Specific Leisure Activities and Cognitive Functions Among the Oldest-Old: The Chinese Longitudinal Healthy Longevity Survey

Bi-directional association between outdoor or social activities and cognitive function: do the PM2.5 exposure catalyze the detrimental inactivity-poor cognition cycle?

BACKGROUND

Previous research has shown that lack of leisure activities, either outdoor or social activities, impedes cognitive function. However, the interrelationship between poor cognition and deficient activities is understudied. In addition, whether exposure to air pollution, such as PM2.5, can accelerate the detrimental 'inactivity-poor cognition' cycle, is worthy of investigation.

METHODS

We used data from the 2008, 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We assessed the frequency of outdoor or social activities at each wave. The cognitive function was examined using a China-Modified Mini-mental State Examination. We estimated the residential exposure to fine particular matter (PM2.5) via a satellite-based model. We applied cross-lagged panel (CLP) model to examine the bi-directional relationship between outdoor or social activities and cognitive function. We then examined the effect of PM2.5 exposure with sequent cognitive function and activities using generalized estimation equation (GEE) model.

FINDINGS

Overall, we observed significant bi-directional associations between outdoor or social activities and cognitive function. Participants with better cognitive function in the last wave were more likely to engage in outdoor or social activities in the following wave (outdoor activities: β = 0.37, 95% CI [0.27,0.48], P < 0.01; social activities: β = 0.05, 95% CI [0.02,0.09] P < 0.01). Meanwhile, higher engagement in outdoor or social activities in the last wave was associated with more favorable cognitive function in the following wave (outdoor activities: β = 0.06, 95% CI [0.03,0.09], P < 0.01; social activities: β = 0.10, 95% CI [0.03,0.18], P < 0.01). Notably, an increase in PM2.5 exposure during the preceding year was significantly associated with a declining cognitive function (β = -0.05, 95% CI [-0.08,-0.03], P < 0.01), outdoor activities (β = -0.02, 95% CI [-0.04, -0.01], P < 0.01) and social activities (β = -0.02, 95% CI [-0.02, -0.01], P < 0.01) in the current year; the lagged effects of the PM2.5 exposure in the past year of the last wave on activities and cognitive function of the following wave were also observed.

INTERPRETATION

Our findings not only indicate the bi-directional links between the frequency of outdoor or social activities and cognitive function, but also report that PM2.5 exposure plays a role in catalyzing the detrimental inactivity-poor cognition cycle. Future research should investigate whether the policy-driven interventions, such as clean air policies, can break the unfavorable activity-cognition cycle, and thereby promoting health from the dual gains in leisure activities and cognition.

How does urbanization affect the cognitive function among older adults: A geospatial analysis in China

There has been a plethora of studies on urbanization and older adults, and more recent ones on how older adults adapt to this process with their cognitive competence. Yet it has been unclear about the relationship between them, like how the level and rate of urbanization affect the cognitive function among older adults. This study sourced, formed, and analyzed a set of geospatial big datasets from different sources, such as the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data, and the NPP/VIIRS nighttime light (NTL) data. Results showed a generally negative linear association between the rate of urbanization and cognitive performance among older adults in China. The "U" shaped non-linear relationship between urbanization level and cognitive function, as well as the tipping point, were identified. At the same time, it should be noted that mediators such as education, physical activity, social activity, and community elderly service might be able to mitigate these negative associations. Furthermore, older adults living in eastern regions or urban areas appeared to have better cognitive function than those living in mid-western regions or rural areas in China. The findings also pointed to the importance of focusing on older adults with poor cognitive health status in rapidly urbanizing areas.

The effects of cognitive leisure activities on frailty transitions in older adults in China: a CHARLS-Based longitudinal study

BACKGROUND

In an effort to identify factors associated with frailty transitions that trigger a significant difference in preventing and postponing the progression of frailty, questions regarding the role of cognitive leisure activities on various aspects of older adults' health were raised. However, the relationship between cognitive leisure activities and frailty transitions has rarely been studied.

METHODS

A total of 5367 older Chinese adults aged over 60 years from the China Health and Retirement Longitudinal Study (CHARLS) were selected as participants. The 2nd wave of the CHARLS in 2013 was selected as the baseline, and sociodemographic and health-related status baseline data were collected. The FRAIL Scale was used to measure frailty, while cognitive leisure activities were measured by the Cognitive Leisure Activity Index (CLAI) scores, which consisted of playing mahjong or cards, stock investment, and using the internet. After two years of follow-up, frailty transition from baseline was assessed at the 3rd wave of the CHARLS in 2015. Ordinal logistic regression analysis was used to examine the relationship between cognitive leisure activities and frailty transitions.

RESULTS

During the two-year follow-up of 5367 participants, the prevalence of frailty that improved, remained the same and worsened was 17.8% (957/5367), 57.5% (3084/5367) and 24.7% (1326/5367), respectively. Among all participants, 79.7% (4276/5367), 19.6% (1054/5367), and 0.7% (37/5367) had CLAI scores of 0, 1, and 2 to 3, respectively. In the univariate analysis, there was a statistically significant association between a score of 2 to 3 on the Cognitive Leisure Activity Index and frailty transitions (odds ratio [OR] = 1.93, 95% CI 0.03 to 1.29, p = .04), while all other covariates were not significantly different across the three groups. After adjusting for covariates, participants with more cognitive leisure activities had a higher risk of frailty improvement than those without cognitive leisure activities (odds ratio [OR] = 1.99, 95% CI 1.05 to 3.76, p = .04).

CONCLUSIONS

Cognitive leisure activities were positively associated with the risk of frailty improvement in older adults, mainly when participating in multiple such activities. Older adults may be encouraged to participate in a wide variety of cognitive leisure activities to promote healthy aging.

The mediating roles of depressive symptoms and social participation in the relationship between the effects of pain and cognitive function among Chinese older adults: A longitudinal study

Decline in cognitive function poses a substantial burden on individuals, families, and society. However, the longitudinal potential mechanism underlying the link of pain and cognitive function remains unclear. Using data of 4247 participants aged 60 years and over from the China Health and Retirement Longitudinal Study in 2011, 2013, 2018, and 2020, we discussed the longitudinal predictive effect of pain on cognitive function and the mediating effects of depressive symptoms and social participation. The longitudinal mediation model analysis revealed that pain could not directly influence cognitive function, but it could indirectly predict cognitive function through the independent mediation effects of depressive symptoms and social participation. Moreover, the association between pain and cognitive function was serially mediated by depressive symptoms and social participation. Diversified interventions aimed at relieving pain and depressive symptoms, and increasing social participation in older adults would be beneficial for their cognitive function.

Long-term exposure to fine particulate matter constituents and cognitive impairment among older adults: An 18-year Chinese nationwide cohort study

BACKGROUND

Although growing evidence has shown independent links of long-term exposure to fine particulate matter (PM2.5) with cognitive impairment, the effects of its constituents remain unclear. This study aims to explore the associations of long-term exposure to ambient PM2.5 constituents' mixture with cognitive impairment in Chinese older adults, and to further identify the main contributor.

METHODS

15,274 adults ≥ 65 years old were recruited by the Chinese Longitudinal Healthy Longevity Study (CLHLS) and followed up through 7 waves during 2000-2018. Concentrations of ambient PM2.5 and its constituents (i.e., black carbon [BC], organic matter [OM], ammonium [NH4+], sulfate [SO42-], and nitrate [NO3-]) were estimated by satellite retrievals and machine learning models. Quantile-based g-computation model was employed to assess the joint effects of a mixture of 5 PM2.5 constituents and their relative contributions to cognitive impairment. Analyses stratified by age group, sex, residence (urban vs. rural), and region (north vs. south) were performed to identify vulnerable populations.

RESULTS

During the average 3.03 follow-up visits (89,296.9 person-years), 4294 (28.1%) participants had developed cognitive impairment. The adjusted hazard ratio [HR] (95% confidence interval [CI]) for cognitive impairment for every quartile increase in mixture exposure to 5 PM2.5 constituents was 1.08 (1.05-1.11). BC held the largest index weight (0.69) in the positive direction in the qg-computation model, followed by OM (0.31). Subgroup analyses suggested stronger associations in younger old adults and rural residents.

