Social participation and urban-rural disparity in mental health among older adults in China

Interpretable machine learning models to predict decline in intrinsic capacity among older adults in China: a prospective cohort study

BACKGROUND

Monitoring intrinsic capacity and implementing appropriate interventions can support healthy aging. There are, though, few tools available for predicting decline in intrinsic capacity among older adults. This study aimed to develop and validate an interpretable machine learning model designed to identify populations at elevated risk of a decline in intrinsic capacity.

METHODS

Using data from the China Health and Retirement Longitudinal Study baseline (2011) and 4-year follow-up (2015), a total of 822 participants were randomly allocated to a training set and a testing set at a 7:3 ratio. Five machine learning methods were employed to train the model and assess its performance through various metrics. The SHapley Additive exPlanation method was subsequently used to interpret the optimal model.

RESULTS

The 4-year incidence of decline in intrinsic capacity among the older adults in the sample was 44.6 % (n = 367). Nine variables were screened for model construction, among which eXtreme gradient boosting demonstrated the best predictive performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.715 (95 % CI 0.651-0.780) in the testing set. The SHapley Additive exPlanation method identified educational level, smoking, handgrip strength, self-rated health, and residence as the top five significant predictors.

CONCLUSIONS

The developed model can serve as a highly effective tool for primary care teams to identify older adults with early signs of decline in intrinsic capacity, facilitating the provision of subsequent screening and tailored interventions for intrinsic capacity.

Association Between Multidimensional Social Participation and Hypertension Among Middle-Aged and Older Adults in China: A Cross-Sectional Analysis From the China Health and Retirement Longitudinal Study

Hypertension is a significant public health issue, particularly among middle-aged and older adults. This study investigated the impact of multidimensional social participation, including its diversity and frequency, on hypertension in this population in China, with a focus on urban-rural differences. Using data from the 2015 China Health and Retirement Longitudinal Study (CHARLS), which included 12 165 participants aged 45 and older, social participation was categorized by diversity (e.g., voluntary activities, Mahjong, cards, chess, or other clubs) and frequency. Hypertension was determined based on self-reported diagnoses, medication use, and blood pressure measurements. Logistic regression analyses, adjusted for demographic and health-related factors, revealed that more diverse social participation was associated with lower hypertension rates (OR = 0.718, 95% CI = 0.612, 0.840). Participating more than once a week also correlated with reduced hypertension risk (OR = 0.877, 95% CI = 0.803, 0.958). Specific activities, such as volunteering, internet use, and Mahjong, were notably protective against hypertension. Subgroup analyses highlighted urban-rural disparities, with differing impacts of social participation observed. However, interaction analyses showed that urban-rural residency did not significantly modify the relationship between social participation and hypertension. These findings emphasize the role of social participation in mitigating hypertension risk among middle-aged and older Chinese adults, and underscore the need for targeted public health strategies to address urban-rural disparities and promote social participation.

Key influencing factors analysis on life satisfaction among Chinese older adults with hypertension: a National Cross-Sectional Survey

Objectives

This study aimed to assess the current situation and influencing factors of life satisfaction among Chinese older adults with hypertension and to identify its key factors.

Methods

In this study, 4,197 hypertensive patients were selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database for inclusion in the analysis. A multivariate logistic regression model was used to analyze the influencing factors of life satisfaction in hypertensive patients, and the random forest was further used to rank the importance of the significant influencing factors.

Results

Overall, 29.52% of hypertensive patients reported dissatisfaction with their lives. The life satisfaction of these patients was influenced by a combination of factors. According to the results of the random forest, the variables that significantly influenced life satisfaction, in descending order of importance, are self-rated health, economic status, depressive symptoms, sleep duration, fruits, living arrangements, hearing impairment, heart disease, and gender.

Conclusion

Our research indicates that currently, people with hypertension experience a high level of dissatisfaction with their lives, making it necessary to take preventive and intervention measures from multiple aspects.

The impact of active social media use on the mental health of older adults

BACKGROUND

With the rising population age and the development of information technology in China, a growing number of older adults use social media as a means of social participation. The impact of posting on WeChat Moments on the mental health of older adults is worthy of attention.

AIM

The aim of this study is to identify posting on WeChat Moments as an active social media use and analyze its impact on the mental health of older adults.

METHOD

Using the survey data from the China Health and Retirement Longitudinal Study (CHARLS), we defined posting on WeChat Moments as an active social media use and used propensity score matching (PSM) to analyze the impact of such posting on the mental health of older adults.

RESULTS

The results of the study showed that posting statistically significantly improved the depression, self-rated health, and health satisfaction of older adults. Heterogeneity analysis showed that the female older-adult population and the younger older-adult population derived the most mental health benefit from posting on WeChat Moments.

CONCLUSION

Posting on WeChat Moments statistically significantly improved the depression, self-rated health, and health satisfaction of older adults. Older adults who use WeChat and post on WeChat Moments derive much benefit from their active social media use.

The impact of social participation on mental health among the older adult in China: an analysis based on the mental frailty index

Objectives

Social participation and the psychological well-being of the older adult are correlated. A substantial body of research has delineated the relationship between social participation and the mental health of older adults, while the indicators for assessing the mental health of the older adult are not sufficiently systematic or comprehensive. This study aims to further explore the relationship between social participation and the mental health of older adults from the perspective of mental frailty, providing a reference for the improvement of health among the older adult population.

Methods

We selected 9,208 older adults aged 60 years and older from the China Health and Retirement Longitudinal Study (CHARLS) 2013-2018 database. The mental frailty index was constructed, which integrates both depression and cognitive status to assess the mental health status of the older adult. By using a fixed-effects model, we analyzed the impact of social participation on the mental health of the older adult and compared gender, residence and marriage difference. Meanwhile, the instrumental variables method was used to conduct endogeneity tests.

Results

Overall, 65.8% of the respondents had low social participation. Social participation had a significant enhancement effect on mental health in the older adult (β = -0.013, p < 0.001). In specific types of social participation, cultural and sports activities (β = -0.006, p < 0.001), communication and educational activities (β = -0.002, p < 0.05), and skill-enhancing (β = -0.006, p < 0.001) activities were negatively correlated with the index of mental frailty of the older adult, whereas volunteering activities (β = 0.002, p < 0.05) was positively correlated with the index of mental frailty of the older adult.

Conclusion

Social participation has a positive effect on the mental health of the older adult in China, and the effect varies for the older adult with different characteristics, which suggests that social participation may be a protective factor for the mental health of the older adult population. Targeting differentiated population characteristics, individualized policies should be developed for different groups of older persons.

Physical health problems, views on ageing, and emotional distress among older Chinese population: a moderated mediation model

OBJECTIVES

This study aims to investigate the mediation effect of negative views on ageing (VoA) between physical health problems and emotional distress, and the moderation effect of urban/rural residence ('hukou').

METHODS

We adopted a sample of 936 older Chinese people aged 60 and above from the China General Social Survey (CGSS). A structural equation model (SEM) approach was adopted to test the measurement model of latent variables and the structural model examining the hypothesized pathway. The bootstrapping bias-corrected approach (5000 bootstrap samples) was adopted.

RESULTS

The SEM shows that negative VoA mediates physical health problems and emotional distress (β = 0.041, B = 0.063, 95% CI [0.029, 0.102], p = 0.001). The relationship between negative VoA and emotional distress is more pronounced among urban than rural older residents (β = 0.181, B = 0.168, 95% CI [0.004, 0.377], p = 0.076), which may suggest that being dependent on others is less desirable among urban older people.

CONCLUSION

This study underscores the importance of having positive VoA, especially for urban older residents. More studies on the formation and impacts of older people's expectations of their own ageing are warranted.

Associations between social participation and psychological distress among older adults with hypertension in rural China: The mediating role of social capital

Psychological distress in older adults with hypertension in rural China significantly impacts their families and society. This study aims to explore how social participation affects psychological distress among older adults with hypertension in rural China, focusing on the mediating role of social capital. A total of 950 respondents completed surveys measuring social participation based on the frequency of social, recreational, and literary activities, the Resource Generator China scale, and the Kessler Psychological Distress Scale. Structural equation modeling was used to analyze the relationships between the variables. The results showed that social participation significantly affects psychological distress, with social capital mediating this relationship. The indirect effect of social capital accounted for 61.0% of the total effect. These findings suggest targeted interventions in social participation and social capital to reduce psychological distress among rural elderly individuals with hypertension in China.

From work to community: how social participation and retirement can benefit older adults' depression

Objectives

The retirement phase and social participation influence the depressive symptoms of older individuals. Nonetheless, the fundamental mechanisms connecting these factors remain unclear. This analysis examined mediating social participation in the relationship between older adults' retirement and depressive symptoms.

Methods

The study analyzed 9,103 Chinese individuals aged 60 and above utilizing the 2020 China Health and Retirement Longitudinal Study (CHARLS). Researchers evaluated participants' depression utilizing the Center for Studies in Epidemiology Depression Scale (CESD-10). The hierarchical multiple regression models were utilized to evaluate the link between retirement and depression, through cross-sectional analyses, along with the possible influence of social participation on this relationship.

