The impact of aerobic and resistance training intensity on markers of neuroplasticity in health and disease

ObjectiveTo determine the effects of low- vs. high-intensity aerobic and resistance training on motor and cognitive function, brain activation, brain structure, and neurochemical markers of neuroplasticity and the association thereof in healthy young and older adults and in patients with multiple sclerosis, Parkinson’s disease, and stroke.DesignSystematic review and robust variance estimation meta-analysis with meta-regression.Data sourcesSystematic search of MEDLINE, Web of Science, and CINAHL databases.ResultsFifty studies with 60 intervention arms and 2283 in-analyses participants were included. Due to the low number of studies, the three patient groups were combined and analyzed as a single group. Overall, low- (g=0.19, p = 0.024) and high-intensity exercise (g=0.40, p = 0.001) improved neuroplasticity. Exercise intensity scaled with neuroplasticity only in healthy young adults but not in healthy older adults or patient groups. Exercise-induced improvements in neuroplasticity were associated with changes in motor but not cognitive outcomes.ConclusionExercise intensity is an important variable to dose and individualize the exercise stimulus for healthy young individuals but not necessarily for healthy older adults and neurological patients. This conclusion warrants caution because studies are needed that directly compare the effects of low- vs. high-intensity exercise on neuroplasticity to determine if such changes are mechanistically and incrementally linked to improved cognition and motor function.     

Types of exercise and training duration on depressive symptoms among older adults in long-term care facilities

BackgroundDepression is associated with a greater risk of disability, cognitive impairment, and suicide. Older adults in long-term care facilities (LTCFs) are more likely to develop depression due to changes in family roles and separation from family members. The aim of this study was to synthesize and analyze the effects of different types of exercise and training duration on depressive symptoms of older adults in LTCFs.MethodsRelevant peer-reviewed journal articles published in English were identified through a search of six electronic databases up to June 2021.ResultsA total of 25 studies were included in the systematic review and 22 in the meta-analysis. The results of meta-analysis showed that exercise interventions reduced depression in cognitively intact older adults and in cognitively impaired older adults. Both exercising less than 150 min per week or more than 150 min per week, reduced depressive symptoms of older adults. In terms of exercise types, mind-body exercises, exergames, and strength training reduced depressive symptoms.ConclusionExercise has a positive effect on reducing depressive symptoms with mind-body exercises, exergames, and strength training producing the best effect. Regardless of cognitive impairment, older adults in LTCFs benefited from exercise in reducing depressive symptoms.     

Dose Response Association between Physical Activity and Biological,Demographic, and Perceptions of Health Variables

BackgroundFew population-based studies have examined the association between physical activity (PA) and cardiovascular disease risk factors, demographic variables, and perceptions of health status, and we do not have a clear understanding of the dose-response relationship among these variables.MethodsData from the 2003-2006 National Health and Nutrition Examination Survey was used to examine the dose-response relationship between objectively measured PA and metabolic syndrome (and its individual cardiovascular disease risk factors), demographic variables, and perceptions of health. After exclusions, 5,538 participants 18 years or older were included in the present study, with 2,538 participants providing fasting glucose and 2,527 providing fasting triglyceride data. PA was categorized into deciles.ResultsOverall, the health benefits showed a general pattern of increase with each increasing levels of PA. Of the ten PA classifications examined, participants in the highest moderate-to-vigorous physical activity (MVPA) category (at least 71 min/day) had the lowest odds of developing metabolic syndrome.ConclusionAt a minimum, sedentary adults should strive to meet current PA guidelines (i.e., 150 min/week of MVPA), with additional positive benefits associated with engaging in three times this level of PA.Key Words: Epidemiology, Exercise, Health benefits     

Effects of listening to music and practicing physical exercise on functional and cognitive aspects in institutionalized older adults with dementia: Pilot study

AimDetermine the effects of listening to music and practicing physical exercise on functional and cognitive aspects in institutionalized older adults with dementia.MethodsA randomized clinical pilot trial was conducted involving 17 institutionalized older adults with moderate to advanced dementia. The participants were allocated to two groups: training with music (TWM) and training without music (TWtM). The TWtM group performed light exercises with a focus on mobility. The TWM group was initially submitted to a cognitive stimulus with music, followed by the same exercises as those performed in the TWtM Group. Sessions were held once a week for 12 weeks. Functional and cognitive assessments were performed at baseline and after the 12-week intervention.ResultsNo significant differences in functional or cognitive performance were found between groups or evaluation times. Both groups maintained their performances after 12 weeks.ConclusionsListening to music combined with physical exercise training did not exert an effect on functional or cognitive performance in institutionalized older adults with moderate to advanced dementia.     

