The challenge of aging is becoming increasingly severe in China. Understanding the trends in chronic disease prevalence and comorbidity spectrum among the elderly is crucial for primary healthcare.

To analyze the prevalence and comorbidity patterns of chronic diseases among the elderly in China based on data from the China Health and Retirement Longitudinal Study (CHARLS) .

Participants aged ≥60 years from the 2011 (Wave 1) and 2015 (Wave 3) CHARLS dataset were selected. Their physical examination data and self-reported disease conditions, as well as the questionnaire data were extracted for descriptive statistical analysis of chronic disease and comorbidity prevalence, comparing changes over time. Latent class analysis (LCA) was employed to identify common clusters of comorbidities in the elderly and to assess their impact on daily living activities (evaluated using the Activities of Daily Living Scale, ADL) .

A total of 7 290 individuals in 2011 and 9 845 in 2015, all aged≥60 years, were included in the study. The prevalence of chronic disease comorbidity increased from 85.96% in 2011 to 92.24% in 2015, indicating a significant rise (χ²=109.65, P<0.05). Except for pain and oral diseases, the prevalence of all other chronic diseases increased in 2015 (P<0.05). Combining self-reported diseases and laboratory results, the prevalence of overweight or obesity increased from 39.53% in 2011 to 42.88% in 2015 (χ²=35.12, P<0.01), and abdominal obesity from 45.37% to 47.99% (χ²=18.09, P<0.01). The prevalence of cardiovascular-metabolic disease comorbidity increased from 52.75% in 2011 to 60.49% in 2015 (χ²=64.39, P<0.01), becoming the primary form of chronic disease comorbidity in this population. The LCA categorized the elderly population into five comorbidity patterns in the elderly, with the "cardiovascular-metabolic + musculoskeletal diseases" pattern showing higher ADL scores compared to the "cardiovascular-metabolic diseases""musculoskeletal diseases""respiratory diseases" and "nonspecific comorbidities" patterns.

According to CHARLS data from 2011 and 2015, there is a high prevalence (85.96% in 2011 and 92.24% in 2015) and increasing trend in chronic disease comorbidity among Chinese individuals aged ≥60. Cardiovascular-metabolic comorbidity pattern is the most common, with many cases undetected, and the combination of cardiovascular-metabolic and musculoskeletal diseases has the most significant impact on the daily living abilities of the elderly.

The problem of population aging is serious in China, and chronic diseases comorbidity is becoming more and more common.

Based on the health ecology model, to systematically understand the main influencing factors of chronic disease comorbidity among the elderly in China, and to provide scientific reference for the prevention and control of chronic disease comorbidity among the elderly in China.

Based on the follow-up data of China Health and Retirement Longitudinal Study (CHARLS) 2018, a total of 10 779 samples aged ≥60 years were selected in March 2021. After excluding the samples with missing data and unqualified data, a total of 7 354 samples was included in this study. With the occurrence of chronic comorbidities (having ≥2 chronic conditions) as the dependent variable and the inclusion of independent variables according to the 5 dimensions of the health ecology model, a multivariate Logistic regression model was used to analyze the influencing factors of chronic disease comorbidity in the elderly.

Among the elderly≥60 years old in China, the comorbidity rate of chronic diseases was 65.16% (4 792/7 354) , with 32.16% (1 541/4 792) patients suffered from two kinds of chronic diseases, and the diseases with the largest combination of two comorbidities were hypertension with arthritis or rheumatism〔16.42% (253/1 541) 〕. The results of the multivariate Logistic analysis showed that for the risk of comorbidities of chronic diseases in the elderly, females were higher than that in males〔OR (95%CI) =1.371 (1.177, 1.596) 〕, those over 70 years old were higher than those aged 60-70 years old〔OR (95%CI) =1.189 (1.061, 1.333) 〕, those who slept for 6-8 hours or more than 8 hours at night were lower than those who slept for less than 6 hours at night〔OR (95%CI) =0.759 (0.678, 0.850) , OR (95%CI) =0.686 (0.572, 0.821) 〕, those who took nap time of 0.5-1.0 h and over 1.0 h were higher than those of less than 0.5 h 〔OR (95%CI) =1.238 (1.102, 1.391) , OR (95%CI) =1.219 (1.604, 1.396) 〕, those who felt general and less satisfied with their health were higher than those who were very satisfied〔OR (95%CI) =1.755 (1.537, 2.004) , OR (95%CI) =5.890 (4.930, 7.037) 〕, those who registered in urban areas were higher than those in the rural areas〔OR (95%CI) =1.167 (1.036, 1.315) 〕, those living in the central and western regions were higher than those in the eastern region〔OR (95%CI) =1.311 (1.158, 1.483) , OR (95%CI) =1.491 (1.315, 1.692) 〕, those who were working were lower than those who had worked〔OR (95%CI) =0.768 (0.680, 0.866) 〕, and those with annual income > 50 000 per capita were higher than that of less than 20 000 yuan〔OR (95%CI) =1.413 (1.009, 1.978) 〕.

The incidence of chronic diseases comorbidity is higher in the elderly in China. The influencing factors of comorbidity of chronic diseases are multi-level and multi-dimensional. There are complex relationships between different influencing factors, which suggest strengthening multi-dimensional intervention and management of chronic diseases from individual to environment, so as to improve the health level of the population.

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.

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.

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.

Considering that our country has entered an aging society, the health problems of the older people has evolved into a concern due to the association with a variety of diseases. In recent years, Chinese households and society have suffered a serious economic burden due to the increasing prevalence of dysphagia among the elderly.

The purpose of this study is to evaluate the prevalence of dysphagia in the elderly in China systematically.

PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, Wanfang Data, and China Biomedical Literature Database were searched for epidemiological studies related to the prevalence of dysphagia in the elderly in China. Searches were conducted from database inception to May 2022. Two researchers were responsible for screening literature and extracting data according to the inclusion and exclusion criteria. The AHRQ scale was used to evaluate the quality of cross-sectional studies. Meta-analysis was performed with Stata 15.0 software.

A total of 22 articles were analyzed, containing 308 289 patients, including 47 940 patients with dysphagia. Meta-analysis revealed that the prevalence of dysphagia in the elderly in China was 66.0%〔95%CI (58.0%, 73.0%) 〕. According to subgroup analysis, among elderly Chinese males and females dysphagia was prevalent in 38.0%〔95%CI (31.0%, 45.0%) 〕 and 38.0%〔95%CI (29.0%, 46.0%) 〕 of cases, respectively. The prevalence of dysphagia was 21.0%〔95 %CI (13.0%, 29.0%) 〕 in 60-69 years old, 28.0%〔95%CI (18.0%, 37.0%) 〕 in those aged 70-79, and 41.0%〔95%CI (31.0%, 50.0%) 〕 in those aged more than 80. In primary, secondary, and technical secondary school, and college and up, dysphagia was observed in 28.0%〔95%CI (20.0%, 35.0%) 〕, 32.0%〔95%CI (17.0%, 53.0%) 〕, 30.0%〔95%CI (18.0%, 42.0%) 〕 of the elderly. The prevalence of elderly dysphagia was 68.0% in the hospital〔95%CI (52.0%, 85.0%) 〕, 56.0%〔95%CI (41.0%, 71.0%) 〕 in the nursing home and 76.0%〔95%CI (56.0%, 97.0%) 〕 in the community. According to the Kubota Drinking Test, 32.0%〔95%CI (21.0%, 43.0%) 〕 of the elderly suffer from dysphagia, 41.0%〔95%CI (16.0%, 66.0%) 〕 exprience it according to the EAT-10 scale, and 35.0%〔95%CI (14.0%, 56.0%) 〕 suffer from it according to the Water Swallowing Test scale.

The prevalence of dysphagia among the elderly in China is 66.0%〔95%CI (58.0%, 73.0%) 〕. The prevalence of dysphagia among those≥80 years old, those with secondary school and technical secondary school education, elderly care in community, and those with dysphagia diagnosed by the EAT-10 scale is high. In order to improve the quality of life and reduce the prevalence of dysphagia among the elderly, we must pay more attention to and understand elderly dysphagia early.

Type 2 diabetes mellitus (T2DM) among the elderly has become a significant public health problem both globally and in China, affecting population health. It is extremely urgent to clarify the related disease burden.

To assess the disease burden of T2DM among the elderly population globally and in China from 1990 to 2021, project future trends, and offer insights to inform public health and medical decision-makings.

Data on incidence and mortality burdens of individuals aged 60 years and above with T2DM in China and around the world were extracted from the global Burden of Disease (GBD) 2021 database. Age-standardized incidence and mortality rates were estimated based on the GBD 2021 standard population. Joinpoint regression was utilized to calculate the average annual percentage change (AAPC) for assessing disease burden trends. Subgroup analyses were performed based on age and sex, and decomposition analysis was performed to examine how aging, population growth, and epidemiological changes impacted disease burden. Bayesian models were employed to forecast prevalence and mortality between 2022 and 2035.

In 2021, the global incidence of T2DM stood at 6 047 049, while in China, it reached 800 764, representing increases of 178.68% and 220.28%, respectively, compared to the incidence in 1990. Over the period from 1990 to 2021, the global age-standardized incidence rate exhibited a significant overall upward trend (AAPC=1.21%, P<0.001), whereas the trend in China was not statistically significant (AAPC=0.29%, P=0.189). The number of deaths among elderly T2DM patients in 2021 in the global and Chinese populations was 1 304 150 and 149 972, respectively, marking increases of 164.68% and 197.98% compared to the number of deaths in 1990. Throughout the same period, the global age-standardized mortality rate displayed a consistent upward trend (AAPC=0.32%, P<0.001), while the trend in China remained relatively stable (AAPC=0.01%, P=0.922). Notably, the number of incidence and mortality for female in 1990 and 2021, globally and in China, exceeded those of males. Meanwhile, the 60-64 age group had the highest proportion of incidences in 2021, while the 70-74 age group had the highest proportion of deaths. Population growth emerged as the primary influencer driving the rise in incidence and mortality in elderly T2DM patients in both global and Chinese populations, as revealed by decomposition analysis. The projection indicates a continued increase in the incidence and mortality of elderly T2DM patients worldwide and in China from 2022 to 2035.

The persistent heavy burden of incidence and mortality among elderly individuals with T2DM in both global and Chinese populations necessitates urgent reinforcement and formulation of more effective public health policies and clinical prevention and control strategies to alleviate the fundamental burden associated with this demographic.

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.

Dysphagia, a prevalent geriatric syndrome, has been witnessing an upward trend in incidence rates, potentially leading to severe complications like aspiration pneumonia and asphyxia. Despite its significance, research on the prevalence and determinants of dysphagia among community-dwelling elderly remains scarce.

This study aims to ascertain the prevalence of dysphagia among Shanghai's elderly community by identifying influencing factors and analyzing occurrence rates and determinants across different age brackets.

