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Background: Due to the heterogeneity of existing studies and wide range of human papilloma virus (HPV) prevalence in India, further research into the incidence of HR-HPV and its spectrum of genotypes is essential to develop screening policies. This study aimed to determine the incidence and demographic distribution of HR-HPV among cisgender female patients attending a tertiary care facility in North India. Materials and Methods: This study was conducted in the Department of Obstetrics and Gynaecology, SGRR Institute of Medical and Health Sciences, Dehradun, India. HPV-DNA test results of 653 female patients were assessed for HR-HPV positivity, genotyping, and age-based differences via Chi-square analysis. Results: Overall prevalence of HR-HPV was 4.90%, HPV-16 was 1.37%, HPV-18 was 0.76%, and HPV non-16,18 was 2.7%. In patients ≤ 50 years, prevalence of HPV-16 was 0.97%, HPV-18 was 0.38%, and HR-HPV non-16,18 was 2.71%. In patients > 50 years, prevalence of HPV-16 was 2.89%, HPV-18 was 2.17%, and HR-HPV non-16,18 was 2.89%. The difference in the prevalence of HPV-16,18 between patients ≤ and > 50 years was found to be highly statistically significant (P = 0.007485). The difference in the prevalence of total HR-HPV between patients ≤ and > 50 years was not found to be statistically significant (P = 0.059905). Conclusion: Our study's finding of higher HR-HPV positivity rates in patients > 50 years emphasizes the need for continued HR-HPV-DNA-based screening of this cohort. With widespread use in post-menopausal patients, HPV screening can serve as an important armamentarium in the fight against cervical cancer.

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INTRODUCTION: A substantial majority of patients diagnosed with metastatic breast cancer consists of individuals 65-year-old or above. Emerging treatment approaches, which utilize genomics-guided therapy and innovative biomarkers, are currently in development. Given the numerous choices in the metastatic context, it is necessary to adopt a personalized approach to decision-making for these patients. AREAS COVERED: The authors provide a comprehensive analysis of the existing literature on the use of systemic anticancer treatments in older women, specifically those aged 65 and above, who have metastatic breast cancer, focusing on the reported effectiveness and adverse effects of these treatments in this population. EXPERT OPINION: The evidence to treat older patients with metastatic breast cancer primarily relies on subgroup analyses, whose interpretation should be approached with caution. In several clinical trials subgroup analysis, it has been observed that this population seem to have comparable benefits and toxicities to younger patients, but real-world data have showed older women exhibit worse rates of survival compared to younger women. Multiple factors are likely involved in this, but we postulate this is related to lower rates of guideline concordant, and factors such as comorbidity, lack of social supports, malnutrition, and geriatric factors like frailty and/or vulnerability. This underscores the importance of a broader assessment for patients with a geriatric perspective and involvement of multi-disciplinary team.

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Introduction: Population pyramids are significantly impacted by the global phenomena of ageing. It has been reported that depression and cognitive function have an impact on the nutritional status of older adults. Depression is the most common psychiatric problem in old age, and cognitive deterioration is frequently observed in this age group. Objective: This descriptive and comparative study set out to compare the cognitive abilities, nutritional health and depression status of older adults who lived in community settings and in assisted living facilities. Materials and Methods: A total of 250 older women (125 from institutionalised old age home and 125 from community) participated in a cross-sectional study (residing at Rajarhat, Newtown area). The lengthy version of the Mini Nutritional Assessment tool (MNA®) was used to evaluate the participants' nutritional status. The Geriatric Depression Scale (GDS 30) was used to evaluate the severity of the depression. Using the Folstein Mini-Mental State Examination (MMSE), cognitive function was assessed. Using SPSS software, the Chi-square, Kruskal-Wallis test, and Spearman's rho correlation coefficient were computed. Results: In the present study, it was observed that only 30.4% of the respondents who are community-dwelling elderly had normal MNA score, whereas 69.6% were at risk of malnutrition or already malnourished. Considering institutionalised elderly it was observed that only 7.2% were normal and 92.8% were malnourished/at risk of malnutrition. Statistically significant association was observed between nutritional status and mental health status (P = 0.00) as well as cognitive function (P = 0.00) among old age home residing elderly. Among the community-dwelling elderly mental health status has significant association with their nutritional status (P = 0.00) and cognitive function (P = 0.00) as well. Conclusions: Community-dwelling elderly were relatively healthy compared to old age home residents. Maintaining the nutritional, cognitive, and mental health of institutionalised and community-dwelling elderly women requires the implementation of physical and cognitive stimulation activities as well as interventions targeted at improving a healthy diet.

