The Association Between Family Health and Frailty With the Mediation Role of Health Literacy and Health Behavior Among Older Adults in China: Nationwide Cross-Sectional Study

Cross-cultural adaptation and validation of the Chinese version of the Revised Identification of Seniors At Risk tool in the emergency department

OBJECTIVE

To adapt and validate the Simplified Chinese version of the Revised Identification of Seniors At Risk (ISAR-R) tool for identifying older patients at risk of adverse outcomes post-discharge in emergency departments.

METHODS

Brislin's bidirectional translation was used for accuracy. This prospective cohort study involved 1324 patients aged 65+ in three EDs of a tertiary hospital in central China. ISAR-R was administered before discharge, and 30-day outcomes were assessed via follow-up.

RESULTS

The tool showed good content validity (CVI=0.92). Among 1324 patients, 37.5 % were at high risk (ISAR-R ≥ 2). Logistic regression indicated that older age, wheelchair/ambulance arrival, and severe triage levels significantly increased high-risk classification. The primary endpoint occurred in 54.6 % of patients at 30 days. The ISAR-R score's AUC was 0.663.

CONCLUSIONS

The Simplified Chinese ISAR-R tool effectively identified older patients at risk of adverse outcomes in EDs, with appropriate cut-off values for different settings.

Acceptance of advance care planning among older adults in Mainland China: a national cross-sectional study

BACKGROUND

Acceptance of advance care planning (ACP) among older adults is important for the promotion of ACP. It is of great importance to explore the acceptance of ACP and associated influencing factors among older adults in China based on the health ecology model (HEM).

METHODS

Based on a national cross-sectional study in 2022, 4,180 older adults were included. Stepwise linear regression was used to analyze factors associated with acceptance of ACP using SPSS 26.0, based on the HEM. Acceptance scores were calculated based on a self-assessment visual analog scale (range, 0 ~ 100, with higher scores indicating higher acceptance of ACP).

RESULTS

50.05% (2,092) of 4,180 participants were female. The median acceptance of ACP score was 64, and the range was (49, 81). In addition, the study found higher well-being index (β = 0.086; 95% CI, 0.199 to 0.535; P < 0.001) and health literacy (β = 0.054; 95% CI, 0.07 to 0.423; P = 0.006) scores, broader media use behaviors (β = 0.064; 95% CI, 0.127 to 0.419; P < 0.001), and a higher per capita monthly household income (β = 0.086; 95% CI, 1.827 to 3.825; P < 0.001) were associated with a higher acceptance of ACP, while participants with higher depression scores (β = -0.06; 95% CI, -0.435 to -0.129; P < 0.001), larger social network (β = -0.054; 95% CI, -3.289 to -0.937; P < 0.001), and health insurance (β = -0.04; 95% CI, -7.294 to -1.027; P = 0.008) demonstrated a lower acceptance of ACP.

CONCLUSIONS

For the first time, this study revealed basic personal information, economic status, media use, social networks, health knowledge, and mental health as the main factors associated with acceptance of ACP among older adults in mainland China. These findings were of great significant for enhancing healthcare quality and the overall quality of life for older adults in China.

The Non-High-Density Lipoprotein Cholesterol (Non-HDL-C) to HDL-C Ratio (NHHR) and Its Association with Chronic Kidney Disease in Chinese Adults with Type 2 Diabetes: A Preliminary Study

