.4%) 〕 for the 60-70-year-olds, 46.1%〔95%CI (33.8%, 58.4%) 〕 for the 70-80-year-olds, and 44.4%〔95%CI (32.7%, 56.2%) 〕 for the 80-and-over-year-olds. The sleep disturbance prevalence rate among those living in urban and rural areas was 41.5%〔95%CI (32.8%, 50.2%) 〕and 44.0%〔95%CI (36.4%, 51.7%) 〕, respectively. And it was 46.3%〔95%CI (37.6%, 55.1%) 〕for those with junior high school or lower education level, and 37.9%〔95%CI (26.7%, 49.1%) 〕for those with senior high school or higher education level. Meta-regression analysis showed that marital status and chronic disease prevalence were associated with sleep disturbances (P<0.05) .

The prevalence of sleep disturbances in Chinese older people is high. To reduce the risk of sleep disturbances and improve the sleep quality in this group, the prevention and intervention of sleep disturbances should be valued and targeted interventions should be delivered.

Cognitive dysfunction refers to the functional impairment in one or more cognitive domains, mostly occurs in older adults. Cognitive dysfunction can commonly be divided into subjective cognitive decline (SCD), mild cognitive impairment (MCI) and dementia, depending on the degree of cognitive impairment. People with SCD or MCI have a higher risk of dementia, which seriously affects their quality of life, and imposes a huge burden on families and society. Numerous studies have demonstrated that physical activity is one effective non-pharmacological intervention for cognitive dysfunction, but there are no uniform standards for physical activity programs for cognitive dysfunction worldwide, and China still has no physical activity guidelines based on the values and preferences of older adults with cognitive dysfunction, partially impeding the dissemination and application of relevant evidence. In view of this, we developed a guideline containing eight recommendations that is applicable in China, namely the Clinical Practice Guideline on Non-pharmacological Interventions for Older Adults with Cognitive Dysfunction: Physical Activity, by the use of existing evidence, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework combined with values and preferences of Chinese older adults with cognitive dysfunction. This guideline will contribute to the reduction of the incidence of cognitive dysfunction, and preventing or slowing the progression of cognitive dysfunction to dementia.

With the acceleration of population aging, multiple chronic diseases have become common in the elderly, and the research on multiple chronic diseases in the elderly is also increasing. However, few studies have been conducted to analyze its progress and hotspots.

To analyze the hotspots of multiple chronic diseases in the elderly at home and abroad, revealing the hotspots in frontiers research, so as to provide a reference for related researchers to track cutting-edge information.

The literatures related to multiple chronic diseases in the elderly were retrieved from Web of Science, Scopus, CNKI, Wanfang Data, VIP, PubMed, Chinese Medical Association Journal Full-text database, and APA-PsycINFO database of the American Psychological Association with the retrieval time of 2010-2021, based on text mining technology and bibliometrics method, etc. CiteSpace 6.1.3, PASW 18, BICOMB 2.04 and other software were used to analyze and visualize the trends in number of papers published, sources, authors, institutions, keywords and other aspects of literature publication. Strategic coordinate maps were drawn to analyze research hotspots in the field.

Finally, 9 392 literatures related to multiple chronic diseases in the elderly were involved, including 5 776 literatures in foreign language and 3 616 literatures in Chinese. The numbers of literatures related to multiple chronic diseases in the elderly both in foreign language and Chinese have increased exponentially in the past decade, with the annual growth rate of 13.27% in Chinese literature and 15.84% in foreign literature, suggesting the development stage of multiple chronic diseases in the elderly. Five mainstream research hotspots have been identified in both Chinese and foreign literatures. There are more literatures related to multiple chronic disease such as chronic obstructive pulmonary disease, diabetes mellitus, hypertension, and respiratory diseases. The foreign literatures have focused more on the psychiatric comorbidity, followed by somatic comorbidities such as diabetes mellitus, hypertension, and heart failure.

The analysis results shows that the field of multiple chronic diseases in the elderly is in a rapid development stage. Analysis of foreign literature shows that psychiatric comorbidity is a relatively hot topic but not mature enough, research results related to multiple chronic diseases in the elderly are abundant and diversified, but the research depth is in sufficient. Domestic literature analysis shows that chronic obstructive pulmonary disease combined with respiratory diseases in the elderly is at the core of the field, and there is a lack of studies related to psychiatric comorbidity such as depression and mutiple chronic diseases such as health situation, nursing and health care, which may become the main direction of research development in the future.

As population aging progresses, the prevalence of multimorbidity and polypharmacy is increasing in older adults, which may increase the risk of potentially inappropriate medication, causing adverse health outcomes.

To systematically assess the prevalence and associated factors of potentially inappropriate medication in community-dwelling Chinese older adults, in order to provide a reference for developing relevant intervention strategies.

In June 2022, we searched databases of CNKI, CQVIP, Wanfang Data, SinoMed, PubMed, EmBase, and Web of Science from inception to June 2022 for studies on potentially inappropriate medication in community-dwelling older adults in China. Two reviewers independently selected studies, extracted data and assessed the quality of included studies according to the Agency for Healthcare Research and Quality methodology checklist. Meta-analysis was conducted using Stata 12.0.

A total of 24 studies were included, including two with high quality and 22 with moderate quality. Meta-analysis showed that the pooled prevalence of potentially inappropriate medication was 34.8%〔95%CI (31.3%, 38.3%) 〕in community-dwelling older adults in China. Pooled estimates showed 75 years or above〔OR (95%CI) =1.261 (1.074, 1.481) 〕, five or more comorbidities〔OR (95%CI) =3.287 (1.405, 7.691) 〕, and taking five or more medications〔OR (95%CI) =1.800 (1.305, 2.481) 〕or taking 10 or more medications〔OR (95%CI) =4.380 (2.612, 7.347) 〕were associated factors of potentially inappropriate medication.

Potentially inappropriate medication is common in community-dwelling older adults in China, whose risk is associated with older age, multimorbidity and polypharmacy. Prevention and management of potentially inappropriate medication should be paid attention to individuals with the above characteristics.

Population aging is a major challenge in the global healthcare field. Due to pathological and physiological changes in ageing skin, skin injuries are highly prevalent in older population. And epidemiological studies on skin injuries in this population has become a research hotspot recently.

To examine the prevalence and epidemiological characteristics of three types of skin injuries 〔pressure injuries (PI) , incontinence-associated dermatitis (IAD) and skin tears (ST) 〕in elderly inpatients using a multicenter cross-sectional study, providing a basis for formulating strategies for the prevention of skin injuries in older people.

A multicenter study was carried out in 52 hospitals selected from 16 provinces, two autonomous regions and two municipalities of China, from which 1 067 nurses who had completed the online homogenization training conducted by our research group and passed the relevant examination were selectedas investigators. Every 2-3 nurses were divided into a investigation group. Eligible older inpatients were selected as participants. Full body skin examination for screening skin injuries was conducted in participants in each hospital by nurses using the same tools and methods. PI, IAD and ST were defined and classified by relevant international guideline or expert consensus, respectively. Then demographics, length of stay (LOS) , chronic disease history, use of medications in the past month, living independence and risk of PI assessed by the Braden Scale of the participants were collected. After that, two nurses of each group signed to confirm the results, and uploaded to https://www.wjx.cn. SPSS 22.0 was used for statistical analysis.