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BACKGROUND: The creative process of visual artmaking provides an opportunity for older women to express themselves and explore their emotions, thoughts, and experiences. This study examined the roles of visual artmaking in older women's lives in general and in relation to the ongoing challenges of aging. METHODS: The sample was composed of 21 Israeli women aged 60-90, who indicated that they produced visual artworks on an ongoing basis. The participants' artworks were collected, and semi-structured in-depth interviews were conducted. RESULTS: A thematic analysis of the interviews revealed 4 themes: visual artmaking to address the challenges of older women's lives, artwork as a framework for doing, visual artmaking to support the wellbeing of older women, artwork as channel of communication and stronger ties with family members. CONCLUSIONS: The findings contribute to a better understanding of the roles of visual art in older women's lives, especially in times of crisis.

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BACKGROUND: Urinary incontinence (UI) is a highly prevalent condition in women with a profound influence on their well-being and quality of life. Pelvic floor muscle training (PFMT) is a widely accepted conservative management of incontinence. Adequate knowledge of PFMT can enhance the ability of individuals to perform them effectively unsupervised. OBJECTIVES: This study aimed to determine the prevalence of UI and knowledge of PFMT among older women in a selected suburban community in Nigeria. DESIGN: A cross-sectional design. METHODS: This study consecutively recruited 121 older women (65 years and above) with a mean age of 68.59 ± 4.94 years in Nnewi North LGA Anambra state, Nigeria. The International Consultation on Incontinence Questionnaire Short Form and an adopted pre-tested questionnaire were used to assess the prevalence of UI and knowledge of PFMT. Data was analyzed using Statistical Package of Social Sciences (SPSS) version 26 Descriptive statistics, and the chi-square test was utilized with significance determined at an alpha level of 0.05. RESULTS: The results revealed that 33.88% of the respondents experience UI, and 3.3% of them have heard about PFMT. There was significant association between prevalence of UI and number of pregnancies (χ2 = 11.16, p = 0.03) and children (χ2 = 9.77, p = 0.04). There was no significant association between the prevalence of UI and level of education (χ2 = 4.20, p = 0.12) and knowledge of PFMT (χ2 = 0.48, p = 0.42). There was no significant association between knowledge of PFMT and number of pregnancies (χ2 = 04.25, p = 0.37), and number of children (χ2 = 4.02, p = 0.40). There was a significant association between knowledge of PFMT and level of education among the participants (χ2 = 7.46, p = 0.02). CONCLUSION: The study showed a significant prevalence of UI and poor knowledge of PFMT in older women. Health professionals should sensitize older women in hospitals and care homes on the benefits of PFMT to improve their knowledge of PFMT.

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OBJECTIVE: This qualitative descriptive study draws on data collected from a sub-sample of 15 women participating in a national study (n = 60) exploring the breast cancer screening motivations and behaviours of women aged ≥75 years. The study aimed to understand why women living in rural and remote areas might continue accessing mobile breast cancer screening despite being outside the targeted age range. SETTING: Settings ranged from large towns to very remote communities (according to Monash Modified Model (MMM) classification 3-7) where BreastScreen Australia mobile screening services were available. PARTICIPANTS: Interview data from 15 women aged ≥75 years living in rural and remote locations who had used mobile screening services was utilised for this study. DESIGN: In-depth individual interviews were conducted via telephone or online platform (Zoom). These were transcribed verbatim and imported into NVivo software to enable thematic analysis to identify key themes. RESULTS: Many women aged ≥75 years in rural and remote areas expressed clear intentions to continue breast cancer screening, despite no longer being invited to do so. They perceived great value in the mobile service and were highly appreciative for it yet acknowledged limited sources of information about the process of ongoing screening. CONCLUSION: Few women in rural and remote areas had discussed ongoing breast cancer screening with their general practitioner (GP). More information is required to inform women about the risks and benefits of ongoing screening. Without an invitation to attend screening rural women reported difficulty in knowing when the service would be available. Ongoing notification of the availability of mobile services for women aged ≥75 years in rural areas is recommended.

