Age and ageing最新文献

{"title":"The challenges of rehabilitation and delirium trials in the current NHS landscape: learning from the RecoverED feasibility trial.","authors":"Louise M Allan, Abigail O'Connell, Rowan H Harwood, Alison Bingham, Abigail Laverick, Kirstie Chandler, Shruti Raghuraman, Obi Ukoumunne, Thomas Andrew Jackson, Sarah Joanna Richardson, Rob Anderson, Rachel Litherland, Lesley Collier, Victoria A Goodwin, Sarah Morgan-Trimmer, Annie Hawton, Elizabeth Goodwin, Linda Clare","doi":"10.1093/ageing/afaf196","DOIUrl":"10.1093/ageing/afaf196","url":null,"abstract":"<p><p>There is a great need for more high-quality rehabilitation and delirium research and the National Health Service (NHS) should be well placed to deliver such research. This commentary discusses the challenges we faced in delivering a feasibility trial of a rehabilitation intervention aimed at supporting recovery from delirium. We found a number of challenges including identifying therapy teams, delays in study set up, difficulty in identification and recruitment of participants, staff capacity to undertake the research and site selection. As a result of identifying these challenges we propose some recommendations as opportunities to improve the delivery of rehabilitation research in the future. These are: development of research capacity amongst therapy staff; optimising delirium screening to improve patient care and research opportunities; and greater creativity and innovation between funders and researchers to improve recruitment of frail older people with cognitive impairment to research.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 7","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detecting delirium in Parkinson's disease: an evaluation of diagnostic accuracy of bedside tools.","authors":"Rachael Ashleigh Lawson, Sarah Joanna Richardson, Florence Gerakios, Alison Jane Yarnall, Gemma Bate, Laura Wright, Claire McDonald, John Paul Taylor, David Burn, Glenn Stebbins, Louise M Allan","doi":"10.1093/ageing/afaf197","DOIUrl":"10.1093/ageing/afaf197","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a serious, acute neuropsychiatric condition associated with fluctuating attention and altered arousal. Delirium in Parkinson's disease (PD) is common but often missed in hospital due to shared clinical features. This study aimed to evaluate the accuracy of current tools used to identify delirium in inpatients with PD.</p><p><strong>Methods: </strong>People with PD admitted to all hospital wards were invited to take part. Participants completed a standardised delirium assessment based on the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) criteria, in addition to standard bedside tools including the 4 As Test (4AT), arousal and cognition. This was a secondary analysis of a prospective observational study; bedside tools were not completed independently of, or blinded to, the DSM-5 criteria. Accuracy was assessed using Receiver Operating Characteristic area under the curve (AUROC).</p><p><strong>Results: </strong>Participants included 115 people with PD (200 hospital admissions); 66.1% (n = 76/115) had delirium. Considering all admissions, the diagnostic accuracy of tools was good, ranging from 74% to 89% (AUROC = 0.764-0.923, P < .001 for all). The 4AT scores had the highest sensitivity (96.7%, AUROC = 0.922, P < .001). However, accuracy decreased in those with underlying cognitive impairment (AUROC = 0.499-0.886).</p><p><strong>Conclusions: </strong>Current bedside tools can accurately identify delirium in PD inpatients. Although tools were comparable, the 4AT may have greater clinical utility as it had high sensitivity, is quicker to complete and already widely used clinical. However, caution is recommended as tools did not differentiate between symptoms typical in PD and acute symptoms associated with delirium; this should be a focus for future research.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 7","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a model to predict the progression of Alzheimer's disease.","authors":"Chenyin Chu, Yihan Wang, Andrew L H Huynh, Ka Weng Ng, Shu Liu, Guangyan Ji, James Doecke, Jurgen Fripp, Colin L Masters, Benjamin Goudey, Liang Jin, Yijun Pan","doi":"10.1093/ageing/afaf198","DOIUrl":"https://doi.org/10.1093/ageing/afaf198","url":null,"abstract":"<p><strong>Background: </strong>Cognition monitoring is crucial for care planning in people with mild cognitive impairment (MCI) and Alzheimer's dementia (AD).</p><p><strong>Objective: </strong>To develop a machine learning model to assist cognition monitoring.</p><p><strong>Design: </strong>Florey Fusion Model (FFM) was constructed and validated in two phases: (i) model development and cross-validation using data collected via the Australian Imaging, Biomarker, and Lifestyle of Ageing (AIBL) study, and (ii) simulation and missing data trials with 30 new participants.</p><p><strong>Methods: </strong>This prognostic study recruited 238 participants in the AIBL study. Support vector machine, gradient boosting and random forest were trialled to develop the FFM. Cognitive decline was assessed via changes in Clinical Dementia Rating Sum of Boxes (CDR-SB) and Mini-Mental State Examination (MMSE) scores. Model performance was evaluated by cross validation and compared against baseline models.