Purpose: To systematically examine, appraise and synthesise the current literature exploring the association between socioecological factors and meal skipping in community dwelling older adults

Methods: EMBASE, PsycINFO, CINAHL and MEDLINE electronic databases were searched from inception to March 2021 for original research studies on the association between socio-ecological factors and meal skipping in community dwelling adults 65+ years. 

Results: The database search identified 473 studies, and 23 of which were eligible for the review. The frequency of meal skipping ranged between 2.1% to 61%.  This review identified four domains of socio-ecological correlates associated with meal skipping in older adults: socio-demographic, behavioural, biomedical, psychological and social. 

A majority of the studies selected, highlighted that the prevalence of meal skipping was higher for men, for those who lived alone and for those who experienced economic and social disadvantage. Low psychological wellbeing was associated with meal skipping in numerous studies, conversely, higher levels of happiness were associated with a lower risk of meal skipping behaviour. This review also highlighted that health behaviours such as smoking and alcohol were key correlates of meal skipping.

Conclusion: This review identified multiple factors associated with meal skipping in older adults and can help inform the development of targeted interventions to improve nutrition and health in this population group. 

Systematic review registration: PROSPERO (CRD42021249338)

Purpose: Meal skipping may impact the nutritional status of older adults increasing the risk and severity of chronic disease. This study aimed to determine the prevalence and socio-ecological correlates of meal skipping in community dwelling Australian adults aged 70 years of over. 

Methods: Cross-sectional analysis of 10,564 adults aged ≥70 years (mean age 78.0 ± 4.1, 54.5% females), participants in the ASPirin in Reducing Events in the Elderly (ASPREE) Longitudinal Study of Older Persons (ALSOP). Factors hypothesized to be associated with meal skipping were self-reported and included: demographic, socio-economic, behavioural, biomedical, social and psychological factors. Meal skipping was assessed via: “How often do you miss meals?”. Participants could choose from a range of answers, from which a binary variable was created ‘rarely/never or yes’. The association between socio-ecological factors and meal skipping was examined using multivariable binary logistic regression. Odd ratios (OR) and 95% confidence intervals (CI) were reported.

Results: The prevalence of any meal skipping in this cohort was 19.5%. The odds (OR [95%CI]) of meal skipping were lower in adults aged 85+ years (vs. 70-74 years 0.58 (0.47-0.73), those who lived outside urban areas (vs urban 0.81 [0.62-0.83]), and with ≤12 years of education (vs >12 years 0.84 [0.72-0.92]). Higher odds of meal skipping were observed for those who lived alone (vs those living with others 1.72 [1.54-1.92]), were current smokers (vs never smoked 2.39 [1.8-3.10]), consumed over 4 alcohol drinks per day (vs never drinkers 1.56 [1.12-2.18]), had self-reported poor oral health (vs self-reported excellent oral health 1.57 [1.00 -2.46]), experienced regular physical pain (vs rarely or no pain 1.23 [1.02 – 1.48]), or with depressive symptoms (vs who experience them rarely or never 1.43 [1.21-1.83]).

Conclusion: The results indicate that one fifth of the population of apparently healthy older adults skip meals. Greater meal skipping was observed among those who reported living alone, current smoking and greater alcohol consumption, poor oral health, regular physical pain and depressive symptoms. Addressing these correlates of meal skipping may assist in targeting interventions to improve nutritional reserve and advance healthy ageing.

Purpose: Identifying and addressing the barriers to physical activity in older age will help promote equity in PA and PA-related health equity. This study aimed to investigate the demographic, socio-economic and behavioural factors associated with intensity of usual PA amongst Australian community-dwelling adults aged 70 years or older.

Methods: This cross-sectional study utilised pre-existing data from the ASPirin in Reducing Events (ASPREE) clinical trial and ASPREE Longitudinal Study of Older Persons (ALSOP) sub-study. A total of 11,461 participants (mean age (SD) = 75.1 (4.2) years, 53.4% females) self-reported their usual intensity of PA, as well as demographic, socio-economic and behavioural factors. Multinomial logistic regression was conducted to determine the factors associated with PA in Australian community-dwelling older adults.

