Unsupervised statistical concept drift detection for behaviour abnormality detection

As the population ages, understanding the association between sleep patterns and physical frailty in older adults is crucial for formulating effective health interventions. This study aimed to explore the relationship among nap time, nighttime sleep duration, and physical frailty in older Chinese individuals; establish recommended sleep times; and provide a scientific and reasonable basis for the prevention and management of frailty in older adults. On the basis of the 2020 China Health and Retirement Longitudinal Study database, demographic information, health data, and lifestyle information of the research subjects were obtained. A total of 5,761 survey participants were included, and logistic regression and restricted cubic splines were used to explore the association between sleep duration and frailty. In our cross-sectional analysis, the duration of napping in older adults did not show a significant correlation with frailty. The optimal nighttime sleep interval for older adults was 7-8 h, and the maximum health benefit was achieved when nighttime sleep reached 7.5 h. Compared with older adults in China who slept 6-8 h at night, those with a sleep duration of <6 h (OR = 1.58, 95% CI: 1.36-1.82) were more likely to be frail. After adjusting for all covariates such as smoking, multimorbidity, self-rated health, social events, education level, and frequency of physical activity, we found no interaction between gender and age concerning sleep duration. The potential correlation between nighttime sleep duration and frailty in older adults is basically U-shaped. Older Chinese adults with a moderate nighttime sleep duration of 7-8 h exhibited the lowest likelihood of frailty than their counterparts. The duration of napping is not related to the likelihood of frailty in older people. Thus, the importance of sufficient nighttime sleep for the health of older adults must be emphasized.

Hypertension is highly prevalent in the elderly and represents a major risk factor for cardiovascular complications such as coronary heart disease, stroke, and cognitive dysfunction. Frailty is a common geriatric syndrome characterized by increased risk of disability, hospitalization, and mortality. However, little is known about the frailty status in older adults with hypertension. Thus, we aimed to explore the epidemiological characteristics and related factors of frailty in older Chinese adults with hypertension. The current study included data collected from participants in the China Comprehensive Geriatric Assessment Study. Frailty was defined using the frailty index. Hypertension was defined as SBP at least 140 mmHg, DBP at least 90 mmHg, current treatment with antihypertensive medication, or a self-reported diagnosis of hypertension. Frailty index was positively correlated with age. The prevalence of frailty was significantly higher in hypertensive patients than in normal controls. The prevalence of frailty in older adults with hypertension was 13.8% in China. The awareness and treatment of hypertension was higher in frail individuals than in nonfrail individuals. The control rate of hypertension did not differ significantly between the two groups. Logistic analysis showed that older age, poor marital status, coronary heart disease, chronic obstructive pulmonary disease, cerebrovascular disease, diabetic mellitus, osteoporosis, hearing loss, lack of exercise, depression, cognitive impairment, and higher white blood cell count were factors independently related with frailty in older participants with hypertension. The current study provides the first evidence regarding the status of frailty in older Chinese adults with hypertension.

Exercise Testing and Training Strategies for Healthy and Frail Elderly

Anomaly detection in streaming data is an important task for many real-world applications, such as network security, fraud detection, and system monitoring. However, streaming data often exhibit concept drift, which means that the data distribution changes over time. This poses a significant challenge for many anomaly detection algorithms, as they need to adapt to the evolving data to maintain high detection accuracy. Existing streaming anomaly detection algorithms lack a unified evaluation framework that validly assesses their performance and robustness under different types of concept drifts and anomalies. In this paper, we conduct a systematic technical review of the state-of-the-art methods for anomaly detection in streaming data. We propose a new data generator, called SCAR (Streaming data generator with Customizable Anomalies and concept dRifts), that can synthesize streaming data based on synthetic and real-world datasets from different domains. Furthermore, we adapt four static anomaly detection models to the streaming setting using a generic reconstruction strategy as baselines, and then compare them systematically with 9 existing streaming anomaly detection algorithms on 76 synthesized datasets that have various types of anomalies and concept drifts. The challenges and future research directions for anomaly detection in streaming data are also presented.