Employing a cross-sectional survey approach, the study was conducted from July 2022 to May 2023. Using convenience sampling, the study involved 358 individuals aged 60 and above, selected from the outpatient and home care services of five community health service centers in Huangpu, Baoshan and Fengxian Districts of Shanghai. Demographic data were collected, and measurements of the Appendicular Skeletal Muscle Index (ASMI), grip strength, and walking speed were taken. The Eating Assessment Tool-10 (EAT-10) was utilized to assess the risk of dysphagia among the elderly.

Out of the 358 community-dwelling elderly individuals surveyed, 80 (22.3%) exhibited symptoms of dysphagia (EAT-10≥3) (dysphagia group). Multivariate Logistic regression analysis identified advanced age (≥80 years) (OR=18.484, 95%CI=3.571-95.679), depressive state (OR=4.135, 95%CI=1.280-13.364), and a history of choking (OR=13.650, 95%CI=4.345-42.877) as significant risk factors for dysphagia (P<0.05). Conversely, a high Barthel Index (OR=0.891, 95%CI=0.832-0.953) and a robust ASMI (OR=0.330, 95%CI=0.199-0.547) emerged as protective factors (P<0.05). When stratified by age, the prevalence rates of dysphagia were 5.0% (6/119), 11.1% (16/144), and 61.1% (58/95) for the age groups 60-69, 70-79, and ≥80 respectively, with statistically significant differences (P<0.05). Significant disparities were noted between dysphagia and non-dysphagia groups in terms of BMI, ASMI, and depression status for ages 60-69 (P<0.05), grip strength, calf circumference, depression, Barthel Index, and choking history for ages 70-79 (P<0.05), and ASMI, grip strength, walking speed, Barthel Index, MMSE scores, and choking history for ages ≥80 (P<0.05). Within the dysphagia cohort, ASMI and grip strength in the 70-79 and ≥80 age groups were lower compared to the 60-69 age group (P<0.05). The walking speed of individuals aged ≥70 was reduced relative to those aged 60-69 (P<0.05). Additionally, individuals aged ≥80 showed a higher choking incidence and scored lower on the Barthel Index and MMSE than those aged 60-79 (P<0.05) .

The prevalence of dysphagia among community-dwelling elderly in Shanghai is notably high and progressively increases with age, with a corresponding rise in influencing factors. It is imperative to intensify dysphagia screening, particularly among the elderly with depressive symptoms or a history of choking. Enhancing muscle mass and self-care capabilities, coupled with age-specific preventive measures, can substantially alleviate the disease burden and improve prognoses.

The Screening Tool of Older Person's Potentially Inappropriate Prescriptions (STOPP) and the Screening Tool to Alert to Right Treatment (START) were initially developed by a panel of experts from Cork University Hospital, Ireland in 2008, and underwent a second update in 2015. Since their inception, these criteria have played a pivotal role in identifying potentially inappropriate medication use in the elderly, enhancing oversight of medication misuse in older individuals, and reducing adverse drug events among the elderly. In 2023, the third edition of the STOPP/START criteria was released, providing updated and more practical evidence-based guidance. Building upon the second edition, this iteration includes the addition, revision, and removal of certain criteria, resulting in a total of 190 new standards for potentially inappropriate medication use. This latest version incorporates the most recent research findings and clinical evidence related to appropriate medication use in older adults. We provide a detailed analysis of the STOPP/START criteria (version 3), offering valuable insights for the updating and refinement of potentially inappropriate medication criteria in our country. Furthermore, it presents recommendations for future research in this field.

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.

Middle-aged and elderly ischemic stroke patients suffer from multiple co-morbid chronic diseases, and this co-morbidity status has a great impact on the patients' healthy living standard. Currently, there are few studies on the current status of ischemic stroke co-morbidities and the analysis of co-morbidity patterns.

To understand the current status of ischemic stroke co-morbidities in middle-aged and elderly people in Henan Province, and explore the association between ischemic stroke co-morbidities, so as to provide a reference basis for the management of ischemic stroke co-morbidities, as well as the preventive and control measures.

Ischemic stroke patients over 45 years of age attending Henan Provincial People's Hospital from January 2021 to December 2022 were selected for the study, with their chronic disease prevalence counted, the status of ischemic stroke co-morbidities was compared by different demographic characteristics, and the co-morbidity patterns of ischemic stroke in the middle-aged and elderly population were investigated using cluster analysis.

A total of 1 685 middle-aged and elderly ischemic stroke patients were enrolled in this study, of whom 90.0% (1 516/1 685) had at least 1 co-morbid chronic disease; 13.6% (230/1 685) had 2 co-morbid chronic diseases, 26.9% (454/1 685) had 3 co-morbid chronic diseases, and 49.4% (832/1 685) had 4 or more co-morbid chronic diseases. The chronic diseases with high prevalence were hypertension in 1 047 cases (62.1%) and dyslipidemia in 755 cases (44.8%). Among ischemic stroke patients, the prevalence of co-morbidities was higher in females compared with males (χ²=14.516, P<0.05) ; the prevalence of co-morbidities tended to increase with age (χ²_trend=148.889, P<0.001) ; and the prevalence of co-morbidities tended to decrease with higher education (χ²_trend=30.890, P<0.001). Cluster analysis showed four patterns of co-morbidity, which were cardiovascular-metabolic patterns (hypertension, dyslipidemia, heart attack, and diabetes mellitus), patterns characterized by hepato-pulmonary-gastrointestinal-urinary disorders (chronic lung disease, renal disease, hepatic disease, gastrointestinal disorders, and urinary disorders), psychiatric-degenerative patterns (neurological or psychiatric problems, arthritis or rheumatism, disorders related to memory), and cancer.