Instrumented measures of sedentary behaviour and physical activity are associated with mortality in community-dwelling older adults: A systematic review,meta-analysis and meta-regression analysis

BackgroundSedentary behaviour (SB) and physical activity (PA) can be objectively assessed with inertial sensors to describe bodily movement. Higher SB and lower PA is associated with higher chronological age and negative health outcomes. This study aimed to quantify the association between instrumented measures of SB (i-SB) and PA (i-PA) and mortality in community-dwelling older adults, to subsequently compare the quantitative effect sizes and to determine the dose-response relationships.MethodsAn electronic search in six databases from inception to 27th of June 2019 was conducted. All articles reporting on i-SB or i-PA and mortality in community-dwelling older adults aged 60 years or older were considered eligible. A meta-analysis was conducted for the association between i-SB and i-PA and mortality expressed in Hazard Ratios (HR) and 95% Confidence Intervals (95% CI). A meta-regression analysis was performed to determine the dose-response relationship between i-SB and steps per day and mortality.ResultsTwelve prospective articles representing eleven cohorts, reporting data of 38,141 participants were included. In total 2502 (6.4%) participants died during follow-up (2.0 to 9.8 years). Comparing the most sedentary with the least sedentary groups of participants resulted in a pooled HR of 2.44 (95% CI 1.82–3.25). Comparing the least active with the most active groups of participants resulted in a pooled HR of 1.93 (95% CI 1.39-2.69); 2.66 (95% CI 2.11–3.35); 3.43 (95% CI 2.61–4.52), and 3.09 (95% CI 2.33–4.11) for light, moderate-to-vigorous-, total PA and steps per day, respectively. Meta-regression analyses showed clear dose-response relationships between i-SB and steps per day and mortality risk.ConclusionBoth i-SB and i-PA are significantly associated with mortality in community-dwelling older adults, showing the largest effect size for total physical activity. Dose-response relationships could be observed for i-SB and steps per day.     

Exercise interventions in Alzheimer’s disease: A systematic review and meta-analysis of randomized controlled trials

AimsTo assess the potential multi-domain benefits of exercise interventions on patients with Alzheimer’s disease (AD), as well as to determine the specific effects of different exercise modalities (aerobic, strength, or combined training).MethodsA systematic search was conducted in PubMed and Web of Science until March 2021 for randomized controlled trials assessing the effect of exercise interventions (compared with no exercise) on patients with AD. Outcomes included cognitive function (mini-mental state examination [MMSE] test), physical function (e.g., 6-minute walking test [6MWT]), functional independence (Barthel index), and neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]). A random-effects meta-analysis was conducted.Results28 studies (total n = 1337 participants, average age 79–90 years) were included in the systematic review, of which 21 could be meta-analyzed. Although considerable heterogeneity was found, exercise interventions induced several significant benefits, including in Barthel index (n = 147 patients, mean difference [MD]=8.36 points, 95% confidence interval [CI]=0.63–16.09), 6MWT (n = 369, MD=84 m, 95% CI=44–133)), and NPI (n = 263, MD=−4.4 points, 95% CI=−8.42 to −0.38). Benefits were also found in the MMSE test, albeit significance was only reached for aerobic exercise (n = 187, MD=2.31 points, 95% CI 0.45–4.27).ConclusionsExercise interventions appear to exert multi-domain benefits in patients with AD.     