Results

Retirement significantly reduce older individuals' depression and improves their mental health state. In addition, social participation as a mediating variable further enhanced the beneficial impacts of retirement on the mental health state.

Conclusion

This research discovered that retirement indirectly influences older adults' depression, with social participation playing a significant impact. Thus, it establishes a foundation for mitigating psychological issues in this demographic. Engaging in or sustaining social activities during later life enhances the mental well-being of older individuals. Promoting social participation among older individuals is a viable approach to reduce depression and facilitating successful aging initiatives in this demographic.

Longitudinal Associations Between Neighborhood Environments and Functional Disabilities Among Community-Dwelling Older Adults in China

OBJECTIVES

This study aims to investigate the longitudinal associations between neighborhood environments and functional disabilities over time among older adults in China. Urban-rural disparities in these associations were examined in this study.

METHODS

Data from 4 waves of the China Health and Retirement Longitudinal Study (2011-2018) were analyzed, including a sample of 5,379 older adults aged 60 and over. Multilevel linear probability modeling was fitted to estimate the effects of neighborhood environments on functional disabilities, encompassing both incidence and rate of change over a 7-year period.

RESULTS

Older adults residing in neighborhoods with superior infrastructure experienced a lower incidence of functional disabilities in both rural and urban areas. In urban communities, increased handicapped access was associated with a reduced risk of IADL disability onset among older adults (B = -0.013, SE = 0.006, p < .05). In rural villages, the presence of 2 or more bus lines was associated with a slower rate of IADL disablement over the 7-year period (B = -0.019, SE = 0.009, p < .05).

DISCUSSION

This research reveals the prominent roles of neighborhood environments in protecting functional abilities among older adults. The findings highlight the importance of incorporating community policies and infrastructure development into public health considerations. Empirical evidence is provided for policymakers and urban planners aimed at enhancing functional abilities in older adults and mitigating urban-rural disparities in health outcomes.

Depressive symptoms among the oldest-old in China: a study on rural-urban differences

BACKGROUND

In China, In China, depression among the oldest-old (aged 80 + years) is a major public health issue. As the gap in development between urban and rural China widens, the aim of this study was to demonstrated whether there are disparities in the incidence of depressive symptoms between the urban and rural oldest-old (aged 80+) in China and to quantify the contribution of relevant influencing factors.

METHODS

The study evaluated data on 5,116 oldest adults (female, 55.88%; male, 44.12%) from the 2018 Chinese Longitudinal Healthy Longevity Survey. A chi-square test analyzed the distribution characteristics of related indicators among the oldest-old adults in the two areas. Multiple linear regression was applied to exploring the influencing factors of depressive symptoms in the oldest-old (aged 80+) adults in different regions. The Blinder-Oaxaca decomposition method quantified the four categories of influencing factors (demographic characteristics, sociological characteristics, personal lifestyle, personal lifestyle) of the differences in depressive symptoms and estimated their contributions among urban and rural oldest-old (aged 80+) adults.

RESULTS

14.60% of oldest-old (aged 80+) adults reported having depressed symptoms, with rural oldest-old (aged 80+) adults reporting more of these symptoms (15.70%) than urban oldest-old (aged 80+) adults (12.25%). In urban areas, age (90-99: β = -0.583, 95%CI = -1.008 to -0.158), annual income (rich: β = -0.699, 95%CI = -1.368 to -0.029), smoking (yes: β = -0.752, 95%CI = -1.376 to -0.127), exercise (yes: β = -1.447, 95%CI = -1.828 to -1.065), self-rated health status (good: β = -2.994, 95% CI = -3.362 to -2.625) were protective factors against depressive symptoms, and married status (other: β = 1.222, 95%CI = 0.564 to 1.880) were risk factors. In rural areas, education level (1-6: β = -0.374, 95%CI =  -0.686 to -0.062), annual income (poor: β = -0.374, 95%CI = -0.721 to -0.026; rich: β = -0.781, 95%CI = -1.115 to -0.447), exercise (yes: β = -0.844, 95%CI = -1.143 to -0.545) and SRH status (good: β = -3.023, 95%CI = -3.274 to -2.772) were protective factors, whereas body mass index (BMI) (< 18.5: β = 0.532, 95%CI = 0.221 to 0.842) and married status (widowed: β = 0.630, 95%CI = 0.283 to 0.978) were risk factors. The Blinder-Oaxaca decomposition showed that 90.47% of the factors, such as age (90-99, 1.90%), living status (living in an institution, -12.35%), annual income (rich, 42.69%), smoking (yes, -5.56%), exercise (yes, 37.45%), and SRH (good, 19.09%) could significantly explain the depressive symptoms differences between the two populations (p < 0.05).

CONCLUSIONS

The oldest-old (aged 80+) adults in rural areas had a higher prevalence of depressive symptoms than that in urban areas, mostly attributed to variations in income, marital status, physical activity, and health status. These findings can help government agencies design targeted and precise intervention strategies (e.g., health education, improving medical security, and providing sports venues and equipment) to improve mental health and lower the risk of depression among the oldest population.

The Mediating Role of General Self-Efficacy in Health Self-Management and Psychological Stress Among Older Adults in Shanghai: A Structural Equation Modeling Analysis

BACKGROUND

Given the demographic shift towards an older population, it is crucial to understand the determinants and implications of psychological distress among this demographic group. This study explores the relationship between health self-management and psychological distress in older Chinese adults, focusing on the mediating role of general self-efficacy (GSE).

METHODS

We conducted a cross-sectional study in five districts of Shanghai from 1 November to 31 December 2021, employing a random cluster sampling method. Data were collected using the Health Self-Management Scale, the General Self-Efficacy Scale (GSES), and the Kessler-10 Scale. Out of 2050 participants approached, 1905 completed the survey, resulting in a response rate of 91.76%. Data analysis included correlation studies, hierarchical linear regression, and structural equation modeling.

RESULTS

The average Kessler-10 score among elderly individuals in Shanghai was 15.59 ± 6.35. Of these, 22.10% had mild psychological distress, 11.92% had moderate stress, and 5.30% had severe stress. We found significant negative correlations between psychological distress and health self-management (r = -0.34, p < 0.05) and GSE (r = -0.26, p < 0.05). Health self-management had a total effect of -0.284 (95%CI: -0.330 to -0.234) on psychological distress, with GSE mediating approximately 20.42% of this effect.

CONCLUSIONS

GSE plays a significant mediating role between health self-management and psychological distress. These findings highlight the importance of promoting health self-management and GSE to alleviate psychological distress among older adults in Shanghai. This approach could enhance holistic health outcomes and improve the quality of life within this growing population segment.

The impact of the development level of rural e-commerce on the depressive symptoms among rural older adult individuals

Background

In the context of China, where the demographic trend of population aging intertwines with the rapid advancement of information digitalization, rural older adult individuals, who are part of a vulnerable population, are witnessing a deteriorating depression status. The proliferation of rural e-commerce, which fuels the digital economic revolution in rural areas, is concurrently affecting the depressive symptoms among rural older adult individuals.

Methods

This study uses longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) and applies a multi-period Difference-in-Differences (DID) model to explore how rural e-commerce affects the depressive symptoms among rural older adult individuals.

Results

The findings indicate that the development of rural e-commerce can indeed improve the depressive symptoms among rural older adult individuals, with a particularly pronounced effect on those residing in the eastern and central regions of China, as well as those who do not live with their children. The mechanism analysis indicates that e-commerce improves depressive symptoms among rural older adult individuals by enhancing social interaction frequency and increasing financial support by children.

Conclusion

Based on these insights, we recommend a targeted approach to implementing e-commerce policies in rural areas, focusing on innovative methods to improve the depressive symptoms among rural older adult individuals.

Active social participation extends the healthy life expectancy of older men without spouses in Japan: The Yamanashi healthy active life expectancy cohort study

This study aimed to evaluate the association between family structure and healthy life expectancy among older Japanese adults, hypothesizing that social participation increases healthy life expectancy more in older men without a spouse than in older women. This study collected data on Healthy Life Expectancy from 541 older adults between 2003 and 2021 from the Healthy Life Expectancy Study, a cohort study of older adults in Yamanashi Prefecture, Japan. The Japanese long-term care insurance system serves as an indicator of a healthy life expectancy. The family structures of participants were categorized as living alone, with a spouse, and with non-spouse cohabitants, whereas social activity frequency was classified as low or high (Community participation was assessed using a 4-point scale: "often," "sometimes," "rarely," and "never."). Cox proportional-hazards regression was used to analyze the relationship between participant characteristics and the loss of healthy life expectancy. Each additional year of age for older men and women increases the risk of loss of healthy life expectancy by 13% and 16%, respectively. The risk of loss of healthy life expectancy was higher among older men who lived alone or lived with non-spouse cohabitants than older living with a spouse (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.01-3.75; hazard ratio: 1.66, 95% confidence interval: 1.05-2.64, respectively). However, older men living without a spouse and engaging in high social activity participation had a lower risk of loss of healthy life expectancy than did those with low social activity participation (hazard ratio: 0.35, 95% confidence interval: 0.17-0.71). In conclusion, older men living without a spouse with high social activity participation had longer healthy life expectancies than those living alone with low social activity participation did.