A total of 14 675 elderly inpatients were investigated, and all of them responded effectively (100.0%) . The respondents had an average age of (73.5±9.0) years and a median LOS of 7 (4, 13) days, among whom 56.3% (8 262/14 675) were men, and 43.7% (6 413/14 675) were women; 95.5% (14 020/14 675) were Han people, and 4.5% (655/14 675) were 19 ethnic minorities. The overall prevalence of the three types of skin injuries was 6.0% (881/14 675) , of which the prevalence of PI, IAD, ST and at least two types of skin injuries was 3.3% (484/14 675) , 1.4% (199/14 675) , 0.8% (110/14 675) and 0.6% (88/14 675) , respectively. Epidemiologic characteristics: Han people had higher prevalence of skin injuries compared with ethnic minorities (6.2% vs 2.9%, P=0.001) . Eighty-year-olds had higher prevalence of skin injuries than 71-80-year-old (10.2% vs 6.1%, P<0.001) and 60-70-year-old (10.2% vs 3.8%, P<0.001) . Those suffering from at least two chronic diseases had higher prevalence of skin injuries compared with those without chronic diseases (5.7%-12.0% vs 2.9%, P<0.005) or those with only one chronic disease (5.7%-12.0% vs 4.4%, P<0.005) . Users of two or more medications had higher prevalence of skin injuries compared with non-medication users (6.1%-10.2% vs 2.7%, P<0.005) or users of one medication (6.1%-10.2% vs 4.6%, P<0.005) . Those with LOS of over 30 days had higher prevalence of skin injuries compared with those with LOS of 8-30 days (10.7% vs 4.4%, P<0.016 7 ) or ≤7 days (10.7% vs 7.1%, P<0.016 7) . The prevalence of skin injuries in those with PI risk was higher than that in those without risk (20.5% vs 1.6%, P<0.05) . The prevalence of skin injuries in dependent-living individuals was higher than that of independent-living individuals (7.0% vs 0.9%, P<0.05) . The frequently-occurring sites were caudal sacral (57.9%) and heel (14.3%) for PI, peri-anal region (68.3%) and hip fissure (24.6%) for IAD, and lower limbs (38.2%) and upper limbs (28.2%) for ST. PI combined with IAD mostly occurred in sacrococcygeal region (71.0%) . PI combined with ST were common in sacrococcygeal region (50.0%) and heel (35.7%) . ST combined with IAD mostly occurred in caudal sacral (33.3%) , perianal region (33.3%) and gluteal fissure (33.3%) . PI, IAD and ST coexisted mostly in caudal sacral (50.0%) and gluteal fissure (50.0%) .

The prevalence of skin injuries in Chinese older people is high, and may increase with age, prevalence of chronic diseases and use of systemic medications, and dependent-living. In particular, PI risk may be associated with significantly higher possibility of developing skin injuries. Coexistence of multiple types and anatomical sites of skin injuries are important characteristics. The above-mentioned epidemiologic characteristics should be considered when formulating prevention strategies of skin injuries in the elderly.

The Beers criteria is a tool for evaluating potentially inappropriate medication (PIM) in elderly patients widely used in various fields, such as clinical practice, teaching research, supervision and administration. The 2023 American Geriatrics Society Beers criteria (AGS Beers criteria) for PIM use in older adults are the seventh overall update, using the development methodology following previous versions, which includes the rigor of the evidence review and synthesis process. This paper provides a detailed interpretation of the new version of AGS Beers criteria. The AGS Beers criteria aims to reduce the incidence of PIM in older adults by optimizing drug selection. The 2023 AGS Beers criteria can also be used in the education of clinicians and patients, assessment of care quality, health care costs and drug use patterns in older adults. In addition to the five tables associated with PIM as main contents, several drugs and criteria have been added based on updated evidence, mainly on the revisions and streamlining of existing drugs and criteria. The added and revised content mainly involves anticoagulants, antiplatelet agents and hypoglycemic agents. The synthesis of anticoagulation recommendations has been added in the new version of AGS Beers criteria. Thirty-three drugs were removed due to low usage or not on the U.S. market. The 2023 AGS Beers criteria summarizes seven principles on the application of Beers criteria to ensure proper clinical use. Overall, the 2023 AGS Beers criteria have improved its accuracy and utility, which can better identify and reduce PIM prescriptions for the elderly patients and further guide the clinical development of rational drug use regimens.

The older adults are high risk population for malnutrition. Malnutrition is closely associated with numerous adverse clinical outcomes, which may seriously affect the physical health and life quality of the older adults, causing heavy burdens on families and society. Therefore, it is of great importance to take effective measures to improve malnutritionin the older adults, and non-pharmacological interventions have been proved to be important measures to improve nutritional status. However, there is no domestic clinical practice guideline for non-pharmacological interventions specifically for malnourished older adults. Therefore, nutrition experts from China Gerontological Nursing Alliance, National Center for Gerontology and National Clinical Research Center for Geriatric Disorders developed the guideline based on the Grading of Recommendation Assessment, Development and Evaluation (GRADE) including 9 recommendations of non-pharmacological intervention formal nourished older adults through a comprehensive search and analysis of the latest domestic and international literature on malnutrition in the elderly, in order to improve malnutrition and quality of life in the older adults. This guideline focuses on malnourished older adults who can be fed orally and enteral nutrition, parenteral nutrition is not covered by the scope of this guideline.

Chronic diseases have become an important public health problem that affects the economic and social development of country and population health. Quantifying the disease and economic burden of the elderly can provide a better understanding of the impact of chronic diseases on individuals and society.

To understand the prevalence of common chronic diseases among the elderly in Shanxi Province and explore the quality-adjusted life year (QALY) loss and economic loss which caused by chronic diseases.

From June to August in 2019, a multi-stage random sampling method was used to select 3 250 elderly people aged≥ 60 years from 11 cities in Shanxi Province as the research subjects for a questionnaire survey. The questionnaire included general demographic information, disease status survey, and health-related quality of life status. The European Five-Dimensional Health Scale (EQ-5D-5L) was used to assess the health-related life quality of the elderly. The QALY loss caused by chronic diseases was calculated based on the Chinese EQ-5D-5L utility value score system, and the QALY loss and economic loss caused by common chronic diseases in Shanxi Province in 2019 were estimated by using population and GDP per capita from statistical bulletin.