Effects of exercise interventions on the functional status of acutely hospitalised older adults: A systematic review and meta-analysis

BackgroundAcute hospitalisation can have adverse effects in older adults, notably functional decline. We aimed to summarize evidence on the effects of exercise interventions in acutely hospitalised older adults.MethodsRelevant articles were systematically searched (PubMed, Web of Science, Rehabilitation & Sports Medicine Source, and EMBASE) until 19^th March 2020. Randomized controlled trials (RCTs) of in-hospital exercise interventions versus usual care conducted in older adults (>60yrs) hospitalised for an acute medical condition were included. Methodological quality of the studies was assessed with the PEDro scale. Primary outcomes included functional independence and physical performance. Intervention effects were also assessed for other major outcomes (length of hospital stay, incidence of readmission, and mortality). A meta-analysis was conducted when ≥3 studies analysed the same outcome.ResultsFifteen studies from 12 RCTs (n = 1748) were included. Methodological quality of the studies was overall high. None of the studies reported any adverse event related to the intervention. Exercise interventions improved functional independence at discharge (standardized mean difference [SMD] = 0.64, 95% confidence interval = 0.19–1.08) and 1–3 months post-discharge (SMD = 0.29, 95%CI = 0.13–0.43), as well as physical performance (SMD = 0.57, 95%CI = 0.18–0.95). No between-group differences were found for length of hospital stay or risk of readmission or mortality (all p > 0.05).ConclusionsIn-hospital supervised exercise interventions seem overall safe and effective for improving – or attenuating the decline of – functional independence and physical performance in acutely hospitalised older adults. The clinical relevance of these findings remains to be confirmed in future research.     

Age and perceived risks and benefits of preventive genomic screening

PurposeAs genome sequencing moves from research to clinical practice, sequencing technologies focused on “medically actionable” targets are being promoted for preventive screening despite the dearth of systematic evidence of risks and benefits and of criteria for selection of screening subjects. This study investigates researchers’ and research participants’ perceptions of these issues within the context of a preventive genomic screening study, GeneScreen.MethodsWe recorded researcher deliberations regarding age eligibility criteria and the risks and benefits of screening, and conducted interviews with 50 GeneScreen participants about their motivations for joining and their perceptions of risks and benefits.ResultsResearchers made assumptions about who would want and benefit from screening based on age. After discussion, researchers opted not to have an upper age limit for enrollment. Participants of all ages perceived similar benefits, including prevention, treatment, and cascade testing, and similar risks, such as insurance discrimination and worry.ConclusionWhile clinical benefits of preventive genomic screening for older adults are debatable, our respondents perceived a range of benefits of screening in both clinical and research settings. Researchers and clinicians should carefully consider decisions about whether to exclude older adults and whether to provide information about benefits and risks across age groups.     

A realist review to understand the efficacy and outcomes of interventions designed to minimise,reverse or prevent the progression of frailty

ABSTRACT

Interventions to minimise, reverse or prevent the progression of frailty in older adults represent a potentially viable route to improving quality of life and care needs in older adults. Intervention methods used across European Innovation Partnership on Active and Healthy Ageing collaborators were analysed, along with findings from literature reviews to determine ‘what works for whom in what circumstances’. A realist review of FOCUS study literature reviews, ‘real-world’ studies and grey literature was conducted according to RAMESES (Realist and Meta-narrative Evidence Synthesis: Evolving Standards), and used to populate a framework analysis of theories of why frailty interventions worked, and theories of why frailty interventions did not work. Factors were distilled into mechanisms deriving from theories of causes of frailty, management of frailty and those based on the intervention process. We found that studies based on resolution of a deficiency in an older adult were only successful when there was indeed a deficiency. Client-centred interventions worked well when they had a theoretical grounding in health psychology and offered choice over intervention elements. Healthcare organisational interventions were found to have an impact on success when they were sufficiently different from usual care. Compelling evidence for the reduction of frailty came from physical exercise, or multicomponent (exercise, cognitive, nutrition, social) interventions in group settings. The group context appears to improve participants’ commitment and adherence to the programme. Suggested mechanisms included commitment to co-participants, enjoyment and social interaction. In conclusion, initial frailty levels, presence or absence of specific deficits, and full person and organisational contexts should be included as components of intervention design. Strategies to enhance social and psychological aspects should be included even in physically focused interventions.     