CONCLUSION

Long-term exposure to ambient PM2.5, particularly its constituents BC and OM, is associated with an elevated risk of cognitive impairment onset among Chinese older adults.

Late Life Cognitive Function Trajectory Among the Chinese Oldest-Old Population-A Machine Learning Approach

Informed by the biopsychosocial framework, our study uses the Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset to examine cognitive function trajectories among the oldest-old (80+). Employing K-means clustering, we identified two latent groups: High Stability (HS) and Low Stability (LS). The HS group maintained satisfactory cognitive function, while the LS group exhibited consistently low function. Lasso regression revealed predictive factors, including socioeconomic status, biological conditions, mental health, lifestyle, psychological, and behavioral factors. This data-driven approach sheds light on cognitive aging patterns and informs policies for healthy aging. Our study pioneers non-parametric machine learning methods in this context.

Handicraft art leisure activities and cognitive reserve

ObjectiveOlder individuals face a higher likelihood of developing dementia. The rate of cognitive decline resulting from dementia is not equivalent for all, as some patients with dementia are able to function independently longer than others, despite having similar disease burden. The cognitive reserve (CR) theory provides one explanation for the differing rate of decline. CR suggests that there are factors-most notably, educational attainment and occupational attainment-that can protect against the cognitive decline. Although the beneficial effects of these notable CR factors are clear, not all are easily modifiable. Participation in leisure activities may represent a more easily modifiable factor. Some research hints at beneficial effects of leisure activities, although specific leisure activities have not been well examined. The present study examined the relations between handicraft art leisure activities (HALAs) and multiple cognitive domains. MethodArchival WAIS-IV and demographic data for 50 California retirement community residents were examined. ResultsHALA participation accounted for statistically significant variance in working memory performance (R2 = .40, β = .24%) over and above the established CR factors of age, depression, educational attainment, and occupational attainment. In addition, HALA participation was related to a better ability to perform abstract visual information tasks (Block Design subtest, r = .28, p = .05) and non-verbal reasoning tasks (Visual Puzzles subtest, r = .38, p = .008). ConclusionsHALA participation among older adults could contribute to the retention of cognitive function, supporting the role of HALA participation as a CR factor.

Longitudinal associations between the frequency of playing Mahjong and cognitive functioning among older people in China: evidence from CLHLS, 2008-2018

Background

Cognitive decline is prevalent among older adults, often resulting in decreased capabilities for self-care and a diminished quality of life. Mahjong, a culturally cherished and extensively played intellectual game in China, demands considerable cognitive function. While the cognitive benefits of playing Mahjong have been widely accepted, this study investigates an under explored aspect and aimed to ascertain the game's potential contributions toward bolstering self-care abilities, enhancing overall quality of life, and mitigating against rising societal healthcare costs.

Methods

The data analyzed in the study is collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) with cognitive functioning being assessed through the Mini-Mental State Examination (MMSE). The frequency of playing Mahjong was measured through a self-reported questionnaire. Multiple linear regression models, latent variable growth models, and cross-lagged models were used to investigate the longitudinal relationship between game frequency and cognitive function in older people.

Results

Of the 7,535 participants, the mean (SD) age was 81.96 (10.53) years. There were 7,308 (97%), 4,453 (59%), and 1,974 (26%) participants in 2011, 2014, and 2018, respectively. The results showed that Mahjong players had significantly higher MMSE scores compared to non-players from 2008 to 2018 (β = 0.893; p < 0.001), and non-players had significantly lower scores in 2011, 2014, and 2018 than in 2008 (β = -1.326, -0.912, -0.833; Ps > 0.05). Moreover, the frequency of playing Mahjong was associated with improved various cognitive domains. The declining frequency of playing Mahjong was substantially associated with the declining rate of MMSE scores (r = 0.336; p < 0.001). Mahjong frequency showed positive effects on MMSE scores, while the influence of Mahjong on MMSE scores were not significant.

Conclusion

Playing Mahjong has a positive influence on the cognitive functioning among older people. It can help buffer against the decline in cognitive function and maintain cognitive function levels. The higher frequency of playing Mahjong is associated with improved reaction, attention and calculation, and self-coordination. A decline in the frequency of playing Mahjong was associated with a declining rate of cognitive function. The higher frequency of playing Mahjong among older people unilaterally influenced the improvement of cognitive function levels in older people in China.

Effects of leisure activities and general health on the survival of older people: a cohort study in China

Objective

This study aimed to examine the influence of physical and cognitive leisure activities on the survival of older adults in China, while also exploring the potential mediating and moderating effects of general health.

Methods

This study utilized the China Longitudinal Healthy Longevity Survey (CLHLS) datasets spanning from 2008 to 2018, and 10,347 eligible participants were included. The primary study outcome was all-cause mortality, and independent variables included physical leisure activities (PLA), cognitive leisure activities (CLA), and self-rated general health. Three sets of covariates were adjusted, including socio-demographic characteristics, health behaviors, and health status.

Results

The longest survival time was the older people participating in PLA & CLA (mean = 50.31 months), while those participating in neither exhibited the lowest (mean = 29.60 months). Significant differences in survival status were observed in different types of leisure activities participation (Log-rank test, Chi-square = 576.80, p < 0.001). Cox regression indicated that PLA (HR = 0.705, 95% CI: 0.651-0.764), CLA (HR = 0.872, 95% CI: 0.816-0.933), and the both PLA & CLA (HR = 0.700, 95% CI: 0.656-0.747) were protective factors for the survival. Additionally, general health significantly moderated the relationship between PLA and reduced mortality risk (Coefficient = -0.089, p = 0.042). While CLA indirectly influenced the survival through general health (Coefficient = -0.023, p < 0.001). For the older people participating in PLA and CLA, general health played mediating (Coefficient = -0.031, p < 0.001) and moderating (Coefficient = -0.026, p = 0.013) role in the relationship between leisure activities and survival.

Conclusion

Leisure activities and self-rated general health were important predictors of survival of the older adults, and general health exhibited a mediator and moderator in the relationship between leisure activities and survival status.

The role of lifestyle factors in cognitive health and dementia in oldest-old: A systematic review

Oldest-old is the fastest growing segment of society. A substantial number of these individuals are cognitively impaired or demented. Given the lack of a cure, attention is directed to lifestyle interventions that could help alleviate the stress in patients, their families, and society. The aim of this review was to identify lifestyle factors with important roles in dementia prevention in oldest-old. Searches were conducted in PubMed, EMBASE, Scopus and Web of Science. We identified 27 observational cohort studies that met the inclusion criteria. Results showed that eating a healthy diet with plenty of fruits and vegetables, and participation in leisure and physical activities may protect against cognitive decline and cognitive impairment among oldest-old regardless of the APOE genotype. Combined lifestyles may generate multiplicative effects than individual factors. This is the first review known to systematically examine the association between lifestyle and cognitive health in oldest-old. Lifestyle interventions for diet, leisure, or a combination of lifestyles could be beneficial for cognitive function in oldest-old. Interventional studies are warranted to strengthen the evidence.

Development and Validation of a Lifespan Prediction Model in Chinese Adults Aged 65 Years or Older

OBJECTIVES

Previous studies investigated factors associated with mortality. Nevertheless, evidence is limited regarding the determinants of lifespan. We aimed to develop and validate a lifespan prediction model based on the most important predictors.

DESIGN

A prospective cohort study.

SETTING AND PARTICIPANTS

A total of 23,892 community-living adults aged 65 years or older with confirmed death records between 1998 and 2018 from 23 provinces in China.

METHODS

Information including demographic characteristics, lifestyle, functional health, and prevalence of diseases was collected. The risk prediction model was generated using multivariate linear regression, incorporating the most important predictors identified by the Lasso selection method. We used 1000 bootstrap resampling for the internal validation. The model performance was assessed by adjusted R2, root mean square error (RMSE), mean absolute error (MAE), and intraclass correlation coefficient (ICC).