Study protocol: A national cross-sectional study on psychology and behavior investigation of Chinese residents in 2023

Introduction

This study protocol specifies the primary research line and theoretical framework of the 2023 Survey of the Psychology and Behavior of the Chinese Population. It aims to establish a consistent database of Chinese residents' psychological and behavioral surveys through multi-center and large-sample cross-sectional surveys to provide robust data support for developing research in related fields. It will track the public's physical and psychological health more comprehensively and systematically.

Methods

The study was conducted from June 20, 2023 to August 31, 2023, using stratified and quota sampling methods. A total of 150 cities across 800 communities/villages were surveyed, selected from China (Despite extensive coordination, we have been unable to contact our counterparts in the Taiwan region of China to obtain relevant statistical data). The questionnaires were distributed to the public one-on-one and face-to-face by trained surveyors. The questionnaires included basic information about the individual, personal health status, basic information about the family, the social environment in which the individual lives, psychological condition scales, behavioral level scales, other scales, and attitudes towards topical social issues. Supervisors conducted quality control during the distribution process and returned questionnaires, logically checked and cleaned for data analysis.

Discussion

Data collection has been finished, and scientific outputs based on this data will support the development of health promotion strategies in China and globally. In the aftermath of the pandemic, it will guide policymakers and healthcare organizations to improve their existing policies and services to maximize the physical and mental health of the Chinese population.

Trial Registration

This study was filed in the National Health Security Information Platform (Record No.: MR-37-23-017876) and officially registered in the China Clinical Trials Registry (Registration No.: ChiCTR2300072573).

The Association between Residential Environment and Self-Rated Mental Health among Older Canadians: The Moderating Effects of Education and Gender

This study examined the associations between residential environment and self-rated mental health (SRMH) among Canadians aged 65 or older (n = 16,304) and whether education and gender moderated the associations. Data came from the 2018 Canadian Housing Survey. Hierarchical multiple regressions were conducted to test the associations. Analyses revealed that increased dwelling size was associated with better SRMH among older women with high school education. Older adults with higher satisfaction with their dwelling design were more likely to report better SRMH, except for women with some college education. Feeling safer in the community was uniquely associated with better SRMH for men with high school education and women with a university degree. Results confirmed significant associations between specific home and residential environment features and SRMH for each gender-by-education group. Environmental programs designed to improve SRMH for older adult populations should consider within- and between-group diversity.

Rural-urban differences in the association between home-based community care services satisfaction and mental health status among older adults in Zhejiang Province, China: a cross-sectional study

Objective

This study aims to examine the association between home-based community care services (HBCCS) and mental health in older adults and specifically analyzes rural-urban differences in the association.

Methods

This cross-sectional study enrolled 852 older adults from Zhejiang Province, China. The Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder (GAD-7), University of California Los Angeles 3-item Loneliness Scale (UCLA-3), and the Mental Health (MH) component score of the 36-item Short Form (SF-36) were used to measure self-reported mental health status. Four categories of community care services were examined: daily, medical, social and recreational, and spiritual comfort. Satisfaction with community care services was assessed using self-reported measures. We used a multiple linear regression model.

Results

Satisfaction with daily care services, social and recreational services, and spiritual comfort services in rural older adults was significantly higher than in urban older adults (p = 0.016, p < 0.001, p < 0.001, respectively). Rural older adults reported lower scores on the PHQ-9, GAD-7, and UCLA-3 than urban older adults (p < 0.001, p = 0.003, p = 0.001, respectively) and had significantly higher scores on the SF-36 MH than urban older adults (p < 0.001). Among urban older adults, medical care services satisfaction was negatively related to the PHQ-9 and UCLA-3 scores (β = -0.296, p = 0.004; β = -0.447, p = 0.009, respectively). A lower UCLA-3 score was associated with higher levels of satisfaction with social and recreational services and with spiritual comfort services (β = -0.426, p = 0.010; β = -0.523, p = 0.002, respectively). A higher level of spiritual comfort services satisfaction was associated with a lower SF-36 MH score (β = 0.646, p < 0.001). Among rural older adults, medical care services satisfaction was negatively related to the GAD-7 score (β = -0.327, p = 0.028).

Conclusion

Home-based community care services satisfaction was positively associated with older adults' mental health status in Zhejiang Province. More attention should be paid to maintaining relevant satisfaction with HBCCS to ensure positive mental health among rural and urban older adults.

Association between interpersonal sensitivity and loneliness in college nursing students based on a network approach

BACKGROUND

The symptoms of interpersonal sensitivity and loneliness are prevalent among college nursing students. This study aims to investigate the interactions at the symptom level and elucidate the characteristics of the interpersonal sensitivity and loneliness symptoms network among Chinese college nursing students.

METHOD

A cohort of 864 college nursing students participated in the study. Interpersonal sensitivity was assessed using the Chinese Version of the Short Form of the Interpersonal Sensitivity Measure (IPSM-CS), while loneliness symptoms were evaluated using the three-item Loneliness Scale (T-ILS). Central symptoms and bridge symptoms were determined using centrality and bridge centrality indices, respectively. The stability of the network was evaluated through the case-dropping procedure.

RESULTS

The most robust direct relationship was observed between the interpersonal sensitivity symptoms 'Feel happy when someone compliments' (IPSM-CS9) and 'Make others happy' (IPSM-CS10). 'Feel happy when someone compliments' (IPSM-CS9) exhibited the highest node strength in the interpersonal sensitivity and loneliness network, with 'They would not like me' (IPSM-CS2) following closely behind. Among the loneliness symptoms, 'Relational loneliness' (T-ILS1) demonstrated the highest bridge strength, followed by 'Intimate loneliness' (T-ILS3) and 'Social loneliness' (T-ILS2). The entire network displayed robustness in both stability and accuracy assessments.

CONCLUSION

This study emphasized the importance of central symptoms (e.g., 'Feel happy when someone compliments' and 'They would not like me') and bridge symptoms (e.g., 'Relational loneliness', 'Intimate loneliness', and 'Social loneliness'). Intervening in the central symptoms may effectively enhance the self-confidence of nursing students and foster harmonious relationships with others, thereby facilitating better adaptation to interpersonal relationships. Furthermore, by addressing bridge symptoms (e.g., meeting the need for approval and providing social support), nursing students can better adjust to their studies and practice with a more positive attitude during their college years.

Effects of activities participation on frailty of older adults in China

Objective

Frailty represents a significant health challenge among older adults, necessitating effective interventions to enhance their overall wellbeing. This study aims to investigate the impact of various types of activity participation on frailty in older adults and to elucidate their intrinsic associations, thereby providing a basis for targeted interventions.

Methods

This study constructed a classification of activities based on the framework proposed by the WHO regarding functional ability in healthy aging, innovatively dividing activities into five categories: physical activity, social activity, economic activity, information activity and sleep activity. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS 2020), the research employed multiple linear regression and mediation analysis to explore the effects of these activities on the frailty status of older adults and their underlying mechanisms. Furthermore, propensity score matching was conducted to robustly test the regression results.

Results

The study found that physical activity (β = -0.006, p < 0.01), social activity (β = -0.007, p < 0.01), economic activity (β = -0.017, p < 0.01), information activity (β = -0.040, p < 0.01) and sleep activity (β = -0.044, p < 0.01) all had significant positive effects on the frailty status of older adults. Additionally, sleep activity mediated the relationship between physical activity and frailty status, accounting for 4.819%. Social activity mediated the relationship between information activity and frailty status, accounting for 7.692%.

Conclusion

Older adults should enhance their participation in various activities to alleviate frailty. This can be further improved through the following three aspects: engaging in moderate physical exercise, fostering and promoting awareness of volunteer services, and popularizing the use of information technology.

Association between functional disability and mental health among Chinese older adults: Examining the moderating effects of social participation and physical exercise

BACKGROUND

Functional disability significantly burdens healthcare services, negatively affecting older adults' social interaction and quality of life. This study aims to identify the association between functional disability and mental health, and examine the moderating effects of social participation and physical exercise on the association.

METHODS

The data were drawn from 2018 wave of Chinese Longitudinal Healthy Longevity Survey, and ordinary least squares regression model was exploited to explore the association between functional disability and mental health.

RESULTS

Activity of daily living (ADL) disability negatively predicted mini-mental state examination (MMSE) score. Furthermore, social participation and physical exercise moderated the association between ADL disability and MMSE score.

CONCLUSION

The results highlight the importance of social participation and physical exercise for the older adults with ADL disability.

