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.

Vitamin D levels decrease with age and are associated with the occurrence of osteoporosis, fractures, falls and muscle weakness that are common in older adults. In addition, its association with quality of life in the elderly has also been increasingly paid attention.

To investigate the vitamin D level and its correlation with health-related quality of life in the elderly population dwelling in community in Beijing, and to provide decision-making reference for improving the full life-cycle quality of life of this population.

The data of this study were obtained from the BEYOND research database carried out in Chaoyang District and Fengtai District of Beijing from November 2017 to July 2018. A total of 1 066 elderly people aged ≥ 60 were included for analysis. Clinical information including demographic and socioeconomic characteristics, biochemical markers of bone metabolism, bone mineral density, left and right hand grip strength, sitting test, and history of falls and fractures during 2-year follow-up was collected. According to the level of 25-hydroxyvitamin D〔25 (OH) D〕, the subjects were divided into vitamin D deficient group, vitamin D insufficient group and vitamin D sufficient group, and the EuroQol Five-dimensional Questionnaire (EQ-5D) was used to evaluate the quality of life of the subjects.

Among the 1 066 subjects, 729 (68.39%) were in the vitamin D deficient group, 291 (27.30%) were in the vitamin D insufficient group, and 46 (4.32%) were in the vitamin D sufficient group. Serum levels of procollagen type 1 N-terminal propeptide (P1NP) , alkaline phosphatase (ALP) , parathyroid hormone (PTH) , osteocalcin (OST) , and cross-linked type I collagen carboxyl-terminal peptide (β-CTX) , left hip overall T value, right hip overall T value, and left hand grip strength were statistically significant among three groups (P<0.05) . There were significant differences in pain discomfort dimension and EQ-5D utility value among the three groups (P<0.05) . The EQ-5D utility value of vitamin D sufficient group was higher than that in both vitamin D deficient group and vitamin D insufficient group (P<0.05) . The results of multiple linear regression analysis showed that 25 (OH) D level was an influence factor of EQ-5D utility value in the elderly (P<0.05) .

The prevalence of vitamin D deficiency and insufficiency in the elderly in the community in Beijing was 68.39% and 27.30%, respectively. The level of vitamin D is positively correlated with bone mineral density, grip strength and EQ-5D total utility value in the elderly. Early screening of vitamin D levels in the elderly population and timely supplementation with adequate intakes are of great significance to maintain and improve the health-related quality of life in the population.

In recent decades, ischemic stroke is increasingly prevalent, which has become the second leading cause of death and disability in the world. Insulin resistance and obesity are closely related to the development of ischemic stroke. At present, a number of studies have confirmed that obesity is associated with a variety of metabolic diseases and the role of insulin resistance played in the pathogenesis. But it is still unclear whether TyG, an indicator of insulin resistance, and TyG combined with obesity indicators can be used to predict ischemic stroke.

To assess the influencing factors of TyG, and its combination with different obesity indicators for new-onset ischemic stroke in a cohort of middle-aged and elderly people during a 10-year follow-up .

A prospective cohort design was used. The cohort included 9 406 middle-aged and elderly individuals who attended the 2011 Epidemiological Survey on Cancer Risk in Type 2 Diabetics conducted in six communities in Luzhou (including Qiancao, Xiaoshi, Longmatan, Baolaiqiao, Dashanping and Yutang) . Baseline data were collected, including TyG and its combination with different obesity indicators〔TyG-waist circumference (WC) , TyG-waist-to-height-ratio (WHtR) , TyG-body mass index (BMI) , and TyG-waist-to-hip-ratio (WHR) 〕. A 5-year follow-up initiated since June to November 2016, and a 10-year follow-up initiated since April to June 2021 were conducted, with new-onset ischemic stroke incidence (obtained through Luzhou Health Commission and Luzhou Center for Disease Control & Prevention) as an endpoint. For assessing the predictive value of baseline TyG, TyG-WC, TyG-WHtR, TyG-BMI, and TyG-WHR for new-onset ischemic stroke, patients were divided into quartiles of TyG〔Q1 (n=2 351) , Q2 (n=2 351) , Q3 (n=2 352) , Q4 (n=2 352) 〕, quartiles of TyG-WC〔Q1 (n=2 351) , Q2 (n=2 352) , Q3 (n=2 352) , Q4 (n=2 351) 〕, quartiles of TyG-WHtR〔Q1 (n=2 349) , Q2 (n=2 349) , Q3 (n=2 348) , Q4 (n=2 348) 〕, and quartiles of TyG-BMI〔Q1 (n=2 351) , Q2 (n=2 352) , Q3 (n=2 352) , Q4 (n=2 351) 〕, quartiles of TyG-WHR〔Q1 (n=2 343) , Q2 (n=2 343) , Q3 (n=2 342) , Q4 (n=2 342) 〕, respectively. Multivariate Logistic regression analysis was used to explore the relationship between TyG, TYG-WC, TYG-WTHR, TYG-BMI, TYG-WHR and new ischemic stroke in the elderly.