The prevalence of co-morbidities of ischemic stroke in middle-aged and elderly people in Henan province is high, and their co-morbidity patterns include cardiovascular-metabolic patterns, patterns characterized by hepato-pulmonary-gastrointestinal-urinary disorders, psychiatric-degenerative patterns, and cancers, among which cardiovascular-metabolic patterns are more associated with ischemic stroke, and the screening and prevention of which should be better controlled.

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.

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.

With the accelerated population aging, the number of elderly patients with chronic diseases is growingly elevated. Adherence to medication regimens is pivotal for the health outcomes of chronic diseases. Existing research mainly analyzed influencing factors for medication adherence and the outcome of medication adherence by interventions. A single analysis of medication adherence from the aspect of medication experience is one-sided.

To understand the current situations of medication experience and medication adherence in elderly patients with chronic diseases, and to explore the influence of medication experience at multiple dimensions on medication adherence, thus proposing countermeasures to improve medication adherence in elderly patients with chronic diseases.

From September 2023 to December 2023, a total of 2 432 residents of three cities in Shandong Province were selected by stratified random sampling according to the economic level and social development. Elderly patients (>60 years of age) with chronic diseases and long-term medications were screened according to the inclusion and exclusion criteria. A self-designed Medication Experience Scale, consisting of 7 dimensions and 28 items was used to investigate the medication experience. A Chinese version of 4-item Medication Adherence Scale was used to investigate the medication adherence. Current status of patients' medication experience and medication adherence were described. Multiple linear regression was performed to analyze the dimensions of medication experience that greatly influenced medication adherence.

A total of 2 432 questionnaires were distributed in this survey, and 2 415 were retrieved. After excluding samples with missing data on the main variables, a total of 1 544 samples were included in this study. The mean score of medication experience of elderly patients with chronic diseases was (4.31±0.39) point, with the highest score in the dimension of life influenced by medication (4.72±0.58) points, and lowest in the dimension of convenience (3.86±0.49) points. The mean score of medication adherence in elderly patients with chronic diseases was (3.48±0.62) points. A total of 698 (45.2%) patients were identified as a poor adherence. The most common cause for non-adherence was 'forgetting to take medication' (77.1%, 538/698). Medication adherence scores were significantly lower in female elderly, or elderly patients with two or more chronic diseases than those of counterparts (P<0.05). The results of multivariate linear regression showed that medication adherence was worse in female elderly patients (β=-0.056) and elderly patients with two or more chronic diseases (β=-0.053) (P<0.05). Among the dimensions of the Medication Experience Scale, the dimensions of effectiveness (β=0.083), and affordability (β=0.135) positively predicted patients' medication adherence (P<0.05) .

The proportion of elderly patients with poor medication adherence to chronic diseases in Shandong Province is 45.2%, among whom, female patients and elderly patients with two or more chronic diseases have a worse medication adherence. The effectiveness and affordability dimensions of the medication experience are positive predictors of medication adherence. Relevant departments should focus on continuously reducing the price of chronic disease medicines, and doctors should strengthen the pharmacy guidance service provided to female patients and elderly patients with two or more chronic diseases.

There are a large number of middle-aged and elderly patients with chronic diseases. However, there is currently limited research on the depression status and influencing factors of middle-aged and elderly patients with chronic diseases nationwide.

By exploring the depression status and influencing factors of middle-aged and elderly patients with chronic diseases in China, to provide a reference for improving their mental health status.

According to the fifth round of national survey data conducted by the China Health and Retirement Longitudinal Study (CHARLS) in 2020, a total of 12 551 middle-aged and elderly patients with chronic diseases were selected as the study objects. The depression status of the study objects was measured using the Center for Epidemiologic Studies Depression Scale (CES-D), and the main factors affecting the depression status of middle-aged and elderly patients with chronic diseases were analyzed using the chi-square test and multivariate Logistic regression.

Among middle-aged and elderly patients with chronic diseases, the proportion of those with depressive symptoms was 40.7% (5 111/12 551). The results of multivariate Logistic regression analysis showed that: gender (male: OR=0.613, 95%CI=0.553-0.680), age (65-<75 years old: OR=0.862, 95%CI=0.769-0.965; ≥75 years old: OR=0.604, 95%CI=0.510-0.716), presence of spouse/partner living together or not (have OR=0.730, 95%CI=0.648-0.822), places of residence (rural: OR=1.515, 95%CI=1.387-1.654), educational levels (junior high school: OR=0.727, 95%CI=0.657-0.805; senior high school and above: OR=0.561, 95%CI=0.488-0.646), social status (1 item: OR=0.870, 95%CI=0.793-0.956; ≥ 2 items: OR=0.866, 95%CI=0.779-0.963), satisfaction with child relationships (satisfaction: OR=0.266, 95%CI=0.218-0.324), smoking (OR=1.131, 95%CI=1.014-1.263), alcohol consumption (OR=0.873, 95%CI=0.795-0.959), nighttime sleep duration (6-<8 h: OR=0.539, 95%CI=0.493-0.590; ≥8 h: OR=0.443, 95%CI=0.396-0.495), BADL (damaged: OR=1.875, 95%CI=1.692-2.077), IADL (damaged: OR=2.251, 95%CI=2.030-2.496), number of chronic diseases (2 types: OR=1.202, 95%CI=1.076-1.342; 3 types: OR=1.452, 95%CI=1.289-1.636; ≥ 4 types: OR=1.954, 95%CI=1.749-2.183) were the influencing factors of depression symptoms in middle-aged and elderly patients with chronic diseases (P<0.05) .

The incidence of depressive symptoms in middle-aged and elderly patients with chronic diseases is 40.7%, and the situation is not optimistic. Their depression is influenced by various factors. Healthcare institutions and policymakers should pay attention to their mental health and take targeted measures from personal, family, community, and other aspects to improve.

