Background and ObjectivesSocioeconomic positions (SEPs), operationalized by education, occupation, and income, are widely recognized determinants of cognitive function (CF). However, the effect of life-course SEP on cognitive aging remains inconclusive. This study investigated the impact of life-course SEP trajectories on later-life cognitive aging across SEP dimensions among Chinese adults born in the 1940s-70s who experienced distinct social mobility in the rapid social transformation.MethodsWe used data from the China Health and Retirement Longitudinal Study (2011-2020, 20 055 participants aged ≥45 years). Life-course SEP included early-life and adult education, occupation, and income. CF was measured as a composite cognitive score. Latent class analysis was conducted to identify heterogeneous SEP trajectory groups, and mixed-effects models were applied to estimate the impact of SEP trajectory on cognitive aging.ResultsAll life-course SEP indicators were positively associated with late-life CF, with adult SEP showing stronger impacts than childhood SEP. Upward mobility was notable in education (55.5%) and income (65.6%), whereas occupational transitions were relatively stable (68.0-71.3%). Participants with high early-life SEP and upward mobility had higher CF and slower decline than disadvantaged SEP trajectory groups, especially in women. Education and occupation trajectories had stronger impacts on cognitive aging than income trajectories.Discussion and ImplicationsLife-course SEP exerts protective effects on cognitive aging, with education and occupation showing stronger influences than income. Chinese women could gain greater cognitive benefits from SEP improvements than men. Optimizing lifelong SEP trajectories should be targeted as priorities to mitigate cognitive aging in developing countries.

Background and ObjectivesSarcopenia prevalence is higher in aged care facilities than in community settings, yet mechanistic pathways remain poorly understood. Although loneliness–sarcopenia associations are established, no studies have examined mediating mechanisms in institutional settings. We examined whether physical and mental fatigability mediate the loneliness–sarcopenia relationship in aged care residents.MethodsThis cross-sectional study included 205 older adults (Mage = 80.5 ± 8.1 years; 52.2% male) from 6 aged care facilities in Taipei. Sarcopenia was assessed using the Asian Working Group for Sarcopenia 2019 criteria. Loneliness was measured via the UCLA Loneliness Scale and perceived fatigability via the validated Traditional Chinese Pittsburgh Fatigability Scale. Causal mediation analysis examined direct and indirect pathways, adjusting for demographic, health, and psychosocial confounders.ResultsThe sarcopenia prevalence was 58.0%. Physical fatigability significantly mediated the loneliness–sarcopenia association (odds ratio = 1.0, 95% confidence interval: 1.0-1.1), accounting for 15.0% of the total effect. The strongest mediation was for physical performance (44.2%). Substantial interaction effects between loneliness and both physical (74.7%) and mental fatigability (80.5%) suggested synergistic influences on sarcopenia risk.Discussion and ImplicationsPhysical fatigability represents a novel, modifiable mediating pathway between loneliness and sarcopenia in aged care, with particularly strong effects on functional mobility. The substantial interaction effects support the use of combined interventions that address both psychosocial and physiological factors. Dual screening for loneliness and fatigability could identify high-risk residents, addressing the 15.0% mediation pathway. These findings inform integrated care approaches that could transform sarcopenia prevention in institutional settings. Replication in community-dwelling populations is warranted.

Life expectancy and healthy life years diverge considerably in Austria, and variation in quality of life (QoL) among older people cannot be fully explained by sociodemographic and health-related characteristics. We aimed to identify groups of older adults with underlying behavioral and attitudinal patterns and their associations with QoL. Latent class analysis was performed on cross-sectional data, including QoL (WHOQOL-BREF) from the 2019 Austrian Health Interview Survey (3,995 individuals aged 65+) to identify stable patterns of health behaviors associated with QoL. Variables included lifestyle factors and healthcare use. Class differences were assessed with logistic regression analyses. Four distinct health behavioral classes emerged. Compared with the classes "healthy-consistent-positive" (18%; healthy lifestyle, consistent preventive behavior, positive health system attitudes) and "healthy-inconsistent-positive" (25%; healthy lifestyle, inconsistent preventive behavior, lowest vaccination probabilities, positive health system attitudes), both the class with an unhealthy lifestyle, inconsistent preventive behavior and negative health system attitudes ("unhealthy-inconsistent-negative"; 17%) and the class representing a moderately healthy lifestyle with low physical activities, lower prevention but positive health system attitudes ("moderately healthy-moderately consistent-positive"; 41%) were associated with worse QoL in all domains. Classes also differed in sociodemographic characteristics and activity limitations. Most older Austrian adults were predicted to be in classes with suboptimal health behaviors associated with lower QoL. Interventions should reflect the specific characteristics of these disadvantaged groups. To reach the healthy-inconsistent-positive class, vaccination programs should target younger, healthy-living older adults.