Developmental trajectories and heterogeneity of social engagement among Chinese older adults: a growth mixture model

BACKGROUND

Social engagement is closely related to well-being among older adults. However, studies on the changing trajectory and influencing factors (especially time-varying factors) of social engagement are limited. This study aimed to examine the social engagement trajectory of older Chinese adults and explore its time-fixed and time-varying factors, thus providing evidence for the development of strategies to promote a rational implementation for healthy aging.

METHODS

This study included 2,195 participants from a subset of four surveys from the Chinese Longitudinal Healthy Longevity Survey conducted from 2008 to 2018 (with the latest survey completed in 2018), with follow-ups conducted approximately every three years. Growth mixture modeling was used to explore the social engagement trajectory of older adults and the effects of time-varying variables. In addition, multinomial logistic regression was employed to analyze the association between time-fixed variables and latent classes.

RESULTS

Three distinct trajectories of social engagement among older adults in China were identified: slow declining (n = 204; 9.3%), which meant social engagement score decreased continuously, but social engagement level improved; slow rising (n = 1,039; 47.3%), marked by an increased score of social engagement, but with an depressed engagement level; and middle stabilizing (n = 952; 43.4%), which meant social engagement score and engagement level remained quite stable. A time-fixed analysis indicated that age, marital status, educational level, and annual family income had a significant impact on social engagement (P < 0.05). In contrast, the time-varying analysis showed that a decline in functional ability, insufficient exercise (means no exercise at present), deteriorating self-reported health and quality of life, negative mood, monotonous diet, and reduced community services were closely related to the reduction in social engagement levels (P < 0.05).

CONCLUSION

Three trends were observed at the social engagement level. Older adults with initially high levels of social engagement exhibited a continuous upward trend, whereas those with initially low levels experienced a decline in their social engagement, and those with initially intermediate levels remained quite stable. Considering the primary heterogeneous factors, it is imperative for governments to enhance basic services and prioritize the well-being of older adults. Additionally, families should diligently monitor the emotional well-being of older adults and make appropriate arrangements for meals.

Latent transition of social participation and its effects on depression among older adults in China: A National Longitudinal Study

OBJECTIVES

As populations age, the issue of social participation among older adults has gained prominence. Studies indicate variability in social participation trajectories among this demographic, yet the transition patterns and their effects on depression remain unclear. This longitudinal study aims to explore the latent classes and transition patterns in social participation among older adults and to evaluate their effects on depression.

METHODS

Data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2014 (T1) and 2018 (T2) were analyzed, including 2293 older adults. Latent class analysis (LCA) and latent transition analysis (LTA) were employed to identify latent classes of social participation at T1 and T2, as well as the transition probabilities between these classes. Multinomial logistic regression was used to examine predictors of transitions, and depression levels at T2 were compared across transition patterns.

RESULTS

The LCA results supported a 3-class model labeled as low, moderate, and high social participation. The probabilities of remaining stable and transitioning to other classes were similar across the three classes (ranging from 0.50 to 0.54). Age, gender, and other baseline characteristics emerged as significant predictors of transition patterns. Older adults experiencing positive transitions exhibited reduced depression compared to those in their original class over time, while those with negative transitions showed increased depression.

CONCLUSIONS

This research prompts a deep understanding of social participation dynamics in older adults and their effects on depression. Identifying social participation classes and transition patterns could inform interventions to enhance social participation and reduce depression among older adults.

Association between Internet use and depression among older adults in China: the chain-mediating role of volunteer activity participation and friend network

Background

Depression is a significant burden on individuals and society, which requires our attention and action. As the aging wave collides with digitalization, further research is needed to understand how internet use relates to depression in older adults. This study aimed to investigate whether volunteer activity participation and friend networks played a chain mediating role in this relationship from the perspective of the socioemotional selectivity theory.

Method

This study's data was derived from the 2018 China Longitudinal Aging Social Survey (CLASS), comprising 5,558 samples. The study employed the OLS model for benchmark regression and multiple robust check methods, including altering variable settings and utilizing the instrumental variable model. In addition, the generalized structural equation model (GSEM) was used to analyze the mechanism.

Result

Using the internet was significantly associated with reduced depression in older adults (coefficient = -0.9321, p < 0.001). The instrumental variable model confirmed this reduction (coefficient = -0.9200, p < 0.001). Moreover, we found that there were three indirect pathways of Internet use on depression among older adults: the mediating role of volunteer activity participation (all p-values <0.001), the mediating role of friend network (all p-values <0.001), and the chain mediating role of both factors (all p-values <0.001).

Conclusion

Based on the research findings, we suggest mobilizing tech-savvy older adults to assist others in adopting digital technology and using the internet. We also suggest that the government could assist in creating older adult-friendly communities. Social workers could collaborate with tech-savvy older adults to organize various voluntary activities, encouraging more senior citizens to participate. In addition, we recommend that the community should consider the form of activities to help older adults make friends first rather than solely focusing on voluntary activities.

The mediating effect of sleep quality on solid cooking fuel use and psychological distress among rural older adults: evidence from Shandong, China

BACKGROUND

Exposure to indoor air pollution from solid cooking fuel use may increase mental disorders risk through pathways such as oroxidative stress, neuroinflammation, or cerebrovascular damage. However, few studies have explored the underlying mechanism between solid cooking fuel use and psychological distress. The present study aims to investigate the mediating role of sleep quality on the relationship between solid cooking fuel use and psychological distress among older adults in rural Shandong, China.

METHODS

This study used the cross-sectional data from the second follow-up survey of the Shandong Rural Elderly Health Cohort (SREHC). A total of 3,240 rural older adults were included in the analysis. Logistic regression and the Karlson, Holm, and Breen (KHB) mediation analyses were performed to investigate the relationship between solid cooking fuel use and psychological distress, as well as the mediating role of sleep quality in this association.

RESULTS

This study found that solid cooking fuel use was significantly and positively associated with psychological distress among older adults in rural Shandong, China (OR = 1.38, 95% CI: 1.12,1.70). Mediation analysis revealed that sleep quality mediated the association between solid cooking fuel use and psychological distress among older adults (β = 0.06, P = 0.011). The mediation effect accounted for 16.18% of the total effect.

CONCLUSIONS

Our study showed that solid cooking fuel use was associated with psychological distress among rural older adults, and sleep quality mediated this association. Interventions should focus on addressing cooking fuel types and poor sleep quality to reduce psychological distress. In the future, more aggressive environmental protection policies would be needed to lessen the adverse effects of indoor air pollution on the health of older adults in rural China.

Enjoying the golden years: social participation and life satisfaction among Chinese older adults

Introduction

Older adults commonly face the risk of social isolation, which poses a significant threat to their quality of life. This study explores the association between social participation and life satisfaction among older Chinese adults.

Methods

Data were sourced from the 2018 China Health and Retirement Longitudinal Study. Regression analysis and mediation analysis were employed to examine the relationship between social participation and life satisfaction, with a focus on the roles of loneliness and self-rated health.

Results

The results indicate that social participation is significantly positively associated with older adults' life satisfaction. Furthermore, the positive association is more pronounced with increased diversity in social activities. Mediation analysis reveals that reductions in feelings of loneliness and improvements in health levels mediate the relationship between social participation and life satisfaction. Further analysis showed that social participation had a greater positive association among rural older adults and those lacking family companionship.

Discussion

This study provides evidence for enhancing life satisfaction among older adults and highlights the importance of diversity in social participation.

Network analysis of the urban-rural differences in depressive symptoms among older adults with multiple chronic conditions: Evidence from a national survey

BACKGROUND

Evidence on the differences in depressive symptoms among older adults with multiple chronic conditions (MCCs) in urban and rural areas is limited.

METHODS

Measures of depressive symptoms (Center for Epidemiologic Studies Depression Scale-10) and demographic factors (age, gender, and urban-rural distribution) were used.

RESULTS

A total of 4021 older adults with MCCs were included in this study. Significant differences were observed in both network global strength (Urban: 3.989 vs. Rural: 3.703, S = 0.286, p = 0.003) and network structure (M = 0.139, p = 0.002) between urban and rural residents.

CONCLUSIONS

The study highlights the need for region-specific approaches to understanding and addressing depression and holds the potential to enhance understanding of the psychological health status of older adults with MCCs in urban and rural settings.

Functional dentition and well-being among Chilean 80-year-olds

BACKGROUND

The Decade of Healthy Aging 2021-2030 calls for a strengthening of the policies for older people in Latin America. An example of successful oral aging is the Japanese "8020" campaign, which achieved 50% of people aged 80 years having ≥20 teeth by 2016.

OBJECTIVE

To evaluate the association between having a functional dentition (≥20 teeth) and cognitive health, social participation, and quality of life in people aged ≥80 years.

METHODS

Cross-sectional data from 299 complete observations (weighted N = 436 981) of individuals aged ≥80 years from Chile's National Health Survey 2016-2017 were included (3% of the population; total = 5520 clinical observations/weighted N = 14 518 969). Generalised structural equation models (GSEM) evaluated the association between having a functional dentition and cognitive health, measured with the Mini-mental score, between having a functional dentition and social participation, and between having a functional dentition and quality of life, measured with the EQ-5D-3L. Models included the effect of mediators (daily fruit and vegetable consumption; oral health-related quality of life score) and controlled for the exposure-induced mediator-outcome variables: sex, educational level, and location. Data were analysed using the STATA-17 survey module. Statistical significance was set at P < .05 (95% confidence interval [CI]).