</p><p><strong>Results: </strong>The FFM achieved a median area under receive character curve (AUC-ROC) of 0.91 (IQR 0.87-0.93) for MCI-to-AD progression prediction. A mean absolute error (MAE) of 1.32 (IQR 1.30-1.33) for CDR-SB and 1.51 (IQR 1.50-1.52) for MMSE was achieved for 3-year cognition forecast. Simulation and missing data trials yielded up to 94% accuracy for MCI-to-AD conversion and MAEs of 1.27-2.12 for CDR-SB score prediction.</p><p><strong>Conclusion: </strong>The FFM holds the potential to facilitate cognition monitoring in people with MCI/AD; however, a larger trial will be required to refine it as a clinical grade tool.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 7","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a midlife-specific CogDrisk algorithm (CogDrisk-ML) to enable validated implementation of dementia risk assessment from midlife to late life.","authors":"Md Hamidul Huque, Heidi Jane Welberry, Ranmalee Eramudugolla, Nicola T Lautenschlager, Kaarin J Anstey","doi":"10.1093/ageing/afaf201","DOIUrl":"10.1093/ageing/afaf201","url":null,"abstract":"<p><strong>Background: </strong>Existing dementia risk assessment tools, such as The Australian National University Alzheimer's Disease Risk Index (ANU-ADRI), LIfestyle for BRAin health (LIBRA) and Cognitive health and Dementia Risk Assessment (CogDrisk), show limited validation for middle-aged adults (age 40-64 years). The Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) tool, developed almost two decades ago, demonstrated moderate predictive accuracy. As key modifiable dementia risk factors emerge in midlife, there is a need for a new, more accurate midlife dementia risk assessment tool.</p><p><strong>Objectives: </strong>To develop CogDrisk-ML, a midlife dementia risk assessment tool that can complement the existing CogDrisk tool for late-life dementia risk assessment.</p><p><strong>Design and settings: </strong>Data from the UK Biobank and the Atherosclerosis Risk in Communities (ARIC) study were used to develop and validate CogDrisk-ML, which was also externally validated using the Whitehall II cohort.</p><p><strong>Participants and covariates: </strong>Participants without dementia at baseline were included, with CogDrisk predictors along with additional midlife risk factors based on recent evidence.</p><p><strong>Main outcome measures: </strong>Cox regression models estimated the relationship between risk factors and dementia for each sex. A random-effects meta-analysis model aggregated cohort- and sex-specific regression coefficients to develop CogDrisk-ML. Harrell's C statistics measured predictability, with multiple imputation used for missing data.</p><p><strong>Results: </strong>CogDrisk-ML outperformed CAIDE in the UK Biobank and Whitehall II cohorts; however, it provided similar C statistics in the ARIC dataset. C statistics (95% confidence interval) for CogDrisk-ML were 0.71 (0.69, 0.74) for the ARIC, 0.75 (0.73, 0.77) for the UK Biobank and 0.70 (0.62, 0.79) for the Whitehall II study.</p><p><strong>Conclusion: </strong>The novel CogDrisk-ML for assessing dementia risk in midlife offers improved predictive accuracy. Combined with the CogDrisk tool for late life, it provides a comprehensive framework for dementia prevention throughout the life course.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 7","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12277239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of electrical parameters on transcutaneous tibial nerve stimulation for overactive bladder syndrome: a systematic review and meta-analysis.","authors":"David Alejandro Vaca-Benavides, Wei Ju, Camila Gonzalez, Peter Aitken, Anil Kumar Appukuttan Nair Syamala Amma, Srinjoy Mitra, Susan D Shenkin","doi":"10.1093/ageing/afaf203","DOIUrl":"https://doi.org/10.1093/ageing/afaf203","url":null,"abstract":"<p><strong>Introduction: </strong>Overactive Bladder Syndrome (OAB) is common and distressing for older people. Transcutaneous Tibial Nerve Stimulation (TTNS) is a potential treatment when others have failed. Different electrical parameters-electrical frequency, intensity, pulse width-are used. We investigated their effect on urinary incontinence, urgency, frequency and nocturia.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE and AMED to March 2025 for studies comparing TTNS to control/sham in adults with OAB in clinical/home settings. Two reviewers independently screened papers, extracted data and assessed risk of bias (using RoB2). We summarised studies narratively and used the GRADE framework. We meta-analysed RCTs (random-effects), grouping by electrical parameters. PROSPERO registration CRD42024490465.</p><p><strong>Results: </strong>We included 42 papers (13 RCTs), involving 2715 participants (972 in RCTs). Nearly half studies (47.6%) included people aged > = 60. TTNS protocols varied: electrical frequency 10/20 Hz; intensity set with sensory or motor threshold; pulse width mostly 200 microseconds. No serious adverse effects were reported, only mild pain/discomfort. TTNS at 10 Hz improved incontinence episodes (MD = -1.24, 95%CI -2.09 to -0.39, n = 255, N = 3). TTNS with motor threshold improved urgency (MD = -1.44, 95%CI -2.69 to -0.19, n = 193, N = 4) and nocturia (MD = -1.14, 95%CI -1.93 to -0.34, n = 153, N = 3). Risk of bias was low.