The results of univariate analysis showed that there were significant differences in the utility value of EQ-5D-5L among the elderly with different ages, living regions, educational levels, marital status, and family per capita monthly income (P<0.05) . The results of multiple linear regression analysis showed that higher per capita monthly income of families, being married and younger age were the protective factors for the health utility value of EQ-5D-5L (P<0.05) . The prevalence of chronic diseases among the elderly in Shanxi Province was 58.49% (1 901/3 250) . The top 5 chronic diseases by prevalence were: hypertension 29.45% (957/3 250) , diabetes 10.83% (352/3 250) , rheumatism or rheumatoid arthritis 10.28% (334/3 250) , hearing impairment 8.09% (263/3 250) , gastritis or peptic ulcer 6.49% (211/3 250) . Based on the estimation of the total population of Shanxi Province, the loss of QALY caused by five common chronic diseases in Shanxi Province in 2019 was 2 078 685 years, and the economic loss was 95 045 792 940yuan. The chronic disease causing the most QALY loss and economic loss in Shanxi Province was rheumatism or rheumatoid arthritis in Datong, Taiyuan and Luliang; in Jincheng, Yangquan city was hearing impairment; In Jinzhong, Linfen, Yuncheng, Shuozhou, Xinzhou, Changzhi City was hypertension.

The prevalence of chronic diseases among the elderly in Shanxi Province was relatively high, and chronic diseases will not only cause the loss of QALY of the elderly, but also cause a huge economic burden. Common chronic diseases vary by region in Shanxi Province, each region should determine the priority of disease prevention and treatment according to the actual situation, identify the key objectives and population of health management, so as to achieve a multiplier effect.

Along with the advance in the concept of healthy aging, the activities of daily living (ADL) in middle-aged and older Chinese adults has become a research focus. However, factors associated with the impairment of ADL in this group have been assessed in most of available studies while the changes in the process of ADL impairment have been scarcely explored.

To assess the prevalence and associated factors of decline in ADL during the aging process of middle-aged and older adults.

This study was conducted in March 2021. Data were collected from the four waves (2011, 2013, 2015, and 2018) of China Health and Retirement Longitudinal Study (CHARLS) , involving 11 439 individuals (≥45 years old) with normal baseline ADL followed up during 2011—2013, 2013—2015, or 2015—2018. Panel-data multinomial logit model was used to assess the associations of 13 factors (defined as independent variables, including demographics, health status, resource accessibility, and social psychology) with the decline in ADL (defined as dependent variable) in these people over the follow-up period.

The numbers of cases of declined ADL over the three follow-up periods (2011—2013, 2013—2015, and 2015—2018) were 1 829 (44.53%) , 1 758 (40.43%) , 1 215 (40.72%) , respectively. Multinomial logit regression analysis indicated that age, gender, place of residence, education level, number of chronic diseases, prevalence of falls, prevalence of perceived pain, use of auxiliary equipment, natural logarithm of personal income per capita, and level of depression were associated with the decline in ADL (P<0.05) .

The decline in ADL in middle-aged and older Chinese adults may be related to age, education level, number of chronic diseases, auxiliary equipment usage, per capita income, and depression. To reduce the prevalence of declined ADL in this population, we put forward the following recommendations: promoting the construction of a public service system, strengthening chronic disease management in middle-aged and older adults, incentivizing the development of rehabilitation services market, increasing medical subsidies for specific groups, and attaching importance to the mental health of middle-aged and older adults.

China has been already in the stage of deeply aging society, and the health problems of the elderly are getting more and more attention. Depression in the elderly not only affects the quality of life in later life, but also increases the economic burden on society and families, so early identification of the influencing factors of its development is of great significance. However, the existing research conclusions are still controversial, and there are few relevant systematic reviews in China.

To explore the depression detection rate and its influencing factors in the elderly in China since 2018, provide reference for reducing the incidence of depression in the elderly and promoting healthy aging.

In January 2023, PubMed, EmBase, Web of Science, CNKI, Wanfang Date and VIP were searched for publicly available studies on factors influencing depression in Chinese elderly from 2018 to 2022. The data were extracted and the literature quality was evaluated according to the cross-sectional study quality assessment criteria of Agency for Healthcare Research and Quality (AHRQ) and Stata 15.0 was adopted for Meta-analysis.

Twenty-three papers were finally included, with a cumulative study population of 75 599, and a total of 13 815 depressed older adults were detected; the AHRQ quality assessment scores of the papers ranged from 5 to 7. Meta-analysis results showed that the detection rate of depression in the elderly in China was 20.6%〔95%CI (16.6%, 24.8%) 〕, female〔OR=1.46, 95%CI (1.30, 1.64) 〕, advanced age〔OR=1.48, 95%CI (1.13, 1.94) 〕, lower education level〔OR=1.52, 95%CI (1.32, 1.75) 〕, no spouse〔OR=1.60, 95%CI (1.35, 1.91) 〕, living in rural areas〔OR=1.38, 95%CI (1.14, 1.66) 〕, suffering from chronic diseases〔OR=2.75, 95%CI (2.07, 3.66) 〕, 2 chronic diseases〔OR=1.84, 95%CI (1.07, 3.14) 〕, 3 or more chronic diseases〔OR=3.86, 95%CI (2.89, 5.15) 〕, poor self-rated health〔OR=3.47, 95%CI (1.14, 10.53) 〕, insomnia〔OR=2.62, 95%CI (1.88, 3.66) 〕, living alone〔OR=1.86, 95%CI (1.56, 2.21) 〕, no exercise〔OR=1.88, 95%CI (1.60, 2.20) 〕, self-care needs or partial needs〔OR=2.96, 95%CI (1.12, 7.85) 〕were risk factors for depression in the elderly (P<0.05), while drinking〔OR=0.67, 95%CI (0.50, 0.88) 〕and having friends〔OR=0.52, 95%CI (0.38, 0.71) 〕were protective factors (P<0.05) .

Although the detection rate of depression among elderly in China has decreased, it is still at a high level, and the elderly in China who are female, elderly, less educated, without spouse, living in rural areas, suffering from chronic diseases and chronic disease comorbidity, with poor self-rated health, suffering from insomnia, living alone, without exercise, and living in need or partial need of self-care may be more likely to suffer from depression.

Dyslipidemia is the most important and causal independent risk factor for atherosclerotic cardiovascular disease (ASCVD) . The prevalence of dyslipidemia in elderly residents in Guangdong Province is high, and it is urgent to analyze the specific prevalence of dyslipidemia and its influencing factors among the elderly, and to carry out targeted preventive and control measures for dyslipidemia.

To investigate the epidemiological status of dyslipidemia and its risk factors among elderly residents included in the national basic public health service in Yuexiu District, Guangzhou.

A total of 41 469 elderly residents aged 65 years and above with complete important variables were selected as subjects from the information system of community health service center in Yuexiu District, Guangzhou City in 2020, the 2020 health checkup data was used to describe the epidemiological characteristics of the included patients such as basic information, BMI and blood lipid levels. Restricted cubic spline (RCS) fitting Logistic regression model was used to analyze the relationship between age, BMI and the prevalence of dyslipidemia.