The book Clinical Management of the Elderly Patient in Pain is an out of the ordinary read. It is edited by Dr Gary McCleane and Dr Howard Smith, both practicing pain clinicians who also contributed a number of the chapters. Other contributing authors are from the United States, United Kingdom and Canada, and represent a variety of fields including anesthesia, geriatrics, psychiatry and physiatry. The book has three introductory chapters on older adult demographics and pain, aging and pain, and pharmacological changes in elders. The main section of the book consists of 12 chapters on different classes of analgesics administered through a variety of routes and preparations, followed by chapters on physical therapy, psychosocial issues and uses of psychotropics. The book finishes with a chapter listing suggested medications for common painful conditions in older adults. There is an appendix of drug interactions as well as a glossary and index. The preface notes that this is not a typical book on pain management and states that it will consider “treatment that may be conventional, but also that which may appear more contentious”. The preface notes how it can be difficult to balance pain relief with side effects and advocates “considering the patient as a whole”. To the editors, this means considering not only treating the pain but also the harms that can come from analgesic side effects, polypharmacy and drug interactions. The audience of the book is the generalist “busy clinician” faced with “all the problems of satisfactorily managing pain in the elderly”. Each chapter has something for those interested in novel therapies for chronic pain. For example, I learned that menthol has analgesic properties mediated through the delta opioid receptor. I also learned about novel uses of topical nitrates for chronic pain. There are detailed descriptions of the evidence behind topical therapies, which in reducing systemic side effects, are certainly of benefit in older adults. The material is presented with enough prescribing information and supporting evidence to make one comfortable with trying these medications on patients. The editors remain true to the preface in considering the effects of the analgesics and their side effects but this information is not organized in any consistent fashion throughout the book. As indicated in the preface, only a short part of the book is dedicated to discussion of opioids. Some statements in the relevant chapter do stand out and merit mention. There is a statement that the development of analgesic tolerance is quite common in opioids but there is no evidence provided, contrary to most of the book. However, there is evidence that opioid tolerance is quite low (1). As well, a study is quoted as noting the increased risk of nonspine fractures in older women taking opioids (2). This same study shows an even higher risk of nonspine fractures for older women taking antidepressants, a drug class that is recommended throughout the book. The chapter author does say that his overall opinion – that opioids should used only in a limited fashion in chronic pain in elders – is based on his past experience. The evidence for the use of opioids is increasing (3,4); with systematic reviews showing a number needed to treat of 2.5 (5) and studies showing sustained improvement and no significant increase in adverse effects even in frail older adults (6). Increasingly, it is becoming apparent that there may be better opioid choices in frail elders and in renal failure (7,8). One of the best chapters is on psychosocial issues and provides useful and practical help to clinicians. The chapter on use of psychotropics also provides practical information as well as the principle of treating both the symptom and the person. There are other titles of related interest in the Haworth Series on Clinical Pain and Symptom Palliation that likely go into much greater detail on psychological and spiritual issues and nonpharmacological management of pain that would likely provide much greater depth in these areas. One of the major challenges in managing pain in older adults is the issue of pain management in those with cognitive impairment. Unfortunately, the only significant mention of cognitive impairment is with respect to side effects from medication as opposed to the difficulties of assessing and titrating analgesics in those with severe dementia who cannot contribute any meaningful history. The demographics of older adults, their need for improved pain management and the pharmacokinetic alterations in this population are key points that everyone needs to understand to manage pain in this population. However, these points are repeated in a number of chapters as if these were all written separately and not edited as a whole. The writing style is variable and at times faulty, which can distract from the useful content. A more detailed index would help clinicians to retrieve useful medication suggestions during a busy office. The preface noted that this book is intended to act as an interface between the specialist pain practitioner and busy generalist clinician trying to manage older adults in pain. However, many generalist clinicians are still needing to build the basic principles of pain management into their practice and need simpler, more directive tips about pain assessment and reevaluation, diagnosis, and considerations around treatment of underlying pathology to manage an older adult in pain. Clinical Management of the Elderly Patient in Pain is a detailed resource for those who are interested in the evidence that supports the use of new and emerging medications and routes of administration. I believe this book would be of interest to the generalist physician who has a special interest and experience in pain management and is able to read the whole text and bookmark the excellent suggestions for therapies that might be better tolerated in older adults.