Objectives: The objective of this study was to examine the association between non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio (NHHR) and chronic kidney disease (CKD) in Chinese adults with type 2 diabetes mellitus (T2DM). Methods: This study originated from a survey carried out in Zhejiang Province, located in eastern China, between March and November 2018. To explore the relationship between NHHR and CKD, a multivariable logistic regression model was employed. The dose-response relationship was assessed using restricted cubic spline (RCS) analysis, while generalized additive models (GAMs) were applied to examine the associations between NHHR and urinary albumin-to-creatinine ratio (UACR) as well as estimated glomerular filtration rate (eGFR). Subgroup analyses were performed across various demographic and clinical categories to assess the consistency of the NHHR-CKD association. The optimal NHHR cutoff for CKD diagnosis, its predictive accuracy, and its comparison with its components and HbA1c were determined through receiver operating characteristic (ROC) curve analysis. Results: The study enrolled 1756 participants, including 485 individuals with CKD and 1271 without CKD. Multivariable logistic regression revealed a significant positive association between NHHR and CKD, with each standard deviation (SD) increase in NHHR linked to a 23% higher odds of CKD (OR = 1.23, 95% CI: 1.09-1.37) after adjusting for potential confounders. When comparing quartiles, the fully adjusted ORs for Q2, Q3, and Q4 were 1.29 (0.92-1.79), 1.31 (0.94-1.83), and 1.87 (1.34-2.60), respectively, relative to Q1 (p for trend < 0.01). RCS analysis confirmed a linear dose-response relationship between NHHR and CKD in both sexes (p for nonlinearity > 0.05). GAMs indicated a significant positive correlation between NHHR and UACR (ρ = 0.109, p < 0.001) but no significant association with eGFR (ρ = -0.016, p = 0.502). Subgroup analyses demonstrated consistent associations across most subgroups, except for the 18-44 years age group, the well-controlled glycemic group, and the non-alcohol drinking group (p > 0.05). ROC curve analysis identified an optimal NHHR cutoff of 3.48 for CKD prediction, with an area under the curve (AUC) of 0.606 (95% CI: 0.577-0.635). Notably, NHHR outperformed its individual components and HbA1c in predictive performance. Conclusions: This study revealed a linear link between higher NHHR levels and increased CKD prevalence in Chinese T2DM patients. NHHR may also serve as a potential complementary biomarker for early CKD detection, though further prospective studies are needed to confirm its predictive value and clinical utility in high-risk T2DM populations.

The relationship between frailty and depression in Chinese elderly prostate cancer patients following radical surgery: the mediating effect of sleep disturbances

OBJECTIVE

Depression is an important factor affecting long-term outcomes in prostate cancer patients. Frailty and sleep quality are associated with depressive symptoms, but the pathways through which frailty and sleep quality affect depression remain unclear. The aim of this study was to investigate the relationship between frailty and depression in older Chinese patients after radical prostate cancer surgery and to explore whether sleep disturbances mediate the effect of frailty on depression.

METHODS

A cross-sectional study was conducted with 277 elderly prostate cancer patients who underwent radical prostatectomy at a tertiary oncology center in Southern China (January 2022-March 2024). Inclusion criteria required ≥ 3 months postoperative recovery. Standardized instruments were administered: FRAIL Scale for frailty assessment, Pittsburgh Sleep Quality Index (PSQI) for sleep evaluation, and PHQ-9 for depression screening, supplemented by demographic questionnaires.

RESULTS

Clinically relevant depressive symptoms (PHQ-9 ≥ 5) were identified in 18.4% (n = 51). Depression scores showed positive correlations with frailty (r = 0.521, p < 0.01) and negative correlations with sleep quality (r = -0.521, p < 0.01). Mediation analysis revealed frailty directly predicted depression (β = 0.349, p < 0.001) and indirectly through sleep impairment (β = 0.119, p < 0.001), with the indirect pathway accounting for 25.43% of the total effect (95% CI:0.059-0.191).

CONCLUSION

Elderly prostate cancer survivors exhibit heightened post-prostatectomy depression risks. Frailty acts as a dual-pathway predictor-directly exacerbating depressive symptoms and indirectly via sleep deterioration. These findings advocate for multidimensional interventions targeting frailty management and sleep optimization to improve mental health outcomes in this vulnerable cohort.

Associated factors of frailty among community-dwelling older adults with multimorbidity from a health ecological perspective: a cross-sectional study

BACKGROUND

As the global aging process accelerates, the older population is increasing annually, with the majority suffering from one or more chronic diseases. Due to the influence of chronic disease comorbidity, frailty among the older is widespread. Therefore, early identification of frailty in older adults with comorbidities from a comprehensive perspective, along with proactive measures for prevention and timely intervention, becomes an inevitable requirement for healthy aging. This study aimed to identify the entry point of frailty management in the older with multimorbidity in the community and clarify the focus of frailty management.

METHODS

A national cross-sectional survey of 1056 older adults with comorbidities in 148 cities across China was conducted. Frailty was assessed using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale. Based on the health ecological model, the factors which may influence frailty were collected from five levels. Univariate and multivariate analysis were utilized to determine the factors influencing frailty. The STROBE checklist was used preparing the manuscript.