The prevalence of dyslipidemia in 41 469 elderly residents was 53.65% (22 247/41 469) , with a standardized prevalence of 53.89%. The prevalence of hypercholesterolemia (HTC) , hypertriglyceridemia (HTG) , mixed hyperlipidemia and low high-density lipoprotein cholesterol was 21.43%, 16.50%, 14.51% and 3.80%, with the standardized prevalence of 21.57%, 16.53%, 14.61%, 3.78%, respectively. Multivariate Logistic regression analysis showed that gender, age, education level, exercise status, and BMI were all influencing factors for dyslipidemia in elderly residents, among which female, low age group, and high BMI were risk factors for dyslipidemia in elderly residents (P<0.05) . The results of RCS fitting showed a non-linear relationship between age, BMI and the prevalence of dyslipidemia in elderly residents. The overall prevalence of dyslipidemia in elderly residents showed a decreasing trend with the increase of age. The risk of dyslipidemia showed on increasing and then decreasing trend with the increase of BMI, the OR increased significantly at low BMI, while decreased at high BMI.

The prevalence of dyslipidemia is relative high among elderly residents aged 65 years and above included in the national basic public health services in Yuexiu District, Guangzhou. The prevalence of dyslipidemia in the elderly group tends to decrease with the increase of age, and the risk of dyslipidemia prevalence tends to increase and then decrease with the increase of BMI, suggesting special features in the management of dyslipidemia among the elderly, the analysis of risk factors for dyslipidemia in the elderly should be focused on and early preventive and control measures should be carried out.

China is seeing increasingly osteoporosis prevalence as ageing marches on. However, the specific etiology and pathogenesis of osteoporosis are still unclear, and there are still limitations in its prevention and treatment.

To investigate osteoporosis prevalence and associated factors in older Chinese patients with stable chronic conditions.

Three hundred and two elderly inpatients with stable chronic conditions who underwent a reexamination in Department of Geriatrics, Yunnan First People's Hospital from November 2020 to September 2021 were recruited. Dual-energy X-ray absorptiometry (DXA) was used to measure lumbar spine and hip bone mineral density (BMD) . T value ≤-2.5 was defined as osteoporosis. Demographic data were collected. Comprehensive geriatric assessment was conducted via a self-developed online platform named Comprehensive Geriatric Assessment. Fasting venous blood samples were collected and measured for serum biomarkers.

Among the patients, 126 (41.7%) were found with osteoporosis, and other 176 (58.3%) without. Binary Logistic regression analysis indicated that insomnia〔OR=2.180, 95%CI (1.080, 4.443) 〕, multiple chronic conditions〔OR=1.223, 95%CI (1.101, 1.358) 〕, elevated homocysteine〔OR=1.043, 95%CI (1.000, 1.088) 〕 were associated with increased risk of osteoporosis (P<0.05) , while elevated serum uric acid level〔OR=0.996, 95%CI (0.993, 0.999) 〕 was associated with decreased risk of osteoporosis (P<0.05) .

The prevalence of osteoporosis in these older patients with stable chronic conditions was 41.7%. The probability of osteoporosis may be decreased with elevated serum uric acid level, and increased with elevated homocysteine, insomnia and multiple chronic conditions.

The high prevalence of multimorbidity among middle-aged and older adults has become a serious issue needing to be addressed by China's healthcare system. The number of chronic diseases is related to health service utilization and medical costs, but there is still a lack of relevant national surveys in China.

To understand the prevalence and features of multimorbidity and to examine its associations with health service utilization and medical costs among middle-aged and older Chinese adults.

Data were collected from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS) during April to October 2021, involving 16 674 Chinese adults (≥45 years old) . Multimorbidity was defined as the coexistence of two or more of the self-reported 14 chronic conditions. Health service utilization was measured using inpatient service utilization in the past year and outpatient service utilization in the past month. Medical costs were measured using total inpatient cost and out-of-pocket (OOP) cost for inpatient care in the past one year, total outpatient costs and OOP cost for outpatient care in the past one month. Logistic regression was used to estimate the association between the number of chronic diseases and health service utilization. Quantile regression was adopted to estimate the association between the number of chronic diseases and medical costs.

Of all participants, 9 561 (57.34%) had multimorbidity. 2 624 (15.74%) had utilized inpatient services in the past year, and 2 588 (15.52%) used outpatient services in the past one month. Inpatient service utilization, outpatient service utilization, total inpatient cost, OOP cost for inpatient care, total outpatient cost, and OOP cost for outpatient care varied significantly by the number of chronic diseases (P<0.05) . Multivariate Logistic regression analysis indicated that the number of chronic diseases was associated with inpatient service utilization (P<0.05) . Suffering from 1, 2, 3, 4 and ≥5 chronic diseases was associated with 1.882 times〔95%CI (1.547, 2.290) 〕, 2.939 times〔95%CI (2.429, 3.555) 〕, 4.231 times〔95%CI (3.490, 5.130) 〕, 5.723 times〔95%CI (4.680, 7.000) 〕, and 8.671 times〔95%CI (7.173, 10.482) 〕 higher rate of inpatient service utilization, respectively. Having 1, 2, 3, 4 and ≥5 chronic diseases was associated with 1.684 times〔95%CI (1.421, 1.995) 〕, 2.481 times〔95%CI (2.101, 2.931) 〕, 3.691 times〔95%CI (3.115, 4.374) 〕, 3.774 times〔95%CI (3.134, 4.544) 〕, and 5.577 times〔95%CI (4.698, 6.620) 〕 higher rate of outpatient service utilization, respectively. Each increased chronic disease was associated with an increase in both total inpatient costs and OOP for inpatient care at the upper and middle (50, 75 and 90 percentiles) percentile levels, with larger effects on the upper percentile 〔90th percentile Coeff (95%CI) =1 248.43 (219.20, 2 277.66) for total hospital costs; 90th percentile Coeff (95%CI) =706.36 (266.87, 1 145.86) for OOP for inpatient care〕. Each increased chronic disease was also associated with an increase in both total outpatient costs and OOP for outpatient care, and the effects on the upper percentiles were larger〔90th percentile Coeff (95%CI) =196.33 (31.06, 361.61) for total outpatient costs; 90th percentile Coeff (95%CI) =128.56 (26.83, 230.28) for OOP for outpatient care〕.

In middle-aged and older Chinese adults, multimorbidity was highly prevalent, and the increase in the number of coexisted chronic diseases was associated with higher rate of health service utilization and medical costs. The government should pay more attention on primary care to manage the demand for health services and medical costs associated with multimorbidity.

Handwriting synthesis techniques have been extensively studied in the detection of cognitive impairment in dementia and Parkinson's disease. But handwriting characteristics in older adults with mild cognitive impairment (MCI) still need to be studied further.

To explore the differences between the handwriting characteristics of elderly patients with MCI and normal elderly people, and to assess the value of handwriting features in MCI screening.