RESULTS

Twenty-one predictors were included in the final lifespan prediction model. Older adults with longer lifespans were characterized by older age at baseline, female, minority race, living in rural areas, married, with healthier lifestyles and more leisure engagement, better functional status, and absence of diseases. The predicted lifespans were highly consistent with observed lifespans, with an adjusted R2 of 0.893. RMSE was 2.86 (95% CI 2.84-2.88) and MAE was 2.18 (95% CI 2.16-2.20) years. The ICC between observed and predicted lifespans was 0.971 (95% CI 0.971-0.971).

CONCLUSIONS AND IMPLICATIONS

The lifespan prediction model was validated with good performance, the web-based prediction tool can be easily applied in practical use as it relies on all easily accessible variables.

Leisure Activities, Genetic Risk, and Frailty: Evidence from the Chinese Adults Aged 80 Years or Older

INTRODUCTION

About half of adults aged ≥80 years suffer from frailty. Exercise is considered effective in preventing frailty but may be inapplicable to adults aged ≥80 years due to physical limitations. As an alternative, we aimed to explore the association of leisure activities with frailty and identify potential interaction with established polygenic risk score (PRS) among adults aged ≥80 years.

METHODS

Analyses were performed in a prospective cohort study of 7,471 community-living older adults aged ≥80 years who were recruited between 2002 and 2014 from 23 provinces in China. Leisure activity was assessed using a seven-question leisure activity index and frailty was defined as a frailty index ≥0.25 using a validated 39-item health-related scale. The PRS was constructed using 59 single-nucleotide polymorphisms associated with frailty in a subsample of 2,541 older adults. Cox proportional hazards models were used to explore the associations of leisure activities, PRS with frailty.

RESULTS

The mean age of participants was 89.4 ± 6.6 years (range: 80-116). In total, 2,930 cases of frailty were identified during 42,216 person-years of follow-up. Each 1 unit increase in the leisure activity index was associated with 12% lower risk of frailty (hazard ratio: 0.88 [95% confidence interval, 0.85-0.91]). Participants with high genetic risk (PRS >2.47 × 10-4) suffered from 26% higher risk of frailty. Interaction between leisure activity and genetic risk was not observed.

CONCLUSION

Evidence is presented for the independent association of leisure activities and genetic risk with frailty. Engagement in leisure activities is suggested to be associated with lower risk of frailty across all levels of genetic risk among adults aged ≥80 years.

Engagement in leisure activities and cognitive function by socioeconomic groups in China: A prospective cohort study

OBJECTIVE

To investigate whether the effects of leisure activities on cognition differ among socioeconomic groups and the effects of changes in the frequency of habitual leisure activities on cognition.

METHODS

We included 5869 older adults from the Chinese Longitudinal Healthy Longevity Survey (2008-2014). Five typical leisure activities were used to calculate the Leisure Activity Index (LAI). The Mini-Mental State Examination was used to assess cognition. Latent class analysis was used to construct the overall socioeconomic status (SES). Cox proportional hazard regression was applied to explore the associations and further stratified the analysis by SES.

RESULTS

Participants in the highest quartile of LAI had a 50 % lower risk of developing cognitive impairment compared with the lowest quartile of LAI (HR: 0.50, 95 % CI: 0.40-0.62) (P_trend < 0.01). Compared with participants who participated in leisure activities with increased frequency during the follow-up period, the HR (95 % CIs) of participants with no change in frequency was 3.10 (2.39-4.01), and that of participants with decreased frequency was 2.34 (1.81-3.04). A significant interaction between LAI and SES were found (P_interaction = 0.02). The association between LAI and cognitive function was more pronounced in participants with high SES (HR_{Q4 vs Q1}: 0.31, 95 % CI: 0.16-0.59) than in participants with low SES (HR_{Q4 vs Q1}: 0.61, 95 % CI: 0.45-0.83).

CONCLUSIONS

Leisure activities may have significant benefits in preventing cognitive impairment. However, promoting leisure activities alone may not substantially reduce socioeconomic inequalities in cognitive health. Measures addressing the social determinants of cognitive health still need to be further explored.

Path analysis of social engagement, loneliness and cognitive function among Chinese older adults

This study established a research model to fully understand the relationship of social engagement, loneliness and cognitive function among Chinese older adults. In the latest wave (2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a total of 12,852 participants aged 65 years and older were included in the study. Path analysis was performed to examine our hypotheses. The social engagement had a positive relationship with normal cognitive function while loneliness had a negative one, and the standardized regression weights were 0.618 (p < 0.01) and -0.046 (p < 0.01), respectively. Watching TV or listening to the radio had the greatest association with cognitive function, followed by housework, outdoor activities, reading newspapers or books, playing cards or mahjong, and raising domestic animals or pets. Loneliness played a mediating role between social engagement and cognitive function. Social engagement could be considered as one of the interventions to improve older adults' health.

Trajectories of Social Participation and Its Predictors in Older Adults: Based on the CLHLS Cohorts from 2002 to 2018

Social participation is a key factor in achieving active aging. This study aimed to explore the trajectories and predictors of social participation changes among older adults in China. The data used in this study are from the ongoing national longitudinal study CLHLS. A total of 2492 older adults from the cohort study were included. Group-based trajectory models (GBTM) were used to identify potential heterogeneity in longitudinal changes over time and investigate associations between baseline predictors and trajectories for different cohort members using logistic regression. Four different trajectories of social participation were reported in older adults, namely, stable (8.9%), slow decline (15.7%), lower score with decline (42.2%), and higher score with decline (9.5%). On multivariate analyses, age, years of schooling, pension, mental health, cognitive function, instrumental activities of daily living, and initial social participation scores significantly impact the rate of change in social participation over time. Four trajectories of social participation were identified in the Chinese elderly population. Management of mental health, physical function, and cognitive function appear to be important in maintaining the long-term social participation of older people in the community. Early identification of factors influencing the rapid decline in social participation and timely interventions can maintain or improve social participation levels in older adults.

Sex-Moderated Socio-Labor Aspects as Mediators of a Cognitive Stimulation Program in Older Adults: Randomized Clinical Trial

Cognitive stimulation is essential for successful aging. The influence of sex and socio-occupational elements on this area remains unknown. This study aimed to analyze the possible mediation of those elements in the effectiveness of a cognitive stimulation program in primary care. A randomized clinical trial was conducted with 232 adults aged 65 years or older without cognitive impairment. The intervention produced significant cognitive improvements. Women improved independently of social and occupational factors, while men's improvement occurred at a low role level (zero to one), a medium level of interests (two to three), with a medium level of mental occupation (neither high nor low), and with marked personal values. The mediating variables were the intervention group in both sexes and, also in men, a low and medium role level. Therefore, the intervention and roles appear as mediating variables moderated by sex. In conclusion, cognitive stimulation programs should be adapted.

Leisure Participation and Cognitive Impairment Among Healthy Older Adults in China

Leisure participation is beneficial to various health outcomes. This study examined a comprehensive list of leisure activities in relation to incidence of cognitive impairment among healthy older adults (65+) in China. Using data from the 2002 to 2018 Chinese Longitudinal Healthy Longevity Survey, we found that most of the leisure activities were protective of cognitive decline and three leisure activities (watching TV, doing housework, and playing cards/mah-jong) stood out as the most important ones. Additionally, our results revealed subgroup variations in the association between leisure participation and cognitive function: Leisure activities such as reading newspapers/books (not significant for the illiterate), gardening (not significant for the illiterate), and regular exercise (not significant for the rural residents) had different effects across different demographic social groups. Our findings suggest that intervention programs designed to prevent cognitive decline for older adults should consider subgroup and cultural variations in order to yield the best outcomes.

Can Traditional Board Games Prevent or Slow Down Cognitive Impairment? A Systematic Review and Meta-Analysis

BACKGROUND

Traditional board games can entail significant skills encompassing several cognitive functions across different domains. Therefore, they may potentially represent effective cognitive interventions in the aging population with or without Alzheimer's disease or other types of dementia.