BackgroundFrailty is a multi-faceted, aging-related syndrome characterized by reduced physiologic reserve and increased vulnerability to adverse health outcomes. Frailty is dynamic and can improve or worsen over time. Cancer and diabetes are prevalent comorbid conditions in older adults that are independently associated with frailty. Little is known about how the co-occurrence of cancer and diabetes affects frailty in older adults. We investigated how co-occurring cancer and diabetes influence long-term frailty state transitions in older adults.MethodsWe conducted a longitudinal study using Rounds 1–9 of the National Health and Aging Trends Study (2011–2019), a nationally-representative prospective cohort of Medicare beneficiaries (65 + years). We described nine-year transitions across frailty phenotype states (robust, prefrail, frail) and death using a multi-state model, stratifying by cancer and diabetes history in Round 1: neither condition (N = 4,216), cancer only (N = 972), diabetes only (N = 1,434), and both conditions (N = 331). We compared the nine-year incidence of frailty across subgroups using Aalen-Johansen estimators, adjusting for age, race, and gender.ResultsOlder adults without a history of cancer or diabetes had the lowest nine-year mortality (57.5%) compared to those with cancer only (64.4%), diabetes only (65.1%), or both conditions (64.9%). The prevalence of frailty among those alive across time periods was highest in older adults with cancer and diabetes (Round 1 [R1]: 24.7%, R9: 22.3%) and those with diabetes only (R1: 24.0%, R9: 22.4%). The prevalence of frailty was lower in participants with cancer only (R1: 18.0%, R9: 16.3%) and those with neither condition (R1: 13.1%, R9: 15.1%). Among participants who were robust or prefrail at baseline, the nine-year cumulative incidence of frailty was higher among those with diabetes only (52.8%) or diabetes and cancer (54.6%) compared to those with cancer only (41.4%) or neither condition (47.3%).ConclusionsDiabetes and cancer were both associated with an increased frailty prevalence; however, only older adults with diabetes or cooccurring diabetes and cancer had an increased 9-year incidence of frailty relative to older adults without a history of either condition. Future research should explore the underlying mechanisms driving frailty state transitions among chronic disease populations and evaluate targeted interventions to mitigate frailty progression.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-025-06309-6.

With the increase in the percentage of the population in older adulthood, issues such as frailty syndrome need to be considered. The aim of the present study was to evaluate the ability of the Balance Evaluation Systems Test (BESTest) and center of pressure (COP) in their ability to discriminate between nonfrail, prefrail, and frail older adults. The proposed hypothesis is that frail older adults would show poorer performance in BESTest tasks and higher oscillation of COP on a force platform. Sixty older adults 65 years or older were divided into 3 groups of 20: group 1, nonfrail; group 2, prefrail; and group 3, frail. The prefrail and frail identifications were made by Fried's 5 frailty phenotype criteria. Balance was assessed using the BESTest and a force platform in 6 positions: (1) fixed platform with eyes open; (2) fixed platform with eyes closed; (3) unstable platform with foam, with eyes open; (4) unstable platform, with eyes closed; (5) semitandem with eyes open; and (6) semitandem with eyes closed. Frail older adults had lower scores in all sections and in the total score of the BESTest, indicating worse performance in the tasks. However, on the force platform, the frail older adults did not show higher oscillations, having similar mean values when compared with the prefrail and nonfrail older adults, indicating similar behavior of COP. The BESTest seems to be more appropriate than a force plate for assessing postural control impairment and discriminating balance performance among frail, prefrail, and nonfrail older adults, providing information about different components of postural control rather than the force plate, which evaluates sensory orientation.

The potential for developing frailty exists in middle-aged and older adults. While obesity and metabolic syndrome (MetS) increase the risk of frailty in older adults, this relationship remains unclear in middle-aged adults, who are prone to developing lifestyle-related diseases. To examine the effect of overweight/obesity and MetS on frailty development in middle-aged and older Japanese adults using real-world data. This nationwide cohort study used exhaustive health insurance claims data of 3,958,708 Japanese people from 2015 to 2019 provided by the Japan Health Insurance Association. Participants aged ≥35 and<70years who received health checkups in 2015 were included. Multivariate logistic regression was used to assess the effect of body mass index (BMI) and MetS or MetS components (i.e., diabetes, hypertension, and dyslipidemia) in 2015 on frailty risk assessed using the hospital frailty risk score in 2019. Additionally, a subgroup analysis was performed to examine the interaction effects of MetS components and 4-year weight change (%) on frailty risk among participants who were overweight and obese (BMI ≥25kg/m2). In 2019, 7204 (0.2%) and 253,671 (6.4%) participants were at high and intermediate frailty risks, respectively. Obesity and MetS were independently associated with intermediate/high frailty risk (odds ratio (OR) 1.36, p<0.05; OR 1.23, p<0.05, respectively) and high frailty risk (OR 1.80, p<0.05; OR 1.37, p<0.05, respectively) in all participants. Although all MetS components were frailty risk factors, these effects diminished with age in both sexes. Subgroup analysis of patients with diabetes revealed that 5%-10% weight loss was associated with reduced frailty risk in both sexes. Obesity, MetS, and MetS components were independent frailty risk factors in middle-aged and older Japanese adults. Weight loss of up to 10% over 4years prevented frailty in patients with diabetes who were overweight and obese.