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BACKGROUND: Saudi Arabia, like many nations globally, is experiencing a demographic shift towards an aging population. With this demographic shift, falls and the fear of falling (FOF) emerge as serious public health concerns among community-dwelling older adults. Addressing misconceptions and enhancing awareness regarding fall risks among older adults holds significant importance, offering insights for informing targeted interventions and enhancing well-being. This study aimed to examine knowledge and perceptions of fall risk among community-dwelling older women in Saudi Arabia. METHODS: A cross-sectional study was conducted with 150 Saudi older women, with a mean age (SD) of 63.98 (4.90) years. Participants completed questionnaires assessing fall history, fall knowledge, fall perception, the Falls Efficacy Scale-International (FES-I), Timed Up and Go (TUG), and the Barthel Index. Fall knowledge and perception were assessed using previously constructed statements translated into Arabic and carried out in interviewer-administered forms. RESULTS: Nearly half of the participants reported experiencing at least one fall in the previous 12 months. Despite good knowledge of falls, some gaps were identified, particularly regarding the awareness of social isolation as a consequence of falls. Participants demonstrated positive perceptions towards fall prevention programs but also highlighted misconceptions regarding aging and falls. FOF was prevalent, with higher levels identified among participants without a history of falls. CONCLUSION: Multidimensional strategies are needed to address falls and FOF among community-dwelling older women in Saudi Arabia. Leveraging existing knowledge and perceptions towards fall prevention and implementing evidence-based interventions can reduce the burden of falls and enhance health outcomes in older adults. Future research should focus on diverse samples and evaluate the feasibility of implementing fall prevention interventions within Saudi Arabia's healthcare systems.

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BACKGROUND: Young women with breast cancer (YWBC; ≤40 years) often have a poorer prognosis than older women with breast cancer (OWBC; ≥65 years). We explored molecular features of tumors from YWBC and OWBC to identify a biologic connection for these patterns. MATERIALS AND METHODS: We retrospectively analyzed the molecular profiles of 1879 breast tumors. Testing included immunohistochemistry (IHC), in situ hybridization (ISH), and next-generation sequencing. Statistical analyses included Pearson's chi2 test for comparisons, with significance defined as FDR (false discovery rate)-P < .05. RESULTS: TP53 and BRCA1 somatic mutations were more common in YWBC tumors than in OWBC tumors (53%, 42%; P = .0001, FDR-P = .0025 and 7%, 2%; P = .0001, FDR-P = .0025; respectively). Conversely, OWBC tumors had higher androgen receptor expression (55%, 45%; P = .0002, FDR-P = .0025) higher PD-L1 expression detected by IHC (8%, 5%; P = .0476, FDR-P = .2754), and more frequent PIK3CA mutations (33%, 17%; P = < .0001, FDR-P = < .0001). Among HR+/HER2- samples, YWBC had more gene amplifications in FGF3 (27%, 10%; P = .0353, FDR-P = .2462), FGF4 (27%, 9%; P = .0218, FDR-P = .1668), FGF19 (30%, 12%; P = .034, FDR-P = .2462) and CCND1 (37%, 18%; P = .0344, FDR-P = .2462) than OWBC. CONCLUSIONS: Our data suggest distinct molecular aberrations exist between YWBC and OWBC. Exploiting these molecular changes could refine our treatment strategies in YWBC and OWBC.