The number of chronic obstructive pulmonary disease (COPD) patients in China is huge, and respiratory rehabilitation training, as an important part of the management of COPD patients in the stabilization period, can effectively improve their lung function and quality of life, as well as reduce the burden on their families and society. Current data from Europe and the United States have shown that the implementation of respiratory rehabilitation under telemedicine management can improve the lung function and QOL of patients, however, there is a lack of relevant practice in China, especially in the west.

To assess the impact of respiratory rehabilitation training via telemedicine management in combination with conventional therapy on improving ventilatory capacity and lung function in elderly patients with moderate-to-severe COPD.

This study was a prospective randomized controlled study, enrolling consecutive COPD patients who attended the Fourth People's Hospital of Sichuan Province and five joint community clinics from June 2021 to June 2022. The included patients were randomly divided into the experimental group and control group by simple randomized grouping method using random number table. The control group received traditional long-term regular inhalation bronchodilator and oral medication, and the experimental group was guided by telemedicine on the basis of the treatment plan of the control group. A six-month study was conducted on two groups of patients, lung function, Borg score, 6MWT, and quality of life score (QOL score) were recorded at 1 month before and 1, 3, 6 months after intervention.

The study subjects were divided into 72 cases in the control group and 73 cases in the experimental group, and there was no significant difference in gender, age and lung function at baseline [the forced expiratory volume in one second/predicted value ratio (FEV₁%pred) , and the ratio of the forced expiratory volume in one second to the forced vital capacity (FEV₁/FVC) ] between the two groups (P>0.05) . There was an interaction between time and group for dyspnea and mood in FEV₁%pred, FEV₁/FVC, 6MWT level and QOL score (P<0.05) . After 1, 3, and 6 months of intervention, FEV₁%pred, FEV₁/FVC, 6MWT, Borg score, and QOL score of the experimental group were better than those of the control group (P<0.05) ; FEV₁%pred, FEV₁/FVC, Borg score, 6MWT, and QOL scores at 3 and 6 months post-intervention were better than those at 1 month post-intervention in the experimental group (P<0.05) .

The use of telemedicine technology for respiratory rehabilitation of elderly moderate-to-severe COPD patients in the stable stage can effectively improve the pulmonary function, quality of life and the quality of survival of this group of patients after 3, 6-months intervention.

The high incidence of chronic diseases is associated with the inadequate knowledge of health and disease risks. At the national level, traditional health education remains popular in community health services. The health education conducted by primary healthcare providers are often limited, and lacks specificity in the content. Additionally, community residents generally show a low enthusiasm for participating in health education. The quality and effectiveness of health education for chronic disease patients need an improvement.

To explore the effectiveness of individualized health education interventions generated through the application of an information-based knowledge base model on middle-aged and elderly patients with chronic diseases in the community. The findings are expected to provide insights to further enhance the management of community-based chronic diseases.

In 2021, a total of 7 390 patients at the age of 50-70 years with the chronic diseases of hypertension, diabetes, coronary heart disease, and stroke in Beijing Dongcheng District Community Health Service Center were selected as study subjects. A one-year cluster randomized controlled trial was conducted. Patients in both groups received routine follow-up management strategies for chronic diseases, with the preservation of the existing basic public health services for chronic diseases. Those in the intervention group were additionally given individualized health education programs generated through an information-based knowledge base model, including health education prescriptions and individualized health management. Follow-up visits and interventions were conducted every three months, for a total of 12 months. An end-point survey was conducted one year after recruitment. The primary outcome measures were the differences between the baseline and end-point results of the knowledge awareness of chronic diseases, self-management attitudes, self-efficacy, medication adherence, and acceptance of health information technology.

A total of 7 390 patients with the four types of chronic diseases were included in the study, involving 3 673 patients in the intervention group and 3 717 in the control group. There were no significant differences in the age distribution, gender, education level, and employment status between groups (P>0.05). However, there was a significant difference in the type of medical insurance coverage between groups (P<0.05). After the intervention, patients in the intervention group demonstrated significantly higher correct awareness rates of overall disease knowledge, basic knowledge of chronic diseases, diabetes knowledge, coronary heart disease knowledge, and stroke knowledge compared to pre-intervention levels (P<0.05), while that of hypertension knowledge was not statistically significant (P>0.05). In the control group, there were no significant changes in the correct awareness rates of overall disease knowledge, basic knowledge of chronic diseases, hypertension knowledge, diabetes knowledge, or coronary heart disease knowledge before and after the intervention (P>0.05). However, the correct awareness rate of stroke knowledge in the control group was significantly lower after the intervention compared to pre-intervention levels (P<0.05). The scores of the self-management attitude questionnaire, self-efficacy questionnaire, medication adherence questionnaire, and health information acceptance questionnaire in the intervention group were significantly higher than those of the control group after the intervention (P<0.05). Additionally, in the intervention group, the scores on the self-management attitude questionnaire, self-efficacy questionnaire, medication adherence questionnaire, and health information acceptance questionnaire after the intervention were significantly higher compared to pre-intervention levels (P<0.05). In the control group, the scores of the self-efficacy questionnaire and medication adherence questionnaire improved significantly after the intervention compared to pre-intervention levels (P<0.05), while no significant changes in the scores of the self-management attitude questionnaire and health information acceptance questionnaire were detected (P>0.05) .

Knowledge awareness of chronic diseases, self-management attitude, and health information acceptance are more significantly improved in the intervention group than the control group. Both groups showed improvements in self-efficacy and medication adherence following the intervention, especially in the intervention group. Overall, an individualized health education based on an information-based knowledge base model is beneficial for enhancing the health literacy of patients with chronic diseases.