Results: Of 11,416 participants, 3,813 (33.4%) reported rarely or never exercised or engaged in at-most light intensity PA, 5,791 (50.7%) participants engaged in moderate and 1,812 (15.9%) engaged in vigorous intensity PA. Compared to people who rarely/never exercise or only exercise at light intensities, the odds (OR, (95% CI)) of exercising at moderate (M) and vigorous (V) PA, respectively, were lower among people of older age (M: 0.55 (0.49-0.61)) and (V: 0.34 (0.28-0.41)), females (M: 0.59 (0.54-0.65)) and (V: 0.39 (0.35-0.45)), reported never or former alcohol consumption (M: 0.64 (0.53-0.78)) and (V: 0.68 (0.52-0.90)) and in people classified as overweight or living with obesity (M: 0.46 (0.41-0.51)) and (V: 0.26 (0.22-0.30)). In contrast, the odds of exercising at a greater PA intensity were higher among people who reported being former or never smokers (M: 1.31 (1.03-1.67)) and (V: 2.16 (1.44-3.24)), earning an annual income between $50,000-$99,999 or more (M: 1.59 (1.37-1.84)) and (V: 1.98 (1.62-2.42)) or were living in more socio-economically advantaged areas (M: 1.17 (1.02-1.34)) and (V: 1.61 (1.32-1.96)).

Conclusion: Interventions to address the barriers to PA participation in older adults may be key to increasing PA levels in this population group. Special attention should be directed towards females, those who are classified as overweight or obese, current smokers, those of lower socio-economic status or living in areas of greater socio-economic disadvantage.

Purpose: Physical activity (PA) can help protect from a range of health outcomes. However, less is known on the association between usual PA intensity with major adverse cardiovascular events (MACE) and surviving free from disability in older age. This study aims to explore the association of PA with MACE, and disability-free survival in the community-dwelling Australian adults aged 70 years or older.

Methodology: This prospective cohort study utilises data from the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial and the ASPREE Longitudinal Study of Older Persons (ALSOP) sub-study. Baseline participant data were collected through questionnaires and in-person clinical visits. Cox proportional hazards models, adjusted for putative confounders, were used to explore the associations of usual PA intensity with MACE and disability-free survival. Disability-free survival is defined as survival free from dementia, persistent physical disability, or death. The composite endpoint was derived from the first occurrences of the endpoints events of death, dementia, and persistent physical disability.

Results: 11,416 participants (mean age (SD) = 75.1 (4.2) years, 53.4% females) were followed for a median of 4.7 years, and 367 (3.21%) participants developed the MACE outcome, while 832 (7.29%) participants developed the composite endpoint of death, dementia, or persistent physical disability. Compared to those who never/rarely exercised, exercising in light, moderate, and vigorous-intensity PA was association with 47% (HR 0.53, 95% CI:0.30-0.97), 58% (HR 0.42, 95% CI:0.23-0.76), and 62% (HR 0.38, 95% CI:0.20-0.72) lower risk of developing MACE, respectively (p<0.001 for all). The risk of not surviving free from disability was lower by 56% (HR 0.44, 95% CI:0.31-0.63), 65% (HR 0.35, 95% CI:0.25-0.50) and 74% (HR 0.26, 95% CI:0.18-0.40) for older adults who participated in light, moderate and vigorous-intensity PA, compared to those who never/rarely exercised (p<0.001 for all).

Conclusions: The results of the study indicate that being active at any intensity is beneficial for health of older adults when compared to being never or rarely active. Older adults should be encouraged to be active at the intensity suitable to their health condition, to promote healthy ageing, increase disability-free survival and minimise the risk of developing MACE.

Purpose: Walking for transport may help integrate adequate levels of physical activity in the daily routine of older adults, however, less is known about its effect on all-cause mortality in this population group. This study aims to investigate the association between transport-related walking and all-cause mortality among community-dwelling Australians aged 70 years and over.



Methods: This is a prospective cohort study of 11,705 adults (mean age=75.1 years, 53.2% females) part of the ASPirin for PReventing Events in the Elderly [ASPREE] clinical trial and ASPREE Longitudinal Study of Older Persons [ALSOP] sub-study. To assess transport walking frequency participants were asked how often they would usually walk to get around. They could choose from the following responses: never, rarely, once a week, more than once a week, every day. Categories never and rarely were combined for analysis due to a small number of participants in each category.  All-cause mortality was defined as any cause of death that occurred after enrolment in the trial and was detected at any point during the ASPREE trial. Cox proportional hazards models (hazard ratios [HR] and 95% CI), adjusted for putative confounders, were used to explore the associations between transport walking and all-cause mortality.