Hypertension is an important factor affecting the health of older adults. Antihypertensives can reduce stroke, cardiovascular events, and mortality in older hypertensive patients. Blood pressure management is difficult in older adults since geriatric syndromes such as frailty and comorbidities often coexist with hypertension. Recent guidelines propose taking functional status into account when targeting blood pressure in older people. Therefore, a better understanding and control of frailty risk factors could improve the prognosis of older adults with hypertension. However, there are relatively few studies on hypertension and frailty in older adults, especially studies focused on antihypertensive treatment. The goals, target values, and choice of antihypertensive treatment for frail older adults are still disputed. We reviewed the recent literature focusing on frailty and hypertension in older adults and propose a management process for screening and assessing frailty and hypertension before the use of antihypertensives. The process can support older adults with lifestyle interventions and frailty management and help them begin taking a single antihypertensive medication.

Pre-frailty and frailty are dynamic and potentially reversible conditions in older adults, associated with increased risks of disability, hospitalization, and mortality. Evidence supports movement-based interventions as effective strategies to prevent and mitigate these outcomes. This mini narrative review synthesizes recent scientific evidence on movement-based interventions for pre-frail and frail older adults, with emphasis on clinical outcomes, barriers to implementation, and digital innovations. A structured and iterative search was conducted using the AI-based Consensus platform, which integrates major biomedical databases. From 1,049 identified records, 281 were screened, 205 assessed in full text, and 36 studies (systematic reviews, meta-analyses, and randomized controlled trials published between 2019 and 2025) met the inclusion criteria. Eligible studies evaluated movement-based interventions reporting outcomes such as strength, mobility, cognition, mood, or quality of life. Multicomponent, resistance, and mind-body exercises consistently improved muscle strength, balance, mobility, executive function, and psychological well-being. Digital strategies, including exergames and mobile applications, showed comparable effectiveness to traditional programs and enhanced accessibility. However, implementation remains constrained by adherence challenges, infrastructural and professional limitations, and the digital divide. Research gaps persist in institutionalized populations, long-term follow-up, and standardized protocols. Movement-based interventions are safe, clinically effective, and scalable strategies to promote healthy aging in frail populations. To maximize their real-world impact, future research should prioritize standardized protocols, pragmatic long-term trials, inclusive recruitment, and equity-focused digital strategies aligned with global healthy aging policies.

Frailty is a multidimensional state related to multidomain risk factors, including demographic, physical, and psychological variables. The risk factors affecting frailty in postoperative older patients and the interactions between these factors remain unclear. Network analysis provides a novel method for conceptualizing interconnections among complex multidimensional data. This study aimed to explore the relationships between demographic, physical, psychological, surgery-related factors and frailty in postoperative older adults. The Early-Warning model of Perioperative Adverse Events for older adults (EPAE) is an prospective, multicenter, observational study. Participants were assessed for demographic variables, clinical and physical variables, psychological and cognitive variables, surgery-related variables, and frailty assessment during the period of hospitalization. A perioperative network was constructed to identify key risk factors associated with postoperative frailty and specific paths within the network. 2678 older adults were enrolled in the study. Postoperative frailty in older adults was strongly associated with postoperative activities of daily living (ADL) (average edge Weight=-0.26), Morse Fall Scale (MFS)(average edge Weight = 0.19), Hemoglobin(Hb) (average edge Weight=-0.16), Patient Health Questionnaire-9(PHQ-9)(average edge Weight = 0.14), and Mini-Cog(average edge Weight=-0.1). PHQ-9 played mediating roles between Feeling nauseated, Emesis, physical Exam, and Duration of symptoms score (I-FEED) and frailty, Athens Insomnia Scale(AIS) and frailty. Postoperative frailty, Social supporting rating scale(SSRS), PHQ-9, and Mini-Cog were the strongest bridge symptoms in the network. Postoperative frailty was the most prominent bridge symptom in the perioperative network, which was strongly associated with postoperative physical(ADL, Hb, MFS) and psychological factors(PHQ-9 and Mini-Cog). Depression may mediate the associations between postoperative clinical symptoms(gastrointestinal dysfunction and insomnia) and postoperative frailty. Our findings support a clarion call for dynamic assessments for postoperative frailty, and intervention programs targeting specific frailty-related factors, especially depression, to prevent or reverse frailty for older adults after surgery. This study was registered in the Chinese Clinical Registry Center (registration no. ChiCTR2300071535). Date: 17-5-2023.