RESULTS

The sample was mostly female, had <8 years of education, and lived in urban areas. The prevalence of a functional dentition was 9.2% (95% CI 3.6,21.3/n = 21). GSEM demonstrated that the association between functional dentition and cognitive health was mediated by daily fruits and vegetables consumption (β = 0.12/95% CI 0.02,0.21/P = .015), with moderate strength of evidence. Additionally, there was strong evidence of an association between functional dentition and social participation frequency (β = 2.76/95% CI 0.60,4.73/P = .009). Finally, the association between functional dentition and quality of life was mediated by cognitive health (β =0.05/95% CI 0.02,0.09/P = .002) and oral health-related quality of life (β = -0.04/95% CI -0.08 to -0.01/P = .025), with strong and moderate evidence, respectively.

CONCLUSION

Given the beneficial implications of functional dentition in social participation, nutritional benefits and quality of life and well-being of individuals aged ≥80 years.

Symptom patterns of comorbid depression and anxiety among older adults in China and their predictors

Comorbid depression and anxiety causes serious psychological and physiological damage for older people. This study aimed to identify heterogeneous classes of comorbid depression and anxiety (CDA) among older people in China and to ascertain predictors of latent class membership. Cross-sectional data of 10,919 cases were extracted from the Chinese Longitudinal Healthy Longevity Survey. Latent profile analysis (LPA) was used to identify symptom patterns of comorbid depression (measured by the 10-item Center for Epidemiologic Studies Depression Scale) and anxiety (measured by the Generalized Anxiety Disorder 7-item Scale). Multinomial logistic regressions following bivariate analyses were used to explore the relationship between the derived classes and individual- and social-level factors. Four patterns of CDA were identified: low symptoms of depression and anxiety (30.52%; n = 3333), mild depression only (53.26%; n = 5815), moderate depression and anxiety (13.82%; n = 1509), and severe depression and anxiety (2.40%; n = 262). Older people who are male, suffer from multimorbidity, and lack a healthy lifestyle are more likely to have problematic symptom profiles. While intimate relationships with partners and children significantly predicted CDA patterns, the effects of sibling relationships, daily life, and emotional support from the community were insignificant. LPA identified four distinct CDA patterns among a representative sample of older Chinese people. While restless sleep, lack of positive emotions, uselessness, and weak concentration are salient across all profiles, "difficult to relax" is prominent in profiles high in anxiety. In addition to individual-level variables, social-level factors, especially intimate relationships with partners and children rather than general links to siblings or the community, have unneglectable impacts on whether and to what extent older Chinese adults suffer from CDA in the cultural context of relationism, patriarchy, and filial piety.

Contribution of diversity of social participation on the mental health of humanitarian migrants during resettlement

AIMS

By the end of 2022, an estimated 108.4 million individuals worldwide experienced forced displacement. Identifying modifiable factors associated with the mental illness of refugees is crucial for promoting successful integration and developing effective health policies. This study aims to examine the associations between the changes in the diversity of social participation and psychological distress among refugees throughout the resettlement process, specifically focusing on gender differences.

METHODS

Utilizing data from three waves of a longitudinal, nationally representative cohort study conducted in Australia, this study involved 2399 refugees interviewed during Wave 1, 1894 individuals interviewed during Wave 3 and 1881 respondents during Wave 5. At each wave, we assessed psychological distress and 10 types of social participation across 3 distinct dimensions, including social activities, employment and education. The primary analysis employed mixed linear models and time-varying Cox models. Gender-stratified analyses and sensitivity analyses were performed.

RESULTS

Refugees engaging in one type or two or more types of social participation, compared with those not engaging in any, consistently had lower psychological distress scores (β = -0.62 [95% confidence interval (CI), -1.07 to -0.17] for one type of social participation; β = -0.57 [95% CI, -1.04 to -0.10] for two or more types of social participation) and a reduced risk of experiencing psychological distress (hazard ratio [HR] = 0.81 [95% CI, 0.65-0.99] for one type of social participation; HR = 0.77 [95% CI, 0.61-0.97] for two or more types of social participation) during the resettlement period. When stratifying the results by gender, these associations in the adjusted models only remained significant in male refugees. Moreover, three specific types of social participation, namely sporting activities, leisure activities and current employment status, were most prominently associated with a reduced risk of psychological distress.

CONCLUSIONS

The findings of this cohort study suggest that social participation was consistently associated with reduced risks of psychological distress among male refugees during resettlement. These findings highlight the significance of promoting meaningful social participation and interaction may be an effective strategy to improve the mental health of refugees and facilitate their successful integration into society, especially among male refugees.

Influence of intergenerational support on the mental health of older people in China

Today, population aging is the main trend of population development. Home-based care is mainly adopted in Chinese society, and scholars have paid ample attention to the effect of intergenerational support on the mental health of older people. However, research conclusions differ. This study uses data from the 2018 China Health and Pension Tracking Survey (CHARLS), which we analyzed with STATA software to construct least squares regression and two-stage least squares regression models. The regression model included 6,647 respondents to investigate the mental health status of older people based on depression status. Intergenerational support was defined as economic support, emotional support, and daily care provided by the children of older people. We studied the impact of three aspects of intergenerational support on the mental health of the elderly. We performed a robustness test using the variable replacement and propensity score matching methods, and analyzed age, gender, and urban-rural heterogeneity. The results showed that economic support had no significant impact on the mental health of older people, while emotional support and daily care had a positive effect. The heterogeneity results indicated that the relationship between intergenerational support and mental health of older people differed significantly based on age, gender, and urban and rural areas. Therefore, children should raise their awareness of supporting their parents, pay attention to their parents' mental health, and provide emotional support and daily care. Furthermore, community work improves family relations, creates a good social environment, and encourages young people to respect and be filial to older people. The government should improve the medical security system and old-age service system, and provide policy support to help the mental health of older people.

Associations between employment and mental health of older workers with disparate conditions: Evidence from China

PURPOSE

This study aimed to examine associations between the employment of older people and mental health across demographic characteristics, socioeconomic conditions, and health status, with a focus on pensions.

METHODS

This study included 4,512 participants aged 60-69 from the CLASS in 2014. A multiple linear regression was conducted to investigate the association between employment and mental health. A causal forest model was applied to estimate the heterogeneous treatment effects.

RESULTS

Employed individuals (n = 1,295) reported better mental health than their non-employed counterparts. This association displayed significant heterogeneity, primarily attributed to pensions. Those with lower pensions may be compelled to work due to financial reasons, thus offsetting the health-promotion effect of employment.

CONCLUSION

Employment may benefit the mental health of older adults, which has a more significant marginal effect on those who are men, older, urban residents, without a spouse, below primary education, receiving more pensions, and less family and friend support.

Effects of tai chi, ba duan jin, and walking on the mental health status of urban older people living alone: the mediating role of social participation and the moderating role of the exercise environment

With the global trend of aging, lacking of interpersonal communication and spiritual support and companionship have had a great impact on the mental health of older people living alone. This study examines the multifaceted impacts of engaging in tai chi, ba duan jin, and walking on the mental wellbeing of older people residing alone in urban areas. Additionally, this research aims to explore the association between tai chi, ba duan jin, and walking, and the mental health status of urban older people living alone, by considering the mediating influence of social participation and the moderating influence of the exercise environment. To do so, 1,027 older people living alone in six Chinese cities were investigated using the Physical Activity Rating Scale (PARS-3), the Geriatric Health Questionnaire (GHQ-12), the Social Participation Indicator System Scale, and the Exercise Environment Scale. SPSS 25.0 was utilized for conducting mathematical statistical analysis, specifically for doing linear regression analysis. Additionally, AMOS was employed to develop the study model. We found that a significant negative correlation between tai chi, ba duan jin, and walking and mental health status; among these, tai chi had the greatest impact on the mental health status of urban older people living alone. Social participation mediated the relationship between tai chi, ba duan jin, walking, and mental health status, and the exercise environment had a moderating effect on this relationship. The findings of this study indicate that tai chi, ba duan jin, and walking have a positive impact on the mental health of urban older people living alone, which can be influenced by the mediating efficacy of social participation and the moderating effect of the exercise environment.

Job preference of preventive medicine students during the COVID-19 pandemic: a discrete choice experiment survey in Shandong Province, China

BACKGROUND

Public health workers are a crucial part of the health workforce, particularly during the coronavirus disease (COVID-19) pandemic. They play an important role in achieving universal health coverage and sustainable development goals. Human resources in public health in China are in short supply, their distribution is unequal, and their turnover rate is high. A discrete choice experiment (DCE) was applied to investigate preventive medicine students' preferred job choice criteria and trends in trade-offs by calculating the marginal rate of substitution between these criteria. This study identified the properties of jobs primarily selected by preventive medicine students and estimated the monetary value of each attribute.