RESULTS

A total of 417 patients (39.5%) reported having frailty, while 613 patients (58.0%) were in the pre-frail state. Multivariate logistic regression analysis indicate that compared with robust patients, number of comorbidities, self-efficacy, sleep quality and perceived social support are associated with frailty in older patients with comorbidities (P < 0.05). Compared to pre-frail group, factors such as number of comorbidities, gender (female), cognitive status of diseases, anxiety, having four or more comorbidities, smoking, eating habits, taking three or more different types of medication and perceived social support are associated with frailty (P < 0.05).

CONCLUSIONS

The prevalence of frailty among older adults with comorbidities is exceptionally high, influenced by various dimensions from health ecology perspective. Psychological care and daily behavior management should be strengthened for the frail older with multimorbidity. Precise and individualized care interventions need to be developed to help promote healthy aging.

Translation and Validation of the Chinese Version of the Rapid Geriatric Assessment (C-RGA): A Screening Tool for Geriatric Syndromes in Nursing Home Residents

Background: Frailty, sarcopenia, nutritional risk, and cognitive impairment are prevalent geriatric syndromes that adversely affect health outcomes in older adults, underscoring the need for an effective screen tool to enable early detection and timely intervention. Methods: This study employed a cross-sectional validation design and translated, culturally adapted, and validated the Chinese version of the Rapid Geriatric Assessment (C-RGA) among 416 nursing home residents. The C-RGA consists of four subscales: the simple frail questionnaire screening tool (FRAIL), SARC-F for sarcopenia (SARC-F), the Simplified Nutritional Assessment Questionnaire (SNAQ), and the Rapid Cognitive Screen (RCS). Results: The C-RGA demonstrated high content validity (S-CVI/Ave = 0.982) and strong internal consistency (Cronbach's α = 0.839). Factor analysis confirmed its four-domain structure, accounting for 61.497% of the variance. Model fit indices demonstrated good construct validity (χ2/df = 1.122, RMSEA = 0.024, GFI, AGFI, and CFI > 0.90), supporting the robustness of the assessment tool. Pearson correlation analysis revealed a strong association between FRAIL and SARC-F with SNAQ (r = -0.671, 95% CI: [-0.742, -0.600], p < 0.01) and a moderate correlation with RCS (r = -0.426, 95% CI: [-0.513, -0.339], p < 0.01), underscoring the interplay among nutritional deficits, muscle weakness, and cognitive impairment. Conclusions: The C-RGA demonstrates strong psychometric properties, supporting its potential use as a screening tool for the early detection of frailty, sarcopenia, nutritional risk, and cognitive impairment among nursing home residents, enabling timely and targeted interventions. Future research should further assess its applicability across diverse healthcare settings to enhance its generalizability and clinical utility.

Prevalence and associated factors with oral frailty in middle-aged and older hospitalized patients: a cross-sectional study

Background

With the development of the economy and society, people pay more and more attention to oral health. Oral frailty can limit nutritional intake and make an individual physically weak, which is detrimental to people's health. Therefore, it is urgent to identify oral frailty and their associated risk factors. In this study, we aimed to evaluate the oral frailty and its influencing factors in Chinese middle-aged and older hospitalized patients.

Methods

A cross-sectional study was conducted from May 2023 to February 2024 in 2 tertiary hospitals in Wuhu City, Anhui Province, China. The self-designed sociodemographic information, the Oral Frailty Index-8, the 2-item Connor-Davidson resilience scale (CD-RISC-2), the sarcopenia screening questionnaire, and the three-item short literacy survey were used in this study.

Results

A total of 914 middle-aged and older adults patients were recruited. The prevalence of oral frailty was 48.7% (445/914). In the univariate analysis, oral frailty was significantly associated with age, education, place of residence, monthly income, sarcopenia, resilience, and health literacy. Correlation analysis showed that oral frailty was significantly negatively correlated with sarcopenia, resilience, and health literacy. In the binary logistic regression analysis, oral frailty was significantly associated with sarcopenia, and health literacy. Health literacy was a protective factor of oral frailty.

Conclusion

This study aimed to investigate the prevalence of oral frailty and identify the associated influencing factors among middle-aged and older adults patients in Anhui Province, China. This study identified several factors influencing oral frailty in middle-aged and older adults patients. Therefore, the government and relevant departments should implement targeted interventions to improve middle-aged and older adults patients' oral frailty.