</p><p><strong>Conclusions: </strong>TTNS is a safe option to treat OAB. Electrical parameters may impact effectiveness (in favour of 10 Hz, motor threshold). Certainty is reduced due to the small number of studies and participants. Future studies should include different electrical parameters to clarify their impact, particularly with older people and to allow standardisation of future treatment and effect on specific symptoms.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 7","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed orthostatic hypotension in Parkinson's disease and in the general ageing population.","authors":"Bianca Calió, Fabian Leys, Giulia Matteucci, Nicole Campese, Giulia Rivasi, Georg Göbel, Giuseppe Dario Testa, Roberta Granata, Susanne Dürr, Jean-Pierre Ndayisaba, Karoline Radl, Michael Thurner-Rodriguez, Klaus Seppi, Werner Poewe, Stefan Kiechl, Andrea Ungar, Gregor Wenning, Martina Rafanelli, Alessandra Fanciulli","doi":"10.1093/ageing/afaf187","DOIUrl":"10.1093/ageing/afaf187","url":null,"abstract":"<p><strong>Objective: </strong>Delayed orthostatic hypotension (dOH) is defined by a sustained blood pressure (BP) fall ≥20/10 mmHg occurring beyond 3 minutes in the upright position, whose clinical relevance is yet undetermined. We investigated frequency, associated features and treatment strategies of dOH in Parkinson's Disease (PD) and ageing individuals with history of syncope or orthostatic intolerance.</p><p><strong>Methods: </strong>We retrospectively studied 213 individuals with PD and 213 age-matched individuals without parkinsonism referred for tilt-table testing to the Innsbruck and Florence Dysautonomia centres. In both cohorts, we reviewed the medical records of the 6 months before testing for history of syncope and falls, and of the 6 months afterwards for the recommended dOH treatment and clinical outcome.</p><p><strong>Results: </strong>dOH was twice as frequent in PD than in ageing individuals [18% versus 9%; OR = 2.9 (95 CI.: 1.3-6.5), P = .007]. Upon prolonged head-up tilt, PD individuals showed a more severe systolic BP fall (P < .001). PD individuals with history of syncope also exhibited a sustained systolic BP fall from the 3rd minute of head-up tilt onward compared to those without (P = .014). Both non-pharmacological and pharmacological OH treatment strategies were associated with symptomatic improvement at follow-up.</p><p><strong>Conclusions: </strong>In PD individuals referred to tertiary settings, tilt-table testing more frequently disclosed dOH compared to age-matched individuals without parkinsonism. In PD, dOH is mainly driven by a progressive orthostatic systolic BP fall, increasing the risk of syncope. Given its prevalence and the potential for effective treatment, dOH should be actively screened for in clinical practice.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 7","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between longitudinal trajectories of insomnia symptoms and subsequent cognitive decline: a prospective cohort study.","authors":"Qing-Mei Huang, Huan Chen, Pei-Dong Zhang, Jin Yang, Dan Liu, Zhi-Hao Li, Chen Mao","doi":"10.1093/ageing/afaf186","DOIUrl":"10.1093/ageing/afaf186","url":null,"abstract":"<p><strong>Background: </strong>Previous studies found that insomnia was an important risk factor for cognitive decline. However, previous studies only focused on baseline insomnia status, not taking into consideration the changes in insomnia status during follow-up. The study aimed to investigate the association between longitudinal trajectories of insomnia symptoms and subsequent cognitive decline.</p><p><strong>Methods: </strong>Data were from 7727 adults aged ≥50 in the Health and Retirement Study. The exposure variable was insomnia symptoms, including difficulties in initiating and maintaining sleep, early morning awakening and non-restorative sleep. Insomnia status was assessed biennially from 2002 to 2006, and its change patterns were categorised as low, decreasing, increasing and high trajectory. Linear mixed effects models were used to evaluate the associations between trajectories of insomnia symptoms and consequent cognitive decline.</p><p><strong>Findings: </strong>Compared with participants experiencing sustained low insomnia symptoms, those experiencing decreasing insomnia symptoms (β = -0.013; 95% CI, -0.020 to -0.006), increasing insomnia symptoms (β = -0.018; 95% CI, -0.031 to -0.006) and sustained high insomnia symptoms (β = -0.025; 95% CI, -0.037 to -0.014) showed significantly accelerated global cognitive decline. In contrast, compared with participants experiencing sustained high insomnia symptoms, those with decreasing insomnia symptoms were significantly associated with decelerated global cognitive decline.</p><p><strong>Conclusion: </strong>Sustained high insomnia symptoms accelerates cognitive decline, while recovery of insomnia symptoms decelerates cognitive decline.