OBJECTIVE

We aimed at verifying the hypothesis that traditional board games can prevent or slow down cognitive decline, through a systematic review on traditional board games and dementia.

METHODS

We searched five databases with tailored search strings. We included studies assessing the impact of board games on elderly subjects at risk of or suffering from cognitive impairment, or subjects with cognitive impairment irrespective of age. Studies where the effect of board games was not separated by cards or other games were excluded. A meta-analysis was performed for specific cognitive and non-cognitive outcomes.

RESULTS

Board games improved mental function, as measured by Montreal Cognitive Assessment (p = 0.003) and Mini-Mental State Examination (p = 0.02). Ska and Go improved Trail Making Test -A, while Mahjong improved executive functions. There was no consistent effect across different games on Digit Span or Categorical Fluency. Chess improved quality of life measured with the WHO-QoL-OLD scale (p < 0.00001). Mahjong temporarily improved depressive symptoms. Go increased BDNF levels and left middle temporal gyrus and bilateral putamen metabolism.

CONCLUSIONS

Traditional board games may slow global cognitive decline and improve the quality of life in elderly subjects. Different games have varying impacts on specific cognitive domains, possibly mediated by functional and biological factors.

Effect of leisure activities on cognitive aging in older adults: A systematic review and meta-analysis

Abnormal cognitive aging in older adults is a growing public health problem. Previous studies showed inconsistent results pertaining to the effects of leisure activities on cognitive function in older adults. We conducted a systematic review and meta-analysis of published observational longitudinal studies to examine and synthesize the effects of leisure activities on cognitive function in older adults. MEDLINE, PubMed, EMBASE, PsycINFO (Ovid), CINAHL (EBSCO), and Web of Science databases were searched from January 2012 to January 2022. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled using random-effects meta-analysis. Most studies found that leisure activities had a positive effect on cognitive function in older adults. The pooled RR for the effect of leisure activity on cognitive function was 0.77 (95% CI: 0.72-0.81, p < 0.01). The effects of leisure activities on cognitive function varied by different cognitive statuses in older adults, with RRs ranging from 0.55 (95% CI: 0.37-0.83) to 1.07 (95% CI: 0.95-1.22). Meta-regression analysis showed that compared with studies with percentage of female ≥50%, studies with female participant percentage <50% had significantly increased RR (p = 0.01). Moreover, studies conducted in European and American countries had significantly lower RR (p = 0.019), compared with those conducted in Asian countries. Our study revealed different effects of various types of leisure activities on different cognitive statuses in older adults. To make innovative recommendations for promoting cognitive function in older adults, more detailed observational longitudinal studies investigating the effects of different types of leisure activities on different cognitive statuses in older adults are needed.

Bidirectional associations of intellectual and social activities with cognitive function among middle-aged and elderly adults in China

BACKGROUND

Previous studies evaluating the association between leisure activities and cognitive function produced conflicting results. Different types of leisure activities may have different effects on cognition, and very few studies have explored their bidirectional associations. Our study aimed to explore whether intellectual and social activities had bidirectional associations with cognitive function among the middle-aged and elderly adults in China.

METHODS

Data was derived from the China Health and Retirement Longitudinal Study. The data in this study were based on 11,549 participants aged 45 or older whose intellectual and social activities and cognitive function were assessed at baseline. Cross-lagged panel model was used to examine the temporal relationship of intellectual and social activities with cognitive function.

RESULTS

Totally, 5624 participants completed the third follow-up in 2018. The results showed that the better the cognitive function they had at baseline, the more intellectual activities they were engage in (β = 0.044, P < 0.001) and vice versa (β = 0.042, P = 0.001). Additionally, better cognitive function at baseline was significantly associated with more engagement in social activities (β = 0.028, P = 0.030); in contrast, higher engagement in social activities at baseline was not related to better cognitive function (β = -0.008, P = 0.523).

LIMITATIONS

Engagement in social and intellectual activities was assessed via questionnaire.

CONCLUSIONS

Our findings indicated that there was a bidirectional relationship between intellectual activities and cognitive function. However, participation in social activities did not slow down the decline in cognitive function. Participating in intellectual activities, compared to social activities, is especially beneficial for cognitive function.

The shift from old age to very old age: an analysis of the perception of aging among older people

Background

The oldest-old (individuals over 90 years) are a fast-growing population. Understanding the perceptions of older people about very old age is the first step towards developing optimal geriatric care for an aging population. This study aimed to explore the potential shift from old age to very old age through the exploration of older people’s perception of aging.

Methods

Qualitative study conducted through individual interviews in the homes of older people. We voluntarily chose to include persons a decade under and above 90 years old to explore other factors than age that could participate in the shift from old age to very old age. The sampling was theoretical. We carried out the analyses using an inductive approach based on the phases of grounded theory. The researchers used triangulation. Collection was concluded when theoretical saturation was reached.

Results

Fourteen participants were interviewed. The shift from old age to very old age was not based on age but occurred when participants became conscious of the irreversibility of aging and its effects, and when they started living day-by-day, renouncing to any plan in a near future. The transition to very old age seemed to be preceded by a progressive disengagement from non-essentials activities. Participants reported a sensation of progressive social exclusion due to the loss of contemporaries or spouse, the difficulty to connect with younger generations or the absence of relationships in their neighborhood. The last step of life was feared, not because of the idea of death itself but because of the associated suffering and loss of autonomy.

Conclusion

Precipitating and slowing factors of the shift to very old age were identified to help general practitioners support older patients throughout their life trajectories.

Television watching, reading, cognition, depression and life satisfaction among middle-aged and older populations: A group-based trajectory modelling analysis of national data

This retrospective cohort study aimed to identify heterogeneous cognition, depression, and life satisfaction trajectory groups, and to examine the independent contributions of watching television and reading to these trajectories among middle-aged and older adults. A sample was taken from the Taiwan Longitudinal Study on Aging (TLSA) with measures of cognition, depression, life satisfaction, watching television, and reading during 12 years of follow-up (N = 4440). Group-based trajectory models and multinomial logistic regressions were used. The findings showed that the cohort was separated into three global cognition groups of low-cognition (n = 376), declining-cognition (n = 805), and maintained-cognition (n = 2718); three episodic memory groups of high-declining (n = 540), middle-stable (n = 2066), and improving groups (n = 1293); three depression groups of low-to-low (n = 2571), median-to-high (n = 960), and high-to-high groups (n = 368); and three life satisfaction groups of low- (n = 1133), middle- (n = 977), and high-level groups (n = 1789). Also, the findings demonstrated that after adjusting for covariates, those who did not watch television or read at the baseline had independently significantly increased odds of having lower global cognitive function, higher depression, and lower life satisfaction over time versus those who watched television or read almost every day. Based on the findings obtained, group-based trajectories of cognition, depression, and life satisfaction scores identified distinct subgroups among TLSA participants. Moreover, the findings suggest that healthcare providers need to develop more targeted population interventions to ensure successful aging. Healthcare providers can encourage older adults, particularly new retirees, to participate in leisure activities (i.e., watching television and reading) to reduce prevalence rates of cognitive impairment and depression.

Association between playing cards/mahjong and risk of incident dementia among the Chinese older adults: a prospective cohort study

Objectives: Studies have shown that the frequent participation of the elderly in cognitive stimulation activities is associated with a reduced risk of dementia, but the prospective evidence of this association is limited.

Methods: We used data from a prospective cohort study of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), and included 11,821 community-living Chinese individuals aged 65 years or older at 2008 baseline who were free of dementia, and were followed up every 2–3 years until 2018. Cox proportional hazards models were applied to generate the hazard ratios (HRs) and 95% confidence intervals (CIs) for analyzing the associations between the frequency of playing cards/mahjong and the incidence of dementia.

Results: A total of 821 participants were diagnosed with dementia during the 10-year follow-up. The average age of patients with dementia and non dementia were 89 and 90 years old, respectively. Compared with participants who rarely or never played cards/mahjong, participants who played cards/mahjong almost every day had a significantly lower risk of dementia (HR = 0.63; 95%CI, 0.42–0.95) after the multivariable-adjusted model. Similar results were observed in subgroup analyses based on sex (male: HR = 0.52, 0.28–0.96; female: HR = 0.62, 0.36–0.98), age (<85years: HR = 0.55, 0.32–0.89), regularly exercise (yes: HR = 0.44, 0.28–0.87) and MMSE score [above median (25): HR = 0.66, 0.41–0.92].