In the context of an aging society, the number of elderly Alzheimer's disease and related dementia (ADRD) patients in China has been increasing year by year, placing a heavy caregiving burden on their primary family caregivers and garnering extensive attention both domestically and internationally.

This study aims to analyze the burden of ADRD among Chinese elderly individuals, explore the influence of age, period, and cohort factors on its incidence and prevalence, and predict its incidence post-2021, providing a basis for the development of preventive and curative measures by relevant authorities.

Using ADRD data from the Global Burden of Disease Study 2021 (GBD 2021), we extracted the crude incidence rate, crude prevalence rate, crude mortality rate, and crude DALY rate of ADRD among Chinese elderly individuals from 1992 to 2021. After age standardization, we analyzed trends using the Joinpoint regression model and calculated the annual percentage change (APC) and average annual percentage change (AAPC). Age-period-cohort models were used to analyze the effects of age, period, and cohort factors on the incidence and prevalence of ADRD, while Bayesian age-period-cohort models were employed to predict incidence rates from 2022 to 2030.

The age-standardized incidence and prevalence of ADRD among China's elderly population from 1992 to 2021 showed an overall increasing trend (incidence: AAPC=0.57%, 95%CI=0.41%-0.72%; prevalence: AAPC=0.64%, 95%CI=0.60%-0.68%). The growth rate of standardized incidence was higher in men than in women (AAPC: 0.63% vs. 0.60%), while the growth in standardized prevalence was higher in women than in men (AAPC: 0.68% vs. 0.66%). The standardized mortality rate decreased across three intervals (1992-2019: APC of -0.11%, -0.41%, and -0.08%) but increased from 2019 to 2021 (APC=1.96%, 95%CI=0.78%-3.15%). The effects of age, period, and cohort factors on ADRD incidence and prevalence were significant. Specifically, the risk of incidence and prevalence increased with age in both men and women over 60 years old, with individuals aged 95 years and older having 13.24 and 13.53 times higher risk of incidence in men and women, respectively, compared to the 60-64 age group. The corresponding prevalence risks were 13.55 and 16.05 times higher. Over time, the risk increased, peaking during 2017-2021. In contrast, cohort effects revealed a progressive decrease in risk with later birth cohorts. By 2030, the standardized incidence rate is projected to increase by approximately 43.62% in women (from 1 267.77 to 1 820.80 per 100 000) and by 36.52% in men (from 920.22 to 1 256.30 per 100 000). Additionally, the number of ADRD cases among men and women was expected to rise significantly, with increases of 89.74% and 105.06%, respectively, between 2021 and 2030.

The increasing burden of ADRD in China's elderly population highlights the need for effective measures, particularly to protect elderly women.

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.

Poor sleep quality in older adults is closely associated with a range of adverse health outcomes. Strengthening sleep health and rehabilitation management within existing primary healthcare for older adults can help prevent or slow the onset and progression of many chronic diseases, thereby saving substantial medical resources. However, a comprehensive sleep-rehabilitation management system has yet to be established at the primary healthcare level. To address this gap, the Community Rehabilitation Working Committee of Chinese Rehabilitation Medical Association, has developed the Chinese Expert Consensus on Sleep Health and Rehabilitation Management for Community-dwelling Older Adults (2025 Edition), in collaboration with experts from multiple domestic institutions. Grounded in evidence-based research on sleep rehabilitation and informed by multidisciplinary clinical experience, the consensus considers the current availability of community-level rehabilitation resources and future trends in primary healthcare. It offers consensus-based recommendations on age-related changes in sleep physiology, goals and requirements for sleep management, rehabilitation screening and assessment, management content, and procedural workflows. The publication of this consensus is expected to play a pivotal role in guiding primary healthcare institutions to implement standardized and evidence-based management of sleep rehabilitation in older adults.

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.

With the change of lifestyle, atherosclerotic cardiovascular disease (ASCVD) is showing a younger trend as an important component of ASCVD. Snoring as a common health problem related to sleep breathing, which is a characteristic indicator of obstructive sleep apnea-hypopnea syndrome (OSAHS) . However, there are few studies on the correlation between snoring and ASCVD, and it is still necessary to identify this factor to provide scientific basis for early intervention.

To investigate the correlation between snoring frequency and 10-year risk of ASCVD in middle-aged and elderly population.

From 2018 to 2021, a multi-stage stratified cluster sampling method was adopted to investigate the permanent residents aged 35-75 in Jing'an District. General information of the subjects was collected through questionnaire survey, and laboratory tests were used to collect total cholesterol (TC) , triacylglycerol (TG) , low-density lipoprotein cholesterol (LDL-C) , and high-density lipoprotein cholesterol (HDL-C) . Snoring frequency: snoring 1-2 times per week was considered as mild snoring, snoring 3-4 times per week was considered as moderate snoring, and snoring 5-7 times per week was considered as severe snoring; the 10-year risk of ASCVD <5%, 5%-<10%, and≥10% were defined as low-risk group, intermediate-risk group, and high-risk group, respectively. Multilevel ordinal Logistic regression analysis was used to explore the correlation of snoring with the 10-year risk of ASCVD and ASCVD risk factors.