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While many studies have described the association between cognitive decline and eating habits, little attention has been paid to its association with cheese intake. In this epidemiological study of 1035 community-dwelling women aged ≥ 65, we investigated the association between intake/type of cheese and cognitive function. The anthropometry, functional ability, and the frequency of food intake, including cheese, were assessed. The mini-mental state examination (MMSE) was used to assess cognitive function, and a score of 20-26 was operationally defined as mild cognitive decline. We found that the MMSE score was significantly different between the presence of cheese intake and not (cheese intake: 28.4 ± 1.9; non-cheese intake: 27.6 ± 2.4) and between those who consumed Camembert cheese and those who did not (Camembert cheese: 28.7 ± 1.4; others: 28.3 ± 2.0). After adjusting for confounders, multiple logistic regression identified four independent variables significantly associated with mild cognitive decline: Camembert cheese intake (odds ratio = 0.448, 95% confidence interval = 0.214-0.936), age, usual walking speed, and repetitive saliva swallowing test scores. Our results, while based on cross-sectional data from Japanese community-dwelling older women, identified the significant inverse association between Camembert cheese intake and mild cognitive decline.

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BACKGROUND: Older adult women often do not engage in sufficient physical activity (PA) and can encounter biological changes that exacerbate the negative effects of inadequate activity. Wearable activity monitors can facilitate PA initiation, but evidence of sustained behavior change is lacking. Supplementing wearable technologies with intervention content that evokes enjoyment, interest, meaning, and personal values associated with PA may support long term adherence. In this paper, we present the protocol of an NIA-funded study designed to evaluate the efficacy of CHALLENGE for increasing step count and motivation for PA in insufficiently active older women (Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-based Exercise). CHALLENGE uses social media to supplement wearable activity monitors with the autonomy-supportive frame of a game. We hypothesize that CHALLENGE will engender playful experiences that will improve motivation for exercise and lead to sustained increases in step count. METHODS: We will recruit 300 healthy, community dwelling older adult women on a rolling basis and randomize them to receive either the CHALLENGE intervention (experimental arm) or an activity monitor-only intervention (comparison arm). Participants in both groups will receive a wearable activity monitor and personalized weekly feedback emails. In the experimental group, participants will also be added to a private Facebook group, where study staff will post weekly challenges that are designed to elicit playful experiences while walking. Assessments at baseline and 6, 12, and 18 months will measure PA and motivation-related constructs. We will fit linear mixed-effects models to evaluate differences in step count and motivational constructs, and longitudinal mediation models to evaluate if interventional effects are mediated by changes in motivation. We will also conduct thematic content analysis of text and photos posted to Facebook and transcripts from individual interviews. DISCUSSION: By taking part in a year-long intervention centered on imbuing walking behaviors with playful and celebratory experiences, participating older adult women may internalize changes to their identity and relationship with PA that facilitate sustained behavior change. Study results will have implications for how we can harness powerful and increasingly ubiquitous technologies for health promotion to the vast and growing population of older adults in the U.S. and abroad. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT04095923. Registered September 17th, 2019.

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Inspired by Freud's "Mourning and Melancholia" and expanding upon his notions within the social context, this article proposes an innovative concept called "age melancholy" to describe the multifaceted elements of social loss experienced by empty nest older adults. While most studies emphasize a psychological-individualist approach to this phenomenon, age melancholy frames older age as a process marked by a loss of social engagements. The findings are grounded in anthropological fieldwork conducted from 2010 to 2013 in a lower-income neighborhood of Tel Aviv. They are based on deductive comprehension of social melancholy, combined with inductive qualitative analyses of 29 meetings within a designated narrative group of older Mizrahi women-Jewish immigrants from Islamic countries. The results reveal that empty nest older adults perceive their loneliness, fragile health, and approaching death as interrelated aspects of social detachment, leading to melancholy. However, whereas their emotional experiences are tainted by age melancholy, it is temporal and contextual and may be mitigated through social support.