By use of convenience sampling, 33 older adults with MCI were recruited from Huzhou communities from January to April 2022 (observation group), and were compared to age-, sex- and education level-matched 43 community-living older adults with normal cognitive function (control group). The General Information Questionnaire, the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment-Basic (MoCA-B), the Activity of Daily Living Scale (ADL), and the 15-item Geriatric Depression Scale (GDS-15) were used to survey subjects. Subjects were invited to complete six handwriting tasks (four are Chinese characters tasks and the other two are graphical drawing tasks) using a dot matrix digital pen to collect their kinematic parameters of handwriting. The classification accuracy, sensitivity and specificity of handwriting characteristics for the diagnosis of MCI were analyzed by discriminant analysis and receiver operating characteristic (ROC) curve, and predictive values of different schemes for MCI were analyzed.

Compared with the control group, the observation group had higher average pressure in writing (Z=-2.122, P=0.034), longer time in air (Z=-4.302, P<0.001), writing time (Z=-3.663, P<0.001) and total time (t'=-5.565, P<0.001), lower average writing velocity (Z=-2.458, P=0.014), horizontal (Z=-2.950, P=0.003) and vertical (Z=-2.094, P=0.040) average writing velocity and maximum horizontal writing velocity (Z=-2.206, P=0.027), lower average acceleration of writing in horizontal direction (Z=-2.667, P=0.008) and overall score for writing correctness (Z=-3.593, P<0.001) in completing graphical drawing tasks. The observation group had relatively longer time in air (Z=-3.464, P=0.001) and total time (Z=-2.940, P=0.003) in completing Chinese characters tasks. Compared with the total time for completing Chinese characters tasks, the total time for completing graphical drawing tasks had higher specificity (93.0% vs 55.8%) in differentiating between MCI and control groups, with an area under the curve (AUC) of 0.828. The summary of handwriting characteristics for graphical drawing tasks correctly classified 80.3% (61/76) of older adults with MCI, with 87.9% sensitivity and 79.1% specificity, and had higher diagnostic efficacy for those with MCI than the MMSE scale (Z=1.993, P=0.046) and the summary of handwriting characteristics for Chinese characters tasks (Z=2.408, P=0.016) .

Handwriting characteristics of graphical drawing tasks may have potential application in screening of older adults at risk for MCI, which can be used simultaneously or prior to sets of neuropsychological tests conducted for the diagnosis of MCI in community health care facilities.

Disability influences physical and mental health of older people, and causes a heavy burden on family and society. The increasing prevalence of empty-nested phenomenon has aroused wide concern for empty and non-empty nesters.

To investigate the prevalence and associated factors of comprehensive disability in empty and non-empty nesters in Henan, providing a scientific basis for the prevention and control of disability among these people.

By use of multistage stratified sampling, 5 570 older people aged ≥60 years were selected from Henan's 18 provincial cities from January to September 2019 for a questionnaire survey. The comprehensive ability of them was assessed by using the Ability Assessment for Older Adults Scale developed by the Ministry of Civil Affairs of the People's Republic of China. Binary Logistic stepwise regression analysis was used to identify the factors associated with comprehensive disability.

The participants included 3 731 empty nesters and 1 839 non-empty nesters. The prevalence of intact comprehensive ability, and comprehensive disability in empty nesters was 51.97% (1 939/3 731) , and 48.03% 〔1 792 (1 417 mild, 217 moderate, and 104 severe) /3 731〕, respectively. The prevalence of intact comprehensive ability, and comprehensive disability in non-empty nesters was 44.64% (821/1 839) , and 55.36% 〔1 018 (820 mild, 123 moderate, and 75 severe) /1 839〕, respectively. Empty nesters had lower prevalence of comprehensive disability than did non-empty nesters (χ²=26.448, P<0.001) . Empty and non-empty nesters had significant differences in sex ratio, age distribution, marital status, education level, monthly income, financial support from children, prevalence of disability and accidents (P<0.05) . Stepwise binary Logistic regression analysis showed that age, prevalence of disability and accidents as well as number of chronic diseases were associated with comprehensive disability prevalence in both empty and non-empty nesters, and the specific corresponding data with values of OR and 95%CI were as follows: age 〔70-79 years, OR=1.590, 95%CI (1.373, 1.842) ; ≥80 years, OR=2.429, 95%CI (1.934, 3.050) 〕, disability 〔OR=3.803, 95%CI (2.924, 4.947) 〕, accidents 〔OR=2.747, 95%CI (2.101, 3.591) 〕, and number of chronic diseases 〔4-7, OR=6.549, 95%CI (3.736, 11.482) 〕were associated with comprehensive disability prevalence in empty nesters (P<0.05) . Age〔70-79 years, OR=1.357, 95%CI (1.084, 1.699) ; ≥80 years, OR=3.784, 95%CI (2.820, 5.076) 〕, disability〔OR=3.523, 95%CI (2.413, 5.145) 〕, accidents〔OR=2.789, 95%CI (1.962, 3.965) 〕 and number of chronic diseases 〔4-7, OR=2.997, 95%CI (1.460, 6.151) 〕 were associated with comprehensive disability prevalence in non-empty nesters (P<0.05) . In addition, comprehensive disability prevalence in empty nesters was also affected by education level 〔primary school: OR=0.748, 95%CI (0.629, 0.890) ; middle school: OR=0.776, 95%CI (0.634, 0.949) 〕, and financial support from children〔OR=1.318, 95%CI (1.146, 1.516) 〕 (P<0.05) . And comprehensive disability prevalence in non-empty nesters was also influenced by marital status 〔unmarried/divorced/widowed: OR=1.291, 95%CI (1.047, 1.592) 〕 and monthly income 〔1 001-2 000 yuan: OR=0.574, 95%CI (0.443, 0.743) 〕 (P<0.05) .

The associated factors of comprehensive disability prevalence for Henan's empty and non-empty nesters were not completely the same. Age, prevalence of disability, and accidents as well as number of chronic diseases were associated with comprehensive disability in both of them. Other associated factors of comprehensive disability were education level and financial support from children for empty nesters, and were marital status and monthly income for non-empty-nesters. So targeted interventions delivered to these two groups should be different.

As the main cause of death in the world, the morbidity and mortality of cardiovascular diseases are increasing year by year. Chronic inflammation of circulatory system is common in middle-aged and older people, which is closely related to the pathogenesis of various cardiovascular diseases. Dyslipidemia is also one of the age-specific cardiovascular risk factors. Exercise has attracted much attention as an important intervention method, among which resistance training can reduce the risk of cardiovascular diseases in middle-aged and older people, but the regulation effect of inflammation and dyslipidemia is still controversial.

To explore the effect of resistance training on cardiovascular risk factors in middle-aged and older people, and to provide a basis for formulating exercise prescriptions for middle-aged and elderly people.

PubMed, Cochrane, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Chinese Science and Technology Journal Full-text Database were retrieve by computer for randomized controlled trials on the effects of resistance training on cardiovascular risk factors in middle-aged and older people published from the date of establishment to 2021-08-31. The retrieved literatures were screened and data extracted, including the first author, the year of publication, general characteristics of the study population, resistance training protocols and outcome indicators. The bias risk assessment tool of Cochrane system evaluation manual was used to evaluate the bias risk of literature. Meta-analysis was performed using RevMan 5.3 software, including the statistics of combined effect size, heterogeneity test, sensitivity analysis, and subgroup analysis. Publication bias of included studies was analyzed using Stata 16.0 software, using Egger's test.