METHODS

Based on discussions and in-depth interviews with preventive medicine students and a literature review, we developed a DCE that assessed how students' stated preferences for a certain choice were influenced by several job attributes, including location, salary, bianzhi, career development opportunities, working environment, and workload. We applied this DCE to preventive medicine students in Shandong Province, China, using a brief, structured questionnaire. Conditional logit models were used to estimate the utility of each job's attributes. Willingness to pay (WTP) was estimated as the ratio of the value of the coefficient of interest to the negative value of the cost attribute.

RESULTS

A total of 307 respondents completed the questionnaire, and 261 passed the internal consistency test. All the attributes were statistically significant. Career development opportunities and work locations were the most important factors for the respondents. Preference heterogeneity existed among respondents, e.g., 3-year medical education college students placed a higher value on jobs with bianzhi compared to 5-year medical education college students. Furthermore, rural students' WTP for a job located in the county or city is much lower than that of urban students.

CONCLUSIONS

The heterogeneity of attributes indicates the complexity of job preferences. Monetary and nonmonetary job characteristics significantly influenced the job preferences of preventive medicine students in China. A more effective policy intervention to attract graduates to work in rural areas should consider both job incentives and the backgrounds of preventive medicine graduates.

Mediating and Moderating Effects of Internet Use on Urban-Rural Disparities in Health Among Older Adults: Nationally Representative Cross-Sectional Survey in China

BACKGROUND

The urban-rural disparities in health outcomes in China are remarkable. The internet has shown the potential to reduce the likelihood of contracting a disease by increasing disease knowledge. However, little is known about the effects of internet use in alleviating health inequities between urban and rural areas.

OBJECTIVE

This study aimed to examine the mediation and moderation of health disparities between urban and rural older adults through internet use.

METHODS

A total of 8223 respondents were selected from the China Health and Retirement Longitudinal Study 2018 data set. Basic activities of daily living, a brief Community Screening Instrument for Dementia, and the Centre for Epidemiologic Studies Depression Scale were used to measure functional disability, cognitive function, and depressive symptoms, respectively. Logistic regressions testing "internet use×urban-rural status" interactions for moderation and Karlson-Holm-Breen decomposition for mediation were performed.

RESULTS

Internet use moderated the urban-rural disparities in cognitive function (odds ratio 7.327, 95% CI 3.011-17.832) and depressive symptoms (odds ratio 1.070, 95% CI 1.037-1.787), but the moderating effects were significant only for those using the internet daily. Karlson-Holm-Breen results showed the suppression effects of using the internet daily (β=.012, 95% CI .002-.021) on the association between urban-rural status and cognitive function. The urban-rural inequality in depressive symptoms was partially attributed to the disparity in internet use (β=-.027, 95% CI -.043 to -.009).

CONCLUSIONS

The urban-rural inequalities in mental health are partially attributable to disparities in the prevalence of internet use between the 2 groups. However, using the internet is more beneficial for the psychological health of rural users, thereby alleviating the urban-rural disparities in health. Providing convenient channels for rural older adults to use the internet, improving the ability of rural users to effectively use the internet, and promoting internet popularity in rural areas are effective approaches to reducing urban-rural health inequalities.

Socioeconomic status and subjective well-being: The mediating role of class identity and social activities

BACKGROUND

Subjective well-being has a significant impact on an individual's physical and mental health. Socioeconomic status, class identity, and social activity participation play important roles in subjective well-being. Therefore, the aim of this study was to uncover the mechanisms through which these factors influence subjective well-being.

METHODS

A total of 1926 valid samples were recruited using the Chinese General Social Survey 2021 (CGSS 2021). The Chinese Citizen's Subjective Well-Being Scale (SWBS-CC) was employed to assess subjective well-being. Socioeconomic status was measured using income and education, and class identity and social activity participation were measured using Likert scales. Pearson correlation analysis and the chain mediation model were conducted to explore the relationship between these factors. Finally, the Bootstrap method was used to examine the path coefficients.

RESULTS

A significant correlation was found between socioeconomic status, class identity, social activity, and subjective well-being (p < 0.01). The indirect effect of socioeconomic status on subjective well-being mediated by class identity was 0.351 (95% CI: 0.721, 1.587), while the indirect effect of socioeconomic status on subjective well-being mediated by social activity was 0.380 (95% CI: 0.059, 0.240). The effect mediated by both class status and social activities was 0.011 (95% CI: 0.010, 0.093).

CONCLUSIONS

The study showed that socioeconomic status, class identity, and social activity had significant effects on subjective well-being. Class identity and social activity partially mediated the effects of socioeconomic status on subjective well-being, and they had a chain mediating effect between socioeconomic status and subjective well-being. Therefore, policymakers have the opportunity to enhance subjective well-being in lower socioeconomic status groups by promoting individual class identity and encouraging greater social activity participation.

Dual trajectories of depression and social participation among Chinese older adults

OBJECTIVES

This study aimed to investigate the dual trajectories of social participation (SP) and depression among older adults, and explore common factors that may influence both trajectories.

METHODS

The study utilized data from four waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011 to 2018). The dual-trajectory model was employed to estimate the dual trajectories of SP and depression.

RESULTS

This study identified two SP and three depression trajectories. The results revealed that the reciprocal relationship between SP and depression trajectories is confirmed in all sub-groups of the dual trajectories. Our study identified six distinct sub-groups of individuals based on their SP and depression trajectories and some commen risk factors of SP and depression trajectories.

CONCLUSIONS

Related intervention policies should consider the dual trajectories of SP and depression and focus on subgroups with high vulnerability, such as high depression but low SP. Additionally, attention should be given to addressing the common risk factors that underlie these trajectories.

Impact of pension income on healthcare utilization of older adults in rural China

OBJECTIVE

In China, rural residents experience poorer health conditions and a higher disease burden compared to urban residents but have lower healthcare services utilization. Rather than an insurance focus on enhanced healthcare services utilization, we aim to examine that whether an income shock, in the form of China's New Rural Pension Scheme (NRPS), will affect outpatient, inpatient and discretionary over-the-counter drug utilization by over 60-year-old rural NRPS residents.

METHODS

Providing a monthly pension of around RMB88 (USD12.97), NRPS covered all rural residents over 60 years old. Fuzzy regression discontinuity design (FRDD) was employed to explore the NRPS causal effect on healthcare services utilization, measured by outpatient and inpatient visits and discretionary over-the-counter drug purchases. The nationwide China Health and Retirement Longitudinal Study (CHARLS) 2018 provided the data.

RESULTS

Without significant changes in health status and medication needs, 60-plus-year-old NRPS recipients significantly increased the probability of discretionary OTC drug purchases by 33 percentage points. NRPS had no significant effect on the utilization of outpatient and inpatient utilization. The increase in the probability of discretionary OTC drug purchases from the NRPS income shock was concentrated in healthier and low-income rural residents. Robustness tests confirmed that FRDD was a robust estimation method and our results are robust.

CONCLUSION

NRPS was an exogenous income shock that significantly increased the probability of discretionary over-the-counter drug purchases among over 60-year-old rural residents, but not the utilization of inpatient or outpatient healthcare services. Income remains an important constraint for rural residents to improve their health. We recommend policymakers consider including commonly used over-the-counter drugs in basic health insurance reimbursements for rural residents; provide health advice for rural residents to make discretionary over-the-counter drug purchases; and to mount an information campaign on over-the-counter drug purchasing in order to increase the health awareness of rural residents.

Household Polluting Fuel Use and Frailty among Older Adults in Rural China: The Moderating Role of Healthy Lifestyle Behaviors

This study worked to investigate the effect of household polluting fuel use (HPFU), as an indicator of household air pollution exposure, on frailty among older adults in rural China. Additionally, this study aimed to examine the moderating effect of healthy lifestyle behaviors on the aforementioned association. This study employed cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey, which conducted nationally representative sampling of older adults from 23 provinces in mainland China. The frailty index was calculated using 38 baseline variables that assessed health deficits through questionnaire surveys and health examinations. A total of 4535 older adults aged 65 years and above were included in our study, among whom, 1780 reported using polluting fuels as their primary household cooking fuel. The results of regression analyses and multiple robustness checks indicated a significant increase in the frailty index due to HPFU. This environmental health threat was more profound among women, illiterate individuals, and low-economic-status groups. Moreover, healthy dietary and social activities had significant moderating effects on the association between HPFU and frailty. HPFU can be regarded as a risk factor for frailty among older adults in rural China, with its effects exhibiting socio-economic disparities. The adoption of healthy lifestyle behaviors can alleviate the frailty associated with HPFU. Our findings underscore the significance of using clean fuels and improving household air quality for healthy aging in rural China.

