Current Aging Science - Volume 16, Issue 2, 2023

In 2016, a mini-issue of Current Aging Science (CAS) entitled “Effects of Aging on Circadian and Sleep Timing” has been published to report the state of the art in the studies of the effects of aging on the circadian and sleep regulating processes. The emphasis has been given to the regulatory processes involved in age-specific problems with sleep timing, continuity, and duration. Such problems can serve as targets for novel treatments for geriatric and sleep disorders. In the following 6 years, some new findings provided further insight into the previously recognized age-specific problems and highlighted new questions of research on the relation of aging to the regulatory mechanisms underlying circadian rhythmicity, sleep, and sleepiness. The theoretic framework of one of the directions of this research regards the interaction between the competing drives for sleep and wake as one of the basic features of regulatory processes underlying circadian rhythms, including such rhythms as the sleep-wake cycle and the diurnal variation in alertnesssleepiness levels. Here, earlier and more recently highlighted questions of the research in this framework were briefly reviewed.

The human lifespan is increasing, and mankind is aging. It is estimated that, until the year 2050, this population worldwide will reach 22% of the total world population. Along with aging, the human immunologic system changes, a process called immunosenescence or even inflammaging. The aging immune system increases mortality and morbidity in the elderly mainly because it loses its capacity to react against internal and external aggressions. There is a decrease in B and T lymphocytes and CD4+ lymphocytes lose the CD28 protein expression that is needed for costimulation, leading to reduced response to viral infections. This could be responsible for more deleterious consequences of coronavirus disease infection in the elderly. Besides that, the human brain ages, being more susceptible to damage and viral infections, such as COVID-19 infection. There are several pathways that could explain the susceptibility to the COVID-19 infection in the elderly brain, one of them is binding to ACE 2 receptors in cerebral cells through the spike protein. It has been reported that glial cells and neurons, in addition to endothelial and arterial smooth muscle cells in the brain, express the ACE 2 receptor, which would justify the neurological symptoms and consequences of the disease. This infection can have several clinical manifestations such as hemorrhagic stroke, delirium and long-term cognitive complaints, such as brain fog, polyneuropathies, short time memory complaints and insomnia. Although none of the studies could prove that there is a long-term neuronal damage, there are clinical sequelae that should be taken into account and more studies are necessary to know the consequences of the infection in the elderly brain.

Aging is characterized by progressive regression in tissue and organ functions and an increased risk of disease and death. Aging is also accompanied by chronic low-grade inflammation. Both obesity and aging are associated with the development of metabolic diseases, leading to an increase in the senescent cell burden in multiple organs. Chronic low-grade inflammation of adipose tissue is one of the mechanisms implicated in the progression of these diseases. As a real endocrine organ, adipose tissue secretes many mediators and hormones (adipokines) to maintain metabolic homeostasis, and their dysfunction has been causally linked to a wide range of metabolic diseases. Dysfunctional adipose tissue participates in interorgan communication both by producing new signaling mediators and by transforming or disrupting signal mediators, reaching from other organs. In addition to obesity and similar metabolic diseases, this situation causes dysfunction in more organs in the aging process, and the complexity of the problem causes challenges in the diagnosis and treatment processes. This review aims to highlight recent developments and current information supporting the relationship between obesity and adipose tissue dysfunction with aging and the role of homeostatic and physio-pathological processes that mediate interorgan communication in aging progress. More understanding clearly of interorgan communication in the process of obesity and aging will facilitate the early diagnosis as well as the management of treatment practices in short- and long-term organ dysfunction.

Background: Dementia is a neurocognitive disorder associated with the aging brain and mainly affects the hippocampus and cerebral cortex. The Hippo signaling pathway and autophagy proteins have been found to be perturbed in the brain affected by dementia processes. Objective: This systematic review aims to elaborate on the involvement of the Hippo signaling pathway and autophagy in modulating the progression and severity of dementia in aging. Methods: Searches were conducted on MEDLINE, Google Scholar, Scopus, and Web of Science databases. ; Results: The Hippo signaling pathway is dependent upon the transcriptional co-activator YAP/TAZ, which forms complexes with TEAD in the nucleus in order to maintain cell homeostasis. When the expression YAP/TAZ is reduced, transcriptional repression-induced atypical cell death, ballooning cell death, and necrosis will consequently occur in the neurons. Moreover, the autophagic proteins, such as LC3, ATG proteins, and Beclin, are reduced, resulting in the disruption of autophagosome formation and accumulation and the spread of misfolded proteins in the brain suffering from dementia. Conclusion: The impairment of the Hippo signaling pathway and autophagy in the dementia process in aging should be considered since it might predict the severity, treatment, and prevention of dementia.

Background: Nursing home residents are likely to differ from community older adults when their gait parameters are compared, as nursing home residents present more falls. Aim: The study aim was to identify the main fall (occurrence predictors) (anthropometrics, functional and gait-related parameters) between older adults living in community and nursing homes during self-selected (SSWS) and fast walking speeds (FWS). Methods: A hundred and sixty-five older adults were selected from the community (n = 92) and nursing home (n = 73) with and without fall history. They were assessed for fall history, functionality, cognitive status, and several gait parameters in SSWS and FWS conditions. Results: Fallers differed from non-fallers in the SSWS, while such differences were not evidenced during the FWS. Cadence and stride width did not differ when living backgrounds were compared. Nursing home residents walked slower than their non-institutionalized peers, regardless of fall history or walking speed. Besides, binary logistic regression analysis showed that living in a nursing home, age, body mass index (BMI), mini-mental state examination (MMSE), and step width were related to falls in the SSWS. On the other hand, living in a nursing home, having a larger BMI and having low MMSE scores were fall predictors in the FWS. Conclusion: Fall occurrence can be identified by factors related to living in nursing homes, cognitive status, BMI, and gait parameters, at the SSWS. Cognitive status and BMI are related to falls in the FWS for those living in nursing homes.

