Digital inclusion of older people: harnessing digital technologies to promote healthy ageing in the Western Pacific Region

Adapting systems and technology for an aging population has benefits for older people,the consumer market industry itself and all of society.To promote knowledge sharing on innovations for healthy ageing and digital inclusion of older people in the Western Pacific Region,a hybrid conference on“Digital inclusion of older peo-ple:harnessing digital technologies to promote healthy ageing in the Western Pacific Region”was held on 23 June 2021 by China Academy of Information and Communications Technology,a WHO Collaborating Centre for Digital Health.Barriers from demand side include:(1)unaffordability;(2)poor Information and Communication technology(ICT)knowledge and skills for navigation;and(3)low self-efficacy and motivation.Supply barriers include:(1)youth-centred design;(2)ageism;and(3)anti-facilitative environment including infrastructure and age-biased technology.Existing practices to overcome digital inclusion barriers were shared:(1)landmark ini-tiatives related to the health and social welfare;(2)laws and policies to improve aged care services,strengthen social services,enrich spiritual and cultural life for older people;(3)ICT infrastructure and residential care facil-ities based on the philosophy of family care and supported by community care;(4)affordable digital application and adaptive feature design to better enable and motivate their desire to use digital technology;and(5)com-munity activities such as trainings and tutorials to enhance digital capacity and literacy of older people.Main principles highlighted include market motivation,human-centered design,creating enabling environments,and multi-stakeholder collaborations to provide guidance to customize strategy under context of different regions and countries,instead of a one-size-fits-all solution,to avoid the risk of exacerbating inequalities experienced by older people,caused by accelerated ICT innovation,and advocate for more affordable products in the silver market.

Factors associated with healthy ageing:a comparative study between China and the United States

This study compares the associators of healthy ageing in China and the United States,using the 2005-2014 Chinese Longitudinal Healthy Longevity Survey(CLHLS)and the 2004-2014 Health and Retirement Study(HRS).Health ageing is measured using an overall healthy ageing index(HAI),defined according to five dimensions:no major chronic diseases,free of physical functional impairment,free of cognitive impairment,no depressive symptoms,and socially active engagement.Multilevel logistic regression analysis is adopted to explore the association of demographic characteristics,socioeconomic status,and healthy lifestyles with the odds ratios of healthy ageing in China and the United States.Results indicate that the proportion of individuals experiencing healthy ageing is slightly higher in US than Chinese older adults aged 65-100(25.67%vs 23.27%).Nevertheless,Chinese oldest-old(80-100)have a higher proportion of healthy ageing than American oldest-old(15.05%vs.12.19%).Our results indicate that the odds of healthy ageing decrease with age,whereas they increase with education,income,marriage,and health behaviours.The odds of healthy ageing are lower for older Chinese women than men,whereas the odds are higher for older US women.Moreover,non-white elders in the United States have significantly lower odds of healthy ageing than their white counterparts.These findings suggest certain similar patterns of healthy ageing across two countries,but distinct patterns do exist.Promoting gender and racial equalities in healthy ageing are crucial for Chinese and American policymakers,respectively.

Strengthening Active Aging through Older People’s Association and Economic Activity of the Older People in Nepal

Aging is a natural lifelong process ending in death. Many older people are living in poverty. Older people are generally considered dependent on others as they grow older. The purpose of this article is to explore the entrepreneurship activities of Nepalese older adults. Data for this study were collected from the project Help Age International (HAI) implemented in Nepal. Qualitative data observations and interviews were used to collect data. The findings of this study show the formation of the Older People’s Association (OPA) has supported many older people to participate outside the home in various social activities. Moreover, regular deposits through OPAs offer little help. OPAs support older people in their need of financial support to implement minor entrepreneurship. Older people who received support were pleased and were actively involved in their activities and also regularly deposited money in them. Subsequently, older people’s participation in social activities has increased and also helped to lower elderly abuse, loneliness, and depression. Local governments should promote such activities which will help with healthy aging.

Unhealthy aging? Featuring older people in television food commercials in China

Objectives:Advertising messages can affect the public as a risk or protective factor for socially disadvantaged groups,and they may reflect how characters reflect perceptions are perceived in a society.This study aimed to investigate how older people are portrayed in televised food commercials from the approach of a healthy aging perspective in contemporary Chinese society.Methods:All televised advertising in the Ad Topic archive were screened against inclusion and exclusion criteria,and a total of 164 commercials from the years of 2016-2019 that portrayed Chinese older people were sampled.The association between the main older characters with the product categories,healthy vs.unhealthy foods,use of health claims,sex,type of spokesperson,companions,and tones and manners were included in the analysis.Results:Older people more frequently appeared in unhealthy food products than in healthy food products.Health claims involving older adults were portrayed adequately,whereas nursing professions as companions of older adults were overlooked.Positive advertising that delivered happy,caring,or warm tones was overwhelmingly represented.Thus,the advertising messages circulated in China represent a binary stereotype model of images of older adults'characteristics that reflect ageist and the so-called agelessism,referring to the new application of the look from the approach of social psychology and marketing field.Conclusions:This study examined aging discrimination reflected in advertisements.Studies exploring the impact of a crisis remain limited.Research is needed to improve the accuracy of advertised healthy older adults and normal aging.