Life course rural/urban place of residence, depressive symptoms and cognitive impairment among older adults: findings from the Longitudinal Aging Study in India

BACKGROUND

Given the unique socioeconomic structures, and the rural/urban differentials in the prevalence of mental illnesses in the country, this study aimed to explore the associations of childhood, adulthood and late-life rural/urban place of residence with mental health outcomes, namely depressive symptoms and cognitive impairment, among older adults in India. The study also examined the relationship between older individuals' life-course rural/urban place of residence and late-life mental and cognitive health.

METHODS

Utilizing data from the Longitudinal Aging Study in India (n = 28,027 older adults age 60 years and above), the study employed multivariable logistic and linear regression models to examine the association between urban/rural residential status, life-course residence, depressive symptoms and cognitive impairment among older adults.

RESULTS

Childhood and adulthood place of residence was not associated with depressive symptoms in older men and women. Current rural place of residence was positively associated with depressive symptoms in older women [adjusted odds ratio (aOR): 1.37, confidence interval (CI): 1.05-1.80] but not men. Childhood [aOR: 1.88, CI: 1.16-3.04], adulthood [aOR: 2.00, CI: 1.26-3.16] and current rural residence [aOR: 1.93, CI: 1.27-2.91] was positively associated with cognitive impairment in men. Only current rural residence [aOR: 1.71, CI: 1.29-2.27] was associated with cognitive impairment in women. There was no significant association between life-course place of residence and depressive symptoms except in case of lifetime rural residence Respondents with urban-urban-urban (childhood-adulthood-current) place of residence were less likely to have depressive symptoms [adjusted coefficient (aCoef.): -0.14, CI: -0.21- -0.07] compared to those with rural-rural-rural place of residence. There were significant associations between life-course residence and cognitive impairment except among rural-urban-rural and urban-rural-rural migrants, showing an urban advantage in cognitive function among older adults.

CONCLUSIONS

This study showed significant associations between life-course residence and depressive symptoms among permanent rural/urban residents. The study also showed significant associations between life-course residence and cognitive impairment except among rural-urban-rural and urban-rural-rural migrants. Considering the rural disadvantage in mental and cognitive health among older adults, the government should continue to support policies that can improve access to education and healthcare among people residing in rural areas and women, in particular. The findings also urge social scientists and gerontologists in particular, to consider the importance of lifetime historical context while evaluating mental and cognitive health of older persons.

Subjective poverty, mental health, and mortality among Chinese older people: a prospective cohort study from 2008 to 2018

PURPOSE

The associations of duration of subjective poverty and poverty status with mortality among older people remains inconclusive, and the underlying mechanisms of mental health on them are rarely discussed in population-based epidemiological studies.

METHODS

We used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2008-2018). The Cox regression model was used to estimate hazard ratio (HR) and 95% confidence intervals (CIs) for mortality. Mediation analysis was applied to assess the effect of mental health.

RESULTS

When compared with participants without subjective poverty, those who reported subjective poverty at one time point (2008 or 2011) or two time points (2008 and 2011) had a higher risk of death, with multivariable-adjusted HR (95% CIs) of 1.08 (1.00-1.16) and 1.22 (1.06-1.39), respectively. For poverty status, the multivariable-adjusted HR (95% CIs) of mortality were 0.81 (0.66-0.98) for "just objective poverty" and 0.78 (0.62-0.98) for "neither subjective nor objective poverty" compared with participants who reported "just subjective poverty", while there was no statistically significant association between "poverty subjectively and objectively" and mortality (HR = 0.88, 95% CI 0.72-1.07). Besides, we found that the proportion mediated by mental health was 26.6%, and age was a significant effect modifier.

CONCLUSIONS

Subjective poverty may be associated with a higher risk of death among Chinese older people. This study showed that promoting mental health alone may not substantially reduce socioeconomic inequality in health. Further explorations of measures to tackle the social determinants of health are still needed.

Happiness and mental health of older adults: multiple mediation analysis

Introduction

This study aims to explore the influence mechanism of older adult mental health. As the aging population grows, the mental health of older adults becomes a significant public health and social issue, with happiness serving as a key dimension of mental health.

Methods

This study utilizes public data from CGSS to investigate the relationship between happiness and mental health, with Process V4.1 used for mediating effects analysis.

Results

The findings suggest a positive predictive effect of happiness on mental health, with three mediating paths identified: independent mediating effect paths of income satisfaction and health, as well as a multiple mediating effects path through income satisfaction and health.

Discussion

The study suggests that improving the multi-subject mental health support service system for older adults and creating public values for mental health risk coping mechanisms. This helps to understand the complex relationship between aging on individual and social levels. These results provide empirical support for healthy aging among older adults and future policymaking.

Association of social participation and psychological resilience with adverse cognitive outcomes among older Chinese adults: A national longitudinal study

BACKGROUND

Limited epidemiological evidence exists regarding the association of social participation and psychological resilience with cognitive health. This study aimed to comprehensively investigate the effects of social participation and psychological resilience on adverse cognitive outcomes among older adults in China.

METHODS

We used two waves (2011 and 2014) of data from the Chinese Longitudinal Survey of Health and Longevity (CLHLS), and 9765 respondents were eligible for the subsequent screening for the present prospective analysis. The Cox proportional hazards model was utilized to examine the association of social participation and psychological resilience with cognitive impairment, cognitive decline and greater cognitive decline. The restricted cubic spline plots were applied to clarify the dose-response relationships between them.

RESULTS

Compared to those with low social participation, participants with high social participation had a lower hazard ratio (HR) of 0.72 (95 % confidence interval [CI]: 0.59-0.89) for cognitive impairment, 0.85 (95 % CI: 0.76-0.94) for cognitive decline and 0.78 (95 % CI: 0.67-0.90) for greater cognitive decline. Participants with high psychological resilience had an HR of 0.77 (95 % CI: 0.63-0.95) for cognitive impairment 0.85 (95 % CI: 0.76-0.94) for cognitive decline and 0.85 (95 % CI: 0.73-0.98) for greater cognitive decline compared with those with low psychological resilience. Similar effects were observed for social participation score and psychological resilience score. The dose-response analysis also showed that the risk of adverse cognitive outcomes decreased gradually with increasing social participation scores and psychological resilience scores. Additionally, the multiplicative interaction between social participation and psychological resilience was not significant.

LIMITATION

All information was collected by self-report, which may lead to biases in the process of information collection.

CONCLUSION

In this study, social participation and psychological resilience were independently associated with a lower risk of adverse cognitive outcomes, and therefore both need to be considered as broader measures to preserve cognitive health among older Chinese adults.

Urban/rural differences in preferences for EQ-5D-5L health states: a study of a multi-ethnic region in China

OBJECTIVES

This study aimed to compare health preferences for EQ-5D-5L health states between urban and rural populations in China.

METHODS

This study used pooled secondary data from two EQ-5D-5L valuation studies. Participants were recruited from Guizhou province and Chongqing municipality, China using quota sampling. Each participant was interviewed face-to-face to value a set of 15 or 16 out of 30 EQ-5D-5L health states using time trade-off (TTO) methods including composite TTO and other two variants. Regression analysis was used to compare health state preferences between urban and rural participants.

RESULTS

A total of 597 participants (urban: 55.44%; rural: 44.56%) completed the valuation interviews. Both univariate and multivariable linear regression analyses showed that rural participants tended to value health states lower than urban participants regardless of severity of health states. The unadjusted and adjusted overall mean differences between the two groups were - 0.041 (95% confidence interval [CI] - 0.077, - 0.004, p-value = 0.031) and - 0.040 (95% CI - 0.078, - 0.002, p-value = 0.038), respectively. Predictions for the 3125 health states based on rural participants' health preferences were lower than those based on urban participants' health preferences.

CONCLUSION

There were small, yet statistically significant, differences in EQ-5D-5L health states preferences between urban and rural populations in China. Future study aiming at establishing a national value set should pay more attention to the sample representativeness.

Association Between Internet Use and Physical Health, Mental Health, and Subjective Health in Middle-aged and Older Adults: Nationally Representative Cross-sectional Survey in China

BACKGROUND

Internet use is an important means of accessing health-related information. Identifying the associations between internet use and health outcomes could provide insight into strategies for improving public health among middle-aged and older adults (45 years and up).

OBJECTIVE

This study aimed to examine the relationship between internet use and health outcomes in middle-aged and older adults.

METHODS

Data were obtained from the 2018 China Health and Retirement Longitudinal Study. Physical, mental, and subjective health were assessed using the Activities of Daily Living (ADL) Scale, the 10-item Center for Epidemiologic Studies Depression Scale, and the 3-level Self-Rated Health Scale, respectively. The chi-square test and rank sum test were used to explore whether internet use was associated with health status. A multivariate logistic regression model was used to determine this association further after controlling for the confounding factors.

