Older adults who typically had longer intervals between meals accumulated chronic diseases more rapidly over time than those with shorter intervals, according to a study from Karolinska Institutet published in the Journal of Internal Medicine. The association was most pronounced among people aged 78 years and older.
Interest in fasting has increased in recent years, but relatively little is known about how meal timing affects health in older adults. In this new study, researchers investigated whether the duration of the longest daily interval between meals was associated with the accumulation of chronic diseases over time.
The researchers used data from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), which includes 2,981 people in Stockholm who were aged 60 years or older at the start of the study. Participants were followed for up to 15 years. The duration of intervals between meals was estimated from participants’ self-reported information about when they typically ate during a 24-hour period.
Association seen across disease types
Longer intervals between meals were associated with faster accumulation of chronic diseases over time. In particular, people whose longest interval between meals during a typical day was 14 to 24 hours accumulated chronic diseases more rapidly than those whose longest interval was 6 to 11.5 hours. The association was observed for the total number of chronic diseases, as well as for cardiovascular and neuropsychiatric diseases, but not for musculoskeletal diseases.
“Much of the research on fasting has been conducted in younger or middle-aged populations. Our findings suggest that the associations may be different in older adults, particularly among the oldest age groups”, says Adrián Carballo Casla, last author of the study and postdoctoral researcher at the Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
The researchers emphasise that the study cannot determine cause and effect. Although longer intervals between meals were linked to faster disease accumulation, the study cannot establish whether the fasting pattern independently contributed to this outcome.
For information on funding and any potential conflicts of interest, please see the study.
A controlled trial across 13 countries found that a self-guided digital program and a version paired with telephone support both outperformed usual care for anxiety and depression
Photo by RDNE Stock project: https://www.pexels.com/photo/an-elderly-man-standing-on-one-leg-on-a-yoga-mat-8173497/
A digital program combining guided movement, breathing and meditation exercises, and coping-skills training reduced anxiety and depression symptoms in adults with chronic medical conditions, according to a new study published August 20th in the open access journal PLOS Medicine by Puneeta Tandon of the University of Alberta, Canada, and colleagues.
More than half of adults living with chronic physical conditions experience anxiety, depression, or fatigue, which can significantly reduce quality of life. Access to effective symptom management support is limited by mobility barriers, geography, cost, and shortages of trained clinicians. Digital programs may offer a scalable way to address this burden, but clinical trial evidence backing these interventions has been limited, and the role of human support in their efficacy is unclear.
Researchers conducted a fully remote, three-arm randomised controlled trial across 13 countries, involving 825 adults with self-reported chronic medical conditions including Primary Biliary Cholangitis, chronic digestive diseases, cirrhosis, and heart failure. Participants were assigned to a waitlist control group, a self-directed digital program (eMPower), or the same program supplemented with weekly telephone check-ins from trained non-clinicians. The program included movement, breathwork/meditation, coping skills, and disease education. Anxiety and depression symptoms were measured using a standard symptom scale ranging from 0 to 42.
At 12 weeks, participants receiving the digital program with telephone support showed significantly greater improvement in anxiety and depression scores than the control group (2.9-point greater improvement; 95% CI, 2.0–3.8). They also reported improved quality of life and less fatigue. In exploratory analyses, the self-directed program alone also significantly improved symptoms compared with control (2.6-point greater improvement; 95% CI, 1.8–3.5), and no significant difference was found between the two program formats, although the trial was not designed or powered to directly compare them.
The study primarily included women with higher education and only measured outcomes for 12 weeks, so longer-term impact and generalisability to other populations remain unclear. However, the authors say the data suggest a path forward for digital mental health interventions.
“Taken together, the eMPower clinical trial provides robust evidence that a fully digital, multicomponent intervention reduced anxiety and depression symptoms and was associated with improvements in fatigue, and quality of life across a range of chronic disease populations,” the authors say. “Rather than developing separate digital programs for each condition, a single cross-condition approach with tailoring for disease-specific education is effective in addressing shared symptoms.”
Corresponding author Dr. Puneeta Tandon states, “As clinicians, we are good at treating organ-specific problems, but the whole-person burden of chronic illness – the anxiety, low mood and exhaustion – that is often where patients have fewer practical options. People often leave the clinic without much they can try, but it doesn’t need to be that way. While these skills don’t replace medication or mental health care when those are needed, they do give people a practical place to start at home.
“What was surprising was that, in an exploratory analysis, we did not find a significant difference between the fully self-directed program and the program with brief weekly check-ins from a trained team member. This does not prove that the two approaches are equal, but it suggests that a program like this may be able to reach far more people without requiring one-to-one support for everyone. Support could then be focused on those who need it most.
“Because the study was entirely online, people could take part from home. The average age was 56, almost one in four participants was over 65, and 84% completed the 12-week follow-up – a strong result for a fully online study. We’re very grateful to the patient partners and organisations representing heart, kidney, liver, transplant and digestive communities who helped shape the program from the beginning. Their involvement was an important part of the study’s success.”
“The 12-Week eMPower program has demonstrated meaningful improvements in quality of life for people living with primary biliary cholangitis (PBC), the largest group enrolled in the eMPower study,” said Gail Wright, a PBC patient and President of the Canadian PBC Society. “Participants living with a significant symptom burden reported clinically meaningful improvements in fatigue and overall quality of life. The success of this program represents an important milestone for the PBC community, providing clinicians with evidence to support more personalised care that combines pharmaceutical treatment with an evidence-based self-management program for people living with PBC.”