Conclusions: Playing cards/mahjong in the elderly may contribute to reducing the risk of dementia.

Using machine learning algorithms for predicting cognitive impairment and identifying modifiable factors among Chinese elderly people

Objectives: This study firstly aimed to explore predicting cognitive impairment at an early stage using a large population-based longitudinal survey of elderly Chinese people. The second aim was to identify reversible factors which may help slow the rate of decline in cognitive function over 3 years in the community. Methods: We included 12,280 elderly people from four waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), followed from 2002 to 2014. The Chinese version of the Mini-Mental State Examination (MMSE) was used to examine cognitive function. Six machine learning algorithms (including a neural network model) and an ensemble method were trained on data split 2/3 for training and 1/3 testing. Parameters were explored in training data using 3-fold cross-validation and models were evaluated in test data. The model performance was measured by area-under-curve (AUC), sensitivity, and specificity. In addition, due to its better interpretability, logistic regression (LR) was used to assess the association of life behavior and its change with cognitive impairment after 3 years. Results: Support vector machine and multi-layer perceptron were found to be the best performing algorithms with AUC of 0.8267 and 0.8256, respectively. Fusing the results of all six single models further improves the AUC to 0.8269. Playing more Mahjong or cards (OR = 0.49,95% CI: 0.38-0.64), doing more garden works (OR = 0.54,95% CI: 0.43-0.68), watching TV or listening to the radio more (OR = 0.67,95% CI: 0.59-0.77) were associated with decreased risk of cognitive impairment after 3 years. Conclusions: Machine learning algorithms especially the SVM, and the ensemble model can be leveraged to identify the elderly at risk of cognitive impairment. Doing more leisure activities, doing more gardening work, and engaging in more activities combined were associated with decreased risk of cognitive impairment.

Association of Playing Cards or Mahjong with Cognitive Function in Chinese Older Adults

Cognitive decline in older adults is a major public health threat. This study aimed to explore the association of participation in cards or mahjong with cognitive function in older adults. A total of 7308 older adults were selected from the 2018 Chinese Longitudinal Healthy Longevity Survey. A modified Mini-Mental State Examination (MMSE) was used to assess cognitive function. The participants were classified according to the frequency of playing cards or mahjong into the “regularly” (R) group, “occasionally” (O) group, or “never” (N) group. The results showed that older persons in the R group and O group had better cognitive function than those in the N group. Specifically, significant differences were found in attention and calculation, language, and total MMSE score between the R group and the N group. However, significant differences were not observed for adults aged 60–69 years old. Regression analysis indicated that playing cards or mahjong, together with age, educational level, sex, marital status, and occupation before age 60 could explain the cognitive function. The findings suggest that there is an association between participation in cards or mahjong and cognitive function in the population of Chinese older adults, and that the frequency of participation plays an important role in the association.

Relationships of leisure activities with physical and cognitive functions among Chinese older adults: A prospective community-based cohort study

OBJECTIVES

Based on a prospective design, this study aimed to investigate the relationships of leisure activities with physical and cognitive functions among Chinese older adults.

METHODS

The respondents aged 65 years or more were selected from the 2014-2018 of the Chinese Longitudinal Healthy Longevity Survey. Physical function measurement indicators were reflected by activities of daily living (ADL), instrumental activities of daily living (IADL), and physical performance (PP), while cognitive function was assessed by Mini-Mental State Examination. Fine-Gray competing risk regression models were used to analyze the data.

RESULTS

Using the figures for 2014 as a baseline for the study, we included 6047, 6216, 5951, and 5916 respondents in the ADL, IADL, PP, and cognitive function analyses, respectively. The prospective results showed that keeping domestic animals or pets was related to a lower risk of ADL disability of respondents after adjustment (SHR: 0.619, 95% CI: 0.486, 0.788). Similarly, taking part in social activities (SHR: 0.781, 95%CI: 0.658, 0.929) and reading books or newspapers (SHR: 0.793, 95% CI: 0.656, 0.958) were associated with a lower risk of IADL disability. Playing cards or mahjong was correlated with a lower risk of cognitive impairment (SHR: 0.669, 95% CI: 0.507, 0.882), while keeping domestic animals or pets was related to a higher risk of cognitive impairment (SHR: 1.279, 95% CI: 1.047, 1.562).

CONCLUSION

Participation in leisure activities moderately may decrease the risk of a decline in physical and cognitive functions among Chinese older adults.

Effects of Leisure Activities on the Cognitive Ability of Older Adults: A Latent Variable Growth Model Analysis

Based on the data of four periods of CLHLS (2008, 2011, 2014, 2018), the latent variable growth model (LGCM) was applied to 2344 older adults who completed four follow-up surveys, to study the trajectory of leisure activities and cognitive ability and explore the relationship between leisure activities and cognitive ability of older adults. The results showed that: (1) leisure activities and cognitive ability of older adults showed a non-linear downward trend; (2) leisure activities significantly and positively predicted the cognitive ability of older adults at every time point; (3) the initial level of leisure activity positively predicted the initial level of cognitive ability but negatively predicted the rate of cognitive decline; In addition, cognitive activities had a greater effect on cognitive ability than non-exercise physical activities; (4) the rate of decline of leisure activities also significantly and positively predicted the rate of decline of cognitive ability; (5) cross-lagged regression analysis further suggested the overall positive predictive effect of leisure activity on cognitive ability; (6) overall, education level had a significant contribution to cognitive ability, and the higher the education level, the slower the decline of cognitive ability; and (7) smoking could promote cognitive ability in older adults and no significant effect was found between alcohol drinking and cognitive ability. Accordingly, the government should encourage older adults to do more leisure activities, especially the cognitive activity, to effectively prevent cognitive decline.

Time trend analysis of leisure-time activity participation among young-old adults in China 2002-2018

Background

To examine the time trends of leisure activity engagement among young-old adults aged 65–74 in China over a 16-year period.

Methods

Data for a nationally representative sample of young-old adults was sourced from the 2002–2018 Chinese Longitudinal Healthy Longevity Survey (N = 9504). Generalized estimating equations regressions were implemented to assess temporal trends for 10 different leisure-time activities. We also evaluated time trends for solitary versus social leisure-time activities.

Results

Young-old adults were less likely to engage in any form of social activities (e.g. participate in social events) over time, controlling for other confounders such as age, sex, education, income, and health characteristics. Trends in outdoor activities participation and tourism also declined over 2002-2014, but reversed in 2018. In contrast, solitary leisure activities (e.g. watching TV) became more popular. There was a significant spike in the likelihood of keeping pets from 2011 onwards, especially among urbanites.

Conclusions

The future elderly in China have tended towards home-bound and solitary leisure activities over time, which warrants policy attention and public health interventions to reverse such trends.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12838-1.

Long-term ozone exposure and cognitive impairment among Chinese older adults: A cohort study

Ambient particulate matter pollution has been linked to impaired cognitive performance, but the effect of ambient ozone exposure on cognitive function remains largely unknown. We examined the association of long-term ozone exposure with the risk of cognitive impairment among a national representative cohort of 9,544 Chinese older adults (aged 65 years and over) with baseline normal cognition from the Chinese Longitudinal Healthy Longevity Survey (2005-2018). The ozone exposure of each participant was measured by annual mean ozone concentrations for the county of residence. Cognitive function was assessed by the Chinese version of the Mini-Mental State Examination (MMSE). We defined cognitive impairment as an MMSE score below 18 points accompanied by an MMSE score that declined ≥ 4 points from baseline. Cox proportional hazards models were applied to explore the association of ozone exposure with cognitive impairment. During the mean follow-up time of 6.5 years, 2,601 older adults developed cognitive impairment. Each 10-μg/m³ increase in annual mean ozone exposure was associated with a 10.4% increased risk of cognitive impairment. The exposure-response relationship between ozone exposure and risk of cognitive impairment showed a linear trend. Sensitivity analyses revealed the association to be robust. We found that older adults from Eastern, Central, and Southern China were particularly susceptible. Our results show that ozone is a risk factor for late-life cognitive decline. Reducing ambient ozone pollution may help delay the onset of cognitive impairment among older adults.