RESULTS

Overall, 13% (1752/13,474) of the participants used the internet. Regression analyses revealed that the prevalence of depression (odds ratio [OR] 0.59, 95% CI 0.52-0.68; P<.001), negative self-rated health (OR 0.68, 95% CI 0.61-0.76; P<.001), and difficulty with ADL (OR 0.48, 95% CI 0.39-0.60; P<.001) in the participating middle-aged and older adult was lower in those using the internet than nonusers. After controlling for confounding factors, internet use was found to be negatively associated with difficulty with ADL (urban: OR 0.44, 95% CI 0.32-0.61; P<.001 vs rural: OR 0.55, 95% CI 0.41-0.75; P<.001), depression (urban: OR 0.69, 95% CI 0.57-0.84; P<.001 vs rural: OR 0.52, 95% CI: 0.43-0.63; P<.001), and self-rated health status (urban: OR 0.70, 95% CI 0.61-0.81; P<.001 vs rural: OR 0.67, 95% CI 0.57-0.78; P<.001) among middle-aged and older adults in both urban and rural areas.

CONCLUSIONS

Internet use had a positive effect on the physical and mental health of middle-aged and older adults who participated in this study. However, the internet usage rate remains low among older Chinese people. Therefore, the internet penetration rate should be a priority.

Associations between media use, self-efficacy, and health literacy among Chinese rural and urban elderly: A moderated mediation model

Objectives

The influence of media use on health literacy among urban and rural elderly has been unknown in China. This study aims to examine the association between media use and health literacy and to explore the mediating role of self-efficacy and the moderating role of urban-rural residency.

Methods

Based on the cross-sectional study of the Psychology and Behavior Investigation of Chinese Residents (PBICR) in 2022, a total of 4,070 Chinese old people aged 60 years and above were included. We adopted the simplified New General Self-Efficacy Scale (NGSES) and the simplified Health Literacy Scale-Short Form (HLS-SF) to measure self-efficacy and health literacy. Media use was measured using a self-administrated questionnaire.

Results

Results showed that Chinese urban elderly had a higher frequency of media use than rural ones in the aspects of social activities, self-presentation, social action, leisure and entertainment, information acquisition, and business transactions through media (P < 0.001). Among all participants, self-presentation (B = 0.217, 95% CI: 0.040, 0.394), leisure and entertainment (B = 0.345, 95% CI: 0.189, 0.502), and information acquisition (B = 0.918, 95% CI: 0.761, 1.076) were significantly associated with health literacy. Self-efficacy partially mediated the effect of media use on health literacy (Bindirect = 0.045, 95% CI: 0.032, 0.058), accounting for 18.37% of the total effect. Urban-rural residency (B = 0.049, 95% CI: 0.024, 0.075) moderated the relationship between media use and self-efficacy significantly.

Conclusion

The urban-rural gap in health literacy requires more attention. The promotion of media use and self-efficacy may play a role in eliminating health disparities.

Limitations

As a cross-sectional study, it could not establish cause-effect relationships.

Mental health service needs and mental health of old adults living alone in urban and rural areas in China: The role of coping styles

This study aimed to explore the level and relationship between the mental health service needs (MHSN), coping styles (CS), and mental health (MH) of old adults living alone in urban and rural, and to explore the moderating effects of coping styles. A cross-sectional study was conducted with 717 older adults living alone. The survey measured MHSN, CS, and MH. Data were analyzed using a structural equation and bootstrapping method. There were significant differences in the MHSN, CS, and MH between urban and rural old adults living alone (P < 0.05). The model of the impact of MHSN on MH in urban and rural old adults living alone showed a good fit. These findings highlighted the importance of high MHSN and positive CS as potential protective factors of mental health in old adults living alone. This provides a theoretical basis for psychological nursing for old adults living alone in the community.

Does Neighborhood Social Capital Longitudinally Affect the Nutritional Status of School-Aged Children? Evidence from China

Previous research linking social capital to child nutritional status primarily constitutes cross-sectional studies. To investigate whether a longitudinal relationship exists, by conducting fixed-effects analyses with 16,977 repeatedly measured observations of 6193 children from the 2012, 2014, 2016, and 2018 China Family Panel Studies, this study explored the longitudinal effects of neighborhood participation, bonding trust, and bridging trust on the BMI-for-age z-score (BAZ) and BMI categories of school-aged children, differentiating between urban and rural residence. We found an increasing average BAZ, a decreasing prevalence of underweight, an increasing prevalence of overweight/obesity, and a reducing urban/rural gap in nutritional status. The levels of social capital components descended faster in the urban area. Bonding trust was predictive of a lower BAZ, a higher likelihood of being underweight, and a lower likelihood of being overweight/obese. Bridging trust was predictive of a higher BAZ. The longitudinal effects of bonding trust were significant among only the rural children. Our findings indicate that neighborhood social capital may impose causal impacts on the nutritional status of children. To effectively improve child nutritional status, a more empathetic governmental approach that promotes a more supportive distal social environment is needed.

Internet use and rural-urban mental health inequalities: Evidence from China

Introduction

In the context of the new digital era, clarifying the relationship between Internet use and urban and rural residents' mental health is of important value for reducing rural-urban health inequalities. This paper aims to study the association between Internet use and rural-urban mental health inequalities.

Methods

Based on the data of the China Family Panel Studies (CFPS) in 2020, we firstly examined the existence and specific manifestation of mental health inequalities between urban and rural residents. Secondly, we examined the mediating effect of Internet use by the Bootstrap mediating effect measure. Finally, we verified the robustness of the mediating effect.

Results

There are significant mental health inequalities between urban and rural residents, and urban residents have better mental health than rural residents (p < 0.01). In addition, the test results for the mediating effect of Internet use on mental health inequalities between urban and rural residents were significant (p < 0.01), with a direct effect of -0.028 (p < 0.01) and an indirect effect of -0.49 (p < 0.01), and this result remained significant in the robustness test.

Discussion

In such a new age of the Internet, mental health inequalities between urban and rural residents objectively did exist, and the use of the internet played a positive mediation effect on the formation of mental health inequalities between urban and rural areas.

Association of unmet long-term care needs with depression and anxiety among older adults in urban and rural China

This study examined the association of unmet long-term care (LTC) needs with depression and anxiety in older adults and explored urban-rural disparities. Cross-sectional data for 1896 respondents with a mean age of 91.58 years was from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depression and anxiety were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Unmet LTC needs were self-reported by older adults with functional limitations. Research methods included regression analyses, decomposition analyses, sensitivity analyses. Results showed that unmet LTC needs, depression, anxiety were more severe in rural older adults. Unmet LTC needs were significantly and positively related to depression and anxiety, but their associations with CESD-10 scores, depressive and anxiety symptoms were stronger in urban older adults. Urban-rural disparities in unmet LTC needs explained about 20%-40% of disparities in depression and anxiety. The findings highlighted the role of meeting LTC needs in reducing depression and anxiety, and that LTC policymakers should not ignore the needs of urban older adults and focus solely on rural older adults.

Value of social activities and prerequisites for continued participation of rural older adults: A qualitative study

AIMS

To explore the value of social activities and the prerequisites for continuous participation among rural older adults based on their experiences.

DESIGN

Qualitative, descriptive design.

METHODS

Individual semi-structured interviews were conducted with 14 older adults from voluntary community salons in a rural area in Japan. Participants were selected through purposeful sampling. Data were analyzed using qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) checklist were used.

RESULTS

Four values of social activities were identified: "Mutual benefit connectedness," "Preventing and coping with aging," "Making life brilliant 'now'," and "Building a safety net." Three prerequisites for activities were identified: "Do not overreach," "Do not infringe on personal territory," and "Do not go against community norms." Social activities provide rural older adults with reciprocity ties, coping with aging, enhanced daily lives, and a social safety net. Continued participation in rural social activities requires adherence to cultural norms and moderation of relationship distances. Community and public health nurses are expected to promote social activities that incorporate these values and adhere to these prerequisites.

The mediating role of psychological resilience between social participation and life satisfaction among older adults in China

BACKGROUND

A significant correlation has been discovered between social participation and older adults' life satisfaction, but the relationships among social participation, psychological resilience, and life satisfaction remain to be confirmed. Therefore, this study aims to identify the relationship between social participation and life satisfaction for Chinese older adults and to analyse the possible mediating role of psychological resilience between these two aspects.

METHODS

Data on 15,779 people aged 65 years and above were extracted from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Social participation was classified into two levels: low-level involvement activities and high-level involvement activities. Hierarchical regression analysis was applied to analyse the correlations between the two levels of social participation and older adults' life satisfaction as well as the mediating effects of psychological resilience on this association.

RESULTS

The results indicate that two levels of social participation were each positively correlated with life satisfaction. Specifically, high-level involvement activities (β = 0.070, P < 0.001) were more strongly associated with life satisfaction than low-level involvement activities (β = 0.051, P < 0.001). Moreover, psychological resilience was found to partially mediate the association between low-level involvement activities and high-level involvement activities and life satisfaction.

CONCLUSION

A higher level of life satisfaction for older adults is related to participation in high-level involvement activities. Psychological resilience has a mediating effect on the association between two levels of older adults' social participation and life satisfaction. These findings suggest that the government and society should establish a more concrete understanding of the psychological resilience of older adults.