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 7","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's view-updates on safer prescribing.","authors":"Roy L Soiza","doi":"10.1093/ageing/afaf200","DOIUrl":"https://doi.org/10.1093/ageing/afaf200","url":null,"abstract":"","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 7","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The rising burden of frailty among older adults in China: evidence from the China Health and Retirement Longitudinal Study (2011-2020).","authors":"Na Shen, Xiaoxv Yin, Peng Wang, Han Bai, Ping Yin, Wenhua Liu","doi":"10.1093/ageing/afaf195","DOIUrl":"https://doi.org/10.1093/ageing/afaf195","url":null,"abstract":"<p><strong>Background: </strong>Frailty is a growing public health issue among older adults worldwide, posing significant challenges to society, especially in rapidly ageing populations like China.</p><p><strong>Objective: </strong>This study investigates trends in frailty and its impact on health and productivity among Chinese adults aged 60 and older and provides projections for the next decade.</p><p><strong>Design: </strong>Longitudinal design.</p><p><strong>Methods: </strong>Data from the China Health and Retirement Longitudinal Study were analysed, including 38 071 eligible participants surveyed across five waves between 2011 and 2020. Negative binomial and logistic regression models with random effects were used to examine the impact of frailty on outpatient visits, hospitalisations, catastrophic health expenditure and productive engagement.</p><p><strong>Results: </strong>The prevalence of frailty among older adults in China rose from 16.87% in 2011 to 22.54% in 2020 and is projected to reach 32.46% by 2030. Frail individuals exhibited significantly higher healthcare utilisation, with increased outpatient visits (incidence rate ratio [IRR] = 1.92, 95% CI: 1.81-2.02) and hospitalisations (IRR = 2.78, 95% CI: 2.63-2.94). They were also more likely to experience catastrophic health expenditures (odds ratio: 2.19, 95% CI: 2.04-2.34). Additionally, frailty was associated with more than 50% reduction in productive engagement, particularly in paid working. Additionally, sex and urban-rural disparities were observed, with males and rural residents showing more pronounced reductions in productivity.</p><p><strong>Conclusions: </strong>Frailty is increasing rapidly in China, with profound implications for healthcare utilisation and productivity. This growing burden highlights the urgent need for targeted interventions to mitigate frailty, particularly for vulnerable populations, as this trend is expected to continue in the coming decade.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 7","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motivation, psychological needs and physical activity in older adults: a qualitative review.","authors":"Tommaso Palombi,Andrea Chirico,Barbara Cazzolli,Michele Zacchilli,Guido Alessandri,Lorenzo Filosa,Anna Borghi,Chiara Fini,Chiara Antoniucci,Jessica Pistella,Fabio Alivernini,Roberto Baiocco,Fabio Lucidi","doi":"10.1093/ageing/afaf180","DOIUrl":"https://doi.org/10.1093/ageing/afaf180","url":null,"abstract":"BACKGROUNDDespite the well-documented health benefits of Physical Activity (PA), older adults often struggle to engage in PA. The present review examines the relationship between PA, motivation and basic psychological needs among older adults aged 65 and over, through the lens of Self-Determination Theory (SDT).METHODSRelevant studies that used qualitative methodologies and applied SDT framework were systematically searched in five electronic databases (i.e. Scopus, Web of Science, PubMed, PsycINFO and CINAHL). Methodological rigour was assessed using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research).RESULTS21 studies met inclusion criteria (N = 412; ages 65-97). Four themes and nine subthemes were identified. Peer relationships emerged as a pivotal element in supporting most autonomous forms of motivation and satisfying psychological needs (i.e. autonomy, competence and relatedness). A peer coach was preferred during several health programs, enhancing competence and relatedness. Outdoor activities in natural settings promoted intrinsic motivation, while indoor activities were driven more by extrinsic motivation. Barriers included ageist stereotypes and perceptions of inevitable physical decline, which negatively impacted competence and autonomy, ultimately reducing motivation for PA.CONCLUSIONSThis qualitative synthesis highlights a complex interplay of SDT components and social factors in influencing PA behaviours among older adults. Tailored interventions that integrate social interaction, provide feedback from coaches and offer choices among several exercises with graduate intensity levels are likely to enhance adherence in PA. Future interventions should address both psychological and social barriers to create inclusive PA strategies that meet older adults' needs and motivation.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"92 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}