During the follow-up period, 527 (5.6%) of the 9 406 middle-aged and elderly people had new-onset ischemic stroke. After adjusting for multiple confounding variables, multivariate Logistic regression analysis showed that the risk of new ischemic stroke in the fourth quartile group of TyG was 1.569 times higher than that in the first quartile group of TyG〔OR=1.569, 95%CI (1.007, 2.437) , P=0.046〕. The risk of new ischemic stroke increased by a factor of 1.467, 2.012, and 2.132 in the second, third and fourth quartile groups of TyG-WC〔 OR=1.467, 95%CI (1.010, 2.131) , P=0.044; OR=2.012, 95%CI (1.270, 3.187) , P=0.003; OR=2.132, 95%CI (1.119, 4.063) , P=0.021〕compared with that in the first quartile group of TyG-WC. The risk of new ischemic stroke increased by a factor of 1.481, 1.548, and 1.705 in the second, third and fourth quartile groups of TyG-BMI 〔OR=1.481, 95%CI (1.071, 2.048) , P=0.018; OR=1.548, 95%CI (1.066, 2.247) , P=0.022; OR=1.705, 95%CI (1.054, 2.759) , P=0.030〕compared with that in the first quartile group of TyG-BMI.

The risk of new-onset ischemic stroke in middle-aged and elderly type 2 diabetics in Luzhou increased with the elevation of TyG-WC and TyG-BMI, so TyG-WC and TyG-BMI may be predictors of new-onset ischemic stroke in this population.

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.

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.

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.

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.

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.

The number of dementia patients is increasing along with the aging of the population. Dementia greatly impairs health and quality of life of patients, so early prevention and identification are particularly important.

To compare the results of the brief Community Screening Interview for Dementia (CSI-D) and the Mini-Mental State Examination (MMSE) in dementia screening, and to assess the examination consistency of the two scales.

In November 2021, we collected data of a sample of 2 668 middle-aged and elderly people with complete data (including assessment results of CSI-D and MMSE, sex, age, place of residence, education level and marital status) of the CHARLS 2018. The brief CSI-D and MMSE were used to screen the risk of dementia. Pearson correlation analysis was used to analyze the correlation of the scores of the brief CSI-D with those of MMSE. The consistencies of the two scales in the screening of dementia in all cases and subgroups divided by personal characteristics were calculated, the overall consistency was assessed using Kappa statistic.

The average CSI-D score and average MMSE score for all participants were (5.84±2.26) and (24.93±3.24) , respectively. Pearson correlation analysis showed that the brief CSI-D score was positively correlated with the MMSE score (r=0.394, P<0.001) . The overall prevalence of dementia was 27.36% (730/2 668) screened by the brief CSI-D, and was 22.11% (590/2 668) by the MMSE, showing statistically significant difference (χ²=40.167, P<0.001) . The consistency of the two scales in screening dementia in all cases was 20.22%, and ranged from 12.50% to 30.43% in screening dementia in subgroups divided by personal characteristics. Kappa statistic showed that the kappa value between the two scales was 0.121 (P<0.001) , suggesting a weak level of consistency.

In general, there are differences and weak consistency in the screening results of dementia between CSI-D and MMSE in general household population. Therefore, the use of the scales should be analyzed according to the actual situation. The in-depth comparison and discussion on the screening accuracy of the two scales could be further performed in combination with the gold standard for diagnosing dementia.

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.