The effects of aerobic exercise and transcranial direct current stimulation on cognitive function in older adults with and without cognitive impairment: A systematic review and meta-analysis

BackgroundAerobic exercise (AE) may slow age-related cognitive decline. However, such cognition-sparing effects are not uniform across cognitive domains and studies. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation and is also emerging as a potential alternative to pharmaceutical therapies. Like AE, the effectiveness of tDCS is also inconsistent for reducing cognitive impairment in ageing. The unexplored possibility exists that pairing AE and tDCS could produce synergistic effects and reciprocally augment cognition-improving effects in older individuals with and without cognitive impairments.Previous research found such synergistic effects on cognition when cognitive training is paired with tDCS in older individuals with and without mild cognitive impairment (MCI) or dementia.AimThe purpose of this systematic review with meta-analysis was to explore if pairing AE with tDCS could augment singular effects of AE and tDCS on global cognition (GC), working memory (WM) and executive function (EF) in older individuals with or without MCI and dementia.MethodsUsing a PRISMA-based systematic review, we compiled studies that examined the effects of AE alone, tDCS alone, and AE and tDCS combined on cognitive function in older individuals with and without mild cognitive impairment (MCI) or dementia. Using a PICOS approach, we systematically searched PubMed, Scopus and Web of Science searches up to December 2021, we focused on ‘MoCA’, ‘MMSE’, ‘Mini-Cog’ (measures) and ‘cognition’, ‘cognitive function’, ‘cognitive’, ‘cognitive performance’, ‘executive function’, ‘executive process’, ‘attention’, ‘memory’, ‘memory performance’ (outcome terms). We included only randomized controlled trials (RTC) in humans if available in English full text over the past 20 years, with participants’ age over 60. We assessed the methodological quality of the included studies (RTC) by the Physiotherapy Evidence Database (PEDro) scale.ResultsOverall, 68 studies were included in the meta-analyses. AE (ES = 0.56 [95% CI: 0.28–0.83], p = 0.01) and tDCS (ES = 0.69 [95% CI: 0.12–1.26], p = 0.02) improved GC in all three groups of older adults combined (healthy, MCI, demented). In healthy population, AE improved GC (ES = 0.46 [95% CI: 0.22–0.69], p = 0.01) and EF (ES = 0.27 [95% CI: 0.05–0.49], p = 0.02). AE improved GC in older adults with MCI (ES = 0.76 [95% CI: 0.21–1.32], p = 0.01). tDCS improved GC (ES = 0.69 [90% CI: 0.12–1.26], p = 0.02), all three cognitive function (GC, WM and EF) combined in older adults with dementia (ES = 1.12 [95% CI: 0.04–2.19], p = 0.04) and improved cognitive function in older adults overall (ES = 0.69 [95% CI: 0.20–1,18], p = 0.01).ConclusionOur systematic review with meta-analysis provided evidence that beyond the cardiovascular and fitness benefits of AE, pairing AE with tDCS may have the potential to slow symptom progression of cognitive decline in MCI and dementia. Future studies will examine the hypothesis of this present review that a potentiating effect would incrementally improve cognition with increasing severity of cognitive impairment.     

The more the better? A meta-analysis on effects of combined cognitive and physical intervention on cognition in healthy older adults

Both cognitive intervention and physical exercise benefit cognitive function in older adults. It has been suggested that combined cognitive and physical intervention may induce larger effects than cognitive or physical intervention alone, but existing literature has shown mixed results. This meta-analysis aimed at assessing the efficacy of combined intervention on cognition by comparing combined intervention to control group, cognitive intervention and physical exercise. Eligible studies were controlled trials examining the effects of combined intervention on cognition in older adults without known cognitive impairment. Twenty interventional studies comprising 2667 participants were included. Results showed that the overall effect size for combined intervention versus control group was 0.29 (random effects model, p = 0.001). Compared to physical exercise, combined intervention produced greater effects on overall effect size (0.22, p < 0.01), while no significant difference was found between combined intervention and cognitive intervention. Effects of combined intervention were moderated by age of participants, intervention frequency and setting. The findings suggest that combined intervention demonstrates advantages over control group and physical exercise, while evidence is still lacking for superiority when compared combined intervention to cognitive intervention. More well-designed studies with long follow-ups are needed to clarify the potential unique efficacy of combined intervention for older adults.     