Characteristics of Sleep and Autonomic Activity in Active Older Adults Based on Metabolic Age: A Comparative Case Study

Background: The balance of autonomic nervous system activity and its relationship with body composition, sleep quality, and activities of daily living among older people is still unclear. Purpose: This comparative case study examined the characteristics of body composition, sleep quality, and autonomic nerve activity in active older adults with a younger body age-calculated from age trends in body composition and basal metabolic rate. Methods: We selected two cases with a metabolic age younger than their actual age. They had good sleep quality, no sarcopenia, strong muscle and grip strength, and balanced autonomic nervous system activity. They were compared with two other age- and gender-matched cases, who had poor sleep quality, unbalanced autonomic nervous system activity, and had a physical age closer to their actual age. Results: Older adults with more muscle mass and higher basal metabolism were younger than their actual age, had a better sleep status, and had a good balance of autonomic nervous activity during exercise stimulation. They also had lower percentages of body and visceral fat and higher percentages of body water. Conclusion: Two cases had a metabolic age younger than their actual age were found to be much younger than their actual age. However, the older adults with normal muscle mass and basal metabolic rate had poor sleep status and no sympathetic hyperactivity during exercise simulation.

Structural brain volume differences between cognitively intact ApoE4 carriers and non-carriers across the lifespan

Apolipoprotein E4（ApoE4） is a prominent genetic risk factor for Alzheimer＇s disease. The purpose of this review is to explore differences in structural brain volume detected by magnetic resonance imaging between cognitively intact ApoE4 carriers and non-carriers across the lifespan（i.e., older adults, middle-aged adults, young adults, children and adolescents, and neonates）. Consistent findings are found throughout various developmental stages. This area of research may elucidate the mechanisms by which ApoE4 influences risk of developing Alzheimer＇s disease. It could also inform potential treatment strategies and interventions for carriers of the ApoE4 allele.

Revision and validation of the“Constitution in Chinese Medicine Questionnaire(Elderly Edition)”based on the Delphi process

Objective:This study aimed to revise the Constitution in Chinese Medicine Questionnaire(Elderly Edition)(CCMQ-EE),as well as evaluate its reliability and validity.The objective was to provide a more accurate Chinese medicine constitution identification tool for geriatric health management and help further research on the relationship between geriatric diseases and constitution type,etc.Methods:The Delphi method and a cross-sectional survey of the elderly population were used.From April to October 2021,experts in different fields were invited to participate in the questionnaire,and items were revised through the experts'ratings and feedback.From December 2021 to February 2022,the revised CCMQ-EE was validated in the elderly population.Results:The coefficients of variation of rationality and importance scores decreased to less than 0.25 in the third round of Delphi.The Kendall coordination coefficients of rationality and importance in the third round were 0.15 and 0.17(P=.031 and P=.007,respectively).The revised CCMQ-EE was established with 34 items.The factor loadings of subscales were between 0.39 and 0.92,and the fitting effects of other subscales were acceptable,except for the inherited special constitution.The Cronbach alpha and test-retest reliability coefficients of each subscale ranged from 0.65 to 0.83,and 0.66 to 0.96,respectively.The composite reliability and average variance extraction were between 0.66 and 0.84,and between 0.32 and 0.57,respectively.The reliability and validity of the revised CCMQ-EE were acceptable or satisfactory.Conclusion:The revised CCMQ-EE was developed through a three-round Delphi process and internal team discussion.After the verification in the elderly in Beijing area,its measurement performance was good.The updated questionnaire can probably replace the initial version to better promote health management and help healthy aging by identifying the constitution type of the elderly.

Mechanisms Underlying Brain Aging Under Normal and Pathological Conditions

Aging is a major risk factor for many human diseases,including cognitive impairment,which affects a large population of the elderly.In the past few decades,our understanding of the molecular and cellular mechanisms underlying the changes associated with aging and age-related diseases has expanded greatly,shedding light on the potential role of these changes in cognitive impairment.In this article,we review recent advances in understanding of the mechanisms underlying brain aging under normal and pathological conditions,compare their similarities and differences,discuss the causative and adaptive mechanisms of brain aging,and finally attempt to find some rules to guide us on how to promote healthy aging and prevent age-related diseases.