First author Emily Johnson, MD/PhD Candidate, notes, “Running the trial entirely online meant we could reach people who are often left out of research – including people managing severe fatigue or mobility limitations, people living far from a specialist centre, and people who can’t add another appointment to their week. What struck me most was that they stayed. Patient partners shaped this program from the first draft, and I think that’s why it held people’s attention for 12 weeks. I look forward to continuing with this work and helping even more people.”
If you’re 70 or older, or 50 or older with underlying health conditions, and have tested positive for COVID, you might have been offered free or subsidised antivirals.
Earlier in the pandemic, these medicines were an important way to reduce the chance of people becoming severely ill with COVID, needing to be hospitalised or dying.
But our new research suggests that with high levels of vaccination and immunity from previous infections, COVID antivirals are no longer working as well.
From no treatment to an effective one
When SARS-CoV-2, the virus that causes COVID, first emerged in late 2019, no treatment was available. Existing influenza antivirals, which had been stockpiled by governments, were ineffective and couldn’t be used.
Scientists rapidly tried to figure out which existing or new drugs could be used. In 2021, two industry-sponsored clinical trials reported promising results.
One was for nirmatrelvir-ritonavir (Paxlovid), which reported an 89% reduction in severe illness. The other was a trial of molnupiravir (Lagevrio), which reported a 30% reduction.
Paxlovid and Lagevrio work by stopping SARS-CoV-2 from replicating. So they need to be taken early in the course of illness – within five days – to be effective.
Both drugs became available in Australia and were listed on the Pharmaceutical Benefits Scheme (PBS) in early and mid-2022. This ensured people most at risk of severe illness had access to drugs at low or no cost.
Paxlovid and Lagevrio are expensive. A course of treatment cost the government around A$1,100 from 2022 to 2025, much more than treatment for influenza, oseltamivir (Tamiflu), which costs only around $40.
Between mid-2022andmid-2025, the Australian government spent more than $2 billion on Paxlovid and Lagevrio.
The virus itself has also changed, with the original variants replaced by new ones that appear to be less severe than early in the pandemic.
These changes prompted us to evaluate the more recent evidence.
What did we study and find?
First, we examined randomised controlled trials—the gold standard of evidence. We found eight trials of Paxlovid and Lagevrio, but most were done before people were vaccinated.
The Lagevrio trial reported no statistical difference in hospitalisation or death in people who did and didn’t receive treatment.
The other was a trial of people in hospital who were treated with Paxlovid. It found no difference between people who were treated and those who were not.
There were some nuances to these findings. Randomised controlled trials are expensive and resource-intensive. As COVID went from being the leading cause of death worldwide in 2021 to the 20th in 2023, it became more difficult to justify the costs and recruit enough participants, so some trials were stopped early.
However, two randomised controlled trials of Paxlovid have been published since our work, and neither reported a reduction in hospitalisation or death.
In phase two of our research, we looked at the 35 observational studies, in which researchers can include many more people but can’t control who gets the treatment. We pooled the results from the studies to estimate the effectiveness of each drug against hospitalisation and death.
This meta-analysis found Paxlovid, but not Lagevrio, reduced hospitalisation and death.
Paxlovid was associated with a 40% reduction in hospitalisation and a 67% reduction in death.
Lagevrio wasn’t associated with a significant reduction in hospitalisation, and the results for death were mixed.
Because treatment wasn’t randomised, there may be differences between people who received treatment and those who didn’t. People accessing treatment, for example, may have greater health literacy or access to other health services.
While some studies use methods to adjust for differences in people who do and don’t receive treatment, it’s usually not possible to adjust for every difference.
COVID is still a concern for at-risk groups
SARS-CoV-2, like influenza and respiratory syncytial virus (RSV), remains a common cause of acute respiratory illness in Australia. In 2025, there were:
186,000 cases of COVID reported
178,000 cases of RSV
503,000 cases of influenza.
But the number of COVID, RSV and influenza cases reported is well below the true number, as most people don’t get tested.
The rates of COVID-related hospitalisations so far this year have been lower than last year, with 839 admissions at “sentinel hospitals” (those chosen to monitor disease trends) in the first half of this year. This compares with 1,740 in the same period last year.
What does this mean?
COVID can still cause severe illness, hospitalisation and death, particularly in older people.
If you test positive for COVID, talk to your primary care doctor about whether antivirals may be appropriate for you.
Our work shows there may be some benefit from Paxlovid. But as the number of cases and the risk of severe illness continue to fall, this benefit is becoming very small.
Given how little evidence there is for Lagevrio, its role in treating COVID should be carefully considered.
Harms of antivirals can include side effects – such as taste changes, nausea and vomiting – and allergic reactions.
Paxlovid can also interact with other drugs, causing serious reactions. It should be avoided, or the dose adjusted, in people with severe liver or kidney disease because it can make these conditions worse.
Australia’s independent Pharmaceutical Benefits Advisory Committee (PBAC) is set to review COVID antivirals later in 2026. It will assess the costs and benefits of Paxlovid and Lagevrio, and it may change its recommendations about who can access the drugs on the PBS.