Results: During a median follow-up period of 4.7 years, 462 participants (3.95%) died from any cause. Compared to those who never/rarely walked for transport, walking once a week, and every day was associated with a 30% (HR 0.70 CI: 0.48-1.01) and 26% (HR 0.74 CI: (0.56-0.97) lower risk of all-cause mortality, respectively. The risk of all-cause mortality was also lower for older adults reporting transport walking of more than once a week, compared to those never/rarely walking, however, the result did not reach statistical significance (HR 0.87 CI: 0.65-1.15).



Conclusions: The study results suggest that any transport-related walking during the week compared to never or rarely walking for transport is favourable. Community-dwelling older adults should be encouraged to engage in walking for transport to boost their physical activity levels, lower the risk of all-cause mortality, and promote healthy ageing.

Purpose: Gait speed is associated with fall-risk, functional ability, disability, and mortality; making understanding factors influencing gait speed extremely relevant for public health. When partners walk together, activity may be increased and maintained due to social support and accountability. How partner activity influences individual gait speed is not clear. This study examines associations of individual gait speed with self and partner physical activity and whether partners exercise together.

Methods: Participants were 72 romantic couples; ages 25-79. Gait speed was measured using the Midlife in the United States Survey (MIDUS) protocol. Weekly physical activity (MVPA) was assessed with Actigraph™ GT3X accelerometers. An actor-partner interdependence model was estimated in a structural equation modeling framework. Average gait speed across two trials on a clear path walking alone was modeled for husbands and wives simultaneously. Linear and quadratic associations of MVPA with self and partner gait speed were tested (covariates: self-rated health, husband’s age, and whether the partners report exercising together).

Results: No linear associations of MVPA with self or partner’s gait speed were found.  Husband’s and wife’s own MVPA were associated nonlinearly with their own gait speed. Gait speed increased as MVPA increased up to the average MVPA levels and then MVPA had diminishing to no additional effects on gait speed. Husband’s MVPA was marginally (p = 0.07) associated with wife’s gait speed through the quadratic effect. Exercising together did not associate with either partner’s gait speed directly, but did have a marginal moderation effect on the quadratic component of the MVPA effect for husband’s own gait speed (p = 0.086).

Conclusions: Findings suggest one’s own MVPA is associated with gait speed at lower levels of MVPA with diminishing associations as higher MVPA levels. Further, when husbands report exercising alone, their gait speed is faster at the lowest levels of MVPA compared to husbands who exercise with their partner, with no significant differences at higher MVPA. Future research should identify how health is impacted by the trade-off between increased physical activity and reduced gait speed when romantic partners walk together.

Purpose: There is a risk that promoting physical activity among older people could increase fall rates.The Coaching for Healthy AGEing (CHAnGE) trial is a cluster-randomised controlled trial measuring the effect of a combined physical activity and fall prevention program on physical activity and falls among community-dwelling people aged 60+ years.

Method: Seventy-two clusters (605 people) were randomly assigned to control (35 groups; healthy eating intervention, involving education brochure and phone coaching) or intervention (37 groups; involving fall prevention and physical activity plan, one physiotherapist visit, 12 months of phone coaching, activity monitor, tailored fall prevention advice, education brochure). Physical activity was objectively measured using ActiGraph GT3X+ and expressed in counts/min/day (CPM/day) and daily steps, both assessed at 6 and 12-months post-randomisation. Falls were recorded with monthly falls calendars over 12 months. Between-group differences in physical activity were estimated using linear regression adjusted for corresponding baseline scores. Between-group differences in the number of falls over the 1-year study period were estimated using negative binomial regression models. Analyses took cluster randomisation into account.

Results: Participants had a mean age of 74 years (SD 8.0) and 70% were female. We found a significant between-group difference in physical activity counts at 6 months (mean difference=21.3 CPM/day, 95%CI 3.66 to 39.0, p=0.02); however, this effect was not maintained at 12 months (5.31 CPM/day, 95%CI -21.2 to 31.9, p=0.70). We identified a significant increase in steps/day in the intervention group compared to the healthy eating group at 6 months (649 steps/day, 95% CI 283 to 1015, p=0.001) and 12 months (460 steps/day, 95% CI 26 to 895, p=0.038). The intervention group reported a lower fall rate (193 falls, 0.71 falls per person per year, SD 1.09) than the healthy eating group (229 falls, 0.87 falls per person per year, SD 1.80); however, this difference was not statistically significant (IRR 0.86, 95% CI 0.6 to 1.1, p=0.29).

Conclusions: A combined physical activity and fall prevention intervention significantly improved physical activity without increasing falls among community-dwelling people aged 60 years and older. There was a non-significant reduction in the rate of falls in the intervention group