The relationship between negative psychological state and quality of life among cardiovascular disease patients in China: the masking effect of abnormal dietary behavior

Background

It is well known that abnormal dietary behavior increases the risk for cardiovascular disease especially if the person is depressed and/or anxious. The purpose of this study was to construct a moderated mediation model to explore the roles of abnormal dietary behavior and family health in the mechanism through which depression/anxiety influences Quality of life (QoL) in patients with cardiovascular disease.

Methods

A field survey was conducted in China and ultimately included 730 patients with cardiovascular disease aged 20-60 years. Data were collected using the Europe Quality of five-dimensional five-level questionnaire, Short-Form of the Eating Behavior Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and the Chinese version of the short-form of the Family Health Scale. All data were analyzed using SPSS Statistics 23.0.

Results

(1) Depression was negatively associated with QoL (r = -0.386/-0.230, p < 0.001), and was positively correlated with abnormal dietary behavior (r = 0.377, p < 0.001). Anxiety was negatively associated with QoL (r = -0.383/-0.231, p < 0.001), and was positively correlated with abnormal dietary behavior (r = 0.333, p < 0.001). Abnormal dietary behavior was negatively correlated with QoL (r = -0.077/-0.119, p = 0.039/0.001). (2) In the mediation model, abnormal dietary behavior only had a masking effect on the relationship between depression and QoL, with a mediating effect size of 7.18%. The mediating effect of abnormal dietary behavior between anxiety and QoL was not significant. (3) The mediating effect size of abnormal dietary behavior between depression/anxiety and QoL increased to 14.77% and 13.57% in unhealthy families. The above masking mediation effect was not significant in healthy families.

Conclusions

Abnormal dietary behavior positively mediated the relationship between depression and QoL and attenuated the negative effect of depression on QoL in patients with cardiovascular disease. The masking mediating effect of abnormal dietary behavior between depression/anxiety and QoL was stronger for patients in unhealthy families.

Moderate physical activity and higher frequency are inversely associated with incidence of frailty in middle-aged and older population: a 4-year longitudinal study in Europe

BACKGROUND

Global aging is leading to an increase in frailty patients, and physical activity (PA) may have an impact on frail in middle-aged and older population. This study aimed to explore the relationship between the frequency of different PA intensities and the incidence and prevalence of frailty in middle-aged and older adults based on the Survey of Health, Ageing, and Retirement in Europe (SHARE).

METHOD

Self-reported questionnaires were used to obtain information on demographics and PA, and frailty was assessed using the SHARE Frailty Instrument (SHARE-FI). Cox regression and logistic regression models were used to explore the association between PA and frailty and stratified according to middle or old age.

RESULTS

Among 6315 baseline non-frail participants aged 44-96 years, 16.1% developed frailty over 4 years, with higher incidence and prevalence in women (P < 0.05). Women accounting for 55.80% of the sample. The frequency of participants participating in sports decreased over 4 years (P < 0.05). Compared with participants who engaged in PA more than once a week, participants who engaged in moderated PA less frequently had a higher risk of new-onset frailty (HR: 3.174-6.115), and participants who engaged in vigorous PA 1-3 times a month had a higher risk of new-onset frailty (HR: 1.335). Participation in low-frequency moderate PA and vigorous PA 1-3 times per month were positively associated with the prevalence of frailty (P < 0.05).

CONCLUSION

Physical activity frequency decreases with age in middle-aged and older adults. Those adults who engage in moderate PA more than once a week have a lower risk of incidence of frailty, compared to those with more sedentary life-styles. Additionally, women need to pay more attention to frailty management.

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 prevalence of suboptimal health status among Chinese secondary school students and its relationship with family health: the mediating role of perceived stress and problematic internet use

BACKGROUND

The health status of secondary school students has received widespread attention, and family plays an extremely important role in protecting and promoting their health. However, the relationship between family health and suboptimal health status (SHS) among secondary school students and its underlying mechanisms are unclear. This study aims to understand the prevalence of SHS among Chinese secondary school students and analyze the relationship between family health and SHS, and examine the mediating roles of perceived stress and problematic internet use.

METHODS

The 2,094 secondary school students (52.6% boys, 47.4% girls, Mage ± SD = 15.74 ± 1.78) of this study came from "2022 Psychology and Behavior Investigation of Chinese Residents, PBICR". The chi-square test and t-test were used to analyze the prevalence of SHS in secondary school students with different characteristics. The SPSS PROCESS macro software was used to explore the relationship between family health and SHS and the mediating effects of perceived stress and problematic internet use.

