Subjective life expectancy and associated factors among cancer survivors over 45 years old: evidence from the CHARLS

Development of a psychological frailty index: results from the China health and retirement longitudinal study

Objective

Psychological frailty, an emerging concept, lacks a standardized definition, measuring instrument, and empirical evidence in Asian (especially Chinese) populations. An effective instrument to measure psychological frailty should be urgently developed. Therefore, this study aimed to develop and initially validate a Psychological Frailty Index (PFI) based on the China Health and Retirement Longitudinal Study (CHARLS). The study assessed the applicability of the PFI to adverse health outcomes as a secondary aim.

Results

Factor analysis of the 15-item PFI extracted four factors of psychological frailty (psychological distress, cognitive decline, physical vulnerability, and memory decline). The PFI demonstrated satisfactory internal consistency (Cronbach's alpha = 0.764) and criterion validity (rho = 0.806). Psychological frailty was significantly associated with lower life expectancy (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.71-2.29), higher outpatient treatments (1.25, 1.03-1.51), and increased hospitalization (1.45, 1.22-1.74).

Conclusion

The PFI could be a reliable instrument for identifying psychological frailty. The PFI is a novel tool that measures health indicators of older adults at risk of increased psychological vulnerability, but it requires further validation.

Influence of hypertension diagnosis and subjective life expectancy on health behaviors among middle-aged and older Chinese adults

Objectives

Hypertension can lead to significant health complications if left unmanaged due to unhealthy behaviors. This study investigates hypertension related health behaviors of middle-aged and older Chinese adults, investigating whether a hypertension diagnosis and individuals' subjective life expectancy (SLE) might prompt positive changes in their health behaviors.

Methods

The participants in this study were Chinese adults aged 45 years and older, selected from the 2013-2020 China Health and Retirement Longitudinal Study. Linear mixed-effects models were employed to investigate the influence of receiving a hypertension diagnosis, as well as SLE, on hypertension related behaviors.

Results

Among the respondents, 27.65% reported doctor-diagnosed hypertension, while 19.91% of those who were undiagnosed with hypertension had measured hypertension at baseline. Of those diagnosed with hypertension, only 46.97% in 2013 had their blood pressure within the normal range in 2013, and this slightly improved to 47.80% in 2015. Both receiving a hypertension diagnosis (β = 0.41, 95% CI: 0.37-0.43) and having a low-SLE (β = 0.06, 95% CI: 0.03-0.09) were associated with healthier behavior. Interestingly, individuals with measured hypertension exhibited the highest SLE but the lowest health behavior scores.

Discussion

Although individuals diagnosed with hypertension are able to recognize the dangers of the condition and take proactive steps to improve their health, high blood pressure remains uncontrolled in almost half of them. Those with measured hypertension often lack awareness of hypertension and unhealthier behaviors. Therefore, there is a critical need to enhance hypertension awareness and promote healthier behaviors among both diagnosed individuals with uncontrolled blood pressure and those unaware of their hypertension.

A Painful Reality Check? Examining the Accuracy of Subjective Survival Probabilities by Pain Interference and Depression Status

PURPOSE

Pain and depression are linked to higher mortality risk and lower subjective survival probabilities (SSPs). We examine if SSPs for individuals with pain and depression match their actual lifespans.

METHODS

Using data on 12,745 Health and Retirement Study respondents aged 57-89 in 2000 with follow-up through 2018, we assessed whether respondents' SSPs were "correct," "underestimated," or "overestimated" relative to their lifespans. Adjusted multinomial logistic regressions predicted SSP accuracy based on pain interference, depression, and their interaction.

RESULTS

Severe or interfering pain (i.e., high impact pain) was associated with a 25% higher risk of underestimating SSPs (RRR = 1.25, p = .04), and depression increased the risk by 49% (RRR = 1.49, p < .001). High impact pain and depression also corresponded with lower average SSPs and higher mortality risk.

CONCLUSION

High impact pain and depression increase the risk of underestimating longevity. Future research should explore the impact on health and financial decisions in older adults.

How does chronic disease influence subjective life expectancy among middle-aged and older adults? Evidence from the China Health and Retirement Longitudinal Study (CHARLS) 2018 cross-sectional data

Chronic diseases have become one of the most important factors threatening human health. Subjective life expectancy (SLE) describes an individual's expectation or subjective perception of lifespan. This article aims to explore the relationship between chronic diseases and SLE, as well as the differences among different age groups and different types of chronic diseases in this relationship. China Health and Retirement Longitudinal Study (CHARLS) is a nationwide longitudinal study that evaluates the social, economic, and health conditions of middle-aged and older adult families and individuals aged 45 and above in China. In this study, CHARLS used probability proportional to size sampling (PPS sampling) to ensure the breadth and representativeness of the sample. This study selected cross-sectional data from CHARLS 2018, removed missing values, and obtained a valid sample of 10,658 middle-aged and older individuals, of whom 8564 had chronic diseases. After controlling demographic, health behavior, socioeconomic, psychological, and social security factors, an ordered logistic regression was performed to explore the relationship between chronic disease and SLE in middle-aged and older adults. The results show that chronic diseases negatively correlate with SLE in middle-aged and older adults. Middle-aged and older adults with chronic diseases are 36.2% less likely to have high life expectancy than those without chronic diseases. Many different types of chronic diseases are negatively correlated with SLE. Cancer is most negatively correlated with SLE, far exceeding other chronic diseases. Chronic disease and SLE of middle-aged and older adults have age-heterogeneous differences. For middle-aged people aged 45-59 and young older adults aged 60-79, there is a significant correlation between chronic diseases and SLE. However, there is no correlation between chronic diseases and subjective life expectancy in the older population aged 80 and above. The government and society should pay close attention to the prevention and treatment of chronic diseases among middle-aged and older adults and adjust policies and measures according to the population's age structure. In addition, the government and society should pay attention to the spiritual needs of middle-aged and older adults. The government and society should pay more attention to cancer patients. Finally, the scientific research team should also strengthen research on chronic diseases, research and development of specific drugs and vaccines, improve the cure rate of chronic diseases, promote people's health, and make people no longer afraid of diseases.