Cognitive reserve may outperform age, mood and psychiatric comorbidities as a predictor of executive functioning in bipolar disorder and healthy adults

INTRODUCTION

Cognitive reserve plays a protective role against executive dysfunction in healthy adults and individuals with psychiatric illnesses such as bipolar disorder. However, the magnitude of the influence of cognitive reserve on specific executive functions (EFs), and its impact relative to variables such as depressive symptoms, age and psychiatric comorbidities, is unexplored. This study aimed to quantify the influence of cognitive reserve on specific EFs, and compare its impact with that of depressive symptoms, age and psychiatric comorbidities, in separate models for patients with bipolar disorder and healthy adults.

METHOD

This was a cross-sectional study of 121 adults with no mood disorders and 109 with bipolar disorder, all of whom underwent a comprehensive psychiatric assessment and evaluation of the EFs. Cognitive reserve was measured using years of education, IQ and reading and writing habits. The association between EFs and predictors (cognitive reserve, depressive symptoms, age and psychiatric comorbidities) was evaluated through structural equation modeling. Four models were constructed for each group independently (bipolar disorder and control), one each for working memory, verbal fluency, inhibition and flexibility, due to group differences in age and cognitive reserve.

RESULTS

Working memory, inhibition and flexibility were most significantly predicted by cognitive reserve and age. Verbal fluency was only predicted by cognitive reserve. Comorbidities and depressive symptoms were not significant in any of the models. Cognitive reserve had a positive influence on all EFs in models for patients with bipolar disorder and models for control participants. Age had a negative impact on three of the four EFs tested.

CONCLUSION

Fostering cognitive reserve through continued education and cognitively stimulating leisure activities may be an effective intervention for executive dysfunction in patients and non-patients alike. In some cases, the effects of these interventions may outweigh the negative cognitive impact of aging, depressive symptoms and psychiatric conditions.

Leisure activity and cognitive function among Chinese old adults: The multiple mediation effect of anxiety and loneliness

BACKGROUND

Most countries in the world, including China, are experiencing serious aging problems. The decline of cognitive function seriously affects the quality of life of the elderly in their later years and brings an inevitable heavy burden to the family and society. Therefore, in order to achieve successful aging, the purpose of this study is to test the serial multiple mediation effect of anxiety and loneliness between leisure activity and cognitive function in Chinese elderly population.

METHODS

Using 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset, we finally selected 6,525 Chinese elderly people over 65 years old after screening. Firstly, we described the basic social demographic information of the sample population. Secondly, Spearman correlation analysis was used to determine whether there is a correlation between leisure activity, anxiety, loneliness and cognitive function in Chinese elderly. Finally, the serial multiple mediation analysis was completed using the SPSS macro PROCESS program.

RESULTS

Leisure activity, anxiety, loneliness and cognitive function were significantly correlated (p<0.01). Leisure activity can not only have a direct positive impact on the cognitive function of the elderly (effect=0.2231; SE=0.0122; 95%CI: LL=0.1992, UL=0.2470), but also have an indirect impact on the cognitive function through three paths: the independent mediating role of anxiety (effect=0.0028; SE=0.0015; 95%CI: LL=0.0001, UL=0.0059), the independent mediating role of loneliness (effect=0.0032; SE=0.0016; 95%CI: LL=0.0002, UL=0.0065), and the chain mediating role of anxiety and loneliness (effect=0.0008; SE=0.0004; 95%CI: LL=0.0001, UL=0.0017).

LIMITATIONS

All items were self-reported and some results may have biased. In the future, it may be more instructive to explore the impact of specific leisure activity on the cognitive function of the elderly.

CONCLUSIONS

The study suggests that leisure activity can improve cognitive function through decreasing anxiety and loneliness among the Chinese elderly. Diversified interventions aimed at increasing leisure activity participation in older adults would be beneficial for their mental health and cognitive function.

Associations of changes in late-life blood pressure with cognitive impairment among older population in China

Background

The cognitive impact of changes in late-life blood pressure is less clear. We aimed to investigate the association between late-life blood pressure changing pattern and risk of cognitive impairment.

Methods

Using data from the community-based Chinese Longitudinal Healthy Longevity Survey, change in systolic (SBP) or diastolic (DBP) blood pressure was calculated as the difference between follow-up and baseline, cognitive impairment was defined based on both the Mini-Mental State Examination and education level. The generalized additive model with penalized spline and multivariate logistic regression model were used, respectively, to examine the associations between continuous and categorized blood pressure changes with cognitive impairment at the follow-up wave.

Results

A total of 8493 Chinese elderly without cognitive impairment were included, with mean (standard deviation) age 80.6 (10.7) years. U-shaped associations between late-life blood pressure changes and risk of cognitive impairment were found, with only stable optimal blood pressure related to the lowest risk. For participants with baseline SBP around 130–150 mmHg, the adjusted odds ratio was 1.48 (1.13–1.93) for increasing follow-up SBP (> 150 mmHg), 1.28 (1.02–1.61) for decreasing follow-up SBP (< 130 mmHg), compared to stable follow-up SBP (130–150 mmHg). For participants with relative lower baseline DBP (< 80 mmHg), increasing their DBP to 80–90 mmHg during follow-up was associated with lower cognitive impairment risk (0.73 (0.58–0.93)), compared to steady low follow-up DBP (< 80 mmHg). Sex-specific analysis suggested that men were more vulnerable in term of SBP change.

Conclusions

Adhering to a stable optimal level of blood pressure in late-life is related to lower risk of cognitive impairment in Chinese elderly.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02479-1.

Reduced social activities and networks, but not social support, are associated with cognitive decline among older chinese adults: A prospective study

BACKGROUND

Social relationships consist of distinct dimensions. The literature on the effect of specific social relationship subdomains on cognitive function is limited. This large-scale, prospective cohort study examined the associations of social relationships with cognitive decline and further explored which subdomains of social relationships were predictive of cognitive decline among elderly Chinese individuals.

METHODS

A total of 3314 older Chinese adults aged 65-110 years from the 2011-2012 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Cognitive decline was defined based on the Chinese version of the Mini-Mental State Examination (MMSE). Social relationships were divided into three subdomains: social activities, social networks, and social support. Linear and binary logistic regression analyses were conducted to assess the effect of social relationships and the social relationship subdomains on cognitive decline after adjusting for age, sex, education, residence, exercise, drinking, smoking, activities of daily living, chronic diseases, depression, and baseline cognitive function.

RESULTS

Seven hundred and sixty-eight participants (23.17%) developed greater cognitive decline during the 3-year follow-up. The social relationships score was negatively associated with cognitive decline. Binary adjusted odds ratios showed that after potential covariates were controlled, social relationships, activities, and networks significantly reduced the risk of cognitive decline. When all social relationships variables were entered simultaneously with all covariates, the effect of social activities and networks on the risk of greater cognitive decline remained significant. However, we did not observe a significant association between social support and the risk of greater cognitive decline.

CONCLUSION

Our findings suggest that social relationships and the subdomains of social activities and networks, but not social support, have a protective effect against greater cognitive decline in older adults. This implies that structural dimensions of social relationships might be more important than functional dimensions in preserving cognitive health among elderly Chinese individuals.

Having hobbies and the risk of cardiovascular disease incidence: A Japan public health center-based study

BACKGROUND AND AIMS

The role of hobbies as a protective factor against cardiovascular diseases (CVD) has gained increasing attention; however, no large-scale studies were performed to confirm this. We aimed to examine the association between having hobbies and the risk of total CVD, coronary heart disease (CHD), and stroke in a large Japanese cohort.

METHODS

A total of 56,381 adults aged 45-74 years were divided into the non-hobby, having a hobby, and having many hobbies groups. We performed Cox proportional hazard models to estimate the hazard ratio (HRs) for incident CVD, CHD, and stroke after adjusting for potential confounding factors.