RESULTS

The prevalence of SHS among Chinese secondary school students was 40.7%, and older students, girls, non-only child, high school students, smokers, drinkers, and students living in the Northeast region of China had higher prevalence. Family health, SHS, perceived stress, and problematic internet use were significantly related (P < 0.001). Family health had a negative effect on SHS (β = -0.127, 95% CI: -0.173 to -0.080). At the same time, perceived stress mediated the relationship between family health and SHS (chain mediation model 1: β = -0.109, 95% CI: -0.133 to -0.087; chain mediation model 2: β = -0.098, 95% CI: -0.120 to -0.078) and problematic internet use also mediated their relationship (chain mediation model 1: β = -0.034, 95% CI: -0.056 to -0.014; chain mediation model 2: β = -0.077, 95% CI: -0.099 to -0.055). The chain mediating effect of perceived stress and problematic internet use was also found in this study and the chain path from family health to perceived stress to problematic internet use to SHS was superior (β = -0.043, 95% CI: -0.054 to -0.033).

CONCLUSIONS

Many secondary school students are experiencing SHS. Improving family health, such as strengthening parent-child communication and fostering positive parenting practice, is critical to improving their health. Helping secondary school students relieve perceived stress and reduce their problematic internet use is key to implementing family-oriented health interventions.

Impact of family doctor contracted services on the health of migrants: a cross-sectional study in China

This study investigates the impact of the family doctor contracted service system on the health of migrants in China, utilizing data from the 2018 China Migrants Dynamic Survey (CMDS). The study employs a double machine learning model to estimate the effect of family doctor contracted services (FDCS) on migrants' self-rated health (MSRH). The sample consists of 137,851 migrants, with family doctor service contract status, health education, and health records as key variables. To address potential endogeneity issues, an instrumental variable approach using the regional family doctor contracting rate was implemented. Mediation analysis was conducted to examine the roles of health education and health records in this relationship. The findings indicate that FDCS significantly improve MSRH. This positive effect is robust across various machine learning models, including Lassocv, Random Forest, and Gradient Boost. The instrumental variable approach confirms the validity of these results, mitigating concerns about endogeneity. Mediation analysis reveals that the positive impact of FDCS on MSRH is fully mediated by health education and health records, highlighting their critical roles in enhancing health outcomes. The FDCS play a crucial role in improving the health of migrants by providing continuous and comprehensive care. Enhanced health education and effective health records management are significant pathways through which these services exert their positive effects. Policy recommendations include expanding access to family doctor services, enhancing health education programs, and improving health records management to optimize healthcare delivery for migrants. Future research should consider longitudinal studies to further validate these findings and explore their applicability to specific subgroups or regions.

The impact of health literacy on health-promoting lifestyle among community residents: the chain-mediating role of family health and physical activity

Background

Adopting health-promoting lifestyle (HPL) is crucial for improving overall well-being and reducing the risk of chronic diseases. The relationship between health literacy (HL) and HPL among Chinese community residents is complex, with potential mediating factors yet to be fully understood. Family health and physical activity (PA) may play significant roles in this relationship. This study aims to construct a chain mediation model to explore whether family health and PA mediate the effects of HL on HPL in Chinese community residents.

Methods

Using the convenient sampling method, 1,072 Chinese community residents were selected for a cross-sectional study. All participants completed a self-report questionnaire that collected demographic information, as well as data from the Health Literacy Scale Short-Form (HLS-SF12), Family Health Scale Short-Form (FHS-SF), Physical Activity Rating Scale (PARS-3), and Health Promoting Lifestyle Profile-II Revise (HPLP-II R). Data were analyzed using SPSS 26.0, with mediation analysis performed using the SPSS PROCESS macro.

Results

There were significant pairwise correlations between HL, family health, PA, and HPL (p < 0.01). HL was directly linked to HPL (effect = 0.442; SE = 0.025; 95% CI: 0.392, 0.491). Additionally, three indirect pathways were identified: family health independently mediated 6.02% of the effect (effect = 0.032; SE = 0.010; 95% CI: 0.013, 0.051), PA also independently mediated 9.02% of the effect (effect = 0.048; SE = 0.010; 95% CI: 0.030, 0.068), and a combined chain mediation through both family health and PA accounted for 1.88% of the effect (effect = 0.010; SE = 0.003; 95% CI: 0.005, 0.017).