A total of 10 898 residents participated in the study, excluding 1 079 who were unclear about their individual snoring status, for a total of 9 819 residents included in the study. The risk assessment results of ASCVD showed 5 930 in the low-risk group, 1 804 in the intermediate-risk group and 2 085 in the high-risk group. In the general population, Model 1 with multilevel ordinal Logistic regression analysis showed that both moderate and severe snoring were risk factors for the 10-year risk of ASCVD compared with no snoring (P<0.05) . Model 2 adjusted for age based on Model 1, and Model 3 adjusted for hypertension, diabetes, overweight or obesity, smoking, alcohol consumption, and educational factors based on Model 2, the results showed that increasing snoring frequency would cause an increase in the 10-year risk level of ASCVD. After further dividing the total population into males and females by gender, severe snoring was associated with a 10-year risk level of ASCVD compared with the no snoring (P<0.05) , and severe snoring in males has a greater risk than in females, but mild and moderate snoring was not associated with ASCVD risk (P>0.05) . Further analysis of the relationship between snoring and ASCVD risk factors showed that severe snoring was a risk factor for hypertriglyceridemia, hypercholesterolemia, hyper-low-density lipoproteinemia and hypo-high-density lipoproteinemia, and moderate snoring was a risk factor for hyper-low-density lipoproteinemia and hypo-high-density lipoproteinemia compared with no snoring (P<0.05) . Mild snoring was not associated with ASCVD risk factors.

The frequency of snoring is correlated with the 10-year risk and risk factors of ASCVD, and it is concentrated in moderate and severe snoring population. People with mild and moderate snoring should be regarded as the focus of early intervention to promote the early prevention and treatment of ASCVD.

Obstructive sleep apnea (OSA) is prevalent in the elderly population due to the weakened neuromuscular function of the upper airway and unstable respiratory regulation in the elderly. OSA is a risk factor for a variety of common chronic diseases, and affects cognitive function and multi-system organ function in the elderly. Therefore, it is essential to provide effective therapeutic interventions for OSA in the elderly. The Sleep Medicine Branch of the Chinese Geriatrics Society, as the initiator, organized domestic experts in related fields to repeatedly discuss the operation process, requirements, specific ways and methods of noninvasive positive pressure ventilation (NPPV) treatment for elderly OSA patients with reference to domestic and international clinical studies, and finally made this expert consensus, which is aimed at standardizing the treatment of NPPV in elderly OSA patients in China to provide a reference.

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.

The knowledge-based management model has been widely used in chronic disease management recently. The online-to-offline (OTO) model, a common internet-based chronic disease management model integrating online and offline resources, has been used in disease prevention besides disease treatment, and proven to be effective in supporting chronic disease management. However, there are few studies on the application of OTO model in the management of older adults with diabetes in China.

To explore the influence of OTO model on glycemic control and self-management behaviors in older adults with type 2 diabetes in the community.

By use of convenient sampling, older adults with type 2 diabetes (n=110) who were transferred from a tertiary hospital to five community hospitals in Shenyang were selected from August to October 2020. They were randomly assigned in a 1∶1 ratio, to receive a 12-month usual community-based health management (control group) , or a 12-month OTO model-based health management (intervention group) . The intervention results were evaluated by fasting blood glucose (FBG) , 2-hour postprandial glucose (2 h-PBG) and glycosylated hemoglobin (HbA_1c) at baseline, and 6 months and 12 months after intervention, and total score and dimension scores of the Chinese version of Summary of Diabetes Self-care Activities (SDSCA-C) at baseline and 12 months after intervention.

A total of 105 cases (53 in the intervention group and 52 in the control group) who completed the study were finally included. Two groups had was no significant differences in mean levels of baseline FBG, 2 h-PBG and HbA_1c (P>0.05) . Significant interaction effects produced by the intervention method and time, and significant main effects brought by both intervention method and time on FBG, 2 h-PBG and HbA_1c were observed (P<0.05) . FBG, 2 h-PBG and HbA_1c levels in the intervention group decreased significantly either at 6 or 12 months after intervention (P<0.05) . But in the control group, only FBG and 2 h-PBG levels decreased significantly at 6 and 12 months after intervention (P<0.05) . The 12-month intervention lowered FBG, 2 h-PBG and HbA_1c levels more significantly than 6-month intervention in the intervention group (P<0.05) . But in the control group, only 2 h-PBG level was lowered more significantly by 12-month intervention than 6-month intervention (P<0.05) . The intervention group had lower mean FBG, 2 h-PBG and HbA_1c levels than the control group either at 6 or 12 months after intervention (P<0.05) . At baseline there were no differences between the two groups in total score and dimension scores of SDSCA-C (P>0.05) . After 12 months of intervention, the total score and dimension scores of SDSCA-C increased insignificantly in the control group (P>0.05) , but increased notably in the intervention group (P<0.05) . The intervention group had much higher total score and dimension scores of SDSCA-C than the control group after the intervention (P<0.05) .

The OTO model-based health management could contribute to improving glycemic control and self-management behaviors in older type 2 diabetics, which may benefit effective long-term management of diabetes.

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.

Whether considering the cumulative effect of sustained C-reactive protein (CRP) and distinguishing different aspects of depressive symptoms may be the reasons for the inconsistent conclusions of previous studies on the association between CRP and depressive symptoms among middle-aged and older adults. The relationship between cumulative effects of CRP elevations and different aspects of depressive symptoms in middle-aged and older adults in China is not well understood.

This study aims to examine the relationship between cumulative episodes of CRP elevations over two successive determinations and depressive symptoms, as well as somatic and non-somatic retardation, among Chinese middle-aged and older adults.