Combined physical and cognitive training for older adults with and without cognitive impairment: A systematic review and network meta-analysis of randomized controlled trials

Combining physical exercise with cognitive training is a popular intervention in dementia prevention trials and guidelines. However, it remains unclear what combination strategies are most beneficial for cognitive and physical outcomes. We aimed to compare the efficacy of the three main types of combination strategies (simultaneous, sequential or exergaming) to either intervention alone or control in older adults. Randomized controlled trials of combined cognitive and physical training were included in multivariate and network meta-analyses. In cognitively healthy older adults and mild cognitive impairment, the effect of any combined intervention relative to control was small and statistically significant for overall cognitive (k = 41, Hedges’ g = 0.22, 95 % CI 0.14 to 0.30) and physical function (k = 32, g = 0.25, 95 % CI 0.13 to 0.37). Simultaneous training was the most efficacious approach for cognition, followed by sequential combinations and cognitive training alone, and significantly better than physical exercise. For physical outcomes, simultaneous and sequential training showed comparable efficacy as exercise alone and significantly exceeded all other control conditions. Exergaming ranked low for both outcomes. Our findings suggest that simultaneously and sequentially combined interventions are efficacious for promoting cognitive alongside physical health in older adults, and therefore should be preferred over implementation of single-domain training.     

Healthy Beat Acupunch exercise program: Validation and feasibility study for older adults with reduced physical capacity or probable sarcopenia

Objectives: This research aims to validate the Healthy Beat Acupunch (HBA) exercise program, determine the feasibility of the HBA exercise program protocol and gain an understanding of the effects on well-being for older adults with sarcopenia. Design, Setting & Intervention: Validation of the HBA exercise program was conducted using two rounds of Delphi communication among eight experts. A one-group, pre-post experimental study was conducted with 17 older adults with probable sarcopenia and/or low gait speed at an Australian retirement village. The HBA exercise program lasted 40 min per session, three sessions per week for four weeks. Outcome Measures: Muscle mass, muscle strength, gait speed and health-related quality of life were assessed before and after the intervention. The HBA exercise program was evaluated via a questionnaire and individual interviews. Results: Experts validated the HBA exercise program and deemed it to be simple, safe, suitable and helpful for practice by older adults with sarcopenia. Participants enjoyed the HBA exercise program, planned to continue and would recommend to friends. Frequency, duration and size of the exercise class were appropriate, and they appreciated the trainer's support and directions when mastering the exercise motions. Improvement in participants’ gait speed was found post-exercise intervention (p<.005). Conclusion: The HBA exercise program is appropriate for practice by older adults, particularly those with reduced physical capacity and probable sarcopenia with possible benefits of improved gait speed. Future studies need to consider and overcome the limitations (i.e. study design, sample size) and challenge (participant recruitment) encountered in this research.     

What do community-dwelling older adults with chronic pain value in a program of combined pain neuroscience education plus exercise?

ObjectiveTo explore the experience of older adults after a pain neuroscience education (PNE) and exercise intervention.MethodsFocus group interviews were conducted with 14 older adults after receiving 8-weekly sessions of PNE and exercise and encompassed older adults’ perceptions of the intervention and its impact. Interviews were transcribed verbatim and analyzed by 3 researchers using thematic analysis in a five-step approach (compiling, disassembling, reassembling, interpreting, and concluding).ResultsThree themes emerged: pain reconceptualization, motivational factors, and perceived improvements. Pain reconceptualization was illustrated by participants’ ability to use language that related to PNE concepts (n = 12), increased self-efficacy (n = 5), and adjusted emotions (n = 2) and behaviors (n = 6). Motivational factors were the group-administered intervention (n = 6) and the physical therapists’ communication skills (n = 10). The intervention was perceived as having a positive impact on sleep (n = 3), well-being (n = 6), and activity/ability to perform activities (n = 8).ConclusionOlder adults understand PNE concepts and reconceptualize pain. PNE and exercise were perceived as having a positive impact on day-to-day life.Practice ImplicationsMode of administration, communication skills, and rapport are aspects of the intervention that are valued by older adults. Also, PNE might be used as a strategy to increase older adults’ adherence to physical activity.     