Conclusion

HL not only has a direct impact on promoting HPL but also influences it indirectly through the mediating roles of family health and PA. These insights elucidate the mechanisms by which HL affects HPL, providing valuable theoretical guidance for the development and implementation of effective strategies to encourage healthy lifestyle practices.

The effect of alexithymia on self-perceived aging among community-dwelling older adults with multiple chronic conditions: the mediating role of maladaptive cognitive emotion regulation strategies

Objectives

This study investigated the mediating role of maladaptive cognitive emotion regulation strategies in the relationship between alexithymia and self-perceived aging among older adults.

Methods

We surveyed 478 Chinese community-dwelling older adults from November 2022 to May 2023. The Toronto Alexithymia Scale (TAS-20), Cognitive Emotion Regulation Questionnaire (CERQ), and Brief Aging Perceptions Questionnaire (B-APQ) were used. Correlation analyses, multiple linear regression analysis, and structural equation modeling were performed.

Results

The average age of participants was 71.52 ± 7.80 years, and the number of chronic diseases was distributed as follows: 270 (56.49%) had 2 disease conditions, 156 (32.64%) had 3 disease conditions, and 52 (10.88%) had 4 disease conditions or more. Scores for alexithymia 57.83 ± 10.19; maladaptive cognitive emotion regulation strategies 49.63 ± 10.65; and self-perceived aging 58.74 ± 10.23. Alexithymia and maladaptive cognitive emotion regulation strategies were positively correlated with negative self-perceived aging (r=0.665 and r=0.673, respectively), explaining 51.8% of the variance in self-perceived aging. Structural equation modeling results showed that alexithymia had a direct effect (of 0.368) on self-perceived aging, accounting for 44.1% of the total effect. Maladaptive cognitive emotion regulation strategies partially mediated the relationship, with a mediation effect of 0.386, accounting for 51.8% of the total effect.

Conclusion

These findings suggest that addressing maladaptive cognitive emotion regulation strategies can help reduce negative self-perceived aging in elderly individuals with multiple chronic conditions, particularly among those with alexithymia.

Relationship between big five personality and health literacy in elderly patients with chronic diseases: the mediating roles of family communication and self-efficacy

The significance of health literacy for elderly individuals with chronic illnesses lies in managing and delaying disease development, which is affected by personal and environmental factors. Family communication can provide an emotional support environment; self-efficacy is an important factor of subjective initiative and personality. A relatively persistent thinking and behavior pattern can affect the environment, subjective initiative, and individual health outcomes. This study aims to explore the effects of the Big Five personality traits on the health literacy of elderly individuals with chronic illnesses and to hypothesize that family communication and self-efficacy mediate the Big Five personalities and health literacy. A cross-sectional study of 2251 elderly individuals with chronic diseases was conducted through nationwide random quota sampling. The structural equation model was used to explore the mediating role of family communication and self-efficacy between the Big Five personality and health literacy. Family communication played a simple mediating role in the influence of extraversion, agreeableness, conscientiousness, and neuroticism on health literacy. Self-efficacy played a simple mediating role in the influence of the Big Five personalities on health literacy. Self-efficacy and family communication played a chain mediating role between extraversion, agreeableness, conscientiousness, neuroticism, and health literacy. Nurses can enhance the health literacy of elderly individuals with chronic illnesses with extraversion, agreeableness, conscientiousness, and neuroticism through family communication and self-efficacy while promoting the health literacy of those with openness through self-efficacy.

Investigating Frailty, Polypharmacy, Malnutrition, Chronic Conditions, and Quality of Life in Older Adults: Large Population-Based Study

BACKGROUND

Aging, a significant public health issue, is associated with multiple concurrent chronic diseases and aging-related conditions (geriatric syndromes).

OBJECTIVE

This study aims to investigate the impact of age and chronic conditions on geriatric syndromes and the intercorrelations between multiple geriatric syndromes and quality of life (QoL) in older adults (aged ≥65 years) at the population level.