The current systematic review compared whether combined exercise and nutrition interventions are effective in preventing or improving sarcopenia in frail older adults and healthy older adults. Medline, Embase, Cochrane Library, and CINAHL were searched for randomized controlled trials. Of the 1,596 citations, 22 trials (N = 1,767) were included in the final sample. In frail older adults, significant improvement after combined exercise and nutrition interventions was observed in seven indicators: skeletal muscle index, 0.16 kg/m2; handgrip, 1.41 kg; knee extension strength, 0.24 Nm; five-repetition chair-stand test, -1.89 sec; gait speed, 0.06 m/s; Short Physical Performance Battery, 0.43; and Timed Up and Go test, -0.56 sec. In healthy older adults, two indicators improved and showed statistically significant differences: handgrip, 2.15 kg; and 6-Minute Walking Test, 9.71 m. Combined exercise and nutritional interventions can improve skeletal muscle quality, strength, and physical performance in frail and healthy older adults. [Research in Gerontological Nursing, 16(6), 312-320.].

Background: Falls are a major cause of disability in India’s ageing population. The World Health Organization emphasizes maintaining intrinsic capacity (IC) and preventing frailty in older adults. However, urban–rural differences in these associations remain underexplored. This study examined the relationships among IC, frailty, and fall risk in older Indian adults, including urban–rural differences. Methods: We performed a cross-sectional analysis using Wave 1 (2017–2018) data from the Longitudinal Ageing Study in India (LASI), including 31,902 individuals aged ≥60 years. IC was measured using a composite score (0–10) across five WHO-ICOPE domains, and frailty was assessed using the Fried phenotype. Multivariable logistic regression accounts for complex survey design and covariates, estimated adjusted odds ratios (aORs) for falls, high IC, and frailty. Results: Fall prevalence was higher in rural areas (12.5%) than in urban areas (9.5%; p&lt;0.001). Urban residence was associated with lower odds of falling (aOR 0.73; 95% CI 0.67–0.80) and higher odds of high IC (aOR 1.91; 95% CI 1.78–2.05). High IC was associated with lower odds of falling (aOR 0.80; 95% CI 0.67–0.96), while frailty increased fall risk (aOR 1.24; 95% CI 1.10–1.40). Depression and multimorbidity, which refers to the presence of multiple chronic health conditions, were associated with lower independence in daily activities (IC) and higher frailty. Conclusions: IC and frailty contribute to fall risk among older adults in India, with urban–rural differences suggesting an important role for environmental context.

Introduction: Chronic undernutrition and a homebound state are corelated and are both important components of frailty. However, whether social network intervention combined with protein supplementation is an effective strategy to prevent functional decline among frail older adults is unclear. Methods: 150 frail older adults participated in a 3-month, 3-armed, community-based clinical trial and were randomly assigned to one of 3 groups: high-protein supplementation (additional 27 g of protein/day), the Social Nutrition Program (additional 27 g of protein/day and social network intervention), or a control group. Those assigned to the Social Nutrition Program group received individual counseling from 1 dietitian and 1 social worker during 6 home visits and were encouraged to participate in 4 sessions of community-based cooking activities, the social kitchen program. Primary outcomes were changes in Physical Functioning (PF) and the Timed Up and Go (TUG) test and were assessed at 0 months (baseline), 1.5 months (interim), and 3, 6, and 9 months (postintervention). Results: Compared with the control group, participants in the Social Nutrition Program showed an average improvement of 2.2–3.0 s in the TUG test and this improvement persisted for 3 months after the end of the program (post hoc p ≤ 0.030). The Social Nutrition Program also increased PF by 1.3 points while the control group showed a 1.4 point reduction at the end of the program (post hoc p = 0.045). Improvement in PF and TUG results was primarily observed for the socially frail subgroup of older adults in the Social Nutrition Program group rather than the physically frail subgroup. Frequency of leaving home functioned as a mediator (p = 0.042) and explained 31.2% of the total effect of the Social Nutrition Program on PF change. Conclusion: Our results indicate that social network intervention combined with protein supplementation can improve both the magnitude and duration of functional status among frail older community-dwelling adults.

In evolving data stream, when its concept undergoes a change it is known as concept drift. Detecting concept drift and handling it is a challenging task in data stream mining. If an algorithm is not adapted to concept drift, then it directly affects its performance. A number of algorithms have been developed to handle concept drift, but they are not suited for both sudden concept drift and gradual concept drift. Thus, there is a demand for an algorithm that can react to both the types of concept drift as well as incur less computational cost. A new approach hybrid early drift detection method (HEDDM) has been proposed for drift detection, which works with an ensemble method to improve the performance.