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 prevalence of hip fractures is increasing due to increased number of aging people and availability of modern transportation. Elderly patients with hip fracture tend to have many basic diseases and poor prognosis, with 1-year postoperative mortality as high as 15%-25%. Timely screening of those at high risk of hip fractures with predictive tools and providing them with interventions can improve the prognosis. But there are rare studies and no appropriate objective indicators regarding predicted 1-year postoperative mortality in older hip fracture patients.

To assess the predictive association of Controlling Nutritional Status (CONUT) score and other possible associated factors for 1-year postoperative mortality in elderly patients with hip fracture.

A total of 399 patients with unilateral hip fracture (including femoral neck and intertrochanteric fractures) hospitalized in Xuanwu Hospital Capital Medical University from January 2013 to March 2016 were selected. General data, routine blood test results, biochemical and coagulation indices, and calculated CONUT score, geriatric nutritional risk index (GNRI) and neutrophil-to-lymphocyte ratio (NLR) were collected. All the patients received internal fixation or femoral head replacement procedure, and 1-year postoperative clinic- and telephone-based follow-up with death as an endpoint. Multivariate Logistic regression was used to identify influencing factors of 1-year postoperative mortality. Receiver operating characteristic (ROC) curve analysis was used to analyze the predictive value of CONUT score for 1-year postoperative mortality.

Among the 399 patients, 47 died and 352 survived at the end of follow-up. Multivariate Logistic regression analysis found that age〔OR=1.093, 95%CI (1.040, 1.148) 〕, old cerebral infarction〔OR=0.353, 95%CI (0.169, 0.737) 〕, serum creatinine〔OR=1.006, 95%CI (1.002, 1.010) 〕, CONUT score〔OR=1.261, 95%CI (1.005, 1.583) 〕 and NLR〔OR=1.049, 95%CI (1.003, 1.098) 〕 were associated with 1-year postoperative mortality (P<0.05). In predicting 1-year postoperative mortality, the area under the curve of CONUT score was 0.681〔95%CI (0.590, 0.771) 〕 with 4.5 as the optimal cutoff point, 48.9% sensitivity and 83.5% specificity. The area under the curve of NLR was 0.611〔95%CI (0.523, 0.699) 〕, with 7.055 μg/L as the optimal cutoff point, and 47.8% sensitivity and 75.9% specificity.

Age, old cerebral infarction, serum creatinine, CONUT score and NLR were associated with 1-year postoperative mortality in elderly patients with hip fracture. Preoperative CONUT score greater than 5 may be associated with worse postoperative nutritional status and higher risk of death. The CONUT score could be used for postoperative risk assessment in these patients.

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.

Low attenuation area ratio (LAA%) and pectoral major parameters are in elderly patients with COPD related to pulmonary ventilation function, but there are few studies at home and abroad.

To analyze the correlation of LAA% and pectoral major parameters with impaired pulmonary ventilation function in elderly patients with COPD, and to explore the predictive value of LAA% and PMcsa in the severity of airflow restriction, in order to provide clinical basis for the early detection and diagnosis of COPD.

A total of 270 elderly patients with stable COPD who underwent chest CT and lung function examination in North Jiangsu People's Hospital affiliated to Yangzhou University from December 2019 to June 2021 were selected and divided into GOLDⅠgroup (FEV_l%pred≥80%, n=47) , GOLD Ⅱgroup (50%≤FEV_l%pred<80%, n=88) , GOLD Ⅲ group (30%≤FEV_l%pred<50%, n=84) and GOLD Ⅳ group (FEV_l%pred<30%, n=51) according to GOLD classification with their general information and CT quantitative indexes recorded. Pearson correlation analysis and multiple linear regression analysis were used to explore the relationship between LAA%, pectoralis major areas (PMcsa) and lung function. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of LAA% and PMcsa for FEV₁%pred<50% and FEV₁%pred<80%.