Chemistry-led investigations into the mode of action of NAMPT activators,resulting in the discovery of non-pyridyl class NAMPT activators

The cofactor nicotinamide adenine dinucleotide(NAD+)plays a key role in a wide range of physiological processes and maintaining or enhancing NAD+levels is an established approach to enhancing healthy aging.Recently,several classes of nicotinamide phosphoribosyl transferase(NAMPT)activators have been shown to increase NAD+levels in vitro and in vivo and to demonstrate beneficial effects in animal models.The best validated of these compounds are structurally related to known urea-type NAMPT inhibitors,however the basis for the switch from inhibitory activity to activation is not well understood.Here we report an evaluation of the structure activity relationships of NAMPT activators by designing,synthesising and testing compounds from other NAMPT ligand chemotypes and mimetics of putative phosphoribosylated adducts of known activators.The results of these studies led us to hypothesise that these activators act via a through-water interaction in the NAMPT active site,resulting in the design of the first known urea-class NAMPT activator that does not utilise a pyridine-like warhead,which shows similar or greater activity as a NAMPT activator in biochemical and cellular assays relative to known analogues.

Challenges in the provision of community aged care in China

Objective:Population ageing in China is a significant challenge for the Chinese government,the society and Chinese people.The dramatic process of population ageing together with social and economic diversity in China has created issues in the availability,equality and sustainability of social and financial support for older people.The aims of this review are to identify the social and economic challenges to the traditional caregiving system in China,and to examine possible solutions to improve the care of older people in China using the framework of ageing in place.Methods:Electronic literature searches were conducted in May and June 2013 using PubMed,CNKI,and MEDLINE.Statistical data and reports were retrieved from the United Nations,the World Health Organisation,the World Bank and National Bureau of Statistics of China.Government policy documents were found through government websites and formal publications.Results:Family-centred care for older people in China is recognised as a cultural tradition in the Chinese community.However,driven by large-scale social,political and economic changes,this model of caring for older people has dynamically changed over the last 50 years.Traditionally the family has been the most important source of social support for older people followed by neighbour support and support from friends.Today family obligations of caring are still centred in a cultural and practical context;however,support from family and children has weakened incrementally.Community-based aged services are absent in most areas,while older people and their families have to pay out-of-pocket expenses for non-residential services.There is a severe shortage of aged care or nursing home resources in China and those that exist are of low quality and expensive.The staff who work in these facilities rarely have any formal training in aged care.In addition,a market approach to the funding of residential aged care has the potential to create a moral hazard due to the poor regulatory control of aged care in China.While the building of residential aged care homes is seen as the solution to the care of older people in China,older people prefer to age in their own homes and expect the restoration of the family care tradition as well as more government support for them to“age in place”.This approach has the potential to be more cost effective than expensive aged care facilities.Conclusion:Given older people’s preferences,ageing in place,with the provision of community services and family support,potentially provides a fair and financially viable approach to promote healthy ageing and supportive care in China.Further studies are required to identify 1)how ageing in place can be supported by a national strategy,2)the financial arrangements required to fund such an approach,and 3)how to train high quality community-based professionals in both rural and urban areas to support the care of older people.

Mitochondrial complex Ⅰ as a therapeutic target for Alzheimer’s disease

Alzheimer’s disease(AD),the most prominent form of dementia in the elderly,has no cure.Strategies focused on the reduction of amyloid beta or hyperphosphorylated Tau protein have largely failed in clinical trials.Novel therapeutic targets and strategies are urgently needed.Emerging data suggest that in response to environmental stress,mitochondria initiate an integrated stress response(ISR)shown to be beneficial for healthy aging and neuroprotection.Here,we review data that implicate mitochondrial electron transport complexes involved in oxidative phosphorylation as a hub for small molecule-targeted therapeutics that could induce beneficial mitochondrial ISR.Specifically,partial inhibition of mitochondrial complex I has been exploited as a novel strategy for multiple human conditions,including AD,with several small molecules being tested in clinical trials.We discuss current understanding of the molecular mechanisms involved in this counterintuitive approach.Since this strategy has also been shown to enhance health and life span,the development of safe and efficacious complex Ⅰ inhibitors could promote healthy aging,delaying the onset of age-related neurodegenerative diseases.