This study used public data from the 2011-2018 Chinese Health and Retirement Longitudinal Study (CHARLS) and included 3 868 subjects. They were categorized based on the frequency of CRP elevations over two consecutive measurements: "elevated on zero occasion" (n=2 918), "elevated on one occasion" (n=763), and "elevated on two occasions" (n=187). Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CESD-10) in 2011, 2015, and 2018, capturing both somatic and non-somatic dimensions. Multiple linear was used to explore the associations between cumulative episodes of CRP elevations over two successive determinations with depressive symptom scores in 2018, as well as the scores of somatic and non-somatic components separately. Multivariate Logistic regression was used to investigate the effects of cumulative episodes of CRP elevations on the risk of depressive symptoms in 2018.

The results of multiple linear regression analysis showed that after adjusting for all covariates, elevated on two occasions compared with elevated on zero occasion, which was an influential factor for the total score of depressive symptoms (β=1.22, P<0.05), the score of somatic depressive symptoms (β=0.51, P<0.05) and the score of non-somatic symptoms (β=0.71, P<0.05). Logistic regression analysis showed that after adjusting for all covariates, elevated on two occasions were associated with a higher risk of depressive symptoms than elevated on zero occasion (OR=1.64, 95%CI=1.18-2.29) .

Among Chinese middle-aged and older adults, there is a positive association between cumulative effects of CRP elevations and depressive symptoms, encompassing both somatic and non-somatic retardation. Addressing chronic inflammation and treating chronic inflammatory diseases promptly may help mitigate depression risk.

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.

With the rapid progression of aging in China, the challenge of multimorbidity has become a significant concern for both public health and clinical practice. Nocturnal sleep status, including sleep duration and quality, is crucial for regulating body metabolism and physiological functions in the elderly. However, current research on the relationship between nocturnal sleep status and multimorbidity was limited to specific regions or the middle-aged population. The association between nocturnal sleep status and prevalence of multimorbidity among community-dwelling older adults remains ambiguous.

To investigate the association between nocturnal sleep status and prevalence of multimorbidity among community-dwelling older adults.

In April 2023, a total of 11 917 community-dwelling older adults from the Chinese Longitudinal Healthy Longevity and Happy Family Study (CLHLS-HF, wave 2018) were selected as the participants. Multivariate Logistic regression was used to explore the association of sleep duration and sleep quality with the prevalence of multimorbidity, represented by odds ratios (OR) and 95% confidence intervals (95%CI). Additionally, restrictive cubic splines (RCS) based on Logistic regression analysis were utilized to analyze the dose-response relationship between sleep duration and prevalence of multimorbidity.

Of the 11 917 community-dwelling older adults, with an average age of (84.4±11.4) years ranged from 65.0 to 117.0 years, 6 477 were females (54.35%) and 5 440 were males (45.65%). Multivariate Logistic regression results after adjusting for covariates such as gender, age, region, and years of education, indicated that compared to those with 6-8 h of nocturnal sleep duration, older adults with shorter sleep duration (<6 h) had a higher prevalence of multimorbidity (OR=1.51, 95%CI=1.36-1.67, P<0.05) ; compared to those with good sleep quality, individuals with fair sleep quality (OR=1.34, 95%CI=1.22-1.46, P<0.05) and poor sleep quality (OR=2.14, 95%CI=1.91-2.40, P<0.05) were associated with higher prevalence of multimorbidity. RCS plots revealed a "U" -shaped nonlinear association between sleep duration and prevalence of multimorbidity, with an optimal sleep duration of approximately 7 hours.

Community-dwelling older adults with sleep durations less than 6 hours, fair or poor sleep quality, are associated with an increased prevalence of multimorbidity. The optimal sleep duration for community-dwelling older adults is approximately 7 hours. Normal sleep duration and good sleep quality are important for the prevention of multimorbidity.

Cognitive impairment is one of the serious risk factors affecting the quality of life in the elderly. Some studies have found an association between frailty and cognitive function, but research on mediating and moderating effects between the two is relatively scarce.

To explore the influence of frailty on cognitive function, and to investigate the mediating role of activities of daily living and depressive symptoms between frailty and cognitive function. Additionally, the moderating effect of social participation will be analysed.

Using data from the 2018 China Longitudinal Healthy Longevity Survey (CLHLS), 8 173 individuals aged 65 and older were selected to obtain relevant information on frailty, cognitive function, activities of daily living, depressive symptoms, social participation, and demographic data among the elderly. The differences in cognitive function among elderly individuals with different characteristics were analyzed. Pearson correlation analysis was employed to investigate the interrelationships between the variables. Stratified regression was utilised to examine the impact of frailty on cognitive function. The Process macro programme was used to test the chain mediating role of activities of daily living and depressive symptoms between frailty and cognitive function, and the moderating effect of social participation within it.

Of the 8 173 participants, 1 769 (21.6%) had cognitive impairment and all variables were correlated. Stratified regression analyses showed frailty negatively predicts cognitive function (B=-2.862, P<0.001). The results of the chain-mediated effects analysis showed that the activities of daily living (B=-1.713, 95%CI=-1.944 to -1.498) and depressive symptoms (B=-0.435, 95%CI=-0.531 to -0.345) mediated the link between cognitive function and frailty to some extent. The interaction term between frailty and social participation (B=1.140, 95%CI=0.822 to 1.457) as well as the interaction term between depression and social participation (B=0.113, 95%CI=0.015 to 0.211) both significantly and positively predicted cognitive function, while the interaction term between activities of daily living and social participation was negatively correlated with cognitive function (B=-0.413, 95%CI=-0.560 to -0.266) .

Social participation moderated the direct and indirect effects of activities of daily living and depressive symptoms on the relationship between frailty and cognitive function. The findings indicate that interventions targeting older people's mental health and enhancing the quality of social relationships may facilitate the dissolution of the correlation between frailty and cognitive impairment.