Narelle Warren

Parkinson's disease (PD) is most often diagnosed in late middle age and old age (mid to late 60s), leaving younger people with PD facing uncertainties and the long‐term challenge of life with a neurodegenerative illness. To advance understanding of the psychosocial burden associated with PD for younger people, we explored PD disclosure narratives with 22 participants diagnosed before 55 years of age. For people with neurodegenerative illness, sharing a diagnosis is only partly scripted and limited to discrete interactional events. We also consider narratives of social isolation, an impact that is not readily recognised because biomedicine mainly addresses older people with PD. The PD body discloses itself in ways that are not always controllable, nuancing sociological understanding of illness narratives to accommodate neurodegenerative illness. With reference to sociological understandings of the ‘leaky’ body and scholarship on disclosure, exposure and related perspectives on social life, we explored social expectations to explain the PD body, the avolitional, repetitive and continual qualities of these expectations and the impact of these dynamics on wellbeing.

Purpose: We examined whether cognitive function statistically accounted for associations between stroke and quality of life (QOL). Methods: A cross-sectional survey included adults aged ≥ 60 years in Segamat, Malaysia. Cognition was assessed using the Identification and Intervention for Dementia in Elderly Africans instrument, and QOL was assessed using the WHOQOL-BREF. Stroke survivors were matched 1:3 with non-stroke participants by propensity scores based on age, sex, and education. Stroke status was the exposure, cognition the proposed statistical mediator, and four QOL domains, overall QOL, and overall health the outcomes. Models were adjusted for sociodemographic and vascular factors, accounted for matching and multiple testing, and p < 0.05 was considered statistically significant. Results: Among 596 participants, 149 reported stroke; the mean age was 70.36 years (SD 6.81); 41.6% female; 58.4% male. An indirect association between stroke and physical QOL via cognition was observed (β = −0.67, 95% CI − 1.30 to − 0.18; BH-adjusted p = 0.018). A residual correlation of ρ = 0.16 between cognition and physical-QOL models would attenuate this association to the null. The indirect association did not differ by sex (index β = −0.49, 95% bootstrap CI − 1.48 to 0.18; p = 0.164). Item-level physical-QOL analysis identified an indirect association with greater pain interference through lower cognition (β = −0.051, 95% CI − 0.113 to − 0.009; BH-adjusted p = 0.028). Conclusion: Reduced cognition partly accounted for associations of stroke with reduced physical QOL and greater pain interference. Findings were sensitive to modest unmeasured confounding but require confirmation from longitudinal studies.

Background/Objectives: Sarcopenia frequently coexists with other geriatric syndromes, and its severity may influence their clinical manifestation. This study examines the prevalence of geriatric syndromes in older adults with non-severe and severe sarcopenia and explores the associations between sarcopenia severity and individual geriatric syndromes in Vietnam. Methods: A cross-sectional study was conducted among 726 older outpatients with sarcopenia. Non-severe and severe sarcopenia were diagnosed according to the Asian Working Group for Sarcopenia algorithm. Fifteen geriatric conditions spanning physical and psychological health, functional status, and social circumstances were assessed using components of the Comprehensive Geriatric Assessment. Logistic regression models were used to examine associations between sarcopenia severity and geriatric syndromes. Results: A total of 726 older patients with sarcopenia (mean age 74.4 years, 77.4% females) were included, of whom 53.4% had severe sarcopenia. A significantly higher prevalence of geriatric syndromes was observed in patients with severe compared with non-severe sarcopenia, including sleep disturbances (79.4% vs. 67.5%), frailty (71.4% vs. 54.7%), malnourishment/risk of malnutrition (61.9% vs. 50.0%), depression (54.9% vs. 34.9%), polypharmacy (49.5% vs. 42.0%), impairment in activities of daily living (52.8% vs. 32.5%), and impairment in instrumental activities of daily living (58.2% vs. 39.3%). After adjustment for potential confounders, severe sarcopenia remained associated with sleep disturbance (adjusted OR 1.49, 95%CI 1.02–2.18, p = 0.046), depression (adjusted OR 1.90, 95%CI 1.36–2.66, p < 0.001), and mobility impairment (adjusted OR 3.01, 95%CI 2.12–4.27, p < 0.001). Conclusions: Older Vietnamese adults with sarcopenia had a high burden of geriatric syndromes, particularly among those with severe disease. Severe sarcopenia was independently associated with sleep disturbance, depression, and impaired mobility—clinically relevant and potentially modifiable conditions. These findings highlight the importance of evaluating sarcopenia within a broader geriatric framework and may inform early identification and prioritization of coexisting geriatric syndromes, especially in resource-limited settings.