METHODS

A large representative sample was randomly selected from a county in China, Feidong, with 17 towns and 811,867 residents. Multiple chronic conditions, geriatric syndromes (frailty, polypharmacy, and malnutrition), and QoL were assessed and compared. Associations of demographic information and chronic conditions with geriatric conditions and QoL in older adults were assessed using multivariable-adjusted logistic regression. Intercorrelations between age, multiple geriatric syndromes, and QoL were investigated using both correlation analysis and restricted cubic splines-based multivariable-adjusted dose-response analysis.

RESULTS

Older adults comprised 43.42% (3668/8447) of the entire study population. The prevalence of frailty, premalnutrition or malnutrition, polypharmacy, and impaired QoL (median age 73, IQR 69-78 years; 1871/3668, 51% men) was 8.26% (303/3668), 15.59% (572/3668), 3.22% (118/3668), and 10.8% (396/3668), respectively. Different age and sex subgroups mostly had similar prevalence of geriatric syndromes (except that frailty occurred more often with older age). Premalnutrition or malnutrition were associated with a lower frequency of obesity and a higher frequency of constipation, polypharmacy with a higher frequency of diabetes and constipation, frailty with a higher frequency of constipation and hernia, and impaired QoL with a higher frequency of hypertension, diabetes, physical disability, and constipation. Mini Nutritional Assessment-Short Form, Groningen Frailty Indicator, and EQ-5D-5L scores, as well as the number of medications used, mostly predicted each other and QoL. Impaired QoL was associated with a higher frequency of frailty, premalnutrition or malnutrition, and polypharmacy, and frailty with a higher frequency of premalnutrition or malnutrition and polypharmacy. At a 1.5-year follow-up, impaired QoL was linked to polypharmacy and frailty at baseline, premalnutrition or malnutrition and polypharmacy were associated with frailty at baseline, and frailty was linked to both premalnutrition or malnutrition and polypharmacy at baseline. Causal mediation analyses showed that frailty mediated the link between polypharmacy and worse QoL and that polypharmacy mediated the link between frailty and worse QoL.

CONCLUSIONS

In this large population-based study of older adults, multiple chronic conditions were associated with ≥1 of the investigated geriatric syndromes. Geriatric syndromes were mostly intercorrelated with, and well predictive of, each other and QoL; and causal relationships existed between geriatric syndromes and QoL, with other geriatric syndromes being mediators. The findings might be biased by residual confounding factors. It is important to perform personalized geriatric syndrome assessments stratified by chronic condition; active prevention of, or intervention for, any syndrome might help to reduce the others and improve QoL.

The effects of big five personality traits on sub-health in a Chinese young adults: A moderated mediation model

BACKGROUND

Sub-health can have an impact on the physical condition of the young adults, and this study aimed to investigate the influencing factors of sub-health related to the Big Five personality in Chinese young adults.

METHODS

A multi-stage random sampling method was used to survey the Chinese young adults. A moderated mediation analysis was conducted to investigate how sleep quality and family health influenced the relationship between diverse personalities and sub-health in young adults.

RESULTS

A total of 6165 young adults were included in this study. The results of the mediation analysis indicated that sleep quality partially mediated the relationship between neurotic, extraversion, agreeableness, and conscientiousness of young adults and sub-health. Family health played a moderating role between the sleep quality and agreeableness of young adults.

LIMITATIONS

The cross-sectional study limits conclusions about causal relationships between factors.

CONCLUSION

Family health and sleep quality can influence sub-health in Chinese young adults with different personality traits.

Health literacy and falls among community-dwelling older people in China: is there a sex difference?

BACKGROUND

Health literacy is one of the important determinants of healthy aging, yet few studies have focused on the association between health literacy and falls.

AIMS

This study aims to explore the relationship between health literacy and falls, with a focus on sex differences among older people in China.

METHODS

This cross-sectional study enrolled 2,144 older people aged ≥ 60 years from Shandong Province, China in 2021. We used general health literacy screening scale to assess health literacy, and collected the incidence of falls in the past year. Logistic regression models were employed to analyze the relationship between health literacy and falls. We investigated the sex differences by subgroup analyses.

RESULTS

The prevalence of adequate health literacy and falls was 21.7% (95% CI: 20.0-23.5%) and 25.4% (95% CI: 23.6-27.3%), respectively. In a fully-adjusted model, adequate health literacy was associated with a lower prevalence of falls in older adults (OR = 0.71, 95%CI: 0.52-0.96). Subgroup analysis revealed sex differences in this relationship (Pfor interaction <0.05). Specifically, the female group showed no significant relationship between health literacy and falls (OR = 0.92, 95% CI: 0.59-1.44); however, the male group demonstrated a robust and significant relationship (OR = 0.58, 95% CI: 0.37-0.90).