Abstract Background and Objectives Korea is undergoing one of the fastest demographic transitions among OECD countries, with rural communities experiencing the sharpest consequences of aging and depopulation. In these areas, older adults face multiple disadvantages, including social isolation, limited income and education, and restricted access to health and welfare services. In response, national policies have promoted smart care technologies—sensors, monitoring devices, and AI-based services—as part of community-based integrated care. While these technologies are expected to reduce service gaps, less attention has been paid to how frontline providers understand what constitutes “good care” in this context. Research Design and Methods Our study examined the perspectives of village care managers, who coordinate health, welfare, and smart care resources in rural communities. 16 managers involved in a pilot smart integrated care project in Jeongeup, Jeonbuk-do, were interviewed through semi-structured, in-depth interviews. Results : Our findings suggest that good care cannot be solely achieved through technological monitoring or efficiency. It still requires relational qualities—sincerity, respect, and social connection—combined with professional competence and coordination across fragmented services. Participants highlighted that smart technologies may support safety and access but cannot substitute for human interaction, local collaboration, and skilled guidance in bridging digital divides. Discussion and Implications By foregrounding providers’ perspectives, this study adds to ongoing debates about the meaning of good care in digitally integrated rural care settings. Smart technologies can support safety and access, but their value depends on how they are embedded in practices of empathy, respect, professional guidance, and community collaboration.

Background and ObjectivesThere is a need to understand Black older adults’ perceptions and attitudes about commercial activity trackers to measure and monitor outcomes in clinical trials. We sought to identify the preferred activity tracker features of Black older adults living with memory challenges or dementia and their care partners.MethodsUtilizing a mixed-methods convergent parallel design, 9 participants were recruited from Eskenazi Health in Indianapolis, Indiana. Data were collected through 2 focus groups with participants (n = 3) and care partners (n = 4), and a group interview with 1 participant and 2 care partners. The focus groups were guided by semi-structured interviews, whereas participants interacted with 4 common consumer activity tracking devices (Fitbit Inspire 3, Apple Watch SE, Polar Watch, Oura Ring Heritage). Audio recordings were analyzed using the Rapid Identification of Themes from Audio Recordings method. Participants ranked each device based on comfort, convenience, and features (eg, tracked outcomes of activity, distance/GPS, and respiratory rate). Device rankings were summarized with descriptive statistics.ResultsParticipants with memory challenges rated Apple Watch SE highest, with mean scores in comfort (4.3), convenience (3.3), and features (4.3). Care partners rated Fitbit Inspire 3 highest in comfort and Apple Watch SE for convenience and features. Qualitative findings highlighted physical attributes and comfort (large screen size), convenience (viewing progress), and features (having an emergency button and GPS).Discussion and ImplicationsFindings can guide the selection of activity trackers in future research for this population and may increase wear time and adherence in clinical trials.

Approaches to caregiving interventions are often "one-size-fits-all," yet family caregivers for individuals with dementia have unique caregiving styles with which they enact daily care. This study describes the development of CG-STYLE, the first person-centered assessment of caregiving style. Development phases of this measure included mixed-methods exploratory research, iterative item development and refinement, cognitive interviews, expert review, literacy and translatability review, and field testing of the items in 209 family/friend caregivers for an individual with dementia. Item response theory and classical test theory analyses were run. Confirmatory factor analysis affirms the unidimensionality of 7 item banks of the measure: orientation toward the care partner, adaptability, understanding of dementia, emotional expression (positive, negative), and behavioral management (adaptive, maladaptive). A person-centered assessment measure can help tailor services and interventions to best fit unique styles of care, ultimately improving the well-being of the caregiver and the quality of care for the individual with dementia.