Caregivers of people with dementia living in rural areas face numerous challenges owing to the progressive nature of the disease, limited resources, and inadequate support services. Research on how caregivers experience dementia caregiving in Vietnam and similar Asian settings is limited. This study explored caregivers’ experiences, consequences, and caregiving needs in a rural district of Hanoi. We recruited 20 dyads (people with dementia and their caregivers) and eight health professionals. A qualitative study design using a semi-structured interview approach was employed. This study used a thematic analysis approach. Nine major themes were identified: (1) stepping into the caregiver role and responsibilities; (2) supporting activities of daily living; (3) managing behavioural problems; (4) complex care needs; (5) caregiver-related challenges; 6) healthcare-related challenges; (7) knowledge, perception, and awareness of caregivers; (8) consequences of caregiving; and (9) perceived needs. Thematic analyses revealed that the caregiving challenges of dementia caregivers were related to behavioral disturbance, functional care needs, complex care needs, caregiver-related challenges, healthcare-related challenges, understanding of dementia, and stepping into the caregiver role and responsibilities. The consequences of caregiving affect caregivers’ physical, psychological, and financial health. Understanding their experiences is essential for developing effective interventions to reduce caregiving burden and improve the quality of care.

Long-term caregiving can lead to a high caregiver burden for caregivers of community-dwelling people with dementia in Asia's low- and middle-income countries (LMICs). It is essential to assess the level of caregiver burden and its factors in such settings to understand the impact on caregivers' well-being. A systematic review was conducted based on the PRISMA. Articles were identified from seven databases published from 2000 to November 2023. Each article's methodological quality was assessed with an appraisal checklist developed by the Joanna Briggs Institute. 64 studies with 12 measurement tools were identified from 9 countries. Only 20% of studies using 22-item ZBI show caregivers experienced no or little burden while caring for their care recipients. The mean 22-item ZBI score ranged from 24.5 in Turkey to 34.7 in India, while the mean CBI score varied from 24.0 in Thailand to 47.8 in China. Patient, caregiver characteristics, and caregiving context are associated with caregiver burden. Dementia caregivers in Asian LMICs exhibit a wide variation in caregiver burden. Programs that promote protective factors and address modifiable factors are imperative to mitigate burdens and enhance caregivers' quality of life in these settings.

Previous studies found that online communities are critical in supporting stroke survivors and caregivers for stroke recovery. However, it is unclear how such online communities are designed, or could be designed. This review aims to identify the key design elements of an online community to support stroke survivors and caregivers, that is, the actors, types of community support, and supporting technologies. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We included journal articles related to online community support for stroke. Editorials, registers, opinion pieces, letters, and conference papers were excluded. Online databases PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, and ProQuest were searched for articles published from January 2015 to June 2025. Articles were screened based on the title, abstract, and full text using Covidence software. After screening and full-text review, we read the selected articles in detail to analyze and synthesize information on key actors, types of support, and technologies used to support stroke survivors and caregivers. A total of 77 articles were included. These articles discussed digital support technologies (52 articles), community functions and roles (18 articles), online stroke community systems (6 articles), and the stroke ecosystem (1 article). Our review found that the online community of support for stroke survivors and caregivers includes the caregivers themselves (46 articles), health workers (24 articles), and the local community/society (14 articles). Online communities mainly provide informational support, including giving advice (28 articles) and tangible aids (29 articles), followed by social support to create a sense of belonging (26 articles). Technologies discussed included mobile health (25 articles), web-based systems (12 articles), virtual/augmented reality (8 articles), sensors/wearable technology (8 articles), video-guided exercise apps (4 articles), and telehealth/telerehabilitation/teleconsultation/telestroke (4 articles). Only one examined how cultural differences influence technology. Although technologies are essential in online communities of support for stroke survivors and caregivers, this review shows a lack of studies that analyze the use and role of technologies in such online communities. This could be because the key actors of the online communities are the caregivers, who mainly seek social support and therefore do not require sophisticated technology. Nevertheless, technologies such as telerehabilitation and video-guided exercise apps could be important for other actors, including the local community and health workers, to enable them to support stroke survivors and their caregivers.

Background and Objectives: The aging experiences of military veterans provide critical insights into what successful aging is and means for later life contexts constrained by distinct health and social needs. Can veterans “successfully” age when they are exposed to so many stressors with serious health and social consequences for later life? Veterans can offer valuable lessons for developing comprehensive approaches to refining successful aging, ensuring inclusivity of different older populations. Building on Rowe and Kahn’s idea of successful aging, we utilize the complementary concept of “active aging” to explore if there are unique factors, characteristics, and interventions that support active aging in veterans, compared with nonveteran populations. Research Design and Methods: A rapid review and evidence synthesis was conducted across 9 databases in medicine, psychology, anthropology, sociology, and public health to search for peer-reviewed articles and research reports. Results: Findings suggest that programs linking health and social dimensions can support the active aging of veterans, namely interventions promoting active physical and cognitive lifestyle as well as social connectedness and engagement. Such programs and interventions help prevent and combat mental and physical health decline and increase quality of life and well-being. Discussion and Implications: Findings have implications for veteran and nonveteran populations more broadly, as people can actively age even when they have unique health and social needs.