BMI and PMD in GOLDⅠgroup were higher than those in GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) , and the BMI in GOLD Ⅱgroup and GOLD Ⅲ group was higher than that in GOLD Ⅳ group (P<0.05) . PMcsa, PMI, FEV₁%pred, FEV₁ and FVC in GOLD Ⅰgroup were higher than those in GOLD Ⅱ group, GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) . PMcsa, PMI, FEV₁%pred, FEV₁ and FVC in GOLD Ⅱ group were higher than those in GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) . PMcsa, PMI , FEV₁%pred, FEV₁ and FVC in GOLD Ⅲ group were higher than those in GOLD Ⅳ group (P<0.05) . Left lung LAA%, right lung LAA% and total lung LAA% in GOLD Ⅰ group were lower than those in GOLD Ⅱ group, GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) . Left lung LAA%, right lung LAA% and total lung LAA% in GOLD Ⅱ group were lower than those in GOLDⅢ group and GOLD Ⅳ group (P<0.05) . Left lung LAA%, right lung LAA% and total lung LAA% in GOLD Ⅲ group were lower than those in GOLD Ⅳ group (P<0.05) . FEV₁%pred, FEV₁ and FVC were positively correlated with PMcsa, PMI and PMD (P<0.05) . Both FEV₁%pred and FEV₁ were negatively correlated with low attenuation area ratio (right LAA%, left LAA%, total LAA%) (P<0.05) . Multiple linear regression analysis show that gender, total LAA% and PMcsa were independent influencing factors of FEV₁%pred. The area under ROC curve of right lung LAA%, left lung LAA%, total lung LAA% and PMcsa predicting FEV₁%pred<50% in male patients were 0.832, 0.827, 0.834, 0.809, respectively. The area under ROC curve of right lung LAA%, left lung LAA%, total lung LAA% and PMcsa predicting FEV₁%pred<50% in female patientswere 0.844, 0.801, 0.845, 0.839, respectively. The area under ROC curve of right lung LAA%, Left lung LAA%, total lung LAA% and PMcsa predicting FEV₁%pred<80% in male patients were 0.830, 0.815, 0.831, 0.844, respectively. The area under ROC curve of right lung LAA%, left lung LAA%, total lung LAA% and PMcsa predicting FEV₁%pred<80% in female patients were 0.805, 0.817, 0.807, 0.846, respectively.

The low attenuation area ratio and PMcsa can assess the severity of airflow restriction in elderly patients with COPD, and can be used as an important tool for early screening and severity assessment of COPD.

The Self-rated Fall Risk Questionnaire (FRQ) developed by the US CDC is one of the few questionnaires applied for fall risk self-assessment in community-dwelling older adults, which is thought to be simple and highly applicable. The Modified Falls Efficacy Scale (MFES) is also widely used in the fall risk assessment in older adults. Thus the comparison between the Self-rated FRQ and MFES in identifying fall risk in older adults would be meaningful.

To explore the applicability of the Chinese version of Self-rated FRQ (FRQ-C) in assessing the fall risks in community-dwelling older Chinese adults by comparing it with the Chinese version of MFES (MFES-C) .

A total of 203 seniors above 65 who received physical examination services, treatment services, or vaccination services from the community health center were selected by use of convenience sampling and invited to attend a survey for understanding their demographics, and fall risk rated by the MFES-C and the Self-rated FRQ-C. ROC analysis was conducted to assess the performance (sensitivity, specificity, positive and negative predictive values) of the Self-rated FRQ-C and MFES-C in the prediction of having at least one or two falls in the past year.

Fifty-eight (28.6%) of them fell once or more in the past year. The mean score of the Self-rated FRQ-C for the fall group was higher than that of the non-fall group with a statistically significant difference (P<0.001) . But no significant difference in the mean score of the MFES-C was found between the two groups (P>0.05) . Those with high fall risk assessed by the Self-rated FRQ-C (≥4 points) had higher prevalence of fall (P<0.05) . However, no higher prevalence of fall was found in those with high fall risk assessed by the MFES-C (≤112 points) (P>0.05) . The AUC values in identifying having one or more falls in the past year for the Self-rated FRQ-C and MFES-C were 0.74〔95%CI (0.68, 0.81) 〕 and 0.59〔95%CI (0.50, 0.68) 〕. When identifying having two or more falls in the past year, the AUC value of the Self-rated FRQ-C increased to 0.80〔95%CI (0.70, 0.90) 〕, and that of the MFES-C increased to 0.65〔95%CI (0.52, 0.78) 〕. The sensitivity and specificity of the Self-rated FRQ-C with a threshold of 4 points were 81.0% and 51.7%, respectively, and those of the MFES-C with a threshold of 112 points were 53.5% and 60.0%, respectively.