To better inform service provision and social services, Australia has long needed a comprehensive national ageing study that is comparable with international ageing studies and eligible to join the register of harmonized cross-national studies of ageing. We conducted a pilot study to fill this gap in Australia's social and health data collection on ageing. We utilized online computer-assisted web interviewing (CAWI) and a follow-up Telephone Interview for Cognitive Status (TICS) screening. Participants were drawn from a Roy Morgan Consumer Panel using random probability sampling. Data collected were compared with the national Census data. Among 1172 online CAWI survey participants (mean age: 65.8 years; 51.0% female), 46.8% had a chronic health condition or disability, 26.1% were full-time employed, and 46.8% were fully or partially retired. Compared with 2021 Australian Census data, the sample was broadly representative by age, sex, geographic region, and health, but respondents tended to have higher education levels (66% reported completing secondary schooling vs 42% in the Census) and underrepresented culturally and linguistically diverse backgrounds (21% born overseas vs 39%; 4% speak a language other than English at home vs 23%); 804 respondents completed TICS (mean[SD] = 33.6[2.8]; range: 22-41), with 71.4% classified as cognitively normal, 27.7% ambiguous, and 1.1% cognitively impaired. This pilot demonstrated the feasibility of online and telephone-based data collection with cognitive screening to capture demographic and health profiles of older Australians, providing a strong foundation for future large-scale national ageing studies.

Civil money penalties (CMPs) are an important tool for holding nursing homes accountable for regulatory noncompliance. These fines can range from a few thousand to hundreds of thousands of dollars. Meanwhile, many nursing homes operate under financial strain, which has been linked to compromised quality of care. This study assesses the impact of CMPs on 2 indicators of financial performance: net income margin and short-term debt. These indicators were regressed on penalty size using a 2-way fixed effects model, encompassing 87,249 facility-year observations from U.S. nursing homes from 2012 to 2019. The dollar amount of penalties was expressed in equivalent days of operating expenses to account for variation in facility sizes, and the analysis controlled for the nursing home characteristics and market conditions. A negative relationship was found between the size of penalties and net income margin. Penalties equivalent to less than 1 day of expenses were associated with a 0.86 percentage-point decrease in net-income margin; 1-day penalties with a 1.48-point decline; 2-day penalties with a 2.49-point reduction; and those equivalent to 3+ days corresponded to a 3.56-point decline. Effects on short-term debt were minimal, with only modest increases seen. These findings raise a concern for regulators that CMPs, if not carefully calibrated, have the potential to cross the boundary from deterring violations to jeopardizing the financial stability of nursing homes. If a facility struggles to absorb the cost, a CMP could inadvertently affect the care provided to residents.

Extreme outdoor temperatures are known barriers to physical activity and may constrain life-space mobility, the geographic footprint of where people live, work, and recreate, and an important indicator of health and independence among older adults. We conducted a pilot study to evaluate the feasibility of a mobile health (mHealth) app designed to objectively capture life-space and to demonstrate its utility through a downstream analysis of ambient temperature and life-space mobility. Using data collected via an iPhone app from 82 participants in an ongoing cohort study (June 2023-January 2024), we used linear mixed-effects models to examine associations between daily average temperature and 3 objective life-space measures: ellipse area, maximum distance traveled, and total distance traveled. Models were stratified by season and adjusted for relative humidity and sociodemographic covariates. The app successfully captured high-resolution longitudinal mobility data over 2 weeks per participant. There was a significant negative nonlinear association between higher daily average temperature and life-space in the summer. With the peak life-space ellipse area observed at 28.8 °C, for every degree Celsius greater than 28.8 °C, we found a statistically significant decrease in ellipse area by 2.97 km2 (95% CI: -5.45, -0.51; p = .02). Findings were similar for the outcomes of maximum and total distances traveled. This study demonstrates that mHealth technology is a feasible tool for assessing life-space mobility in older adults. Higher temperatures are associated with lower life-space metrics, highlighting the potential of app-derived metrics as digital biomarkers for mobility research.

Financial capability, the interaction of financial literacy, access, and behavior, can influence individuals' ability to manage finances and build economic stability over the life course. However, empirical evidence linking financial capability and economic well-being in old age is limited. We examine the components and mechanisms of the financial capability framework and investigate the differences between middle-aged (aged 50-64) and older adults (aged 65+) using population-based data in the United States. The respondents, 12,840 individuals aged 50 and over, were selected from the population-based 2018 National Financial Capability Study. Structural equation modeling and multigroup analyses were used to examine the mechanisms of financial capability on economic well-being and the moderating effects of age. Financial literacy and access are positively associated with financial behavior and subsequent economic well-being. The mediation results show that financial literacy and access are equally important in contributing to economic well-being in later life. However, age has no moderating effect, suggesting these associations operate similarly in middle-aged and older adults. Strategies to promote economic well-being in later life through effective finance should be multifaceted, targeting each aspect of financial capability. Financial practices such as financial coaching and guidance, credit counseling, and financial assessments should be integrated into social services. Policy innovations that expand financial inclusion, particularly investments in accessible and appropriate financial products, should be developed to reach and cover the financially underserved, especially those with limited financial literacy and restricted access to mainstream financial services.