Purpose: Falls are a common public health problem in older adults regarding increased morbidity, mortality, and healthcare costs. Determining the factors associated with falls is of utmost importance for detecting at risk people. We present here a field study conducted to examine the prevalence of falls and the associated factors among community-dwelling older adults. Methods: In this population-based cross-sectional study, we included adults aged > 60 years living in the Fatih District of the Istanbul Province between November 2014-May 2015, through a simple random sampling method. We noted age, sex, falls, fear of falling, number of diseases and medications, the presence of diabetes, hypertension, dyslipidemia, urinary and fecal incontinence, and chronic pain. Frailty was assessed with the FRAIL questionnaire. Functional capacity was evaluated by Katz’s 6-item ADL and Lawton Brody’s 8-item IADL scales. The European quality-5 dimension (EQ-5D) questionnaire was used for the quality of life assessment. The cognitive status screening was conducted with a Mini-cog test. Depressive mood was evaluated with the Geriatric Depression scale short form (GDS-SF). Malnutrition screening was conducted by the mini-nutritional assessment short form. Handgrip strength (HGS) was measured with a hand dynamometer. Body composition was assessed through a bioimpedance analysis. The 4-meter usual gait speed was recorded. The European Working Group on Sarcopenia in Older People2 (EWSGOP2) criteria was used for the sarcopenia definition. The Romberg and the postural instability tests were evaluated for balance and gait. Continuous variables were expressed as mean ± standard deviation or median and interquartile range for descriptive statistics, while categorical variables were expressed as the number and percentages. The differences between groups were determined through an independent sample t-test or Mann-Whitney U test when required, and Chi-square and Fisher’s exact tests were applied for categorical variables. A multivariate logistic regression analysis was used to determine the independent factors associated with falls among the factors identified as significant in univariate analyses. Results: The prevalence of falls was 28.5% [mean age: 75.4 ± 7.3 (range: 61-101 years), 53.6% female], and a significant association was identified between falls and the number of diseases and medications, diabetes, chronic pain, frailty, ADL, IADL, and EQ-5D scores, dementia, GDS-SF score and level of ambulation in univariate analyses (p = 0.001, 0.030, 0.030, 0.010, 0.004, 0.040, 0.007, 0.003, 0.030 and 0.007, respectively). In the multivariate analysis, positive dementia (OR = 3.66, 95% CI = 1.40-9.53; p = 0.010) and frailty screenings (OR =1.47, 95% CI = 1.05-2.06; p = 0.020) were identified as associates of falls. Conclusion: Falls were independently associated with positive dementia and frailty screening. These results will help develop specific and tailored precautions for at-risk groups to prevent the negative outcomes of falls.

Background: Examining the interrelationships between symptoms of depression and sociodemographic and behavioral correlates is challengeful using traditional regression analysis. Objective: to identify the sociodemographic, movement behaviors, and sleep correlates that contribute the most to symptoms of depression in Brazilian older females, using a network analysis approach. Methods: This cross-sectional study analyzed 1019 older females from Brazil. Data (sociodemographic, height (meters), weight (kilograms), symptoms of depression, physical activity, sleep) were self-reported via phone calls. The relationships between symptoms of depression and their correlates were assessed using the Network Analysis (qgraph package of the Rstudio) for entire sample and age groups (60-69; 70-79 and 80+ years old). Results: 60-69 and 70-79 groups have more weekly home exits, with aging “single, widowed or divorced” was progressively higher, and “married or stable union” and Overweight/obesity were progressively fewer (p < 0.05). 60-69 have more education years and fewest medicaments use. Sleep compliance (for the entire sample), body mass index (for the 60-69), compliance with moderate to vigorous physical activity (for the 70-79), and educational level (for 80+) were the variables with the highest expected influence values (p < 0.05) on symptoms of depression (1.370; 1.388; 1.129; and 1.354, respectively). Conclusion: Symptoms of depression vary throughout the aging process and thus determine that intervention strategies encompass these specific factors according to each age group. Poor sleep behavior has a strong positive association with symptoms of depression. This result highlights that health professionals must be aware of the importance of sleep to mitigate the worsening of depression among older Brazilian females.

Background: Executive function performance has been extensively studied in extreme age groups, but the middle age population, where a decline could begin, is still under investigation. The role of factors like education and physical activity that might influence cognitive performance is not well understood. Objective: The study aimed to examine the influence of age, education, and physical activity on executive function performance and the interaction effects between these factors on two subpopulations of adults, i.e., young adults and middle-aged adults. Methods: 92 adults, 46 young adults (N = 24.4 ± 2.7 years, 25 postgraduates and 21 PhDs) and 46 middle-aged adults (N = 48.08 ± 5.79 years, 28 postgraduates and 18 PhDs), were included. Each subject performed Delayed Matching of Sample (DMS), Spatial Working Memory (SWM), and Multitasking (MTT) test on CANTAB. Physical activity levels were reported through IPAQ. Results: Results indicated age to have a major influence on DMS, SWM, and MTT performance; however, education was only found to influence SWM. MTT and SWM performance was found to be lower in middle-aged adults in comparison to young adults. On comparison of test scores between highly active and moderately active groups of middle-aged adults, no differences were found; however, in young adults, MTT correct scores (p < 0.05) were significantly higher in the highly active group in comparison to their counterparts. Interaction between age and level of education revealed better retrieval in middle-aged adults with higher education in comparison to their counterparts. Conclusion: In comparison to younger counterparts, executive function performance deteriorated around the middle ages. Education was found to play a protective role in executive abilities slowing during middle age. Also, physical activity may play some role in executive function performance.