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OBJECTIVES: To examine the effects of foot dominance and body mass on foot plantar pressures in older women of regular, overweight, and obese weights. METHODS: 96 female adults were divided into regular-weight group (68.30 ± 4.19 yr), overweight group (69.88 ± 3.76 yr), and obesity group (68.47 ± 3.67 yr) based on their body mass index scores. Footscan® plantar pressure test system was used to assess the dynamic plantar pressures, and parameters were collected from risk analysis, foot axis analysis, single foot timing analysis, and pressure analysis. RESULTS: (1) The local risks of lateral forefoot and midfoot, the minimum and maximum subtalar joint angles, the flexibility of subtalar joint, foot flat phase, as well as the average pressures on toes, metatarsals,, midfoot, and lateral heel, with the peak pressures on toe 2-5, metatarsal 2, metatarsal 5, midfoot, and lateral heel had significant within-subject differences. (2) The phases of initial contact and foot flat, the average pressures on toe 2-5, metatarsals, midfoot, and heels, with the peak pressures on metatarsal 1-4, midfoot, and heels exhibited significant between-subjects differences. (3) There was an interaction effect of foot dominance and body mass index on the flexibility of subtalar joint. CONCLUSIONS: The non-dominant foot works better for stability, especially when touching on and off the ground. The dominant foot works better for propulsion but is more susceptible to pain, injury, and falls. For obese older women, the forefoot and midfoot are primarily responsible for maintaining stability, but the lateral midfoot and hindfoot are more prone to pain and discomfort.

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OBJECTIVE: To evaluate the conditional effect of time spent in the kitchen on the association between frailty status and healthy diet among older women. DESIGN: Secondary analysis of an online cross-sectional survey conducted in January 2023. PARTICIPANTS: Six hundred Japanese women (aged ≥ 65 years). MAIN OUTCOME MEASURE(S): Frailty status evaluated using the Kihon Checklist (25 affirmative questions assessing daily functions, weight status, and mental condition); healthy diet assessed by the days of consuming ≥ 2 meals that include staple, main and side dishes in a meal (SMS meal) in a day; and time spent in the kitchen. ANALYSIS: Moderation analysis was used to evaluate the conditional effect of time spent in the kitchen on frailty status and SMS meal intake. Chi-square tests for independence were used to evaluate the differences in the Kihon Checklist items by frailty status. RESULTS: Spending longer time in the kitchen indicated more frequent SMS meal intake and the trend was stronger among older women with frailty than those with robustness. All items except for 1 item regarding weight status (P = 0.15) were significantly associated with frailty status (P < 0.001). CONCLUSIONS AND IMPLICATIONS: Further studies are needed to evaluate the causal relationship between frailty status, healthy diet, and kitchen use.

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This study aimed to assess and compare changes in body composition, standing balance, cardiovascular parameters, and salivary biomarkers, particularly salivary antioxidant status, after brisk walking training with or without music in older women. Twenty-four subjects were randomly assigned to brisk walking groups: with music (BWM) (n=12) or without music (BW) (n=12). Eighteen subjects completed the exercise training (9 in each group), and their data were used for analysis. The research protocols were classified into three phases: pretraining phase, training phase, and posttraining phase, while the data collection was divided into four sessions: resting condition, during treadmill exercise testing, immediately posttreadmill exercise testing, and 5-min posttreadmill exercise testing defined as after the cool-down session. The results showed that 8 weeks of home-based brisk walking with or without music did not improve standing balance, blood pressure, salivary biomarkers including total protein concentration, and antioxidant status but maintained or prevented the decline of these parameters. Only the BWM group reduced fat mass relative to increasing fat-free mass (P<0.05) and improved recovery heart rate (P<0.05) by modifying cardiac autonomic control in posttreadmill exercise testing. Therefore, brisk walking with preferred music can be a tool to delay the progression of cardiovascular dysfunction in older women. A longer duration of the exercise program and larger groups of participants are needed for further investigation of brisk walking with or without music on physiological and biochemical changes.

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Objectives: To investigate the unique challenges faced by older women during the COVID-19 pandemic regarding social connection, feelings of loneliness, and their subsequent impact on mental health and well-being. Method: A qualitative research methodology is used to examine how older women experienced loneliness, social relationships, and mental health consequences during the COVID-19 pandemic. Results: The results are discussed in terms of two main themes each with their sub-themes; 1. Social Connection amidst Physical Distancing Measures, 2. Impact on Mental Health and Well-being. Conclusion: The study highlights the significant impact of loneliness and social isolation on the mental health of older women during the COVID-19 pandemic, emphasizing the need for targeted interventions and support systems.