Fifteen papers with 476 observations were included. Meta-analysis showed that, resistance training were superior to control group in decreasing C-reactive protein〔SMD (95%CI) =-0.67 (-0.89, -0.46) , P<0.01〕, total cholesterol〔SMD (95%CI) =-0.37 (-0.66, -0.08) , P=0.01〕, triglyceride〔SMD (95%CI) =-0.29 (-0.53, -0.05) , P=0.02〕, low-density lipoprotein cholesterol〔SMD (95%CI) =-0.37 (-0.67, -0.06) , P=0.02〕 and improving high-density lipoprotein cholesterol levels〔SMD (95%CI) =0.33 (0.09, 0.57) , P<0.01〕. Subgroup analysis showed that C-reactive protein and total cholesterol levels were lower in the resistance training group than in the control group at training duration ≤12 weeks, with statistically significant differences (P<0.05) . In both the training intensity of high intensity and the chronic disease population, C-reactive protein levels were lower in the resistance training group than in the control group and high-density lipoprotein cholesterol levels were higher, with statistically significant differences (P<0.05) .

Resistance training has been shown to be effective in reducing cardiovascular risk factors, reducing chronic inflammation and improving dyslipidaemia in the middle-aged and older population.

As the aging society develops, multimorbidity is increasingly prevalent in an increased number of older adults, which imposes a heavy treatment burden on the group, but the composition of treatment burden of elderly patients with chronic comorbidity in China is not clear.

To understand the real experience of treatment burden in elderly patients with multimorbidity, providing a theoretical basis for promoting the research on treatment burden in China.

By use of purposive sampling, 21 older inpatients with multimorbidity were selected from three hospitals (one is primary level, another is secondary and another is tertiary) in Chengdu from January to June 2021. Individual, face-to-face, in-depth, semi-structured interviews were utilized to collect their experiences of treatment burden, and the data were recorded, and analyzed using Colaizzi's method of data analysis.

Of the participants, eight were women, and 13 were men; 10 were selected from the tertiary hospital, seven from the secondary hospital, and four from the primary hospital. Six themes were summarized: economic burden, drug burden, self-management burden, medical service burden, social burden and psychological burden.

Taken overall, the treatment burden was relatively heavy in older inpatients with multimorbidity. To reduce the treatment burden and improve the efficacy in this group, it is recommended that medical workers should pay attention to their treatment burden, and formulate individualized treatment plan for them.

Insufficient physical activity is one of the most important public health problems in the 21st century and studies have found an association between physical activity and mortality. The effect of physical activity on mortality risk has attracted much attention in recent years, but few studies have reported the relationship between physical activity and all-cause mortality risk in different populations.

To explore the relationship between physical activity and all-cause mortality risk in middle-aged and older adults (45 years old and above) in China.

Based on the data of China Health and Retirement Tracking Survey (CHARLS) from 2011 to 2018, a total of 2 799 middle-aged and older adults from the 2011 baseline population of the CHARLS were selected as the research subjects on September 10, 2022, their baseline data such as demographic variables, lifestyle variables, and number of chronic diseases were collected, and physical activity level was evaluated based on the International Physical Activity Questionnaire (IPAQ) as low level physical activity〔600 metabolic equivalent (MET) /week) 〕, moderate level of physical activity (600-3 000 MET/week), high level of physical activity (3 000 MET/week). The follow-up period was from 2011 to 2018, and data from 2013, 2015 and 2018 were selected for follow-up, with all-cause death as the endpoint event, and the subjects were divided into the survival group (n=2 424) and all-cause death group (n=375) according to their survival status. Cox proportional hazard regression model was used to analyze the relationship between physical activity level and all-cause mortality risk in middle-aged and older adults, sensitivity analysis and stratification analysis were also performed.

During the 7-year follow-up, 375 cases of all-cause death occurred among 2 799 middle-aged and older adults with the incidence of all-cause death of 13.40%. There were statistically significant differences in physical activity level, gender, age, marital status, education level, ADL limitation, BMI, smoking, alcohol consumption and the number of chronic diseases between the survival group and all-cause death group (P<0.05). After adjusting for confounding factors, multivariate Cox proportional hazard regression analysis showed that the risk of all-cause death was reduced by 43%〔HR=0.57, 95%CI (0.44, 0.75), P<0.001〕and 64%〔HR=0.36, 95%CI (0.27, 0.48), P<0.001〕in the middle-aged and older adults with low level of physical activity and high level of physical activity, respectively. The results of both sensitivity analyses showed a reduced risk of all-cause mortality in the middle-aged and older adults with moderate and high levels of physical activity compared with those with low level of physical activity (P<0.001), indicating that the results are robust. Stratified analysis showed that moderate level of physical activity could reduce the risk of all-cause death by 50%〔HR=0.50, 95%CI (0.33, 0.76), P<0.001〕in people aged 60-74 years and 51%〔HR=0.49, 95%CI (0.33, 0.73), P<0.001〕in people with normal BMI. High levels of physical activity were associated with a 74%〔HR=0.26, 95%CI (0.14, 0.47), P<0.001〕 and 65%〔HR=0.35, 95%CI (0.24, 0.51), P<0.001〕lower risk of all-cause death in people aged 45 to 59 and 60 to 74 years, respectively, and a 71%〔HR=0.29, 95%CI (0.20, 0.43), P<0.001〕and 64%〔HR=0.36, 95%CI (0.22, 0.59), P<0.001〕lower risk of all-cause death in people with normal BMI, overweight or obesity.

Both moderate and high levels of physical activity can reduce the risk of all-cause death in middle-aged and older adults, and the effect of high level of physical activity is more obvious. From the perspective of reducing the risk of all-cause death, it is suitable for people aged 45-59 years old, overweight and obese people to choose high level of physical activity. People aged 60-74 years and with normal BMI can benefit from moderate or high levels of physical activity. There is no clear recommendation with sufficient evidence for people aged≥75 years old and lean people, who should make decisions according to their own specific situations.

With the aggravation of population aging in China, the number of elderly perioperative orthopedic patients is increasing, and the growing prevalence of frailty in older patients undergoing orthopedic surgery has attracted increasing attention. Early preoperative assessment and intervention of frailty are of great significance for improving postoperative prognosis and reducing the occurrence of complications in this population.

To perform a scoping review of frailty assessment tools for elderly orthopedic inpatients, and to provide a reference for the selection of frailty assessment tools for this group.

Seven databases (PubMed, CINAHL, PsycINFO, Scopus, Embase, CNKI and Wanfang Data) were searched for studies on frailty assessment tools for older orthopedic inpatients from 2006 to 2021. Two researchers independently screened the literature and extracted the basic characteristics of the literature (the flint author, publication time, country, basic information, research tools and outcome indicators) and the basic characteristics of involved frailty assessment tools (name, study country, study type, scale dimension, number of items, assessment cut-off value, assessment time, etc.) .