Pain Lowers Subjective Survival Probabilities Among Middle-Aged and Older Adults

OBJECTIVES

Pain is a leading cause of disability and a limiting factor in individuals' assessments of their own subjective health; however, its association with subjective longevity has yet to be explored. Subjective survival probabilities (SSPs), or one's own perceived chances of living to a given age, can influence individuals' behavior as they plan for their futures. This study assesses whether pain correlates to lower SSPs.

METHODS

We use a repeated cross-section of the 2000-2018 waves of the Health and Retirement Study, a longitudinal and nationally representative survey of Americans aged 51 and older (N = 31,773).

RESULTS

Fractional logit regressions indicate that, across all age groups, respondents with severe and/or interfering pain reported significantly lower SSPs than those with no pain (Marginal Effect [ME] = -0.03 to -0.06, p < .05). Controlling for all covariates, mild or moderate noninterfering pain was only associated with a significant reduction in SSPs among the youngest group reporting their chances of living to age 75 (ME = -0.02, p < .001). Descriptively and in the model results, respondents with mild or moderate noninterfering pain appeared to more closely resemble pain-free respondents than those with severe or interfering pain.

DISCUSSION

These findings highlight the importance of pain on SSPs, and contribute to the growing evidence that pain interference is uniquely important in predicting meaningful health outcomes.

Sensory impairments and subjective well-being status in middle-aged and older Chinese population: Cross-sectional and longitudinal analyses of a nationally representative survey

Purpose

To investigate the impacts of sensory impairments (SIs) including single vision impairment (SVI), single hearing impairment (SHI) and dual sensory impairment (DSI) on subjective wellbeing measurements including life expectancy (LE), life satisfaction (LS) and self-rated health (SRH) in middle-aged and older Chinese population.

Methods

We obtained data from the China Health and Retirement Longitudinal Survey (CHARLS). In total, 9,293 Chinese middle-aged and older adults aging over 45 were included at baseline 2011 in this study, and 3,932 participants who accomplished all 4 interviews from 2011 to 2018 were adapted for longitudinal analyses. Sensory status and subjective wellbeing measurements were collected. Other covariates included socio-demographic characteristics, medical condition and lifestyle-related factors. The impacts of baseline sensory status on LE, LS and SRH were assessed using univariate and multivariate logistic regression analyses. A linear regression analysis with generalized estimating equations (GEE) was used to assess the association between time-varying sensory statuses with LE, LS and SRH over 8 years after being adjusted with multi-confounding factors.

Results

Participants with SIs had significantly lower level of LE, LS, and SRH, compared to those who were free of SI. All kinds of SIs were significantly associated with LE, LS, and SRH according to cross-sectional data. The correlations between SIs and LE or SRH over 8 years were also noticed. However, only SHI and DSI were found to be significantly associated with LS according to longitudinal data (all p values &lt; 0.05).

Conclusion

Sensory impairments had explicitly detrimental effects on subjective wellbeing status over time among middle-aged and older Chinese population.

Associations between existing and newly diagnosed chronic health conditions and change in subjective life expectancy: Results from a panel study

Background

Subjective life expectancy (SLE) is a vital predictor of mortality, health and retirement. Nevertheless, we have sparse knowledge about what drives changes in SLE. Having a chronic health condition (CHC) is probably associated with a change SLE. However, how CHCs are associated with changes in SLE may depend on whether the CHC was newly diagnosed and the type of CHC.

Aim

We hypothesize that newly diagnosed CHCs will be strongly negatively associated with changes in SLE than existing CHCs. As CHCs vary in their presentation and prognosis, we differentiate associations between five CHCs - arthritis, cardiovascular diseases, sleep disorders, psychological disorders and life-threatening conditions - and changes in SLE.

Method

Data from two waves of a Dutch pension panel survey, collected 3 years apart in 2015 and 2018, were used. The analytical sample included 4824 older workers between the ages of 60-65 years at wave 1. Data were analysed longitudinally using a conditional change ordered logistic regression model.

Results

In general, newly diagnosed CHCs were strongly negatively associated with changes in SLE, relative to having no CHCs. Existing CHCs were also negatively associated with changes in SLE, but to a weaker strength. Interestingly, associations between CHCs and the change in SLE differed based on the CHC in question.

Conclusion

Newly diagnosed life-threatening conditions, psychological disorders and cardiovascular diseases are strongly negatively associated with changes in SLE. These results provide insight into the differences in how older workers with CHCs experience late career work and how these experiences influence their SLE.