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Background: This study investigates the effects of a 12-week circuit exercise program on blood pressure, vascular function, and inflammatory cytokines in older obese women with sarcopenia. Methods: Twenty-eight older obese women with sarcopenia (mean age: 78.2 ± 3.7 years) were randomly divided into an exercise group (EG, n = 14) and a control group (CG, n = 14). The EG participated in a 12-week circuit exercise training regimen, conducted three times weekly, with each session lasting between 45 to 75 minutes (progressively increased over time). The CG was advised to maintain their regular daily routines throughout the intervention period. All dependent variables, including blood pressure, vascular function, and inflammation cytokines, were evaluated pre- and post-intervention. Results: Positive changes were observed in the EG in body composition (body fat mass; p < 0.001, body fat percentage; p < 0.01, free-fat mass; p < 0.01), blood pressure (heart rate; p < 0.05, rate pressure product; p < 0.01), vascular function (brachial-ankle pulse wave velocity; p < 0.05, flow-mediated dilation; p < 0.001), and inflammation cytokines (interleukin-6; p < 0.05). In the CG, there was an increase in body fat mass (p < 0.05) and body fat percentage (p < 0.05), while no changes were observed in other variables. Conclusions: The 12-week circuit exercise program significantly reduced blood pressure, improved vascular function, and decreased inflammatory cytokines in obese older women with sarcopenia. However, individual variations in response highlight the need for personalized exercise regimens.

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BACKGROUND: Multi-morbidity is a pervasive and growing issue worldwide. The prevalence of multi-morbidity varies across different populations and settings, but it is particularly common among older adults. It poses substantial physical, psychological, and socio-economic burdens on individuals, caregivers and healthcare systems. In this context, the present study aims to provide an insight on the prevalence and degree of multi-morbidity; and also, on the relationship between level of multi-morbidity and morbid conditions among a group of slum-dwelling older women. METHODS: This community based cross-sectional study was conducted in the slum areas of urban Kolkata, West Bengal, India. It includes total 500 older women, aged 60 years or above. Pre-tested schedules on so-demographic and morbidity profile have canvassed to obtain the information by door-to-door survey. To determine the relationship between the level of multi-morbidity and morbid conditions, correspondence analysis has performed. RESULTS: The study revealed three most prevalent morbid conditions- back and/or joint pain, dental caries/cavity and hypertension. The overall prevalence of multi-morbidity was 95.8% in this group of older women. It was highly over-represented by the oldest-old age group (80 years and above). Majority were found to suffer from five simultaneous morbid conditions that accounted for 15.2% of the total respondents. All of the oldest-old women of this study reported to suffer from more than two medical conditions simultaneously. Three distinct groups were formed based on the inter-relationship between level of multi-morbidity and morbid conditions. The group 1 and 2 represents only 27.8% and 18% of the total sample. Whereas, group 3 comprises the highest level of morbidities (≥ 6) and 52.8% of total sample, and strongly related with general debilities, cardiac problems, asthma/COPD, gastrointestinal, musculoskeletal problems, neurological disorders, hypothyroidism and oral health issues. CONCLUSION: The findings confirmed the assertion that multi-morbidity in slum living older adults is a problem with high prevalence and complexity. This study proposes an easily replicable approach of understanding complex interaction of morbidities that can help further in identifying the healthcare needs of older adults to provide them with healthy and more productive life expectancy.

