BackgroundThe promotion and maintenance of higher physical activity (PA) levels in the older population is an imperative for cognitive and healthy ageing but it is unclear what approaches are best suited to achieve this for the increasing number of older people living in the community. Effective policies should be informed by robust, multi-disciplinary and multi-dimensional evidence, which not only seeks what works, but in ‘what context? In addition to evidence on the efficacy and effectiveness of PA for maintaining cognitive health, social contexts such as ‘how do we actually get older people to partake in PA?’ and ‘how do we sustain that activity long-term?’ also need highlighting. This review is part of a comprehensive evidence synthesis of preventive interventions in older age, with a focus on healthy behaviours to identify evidence gaps and inform policy relating to ageing well and cognitive health. An overview of systematic reviews of PA was conducted to explore three topics: (1) PA efficacy or effectiveness for primary prevention of cognitive decline in 55+; (2) Interventions efficacious or effective for increasing PA uptake and maintenance in 55+; (3) barriers and facilitators to PA in 55+.MethodsMultiple databases were searched for studies in English from OECD countries between 2000 and 2016. Quality of included reviews in questions (1) and (2) were assessed using AMSTAR. Review protocols were registered on PROSPERO (CRD42014015554, 42014015584, CRD42014015557) and reviews follow PRISMA guideline.FindingsOverall, 40 systematic reviews were included. Question 1 (n = 14). 8,360 participants. Evidence suggests that PA confer mild positive effects on cognition in older adults with and without previous cognitive impairment. However, there is insufficient evidence of a dose-response relationship. Evidence on the effects of PA on delay of dementia onset is inconclusive. Question 2 (n = 17). 79,650 participants. Evidence supports the effectiveness of a variety of interventions, including group delivered, centre-based and cognitive approaches on short-term uptake of PA behaviour. Question 3 (n = 9). 22,413 participants. Barriers include health status, previous PA habits and experiences, and cultural sensitivity, while facilitators include enjoyable activities and convenient scheduling.ConclusionPA can offer small benefits to brain health, but evidence on how much activity is required to produce this effect is lacking. Evidence on the effectiveness of PA for preventing dementia and cognitive decline is lacking. Behavioural (walking, exercise) and cognitive (counselling and motivational interviews) interventions are effective for short-term uptake of physical activity in older people. In order to maintain long-term participation in PA, individualised interventions modelled using behavioural theories may be required. Public health messages should be aimed at promoting acceptable levels of PA above normal daily activities in older people. Policy and strategies aimed at increasing PA in older people should be encourag...

BackgroundHarmful alcohol consumption in older people has increased and effective approaches to understanding and addressing this societal concern are needed.MethodsSystematic review of qualitative studies in older populations (55+ years) to identify barriers, facilitators or context of drinking in older people. Multiple databases (MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL, Social Sciences Citation Index, York Centre for Reviews and Dissemination, Cochrane database and grey literature) were searched from 2000 to February 2017 for studies in English, from OECD countries using MeSH terms and text words relating to alcohol combined with older age terms. Study quality was assessed using NICE methodology. The review is reported according to PRISMA.ResultsDrinking in older people is strongly linked to social engagement and there is scepticism about the health risks of alcohol. Drinking was also linked to difficulties such as social isolation, illness or bereavement. Alcohol can be related to routines and identity. However, older people often regulate their own drinking and strategies that emphasise the life experience of older people to drink wisely could be helpful.ConclusionsTo be effective societal approaches need to take into account contexts of risks for harmful drinking. The evidence supports a strong social role for drinking alcohol which should be taken into account in any policy development with the potential benefits of social participation for cognitive health. Approaches to reducing alcohol use in older people need to avoid paradoxical harm, with a need for approaches that reduce harm from drinking alcohol but retain the benefit of socialising.

Background: Physical activity can improve cognitive function of older adults, but the influence of sedentary behaviour on cognition is less clear. This systematic review investigated associations between sedentary behaviour and cognitive function in older adults without dementia, and possible mechanisms involved.Methods: Major databases were searched for studies in English between 01/01/1999 and 31/10/2019. The systematic review followed COSMOS-E guideline and a pre-registered protocol (CRD42019122229). Risk of bias was assessed using NICE Quality appraisal checklist. Findings were narratively synthesized and presented.Findings: Eighteen studies comprised of Thirteen cross-sectional and five longitudinal analyses (n= 40,228). Evidence suggested varied associations between varied sedentary behaviours and cognitive function in older adults. 50% of study analyses did not control for physical activity. 3/18 studies demonstrated associations between higher sedentary levels and lower levels of brain biomarkers, while 1/18 showed auto-regulatory effect in the left hippocampus. Conducting a meta-analysis was not justifiable due to considerable methodological, participant, outcome and exposure heterogeneity. Conclusion:There is a lack of clarity about the overall and independent association between sedentary behaviour and cognition in older age. Underlying mechanisms are similar to physical activity and probably multi-modal. More studies with robust designs and methodology are needed to confirm effect of sedentary behaviour on cognition.

IntroductionGlobally, dementia is the most frequent form of degenerative condition in the older adult population and poses a major health burden with high socioeconomic costs. So far, attempts to find pharmacologic interventions that can change the onset or progression of dementia have been largely unsuccessful, prompting a shift to focus on interventions aimed at modifying risk factors that occur throughout the life course.MethodsThe Cognitive Function and Ageing Studies, funded by the Medical Research Council, UK, convened three multidisciplinary groups of experts, expert witnesses, and advocates to discuss the state of evidence on primary, secondary, and tertiary dementia prevention and recommend future direction for intervention studies.ResultsUsing the United Kingdom Parliamentary Select Committees' approach to gathering evidence, the primary prevention working group focused their deliberation on risk factors strongly associated with dementia. The group highlighted the need for high-quality studies to assess the effects of behavioral intervention on the delay of cognitive decline and dementia onset.DiscussionThe working group recommended that the development of a future dementia prevention trial should use a multimodal, multifactor, multilevel, community and individually tailored approach.

Backgroundharmful alcohol consumption is reported to be increasing in older people. To intervene and reduce associated risks, evidence currently available needs to be identified.Methodstwo systematic reviews in older populations (55+ years): (1) Interventions to prevent or reduce excessive alcohol consumption; (2) Interventions as (1) also reporting cognitive and dementia outcomes. Comprehensive database searches from 2000 to November 2016 for studies in English, from OECD countries. Alcohol dependence treatment excluded. Data were synthesised narratively and using meta-analysis. Risk of bias was assessed using NICE methodology. Reviews are reported according to PRISMA.Resultsthirteen studies were identified, but none with cognition or dementia outcomes. Three related to primary prevention; 10 targeted harmful or hazardous older drinkers. A complex range of interventions, intensity and delivery was found. There was an overall intervention effect for 3- and 6-month outcomes combined (8 studies; 3,591 participants; pooled standard mean difference (SMD) −0.18 (95% CI −0.28, −0.07) and 12 months (6 studies; 2,788 participants SMD −0.16 (95% CI −0.32, −0.01) but risk of bias for most studies was unclear with significant heterogeneity. Limited evidence (three studies) suggested more intensive interventions with personalised feedback, physician advice, educational materials, follow-up could be most effective. However, simple interventions including brief interventions, leaflets, alcohol assessments with advice to reduce drinking could also have a positive effect.Conclusionsalcohol interventions in older people may be effective but studies were at unclear or high risk of bias. Evidence gaps include primary prevention, cost-effectiveness, impact on cognitive and dementia outcomes.