城市住区环境如何影响老年人的情绪健康:基于感知调查视角

The daily emotional experience of the elderly is not only related to their mental health,but also influenced and restricted by the urban residential environment.Existing studies have discussed the correlation between residential environment and emotional health from the two perspectives of built and social environment,and a variety of theoretical explanations have been developed.However,it has no explicit and reliable empirical basis.In order to explore how residential environment influences the emotional health of the elderly,this paper conducts targeted empirical research on the issue.Based on the perception survey,the paper adopts the self-assessed health status,living conditions,and mobility capacity to reflect the emotional experience level of the elderly,and explores the statistical correlation between residential environment factors and the emotional health in combination with an analysis on built and social environment factors.It is found that the built and social environment factors have remarkable differences in their effects on the emotional health.In terms of the social environment,neighborhood involvement has wide positive effects on the self-assessment of all three aspects of health status,living conditions,and mobility capacity;while in terms of the built environment,the landscape of leisure places have positive effects on the self-assessment of both living conditions and mobility capacity.In the end,guided by the concept of active health,the paper puts forward the evidence-based planning strategy from the perspectives of leisure landscape,neighborhood involvement,and travel safety,with the hope to improve the residential environment of the elderly.

Nutritional and physical improvements in older adults through the DOREMI remote coaching approach:a real-world study

Background Malnutrition(excess or defect)and sedentariness act as an accelerator in the older people frailty process.A systemic solution has been developed to engage older people in a healthier lifestyle using serious games and food monitoring.The study aimed to evaluate protocol influence on variables related to unhealthy behaviors improving dietary habits through a remote nutritional coaching approach and stimulating the population to increase physical activity through Exergames.Methods Thirty-two subjects(25 Treatments and 7 Controls,aging 65-80 years),of which 15(11 Treatments and 4 Controls)living in the UK(ACCORD and ExtraCare Villages placed in Shenley Wood(Milton Keynes),St.Crispin(Northampton),and Showell Court(Wolverhampton))and 17(14 Treatments and 3 Controls)in Italy(Genoa,Liguria),were recruited and characterized in terms of nutritional status,physical,somatometric,hemodynamic and biochemical measurements,and body composition.Participants were stimulated to adopt the Mediterranean dietary pattern,by a food diary diet-app,and perform regular physical activity,by the Exergame app,for three months.At the end of the trial,users underwent the same test battery.Data were tested for normality of distribution by the Shapiro-Wilk test.Comparisons between groups were performed at baseline by unpaired Student’s t-test for continuous variables,chi-square test,or Fisher’s exact test for categorical variables.Analysis of Variance(ANOVA)for repeated measures was used to analyze the significance of changes over time between groups.Results At the end of the trial,significant reductions of systolic(15 mmHg,P=0.001),diastolic(5 mmHg,P=0.025),mean(10 mmHg,P=0.001)blood pressure,and rate-pressure product(RPP)(1,105 mmHg∗bpm,P=0.017)values were observed in DOREMI users.A trend of improvement of physical performance by the short physical performance battery(SPPB)was observed for balance and walk subtests.A significant decrease(0.91 kg,P=0.043)in Body Mass Index(BMI)was observed in overweight subjects(BMI>25 kg/m 2)after DOREMI intervention in the entire population.The Mini Nutritional Assessment(MNA)score(1,P=0.004)significantly increased after intervention,while waist measure(3 cm,P<0.001)significantly decreased in the DOREMI users.A reduction in glycated hemoglobin(Hb)was registered(0.20%,P=0.018)in the DOREMI UK users.Conclusions Improvement of healthy behavior by technological tools,providing feedback between user and remote coach and increasing user’s motivation,appears potentially effective.This information and communica-tion technologies(ICT)approach offers an innovative solution to stimulate healthy eating and lifestyle behaviors,supporting clinicians in patient management.

Reversal of age-associated frailty by controlled physical exercise:The pre-clinical and clinical evidences

Demographic aging is one of the most serious challenges facing our society.Although we live longer,we do not live better because it is considered that approximately 16–20%of our life is spent in late-life morbidity.Older people have the greatest risk of developing frailty increasing the risk of presenting various adverse health events such as low quality of life,disability,hospitalization and even death.Frail men and women over 65 years old have lower muscle quality and muscle mass and higher percentage of body fat than non-frail people of the same age.In this review we will address the main physiological changes in the muscular and nervous system associated to aging.More specifically we will review the changes in muscle mass,quality,and strength relating them with the decrease in capillarization and muscular oxidative capacity as well as with the alterations in protein synthesis in the muscle with aging.The last section of the manuscript will be devoted to the animal models of frailty and the indexes developed to measure frailty in these models.We will finally address the importance of exercise training as an intervention to delay or even reverse frailty.