Compared with the MFES-C, the Self-rated FRQ-C may have higher sensitivity in identifying fall risk in older adults with higher operability and applicability in community settings.

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.

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 needs of outpatient services, a key accessible health resource, are increasing in an increasingly aging population in China. So rational allocation of outpatient service resources to meet older people's health needs is a key to improving their health level.

To explore the factors affecting the utilization of outpatient services in the elderly, to provide feasible suggestions for improving older people's health level and the allocation of medical resources.

This study was conducted in 2021 using the data of older people (≥60 years old) attending the CHARLS 2018. The number of using outpatient services in these people in the past month prior to the CHARLS 2018 and associated factors were studied using a system developed based on the framework of Anderson's Behavioral Model of Health Services Use, with sex, age, marital status, the type of hukou (rural or urban), education level, smoking and drinking were classified as predisposing factors, health insurance, monthly household income per capita and the average distance from home to medical institutions as enabling factors, and chronic disease prevalence and self-rated health as need factors. The zero-inflated negative binomial regression (ZINB) was used to identify factors associated with the use of outpatient services.

In all, 9 551 older people were included for analysis. Among them, non-users of outpatient services in the past month numbered 8 038 (84.16%), and one-time, two-time, and three or more-time users numbered 749 (7.84%), 367 (3.84%), and 397 (4.16%), respectively. The number of using outpatient services differed statistically by the type of hukou, education level, smoking, drinking, health insurance prevalence, monthly household income per capita, chronic disease prevalence, and self-rated health status (P<0.05). The results of Logit regression model (one part of the ZINB) in fitting the data indicated that older age, high school education or above, having health insurance, suffering from a chronic disease and poor self-rated health were associated with increased probability of utilizing outpatient services (P<0.05). And the results of negative binomial count model in fitting the data indicated showed that the age of 70-74 years was associated with decreased probability of utilizing outpatient services, while an average distance of greater than 1 km but less than 10 km between home and medical institutions, and three types of self-rated health (good, poor and very poor) were associated with increased probability of utilizing outpatient services (P<0.05) .

Our study indicates that the use of outpatient services was insufficient in these older people, which was associated with predisposing, enabling and need factors. To improve this, it is suggested to rationally strengthen the provision of outpatient services to vulnerable groups with underuse of such services and individuals with needs of high-quality services. In addition, attention should be given to chronic disease management and self-rated health of the elderly to improve their awareness and level of health management.

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.

Gait speed and grip strength are simple markers of physical capability, which are associated with adverse outcomes in the elderly. However, there are few studies on the prediction of adverse outcomes in this population by the combination of the two markers.

To investigate the associations of gait speed and grip strength with adverse outcomes in geriatric inpatients.

A cohort design was used in this study. From August 2015 to December 2018, eligible geriatric inpatients aged≥65 years were recruited from Department of Geriatrics, Fuxing Hospital, Capital Medical University. We measured the gait speed and grip strength with 6-meter walking test and dynamometer, respectively. By the gait speed, the patients were divided into tertiles (T1 group: ≤ 0.6 m/s, T2 group: >0.6-0.8 m/s, T3 group: >0.8 m/s). By the grip strength, they were divided into L1, L2 and L3 tertiles (L1 group: ≤ 21.6 kg for males, ≤ 14.6 kg for females; L2 group: > 21.6 kg but ≤ 28.2 kg for males, >14.6 kg but ≤ 19.4 kg for females; L3 group: >28.2 kg for males, >19.4 kg for females). Follow-up was conducted by telephone once every three months within one year after discharge and once half a year after this until December 31, 2019. All-cause mortality and falls were recorded. Survival curves were constructed by the Kaplan-Meier method. Cox regression analysis was used to investigate the association of gait speed, grip strength, or their combination with all-cause mortality and falls. ROC curves for comparing the ability of the two makers or their combination on predicting all-cause mortality and falls.