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OBJECTIVE: To determine risk factors and to develop a risk prediction score for intrapartum cesarean delivery (CD) in women over 40 years old. STUDY DESIGN: A retrospective cohort study, in a single university-affiliated tertiary medical center. All women aged 40 years or more who planned a trial of labor between 2012 and 2022. Women who opted for an elective CD and those with non-viable fetuses were excluded. Maternal and neonatal characteristics of women who delivered vaginally were compared to those who underwent an intrapartum CD. Risk factors were examined using univariate and multivariate analysis. A score was developed to predict the need for intrapartum CD. We assessed a receiver operating characteristic curve to evaluate the performance of our model. MAIN OUTCOME MEASURE: An unplanned intrapartum cesarean section. RESULTS: During the study period, 122,583 women delivered at our center, of whom 6122 (4.9 %) aged 40 years or more attempted a trial of labor. Of them, 428 (7 %) underwent intrapartum CD. Several independent risk factors were identified, including nulliparity, regional anesthesia, induction of labor, use of antibiotics during labor, multiple gestation, previous cesarean delivery, and the presence of gestational diabetes or preeclampsia. A risk score model, employing a cut-off of 7, demonstrated successful prediction of intrapartum CD, with an area under the curve of 0.86. CONCLUSION: The score model for intrapartum CD can be used by caregivers to offer a more informed consultation to women aged 40 years or more deciding on the mode of delivery.

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The Physical Activity Scale for the Elderly (PASE) is a validated test to assess physical activity in older people. It has not been investigated if physical activity, according to PASE, is associated with fracture risk independently from the clinical risk factors (CRFs) in FRAX, bone mineral density (BMD), comorbidity, and if such an association is due to differences in physical performance or bone parameters. The purpose of this study was to evaluate if PASE score is associated with bone characteristics, physical function, and independently predicts incident fracture in 3014 75-80-yr-old women from the population-based cross-sectional SUPERB study. At baseline, participants answered questionnaires and underwent physical function tests, detailed bone phenotyping with DXA, and high-resolution peripheral quantitative CT. Incident fractures were X-ray verified. Cox regression models were used to assess the association between PASE score and incident fractures, with adjustments for CRFs, femoral neck (FN) BMD, and Charlson comorbidity index. Women were divided into quartiles according to PASE score. Quartile differences in bone parameters (1.56% for cortical volumetric BMD and 4.08% for cortical area, Q4 vs Q1, p = .007 and p = .022, respectively) were smaller than quartile differences in physical performance (27% shorter timed up and go test, 52% longer one leg standing time, Q4 vs Q1). During 8 yr (median, range 0.20-9.9) of follow-up, 1077 women had any fracture, 806 a major osteoporotic fracture (MOF; spine, hip, forearm, humerus), and 236 a hip fracture. Women in Q4 vs. Q1 had 30% lower risk of any fracture, 32% lower risk of MOF, and 54% lower risk of hip fracture. These associations remained in fully adjusted models. In conclusion, high physical activity was associated with substantially better physical function and a lower risk of any fracture, MOF and hip fracture, independently of risk factors used in FRAX, FN BMD, and comorbidity.

The Physical Activity Scale for the Elderly (PASE) is a test to assess physical activity in older people. The purpose of this study was to evaluate if physical activity, according to PASE, is associated with bone parameters, physical function, and independently predicts future fracture in 3014 75­80-yr-old women from the population-based SUPERB study. At baseline, participants answered questionnaires, underwent physical function tests, and DXA. Subsequent fractures were X-ray verified. Women were divided into quartiles according to PASE score (Q1 least and Q4 most physically active). Women in Q4 had 27% shorter timed up and go test and 52% longer one leg standing time compared with Q1. During 8 yr of follow-up, 1077 women had any fracture, 806 a major osteoporotic fracture (MOF; spine, hip, forearm, humerus), and 236 a hip fracture. Women in Q4 vs. Q1 had 30% lower risk of any fracture, 32% lower risk of MOF, and 54% lower risk of hip fracture. These associations remained in models considering comorbidity, BMD, and clinical risk factors. In conclusion, high physical activity was independently associated with better physical function and a lower risk of any fracture.

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Hattie in Saul Bellow's "Leaving the Yellow House" and Sammler in Bellow's Mr. Sammler's Planet are both elderly characters. This article intends to compare the two characters from a gender perspective, to illustrate how these characters appear to experience and respond to old age and how other characters in these two fictions respond to the old age of their respective elderly characters. The comparison of these two characters in the fiction of Saul Bellow gives rise to the observation that old age is not merely a phase of negative changes but also of positive ones; ageism claims victims among both men and women whose suffering is aggravated by other kinds of injustice, such as racism and sexism.

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