Background: Digital health interventions have the potential to improve health at a large scale globally by improving access to healthcare services and health-related information, but they tend to benefit more affluent and privileged groups more than those less privileged.

The Short Physical Performance Battery (SPPB) is an objective tool for evaluating three domains (balance, repeated chair stands, and gait speed) of lower extremity physical function in older age. It is unclear how the associations between SPPB scores and health outcomes persist over time. The aim of this 14-year cohort study was to investigate associations between SPPB scores and health outcomes among participants aged 60+ years in the English Longitudinal Study of Ageing (ELSA). The exposures were SPPB scores (total and domain-specific) at baseline (Wave 2). The outcomes were mobility impairments, difficulties in performing basic activities of daily living (ADL) or instrumental activities of daily living (IADL), and falls, measured at seven subsequent timepoints (Waves 3 to 9). The analyses involved linear and logistic multilevel regressions. After adjusting for potential confounders, a one-point increase in the total SPPB score was associated with a 0.13 (95% CI: −0.16, −0.10) decrease in mobility impairment, a 0.06 (−0.08, −0.05) decrease in ADL disabilities, a 0.06 (−0.07, −0.04) decrease in IADL disabilities, and 8% (0.90, 0.95) lower odds of falling (averaged across all follow-ups). Associations between the SPPB domains and health outcomes were more varied. The SPPB may be a useful measure for identifying older adults at a high risk of adverse outcomes.

Introduction The influence of the COVID-19 pandemic on physical activity behaviour in older adults is of particular concern. However, little is yet known about how pre-existing socioeconomic inequalities in older adults’ physical activity have been affected by the COVID-19 pandemic. The aim of this study was to explore socioeconomic disparities in physical activity levels and change over time among older adults in England, using data collected before and during the COVID-19 pandemic. Methods This longitudinal cohort study analysed data from 3720 older adults (aged 60+ years) who participated in wave 9 (2018/2019) of the main English Longitudinal Study of Ageing (ELSA) survey and wave 2 of the ELSA COVID-19 substudy (November/December 2020). Using multilevel ordinal logistic models, we investigated associations between socioeconomic variables (education, occupational class and wealth) and physical activity, adjusting for potential confounders. We also examined interactions between socioeconomic variables and time (prepandemic vs intrapandemic) to investigate changes in the magnitude of inequalities in physical activity across the two survey periods. Results The proportion of participants considered ‘inactive’ rose from 5.7% before the COVID-19 pandemic to 12.5% in November and December 2020. Higher education, occupational class and wealth were positively associated with physical activity before the lockdown. These socioeconomic disparities generally persisted during the COVID-19 pandemic. There was some evidence that differences in physical activity based on education and occupational class reduced during the COVID-19 pandemic, relative to prepandemic data. However, these associations were no longer statistically significant when the three socioeconomic variables and their interactions with time corrected for one another (p>0.05). Conclusion Our results suggest there was no additional influence of the COVID-19 pandemic on pre-existing socioeconomic inequalities in older adults’ physical activity levels.

Understanding digital exclusion in older adults during the COVID-19 pandemic could help tailor responses to future outbreaks. This cohort study used data from older adults aged 60+ years in England who participated in wave nine (2018/2019) of the main English Longitudinal Study of Ageing (ELSA) survey, and/or wave one of the ELSA COVID-19 sub-study (June/July 2020). Using latent class analysis and latent transition analysis, we aimed to identify distinct subgroups of older adults characterised by different patterns of internet use pre- and intra-pandemic, explore the extent to which individuals remained in the same subgroup or transitioned to a different subgroup during the COVID-19 pandemic, and examine longitudinal associations of socio-economic factors (education, occupational class, and wealth) with latent class membership. Preliminary tests showed that the types of internet activities differed between men and women; therefore, subsequent analyses were stratified by biological sex. Three clusters (low, medium, and high) were identified in male participants at both timepoints. Among female participants, three clusters were distinguished pre-pandemic and two (low versus high) during the pandemic. The latent classes were characterised by participants’ breadth of internet use. Higher education, occupational class, and wealth were associated with greater odds of membership in the medium and/or high classes, versus the low class, in men and women. A high degree of stability in latent class membership was observed over time. However, men experienced a stark decrease in online health information-seeking. Our results highlight that inequality regarding the range of functional and social opportunities provided by the internet prevailed during the pandemic. Policymakers should ensure that digital access and upskilling initiatives are equitable for all.

Intrinsic capacity is inversely associated with disability; however, little is known about how the magnitude of this association varies leading up to death. Using time-varying effect modeling (TVEM), a statistical tool for capturing dynamic patterns of change, we evaluated the association between intrinsic capacity and disability as a function of time before death. Data were analyzed from 746 participants aged 70+ years of the Precipitating Events Project in the United States who died through 2024. Intrinsic capacity was assessed at baseline and subsequently at 18-month intervals using 25 items. Intrinsic capacity scores (range: 0–100) were derived using Bayesian Multilevel Item Response Theory. Disability was assessed monthly and defined as dependence in instrumental activities of daily living. TVEM was applied to evaluate the association between intrinsic capacity and disability, anchored to participants’ time of death. Trajectories using a backwards timescale spanning 20 years showed a gradual decline in average intrinsic capacity from 80 (95% CI 77–83) to 47 (45–48) points and a non-linear rise in the probability of disability. The inverse association between intrinsic capacity (per 10-point increase) and disability strengthened as death approached. In the last 4 years of life, adjusted odds ratios ranged from 0·56 (95% CI 0·46–0·68) to 0·58 (0·50–0·68). The association between intrinsic capacity and disability emerged roughly 14 years before death, suggesting that intrinsic capacity could serve as an early marker of functional decline and potentially guide the development of targeted interventions. National Institute on Aging.

Background and Objectives: Smartphone-based Ecological Momentary Assessment (EMA) is increasingly used to collect real-time data on physical activity behavior. However, no activity-triggered EMA studies have been conducted among low-income older adults. We aim to assess the feasibility and acceptability of activity-triggered EMA in low-income older adults. Research Design and Methods: Researchers partnered with community organizations and provided technical support to facilitate the recruitment and retention of low-income older adults. For 7 days, 39 older adults (76.4 ± 8.5 years; 76% earning below £25 000/year) received EMA surveys when they surpassed a predefined activity/inactivity threshold, or when two hours elapsed between prompts. Participants wore a Move 4 activity sensor to measure their steps. A post-study questionnaire assessed perceptions of acceptability. Results: Participants completed 84% of the EMA surveys they received. EMA compliance did not appear to differ as a function of age, biological sex, time of day, day of week, or concurrent physical activity. Responses to the post-study questionnaire revealed that the most enjoyable aspects of participating in the study were making a worthwhile contribution to science and becoming more self-aware of their feelings and/or activities. The least enjoyable aspects included the frequency or timing of EMA prompts, the interruption of activities to complete an EMA survey, and limited or inadequate response options for certain EMA items. Discussion and Implications: Smartphone-based, activity-triggered EMA is feasible and acceptable among low-income older adults. Fostering community partnerships, managing participant resource constraints, and providing technical support are crucial strategies for engaging and retaining this population in mobile health research.