A total of 1733 studies were retrieved, and 25 of them with 12 frailty assessment tools were included. The analysis showed that there are a variety of assessment tools, and different studies have used different frailty assessment tools. Frailty Phenotype and Frailty Index are the two common tools. The application of accurate and effective tools for frailty screening is crucial to improving preoperative risk stratification and postoperative prognosis. Frailty assessment using the Reported Edmonton Frail Scale, FRAIL Scale, PRISMA-7 Questionnaire or the Groningen Frailty Index can be completed without the use of additional measuring equipment and surveyors with an experience of training.

The selection of an optimal frailty assessment tool for elderly orthopedic inpatients should be in accordance with patient features, clinical resources and the performance of the tool. However, there is still lack of a gold standard for frailty assessment. Future studies are needed to assess the reliability and validity of existing frailty assessment scales or to develop frailty assessment tools applicable to Chinese older orthopedic inpatients.

The increasing elderly floating people in China are prone to the risk of impaired health status and low utilization of public health services due to older age and unstable life. At present, there is a lack of research on income-related public health services utilization and health inequities in this population.

To understand the utilization of public health services and health status of elderly migrants, evaluate the utilization of public health services and health equities in them, and put forward suggestions for reducing income-related health inequalities.

In April 2022, elderly migrants aged 60 years or over (n=5 840) were selected from the China Migrants Dynamic Survey 2018 as the study population. Public health service utilization was assessed using the data related to the use of health education, health records and family doctor services. Health status was assessed based on self-rated health and morbidity in the past one year. Socio-demographic, economic and migrant characteristics were collected as explanatory variables. The Erreygers-corrected concentration index (EI) was used to measure income-related inequality in the utilization of public health services and health status. The decomposition analysis based on logit model was used to quantify the contribution of each determinant to total inequality.

Among the elderly migrants, the health education acceptance rate was 72.12% (4 212/5 840), with an EI of 0.021 (P>0.05). The rate of health record establishment was 30.99% (1 810/5 840), with an EI of -0.054 (P<0.05). And the rate of contracting a family doctor was 16.83% (983/5 840), with an of EI of -0.057 (P<0.05). Self-rated good health accounted for 82.29% (4 806/5 840), with an EI of 0.199 (P<0.05). The morbidity rate in the past one year was 29.02% (1 695/5 840), with an EI of 0.123 (P<0.05). The decomposition of EI results showed that per capita income had the highest percentage contribution to the equity of public health service utilization (74.354%, 53.383%), followed by geographic range of migration (43.474%, 32.063%). And per capita income also demonstrated the highest percentage contribution to health inequity (59.561%, 66.641%), followed by the impact of household registration on self-rated health (36.347%), and the impact of geographic range of migration on the morbidity (14.153%) .

Low-income older migrants are prone to low rate of public health service utilization and poor health outcomes. Income is the most important cause of public health service utilization inequity and health inequity among elderly migrants. Relevant departments should do a good job in publicizing public health services in this population, and give priority to those with a low economic status.

Elderly patients in community outpatient clinics often suffer from multiple chronic conditions and were particularly vulnerable to potentially inappropriate prescribing (PIP) .

To analyze the influencing factors of prescriptions for elderly patients becoming PIP in community outpatient clinics.

In March 2021, a combination of cluster sampling and simple random sampling was used to select drug prescriptions from elderly patients who visited a community health service center in Beijing from January 1 to December 31, 2019. The prescriptions were evaluated by two pharmacists with intermediate titles based on 2019 American Geriatrics Society Beers Criteria (abbreviated as Beers criteria) and Criteria of Potentially Inappropriate Medications for Older Adults in China (abbreviated as China criteria) , respectively. At the same time, the researchers collected the relevant data of the prescriber, elderly patients and the content of the prescription, and compared the differences in the characteristics of the prescriber, the prescription object and the prescription content of the prescriptions with different evaluation results. Binary Logistic regression method was used to analyze the factors affecting PIP prescribing and to conduct sensitivity analysis (selected prescriptions for patients≥65 years of age) . Descriptive analysis was used to describe the distribution of inappropriate medicine in PIP.

A total of 815 outpatient prescriptions for elderly patients were included, including 266 (32.6%) PIP under the Beers criteria or 182 (22.3%) PIP under the Chinese criteria, respectively. According to the Beers criteria, the differences were statistically significant when comparing the age of prescribers, the age of elderly patients, the proportion of those with the diagnosis of hypertension and insomnia, the number of drug varieties, and the proportion of those with the drug categories of cardiovascular system drugs, antithrombotic drugs, central nervous system drugs, and gastrointestinal system drugs between PIP and non-PIP (P<0.05) . According to the China criteria, the differences were statistically significant when comparing the age or title distribution of prescribers, the proportion of those with the diagnosis of hypertension, coronary heart disease, diabetes, insomnia and osteoarthritis, and the proportion of those with the drug categories of cardiovascular system drugs, antithrombotic drugs, non-insulin hypoglycemic drugs, central nervous system drugs and non-steroidal anti-inflammatory drugs (NSAIDs) between PIP and non-PIP (P<0.05) . The binary Logistic regression results showed that, no matter under the Beers criterion or the Chinese criterion: the prevalence of coronary heart disease or insomnia in elderly patients had an impact on the prescription of PIP, and the inclusion of antithrombotic agents in the prescription was an influencing factor affecting the formation of PIP (P<0.05) . The results of the sensitivity analysis showed that hypertension, coronary heart disease and insomnia in elderly patients have an impact on the prescribing of PIP; the inclusion of antithrombotic medication in the prescription was an influencing factor affecting the formation of PIP (P<0.05) . According to the Beers' criterion, 266 PIP involved a total of 302 cases of inappropriate drug use, of which antithrombotic drugs accounted for 46.4% (140/302) , central nervous system drugs accounted for 16.2% (49/302) , endocrine system diabetes (non-insulin) drugs accounted for 13.9% (42/302) . According to the Chinese criterion, 182 PIP involved inappropriate medications in a total of 205 cases, of which antithrombotic drugs accounted for 44.9% (92/205) , central nervous system drugs accounted for 25.9% (53/205) , oral NSAIDs accounted for 14.1% (29/205) .

Among the community outpatient prescriptions for elderly patients, PIP accounted for a relatively high proportion. In the future, emphasis should be placed on community physicians' knowledge of safe and rational drug use, the use of antithrombotic drugs should be standardized, and the review of drug prescriptions for patients with hypertension, coronary artery disease and insomnia should be strengthened.

Elder abuse is a global public health issue, with a yearly increase in its prevalence. As elder abuse often occurs covertly and is difficult to be detected and identified, effective assessment tools are prerequisites for detecting and stopping elder abuse.

To systematically review the studies on elder abuse assessment tools.