RESULTS

We identified 3685 incident CVDs (940 CHDs and 2839 strokes) during a median follow-up of 16.3 years. After multivariable adjustment, compared to the non-hobby group, participants having a hobby and many hobbies had a 10% (HR = 0.90 [0.83, 0.97]) and 20% (HR = 0.80 [0.69, 0.93]) lower risk of CVD incidence, respectively. The risk of CHD was lower in those with many hobbies, but the association between having many hobbies and CHD risk was not statistically significant. We also found a similar inverse association for stroke. Compared to the non-hobby group, participants having a hobby and many hobbies had a 13% (HR = 0.87 [0.80, 0.96]) and 20% (HR = 0.80 [0.68, 0.94]) lower risk of stroke.

CONCLUSIONS

Having hobbies was associated with a lower risk of CVD. Engagement in hobbies may emerge as an important target for healthy lifestyle promotion for the primary prevention of CVD.

The higher, the better: Cognitive reserve contributes to lifestyle activities in older age

The study aimed at investigating age and gender differences in cognitive reserve (CR) and whether CR can contribute to everyday and physical activity and fluid reasoning in older adults. Participants (N = 294), categorized into three age groups: young-old, middle-old, and old-old, completed the Cognitive Reserve Index questionnaire (CRIq), the Everyday Activity Questionnaire (EAQ), the Physical Activity Scale for the Elderly (PASE), and the Unbalanced Structure Test (UST). The old-old had significantly lower scores on CRI-Total, CRI-Working activity, and CRI-Leisure time compared to young-old and middle-old. Men showed higher scores than women on all CR subscales except for CRI-Leisure time where no significant difference was found. Younger age and higher CRI-Leisure time predicted higher scores on PASE, EAQ, and UST, while higher scores on CRI-Education predicted EAQ and UST. Higher CR seems to enable a more active and healthier lifestyle, while CRIq is a useful tool in the assessment of cognitive potential in the elderly.

Self-reported hearing difficulty increases 3-year risk of incident cognitive impairment: The role of leisure activities and psychological resilience

OBJECTIVE

Although hearing difficulty is associated with cognitive impairment, little is known about the potential mechanisms involved. This study assessed the mediating effects of leisure activities and psychological resilience on the association between hearing difficulty and cognitive impairment.

METHODS

Two waves of Chinese Longitudinal Healthy Longevity Survey (2011-2014) were used in the current analysis. Hearing difficulty, leisure activities and psychological resilience were measured at baseline. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination. The data were analyzed using generalized structural equation modeling with adjustment for confounding factors.

RESULTS

Of the 4267 participants at baseline, 33.5% (1430) reported hearing difficulty. The incidence of cognitive impairment was 15.3% (651) during the 3-year follow-up. Hearing difficulty increased the risk of cognitive impairment (odds ratio [OR] = 1.59, 95% confidence intervals [CI]: 1.26-1.92). Leisure activities and psychological resilience partly mediated the association between hearing difficulty and cognitive impairment. Hearing difficulty was negatively related to leisure activities (β = -0.23, 95% CI: -0.41 to -0.05) and psychological resilience (β = -0.34, 95% CI: -0.57 to -0.11). Furthermore, leisure activities (OR = 0.92, 95% CI: 0.89-0.96) and psychological resilience (OR = 0.95, 95% CI: 0.93-0.98) would significantly decrease the risk of cognitive impairment.

CONCLUSIONS

Hearing difficulty was associated with the incidence of cognitive impairment in older adults. Leisure activities and psychological resilience mediated the relationship. Participation in leisure activity and promoting psychological resilience may be candidate interventions in preventing cognitive impairment among the individuals with hearing difficulty.

Understanding community-dwelling Chinese older adults' engagement in physical activity: A grounded theory study

BACKGROUND AND OBJECTIVE

Limited information is available on the process of Chinese older adults' initiation, engagement, and maintenance of physical activity (PA), thus limiting the development of effective PA promotion programs. The purpose of the study was to investigate Chinese old adults' perspectives and experiences with PA engagement and to develop a conceptual model illustrating the process of how community-dwelling Chinese older adults engage in PA.

RESEARCH DESIGN AND METHODS

This study used grounded theory methodology. Nineteen community-dwelling Chinese older adults age over 60 years participated. We conducted semi-structured in-depth interviews with participants. Open, axial, and selective coding, along with constant comparative analysis was performed to analyze the data.

RESULTS

Participants described PA engagement as a complex and dynamic process, consisting of three stages: Getting started, Participating in PA, and Making PA Part of Life. The transition from one stage to the next was driven by an increasing internalized motivation towards PA through Seeing benefits. Many participants described that Staying in Groups was a key strategy for them to keep physically active. Moreover, Restructuring occurred when Chinese older adults encountered trigger situations.

DISCUSSION AND IMPLICATIONS

This study identified the stages of how community-dwelling Chinese older adults engage in to perform and maintain PA. The developed conceptual model can inform future interventions for promoting PA among Chinese older adults.

Leisure activities and psychological wellbeing reduce the risk of cognitive impairment among older adults with hearing difficulty: A longitudinal study in China

OBJECTIVES

. We used longitudinal cohort data to examine the effect of leisure activities and psychological wellbeing on the risk of cognitive impairment among Chinese older adults with hearing difficulty (HD).

STUDY DESIGN

. This prospective cohort study included 10,341 cognitively normal individuals aged 65 years or more at baseline from the Chinese Longitudinal Healthy Longevity survey (from 2002 to 2011).

MAIN OUTCOME MEASURES

. Hearing difficulty, leisure activities and psychological wellbeing were measured at baseline. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (MMSE). Cognitive impairment was defined as an MMSE score of less than 18 points.

RESULTS

. During a median follow-up of 5.6 years (59,869 person-years), 2,614 participants developed cognitive impairment. Cox proportional hazards models showed that the multi-adjusted hazard ratio (HR, 95% confidence interval) of cognitive impairment was 1.42 (1.28-1.58) for HD. Participants with a healthy lifestyle had a lower risk of cognitive impairment (HR = 0.77, 95% CI 0.69-0.85). Furthermore, participants with HD and a healthy lifestyle (HR = 1.67, 95% CI 1.27-2.18) had a lower HR of cognitive impairment than those with HD and an unhealthy lifestyle (HR = 1.86, 95% CI 1.61-2.14). A healthy lifestyle also delayed the onset of cognitive impairment by 0.50 years in people with HD.

CONCLUSIONS

. HD was associated with an increased risk of cognitive impairment, but a healthy lifestyle may decrease the risk of cognitive impairment related to HD and delay the onset of cognitive impairment.

Gendered leisure time-use and its impact on cognitive function among older adults in rural China

Increasing evidence has shown that an active, socially engaged lifestyle in leisure time might protect older adults against the decline of cognitive function. It remains unclear, however, which types of leisure activities are more beneficial to maintain cognitive function, and whether there are gender differences in the association between leisure activities and cognitive function. We used a two-wave of panel data from 1,018 older adults aged 60 and older in rural China to examine the lag effects of different types of leisure activities on cognitive functioning and to identify the gender differences in their impacts on cognition in rural China. Ordinary least-squares regression models showed that high physical activities were associated with better cognitive function. High intensity of cognitive activities and engaging in physical activities have a protective effect on cognitive function among older men rather than older women. Further, we found that cognitive activities had a stronger effect on cognitive function among older men than older women. It is important to consider gender-specific intervention in leisure activities to maintain cognitive function among older adults.

Specific Activities and the Trajectories of Cognitive Decline Among Middle-Aged and Older Adults: A Five-Year Longitudinal Cohort Study

BACKGROUND

How specific activities influence cognitive decline among different age groups, especially the late middle-aged and the early old, remains inadequately studied.

OBJECTIVE

To examine the association between specific activities with trajectories of cognitive functions in different age groups in China.

METHODS

A longitudinal cohort study was conducted based on data from the China Health and Retirement Longitudinal Study (CHARLS). Mixed effects growth models were applied to analyze the association between specific activities and cognitive functions.