Effects of virtual reality combined cognitive and physical interventions on cognitive function in older adults with mild cognitive impairment: A systematic review and meta-analysis

ObjectiveCombined cognitive and physical interventions based on virtual reality may help delay the progression of MCI to dementia or prevent dementia. However, their efficacy is less well studied compared to pharmaceutical treatments. The purpose of this review was to evaluate the effects of cognitive and physical interventions based on virtual reality on cognitive function (global cognition, memory or executive function/attention) of older adults with mild cognitive impairment.MethodsWe searched the PubMed, Web of Science, Scopus, Embase, Cochrane Library, PsycINFO, CINAHL and IEEE from inception to 13 May 2021. Only randomized controlled trials which incorporated virtual reality cognitive and physical components targeted to individuals with mild cognitive impairment were eligible. Two researchers independently conducted document retrieval, study selection, data extraction, and methodological quality evaluation.Result7 randomized controlled trials were included in a total of 8 articles. No studies were rated as having a "high" risk of overall bias. The results of a meta-analysis showed that VR combined cognitive and physical interventions enhanced the global cognitive (MD = 2.66, 95% CI = 1.79–3.54, P = 0.03, I ² = 68%) abilities of older adults with mild cognitive impairment. The meta-analysis indicated that after virtual reality combined cognitive and physical interventions, effects on memory (SMD = −0.03, 95% CI = −0.60 to 0.55, P = 0.78, I ² = 0%) and executive function/attention (SMD = −0.19, 95% CI = −0.74 to 0.36, P = 0.09, I ² = 53%) were not statistically significant.ConclusionsThe present meta-analysis verifies the potential rehabilitative effects of virtual reality combined cognitive and physical interventions for older adults with mild cognitive impairment. More research is also needed to determine the optimal intensity and timing of interventions in the future.     

Unsupervised home-based resistance training for community-dwelling older adults: A systematic review and meta-analysis of randomized controlled trials

BackgroundWe aimed to summarize evidence on the safety, adherence and effectiveness of home-based resistance training (UHBRT) for improving health-related endpoints in community-dwelling older adults.MethodsRandomized controlled trials of UHBRT in older adults (≥60yrs) were included after a systematic search (PubMed, CINAHL, PsycInfo, SPORTDiscus, Web of Science, MEDLINE, Cochrane Central Register of Controlled Trials) until 02/19/2021. Adverse events and adherence rates were assessed as indicators of feasibility. Other endpoints included physical (muscle strength, muscle power, balance, physical performance) and mental-related measures (cognition, quality of life [QoL]) as well as other health-related variables (body composition, physical activity levels, falls).Results21 studies (N = 4,053) were included. No major adverse events were reported, with adherence averaging 67 % (range 47–97 %). UHBRT significantly improved lower-limb muscle strength (Hedges' g = 0.33; 95 % confidence interval [CI] = 0.11−0.57), muscle power measured through the sit-to-stand test (g = 0.44; 95 %CI = 0.06−0.84), and balance (assessed with the postural sway, g = 0.32; 95 %CI = 0.16−0.49). No benefits were found for other strength indices (handgrip strength), balance (single leg stance and functional reach test), physical performance (walking speed, TUG and SPPB), QoL, nor for the risk or rate of falls (all p > 0.05, g<0.61). No meta-analysis could be performed for the remaining endpoints.ConclusionsAlthough efforts are needed to increase adherence, preliminary evidence suggests that UHBRT can be safe and modestly effective for improving some measures of lower-limb muscle strength, balance, and muscle power in community-dwelling older adults. However, no benefits were found for other physical fitness measures, QoL or falls. More evidence is therefore needed to draw definite conclusions.     

Psychosocial and clinical predictors of continued cancer screening in older adults

ObjectiveMany older adults (aged 75+) continue cancer screening despite guidelines suggesting they should not. Using mixed-methods, we examined psychosocial and clinical factors associated with continued breast/prostate screening.MethodsWe conducted an online, scenario-based, randomized study in Australia with participants aged 65+ years. The primary outcome was screening intention (10-point scale, dichotomized: low (1−5) and high (6−10)). We also measured demographic, psychosocial, and age-related clinical variables. Participants provided reason/s for their screening intentions in free-text.Results271 eligible participants completed the survey (aged 65–90 years, 71% adequate health literacy). Those who reported higher cancer anxiety, were men, screened more recently, had family history of breast/prostate cancer and were independent in activities of daily living, were more likely to intend to continue screening. Commonly reported reasons for intending to continue screening were grouped into six themes: routine adherence, the value of knowing, positive screening attitudes, perceived susceptibility, benefits focus, and needing reassurance.ConclusionsPsychosocial factors may drive continued cancer screening in older adults and undermine efforts to promote informed decision-making.Practice implicationsWhen communicating benefits and harms of cancer screening to older adults, both clinical and psychosocial factors should be discussed to support informed decision-making.