From January 10 to 24, 2021, we conducted a comprehensive search of 11 databases (PubMed, CHINAL, PsycINFO, EmBase, Scopus, Web of Science, Cochrane Library, CQVIP, Wanfang Data, CNKI, and Taiwan Scholar Database) to identify eligible studies of elder abuse assessment tools published up to December 31, 2020. Literature screening and data extraction were performed by two researchers, separately, and then were cross-checked. Methodological quality was evaluated, an authenticity assessment tool for scale measurement properties.

A total of 29 studies were included, involving 19 elder abuse assessment tools, 18 of which were questionnaires in English and the other one was a questionnaire in Chinese. According to the evaluation content, these tools could be classified into two types: the risk of elder abuse (7) and elder abuse (12) . In particular, Assessment Tool for Domestic Elder Abuse, the Family Violence Against Older Women, and Family Caregivers' Misbehavior toward Elderlies on Hemodialysis belonging to the elder abuse type could be used to assess the severity of abuse.

As elder abuse has gradually attracted wide attention, the international community has developed various types of assessment tools targeting different groups, institutions and cultural backgrounds. Researchers should appropriately select assessment tools according to research objectives, participants, and research institutions, and should develop elder abuse assessment tools for Chinese older people in accordance with China's conditions and cultural background.

Polypharmacy is increasingly common in the elderly. The medication compliance of polypharmacy is closely related to its therapeutic effect and safety. Therefore, it is of great significance to understand the medication compliance and its influencing factors in the elderly with polypharmacy at early stage. However, the conclusions of current studies vary greatly, and there is no clear and unified standard.

To systematically evaluate the current status of polypharmacy in the elderly and its influencing factors, in order to provide reference for improving medication compliance of polypharmacy in the elderly, reducing adverse reactions, and further developing individualized intervention programs.

PubMed, Embase, Web of Science, Cochrane Library, Scopus, Ovid, CBM, CNKI, Wanfang Data and VIP were searched for cohort studies, case-control studies, cross-sectional studies and other observational studies on the influencing factors of medication compliance of polypharmacy in the elderly from inception to March 2023. Two researchers independently screened the literature, evaluated the quality and extracted the data according to the inclusion and exclusion criteria. Stata 17.0 and RevMan 5.3 software were used for meta-analysis.

A total of 19 studies were included with the total sample size of 130 047 subjects, including 50 852 subjects with good medication compliance. Meta-analysis results showed that the medication compliance rate of polypharmacy in the elderly was 41%〔95%CI (34%, 47%) 〕, which was associated with age〔OR=2.62, 95%CI (1.60, 4.78), P<0.000 1〕, gender〔OR=1.70, 95%CI (1.30, 2.23), P=0.000 1〕, education level〔OR=1.73, 95%CI (1.38, 2.16), P<0.000 01〕, residential lifestyle〔OR=2.85, 95%CI (2.18, 3.72), P<0.000 01〕, medication knowledge level〔OR=1.14, 95%CI (1.04, 1.25), P=0.005〕, medication belief〔OR=2.06, 95%CI (1.44, 2.93), P<0.000 1〕, depression〔OR=2.52, 95%CI (1.96, 3.24), P<0.000 01〕, daily living ability (ADL) 〔OR=2.39, 95%CI (1.68, 3.38), P<0.000 01〕, history of falls〔OR=3.51, 95%CI (2.03, 6.06), P<0.000 01〕, professional guidance 〔OR=3.75, 95%CI (1.92, 7.33), P=0.000 1〕, the number of drug types〔OR=2.58, 95%CI (1.96, 3.41), P<0.000 1〕, adverse drug reactions〔OR=3.08, 95%CI (2.17, 4.38), P<0.000 1〕, medication regimen complexity〔OR=1.08, 95%CI (1.03, 1.14), P=0.004〕, medication management〔OR=1.92, 95%CI (1.34, 2.75), P=0.000 3〕 and medication cost〔OR=2.60, 95%CI (1.30, 5.17), P=0.000 7〕. Sensitivity analysis showed that the results of meta-analysis were relatively stable. Begg's test (P=0.441) and Egger's test (P=0.674) suggested that there was a low risk of publication bias for medication compliance of polypharmacy in the elderly in the included studies.

The compliance rate of polypharmacy in the elderly is 41%. And the available evidence shows that general factors (age, gender, education level, residential lifestyle), psychological and social factors (depression, ADL, history of falls, medication knowledge level, medication belief, professional guidance), drug factors (medication management, medication cost, medication regimen complexity, the number of drug types, adverse drug reactions) are the influencing factors of medication compliance of polypharmacy in the elderly. Medical staff should formulate individualized intervention measures and optimize disease management in the elderly with polypharmacy according to the influencing factors of medication compliance of polypharmacy.

Since the Internet dependence of the supply and demand sides of health popularization is increasing, eHealth literacy has become a primary skill that chronic disease patients need to master.

To analyze the current situation and existing problems of online health information usage habits and eHealth literacy in middle-aged and elderly residents, and discuss the relationship between online health information usage habits and eHealth literacy, providing a reference for improving the level of eHealth literacy and developing appropriate Internet-based health popularization services for these populations.

From June to September 2021, a questionnaire survey was conducted among 1 061 middle-aged and elderly residents in Shanghai communities selected by multistage sampling using the General Information Questionnaire and the Chinese version of the eHealth Literacy Scale (eHEALS-C) to understand their habits of using online health information and levels of eHealth literacy. Stepwise multiple linear regression was used to assess the association of habit of using online health information and other potential candidate factors with the level of eHealth literacy.

Altogether, 1 019 cases (96.04%) who effectively responded to the survey were included for analysis. Following health care accounts〔411 cases (40.33%) 〕was a major channel used for seeking online health information, followed by the search functionality or engines〔336 cases (32.97%) 〕, while the health apps or mini programs〔254 cases (24.93%) 〕, and online health communities〔65 cases (6.38%) 〕were less used. The online health information was less sourced from medical institutions〔397 cases (38.96%) 〕and medical workers〔187 cases (18.35%) 〕. The average total score of the eHEALS-C for the respondents was (27.62±8.57). The respondents scored lower in item 2〔 (3.36±1.27) points〕and item 6〔 (3.38±1.23) points〕of the eHEALS-C, indicating that they had low awareness of applying online health information to health problems, and low perceived skills at evaluating the online health information. Multiple linear regression analysis showed that age, participation in both basic and commercial medical insurance, using at least two channels for seeking online health information, having at least two sources of online health information, the habit of forwarding and sharing online health information, participation in collective online learning, and having an attitude of acceptance towards online health information were influencing factors of the level of eHealth literacy.

The eHealth literacy of these middle-aged and elderly residents is at a medium level, which is affected by online health information usage habits and other factors. To help them make better use of online health information and to improve their eHealth literacy, it is suggested to spread integrated authoritative information and retrieval platforms among these populations, give priority to supervision and elderly-oriented transformation of online health information platforms, and mobilize community, family, health associations, and commercial medical insurance institutions to co-deliver health-promotion services targeting these people.