RESULTS

Interacting with friends (infrequent: β= 0.13, confidence interval [CI] = 0.03 to 0.22; daily: β= 0.19, CI = 0.09 to 0.28), playing Mah-jong or other games (infrequent: β= 0.12, CI = 0.02 to 0.22; daily:β= 0.26, CI = 0.10 to 0.42), infrequent providing help to others (β= 0.24, CI = 0.11 to 0.37), and going to a sport (infrequent: β= 0.31, CI = 0.08 to 0.54); daily: β= 0.22, CI = 0.05 to 0.38) are significantly associated with participants' memory. Infrequently playing Mah-jong or other games (β= 0.30, CI = 0.17 to 0.43) and daily sports (β= 0.24, CI = 0.03 to 0.45) are significantly associated with better mental status. Effect of each activity varies among population of different age, education level, gender, and residence.

CONCLUSION

This study identifies four social activities that are associated with better cognitive functions, and provides a comprehensive, in-depth understanding on the specific protective effect of each activity among different subgroups.

Urban-rural differences in the effect of empty-nest on mental health and behaviors of Chinese older population

This study aimed to comprehensively analyze the effect of empty-nest on mental health and behaviors of the older population and explore the urban-rural differences. Data from the Cohort of Older People Health and Environment Controllable Factors were used, including 1071 older people aged 60 or over from a rural and an urban. Mental health, daily life behaviors, chronic physical diseases, and activities of daily living were evaluated. Logistic regression was used. The prevalence of empty-nest in older people was 55.0% in urban and 58.7% in rural. The empty-nest older people in urban were more likely to participate in physical exercise (OR[95%CI]: 1.55[1.03-2.31]), while the empty-nest older people in rural had lower rate of smoking (OR[95%CI]: 0.46[0.28-0.76]) and religious belief (OR[95%CI]: 1.61[1.01-2.58]), and higher prevalence of depression (OR[95%CI]: 1.55[1.03-2.35]) and higher level of total cholesterol (OR[95%CI]: 1.51[1.03-2.19]) compared with the non-empty-nest older people. In conclusion, the prevalence of empty-nest in older people was high both in rural and urban in China. Empty-nest exerts greater influences on the older people in rural than in urban, which should be given more attention, especially the depression and high total cholesterol.

Leisure activities and disability in activities of daily living among the oldest-old Chinese population: evidence from the Chinese Longitudinal Healthy Longevity Study

Introduction: To investigate the independent and joint effects of leisure activities on disability in activities of daily living (ADL) among the oldest-old Chinese population (aged ≥ 80 years).

Results: A total of 3696 participants with ADL disability were identified during the median follow-up period of 3.1 years. Compared to the participants who “never” watched TV or listened to the radio and who “never” kept domestic animals or pets, those who engaged in these activities “almost every day” had a significantly lower ADL disability risk (adjusted hazard ratios were 0.74 and 0.66, respectively; both P < 0.001). Furthermore, participants engaging in multiple leisure activities showed a reduced risk of ADL disability (P for trend < 0.001).

Conclusions: Frequently watching TV or listening to the radio and keeping domestic animals or pets was associated with a lower risk of ADL disability among the oldest-old Chinese population.

Methods: We included 12,331 participants (aged ≥ 80 years) (mean [SD] age: 89.5 [7.0] years) who managed to perform ADL independently at baseline in the Chinese Longitudinal Healthy Longevity Survey 1998-2014 waves. Cox proportional hazards models were used to examine whether leisure activities were associated with ADL disability.

Sensory Impairment and All-Cause Mortality Among the Oldest-Old: Findings from the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

OBJECTIVES

To investigate the association between sensory impairment and all-cause mortality among the oldest-old (aged 80 and older) in China.

DESIGN

Prospective cohort study.

SETTING

Community-based setting in 22 provinces of China.

PARTICIPANTS

A total of 8788 older adults aged 80 and over at baseline with complete hearing and vision function data were included as the study population.

MEASUREMENTS

Sensory impairment was categorized as no sensory impairment, hearing impairment (HI) only, vision impairment (VI) only and dual sensory impairment (DSI) according to hearing and vision function. Deaths were identified through interviews by close family members. Cox proportion hazards regression models were used to examine the association of sensory impairment with mortality, adjusting for socio-demographic data, life style factors and health status.

RESULTS

The mean age was 92.3 ± 7.6 years old, and 60.1% of participants were female. Among 8788 participants, 9.8% were recognized as DSI, 9.7% were HI only and 10.4% with VI only. Comparing with participants with no sensory impairment, those with VI only (HR=1.10, 95% CI=1.01-1.20) and DSI (HR=1.21, 95% CI=1.09-1.35) were significantly associated with higher risk of all-cause mortality in the fully adjusted model.

CONCLUSION

Our results demonstrated that VI only and DSI were significantly associated with higher risk of mortality among Chinese older adults aged 80 and over. The finding advocated that it is necessary to identify and manage sensory impairments for the advanced ages to reduce mortality risks.

Prevalence, Incidence, Influence Factors, and Cognitive Characteristics of Amnestic Mild Cognitive Impairment Among Older Adult: A 1-Year Follow-Up Study in China

BACKGROUND

The risk and protective factors of amnestic mild cognitive impairment (aMCI) and its prevalence as well as incidence among old adult in Chinese community are still unclear.

METHODS

We carried out this 1-year longitudinal study to survey a random sample of 3,246 community elders aged 60 and over in China. All subjects were required to complete a comprehensive clinical assessment, physical examination and several neuropsychological tests at baseline and follow-up. What's more, we also collected their lifestyle information by a standardized questionnaire.

RESULTS

We found that the prevalence of aMCI was 17.1%, while the incidence of aMCI among Chinese old adult was 70.57 per 1,000 person-years. By using Cox regression analysis, we found that male sex (p = 0.001, OR = 0.489, 95%CI 0.319~0.751) and reading (p = 0.023, OR = 0.533, 95%CI 0.310~0.917) were protective factors for against aMCI. Old adult who developed aMCI in the future showed multiple cognitive impairments (such as immediate memory, associative learning memory and executive function) in their early stage, and Wechsler's Block Design (p = 0.027, OR = 0.969, 95%CL 0.943~0.996) could predict whether subjects would turn into aMCI in the future.

CONCLUSIONS

The present study suggests that aMCI is a considerable health problem in China. Executive dysfunction may be an indicator of future development of aMCI in the old normal adult.

Leisure Activities and All-Cause Mortality Among the Chinese Oldest-Old Population: A Prospective Community-Based Cohort Study

OBJECTIVE

To investigate associations between leisure activities, examining each activity separately and in combination, and all-cause mortality among the Chinese oldest-old (≥80 years) population.

DESIGN

Prospective cohort study.

SETTING

Community-living, the oldest-old from 22 provinces in China.

PARTICIPANTS

We included 30,070 Chinese individuals aged ≥80 years (mean age: 92.7 years) from the Chinese Longitudinal Healthy Longevity Survey from 1998 to 2014.

MEASUREMENTS

Cox proportional hazards models were used to estimate relationships between leisure activities and all-cause mortality, adjusting for covariates including sociodemographic and lifestyle factors, self-reported medical history, and other potential confounders.

RESULTS

During 110,278 person-years of follow-up, 23,661 deaths were documented. Participants who engaged in watching TV or listening to the radio, playing cards or mah-jong, reading books or newspapers, gardening, keeping domestic animals or pets, or attending religious activities "almost every day" had a significantly lower mortality risk (adjusted hazard ratios ranged from 0.82 to 0.89; P < .01 for all) than did participants who "never" engaged in those activities. Furthermore, engagement in multiple leisure activities was associated with a reduced risk of all-cause mortality (P for the trend < .001).

CONCLUSIONS AND IMPLICATIONS

Frequent participation in leisure activities might help decrease the risk of death in the Chinese oldest-old population. This finding has important implications for public health policy and encourages the incorporation of a broad range of leisure activities into the daily lives of oldest-old individuals.