Among the 685 patients, 29 (4.2%) were lost to follow-up, and the other 656 cases who finished the follow-up with complete data were included for analysis. During the follow-up period, 130 patients (19.8%) died from all causes and 147 patients (22.4%) experienced falls. There were 222, 225 and 209 patients in the low, moderate and high tertiles of gait speed (T1, T2 and T3 groups), and 215, 229 and 212 patients in the low, moderate and high tertiles of grip strength (L1, L2 and L3 groups), respectively. Log-rank test showed that the cumulative survival curves of all-cause mortality and falls differed significantly among T1, T2 and T3 groups (P<0.01). The same results were obtained in L1, L2 and L3 groups (P≤0.01). Cox regression analysis with adjustment for potential confounders showed that compared to patients in high tertiles of both gait speed and grip strength, the risk of all-cause mortality significantly increased in those both in low gait speed and low or moderate tertiles grip strength〔HR=3.29, 95%CI (1.13, 9.55) ; HR=3.09, 95%CI (1.08, 8.85) ; P<0.05〕, and the risk of fall significantly increased in those in low tertiles of both gait speed and grip strength 〔HR=1.92, 95%CI (1.13, 4.27), P<0.05〕. The prediction probability of the joint diagnostic model of gait speed and grip strength was estimated by Logistic regression analysis, and the AUC of the combination of them for predicting all-cause mortality and falls was 0.756 〔95%CI (0.710, 0.801) 〕, and 0.700〔95%CI (0.659, 0.741) 〕, respectively.

In geriatric inpatients, the combination of gait speed and grip strength had higher predictive value for all-cause mortality and falls, which is helpful to optimize the health management.

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.

There are few studies on the relationship between sleep time and falls at present, and the research results are inconsistent.

To explore the relationship between sleeping time and falls in middle-aged and elderly residents in China, and to provide reference for preventing falls in this population.

The study based on the data from China Health and Retirement Longitudinal Survey (CHARLS) data in 2015. 18 181 subjects aged ≥45 years with complete key data were included. Collect the indicators of the middle-aged and old people in the past two years, such as falls and medical treatment, sleep time, demographic characteristics, behavior and lifestyle, health status, self-life satisfaction and self-rated health. The subjects were divided into 5 groups according to the sleep time per night: <5 h (2 945 cases) , 5-<6 h (2 755 cases) , 6-<7 h (reference group, 3 824 cases) , 7 to <8 hours (3 257 cases) and ≥8 hours (5 400 cases) . Logistic regression model was used to adjust different variables to gradually evaluate the relationship between sleep time and the occurrence of falls and medical treatment for falls in the past two years.

The average sleeping time of middle-aged and elderly people was (6.4±1.9) hours, the incidence of falls in the past two years was 17.01% (3 092/18 181) , and the rate of medical treatment for falls was 6.95% (1 264/18 181) . The incidence of falls in subjects with sleep time <5 h, 5-<6 h, 6-<7 h, 7-<8 h and≥8 h were 25.26% (744/2 945) , 19.82% (546/2 755) , 15.51% (593/3 824) , 14.03% (457/3 257) , 13.93% (752/5 400) , the incidence of falling to hospital was 10.97% (323/2 945) , 8.09% (223/2 755) , 6.04% (231/3 824) , 5.43% (177/3 257) and 5.74% (310/5 400) , which were significant differences demonstrated by the trend chi-square test, and the difference was statistically significant (P<0.05) . Compared with 6-<7 hours after adjusting factors such as age, gender, those with sleeping time ≥8 hours had a significantly lower risk of falling〔OR (95%CI) =0.88 (0.78, 0.99) 〕, and those with sleeping time <5 h and 5-<6 h had a significantly higher risk of falling〔OR (95%CI) _{<5 h}=1.31 (1.16, 1.49) , OR (95%CI) _{5-<6 h}=1.14 (1.00, 1.30) 〕. The middle-aged and old people who slept less than 5 hours per night had a higher risk of falling and seeking medical treatment〔OR (95%CI) =1.30 (1.08, 1.56) 〕.

The incidence of falls in middle-aged and elderly people in China is relatively high, sleep time <6 hours per night will increase the risk of falls, and sleeping≥8 hours may reduce the risk of falls. Adjusting sleeping time of middle-aged and elderly people and strengthening lifestyle intervention can effectively reduce the incidence of falls in the middle-aged and elderly 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.