CONCLUSIONS

Older people with adequate health literacy have lower prevalence of falls, which appears to differ by sex. This relationship was significant among men but not among women. These findings emphasize the need for policymakers and healthcare providers to consider sex differences when designing and implementing programs aimed at improving health literacy and preventing falls in the older population. Improving health literacy among older women could be a strategic component in bridging sex inequality in falls.

Increased Hyperactivity with Decreased Parental Perceived Social Support Among Turkish Children with Autism Spectrum Disorder during Coronavirus Disease 2019 Pandemic

Objective

The aim of the present study is to investigate the change in emotional/behavioral problems of children with autism spectrum disorder (ASD) and the perceived social support of parents during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

A total of 51 children with ASD aged between 6 and 18 years took part in the study. The Aberrant Behavior Checklist (ABC), the Strengths and Difficulties Questionnaire (SDQ), and the Multidimensional Scale of Perceived Social Support (MSPSS) were used to evaluate ASD symptoms, emotional/behavioral problems, and perceived social support, respectively. The cases were assessed before and 6 months after the pandemic.

Results

Our findings indicated that after the onset of the pandemic hyperactivity scores of children with ASD increased, whereas perceived social support of their parents decreased, compared to their pre-pandemic levels (P-value < .05). The increase in hyperactivity and irritability levels among children were positively associated with the presence of a chronic illness in the family and medication discontinuation (P-value < .05).

Conclusion

Quarantine in the COVID-19 pandemic may cause or worsen behavioral problems among children with ASD possibly due to problems related to poor medication adherence and lowered perceived social support among their parents. Clinicians working with children with special needs may be pro-active to assess and manage emotional/behavioral problems among this special population particularly during difficult times such as pandemic.

The effect of family health on suboptimal health status: The parallel mediation role of sleep quality and health behaviour

Background

The prevalence of suboptimal health status has been increasing worldwide, posing a significant challenge to public health. Meanwhile, family health has been recognised as an important factor influencing individual health outcomes. However, the mechanisms through which family health affects suboptimal health status remain unclear. We aimed to investigate the parallel mediation role of sleep quality and health behaviour in the relationship between family health and suboptimal health status.

Methods

We conducted a cross-sectional online survey with a sample of adults >18 years old from four provinces in China. The survey questionnaires queried their demographic characteristics, family health, suboptimal health status, sleep quality, and health behaviour. We assessed family health by the Family Health Scale-Short Form and suboptimal health status using the Suboptimal Health Status Questionnaire. We employed structural equation modelling to analyse the data and test the proposed mediation model.

Results

we collected 4918 valid questionnaires. The mean age of the participants was 30.1 years (standard deviation = 12.5). The correlation analysis demonstrated a significant negative association between family health and suboptimal health status (r = -0.44; P < 0.001). The results of the parallel mediation analysis showed that family health had a significant indirect effect on suboptimal health status through both sleep quality (β = -0.350; P < 0.001) and health behaviour (β = -0.137; P < 0.001). The total indirect effect of family health on suboptimal health status through both sleep quality and health behaviour was also significant (β = -0.569, P < 0.001).

Conclusions

This study highlights the significance of family health as a predictor of suboptimal health status and suggests that sleep quality and health behaviour are parallel mediators in this relationship. By understanding the role of family health, sleep quality, and health behaviour, interventions can be targeted to improve overall health outcomes.

Association of depression and sleep quality with frailty: a cross-sectional study in China

Background

With the rapid growth of global aging, frailty has become a serious public health burden, affecting the life quality of older adults. Depressive symptoms (depression hereafter) and sleep quality are associated with frailty, but the pathways in which sleep quality and depression affect frailty remain unclear.

Method

This cross-sectional study included 1866 community-dwelling older adults. Demographic characteristics and health-related data of them was collected, and we also assessed frailty, depression, and sleep quality. Descriptive statistics were carried out and ordinal logistic regression analysis was used to identify the factors correlated with frailty. Spearman correlation analysis and mediation analysis were employed to assess associations between sleep quality, depression and frailty. Two-sided p < 0.05 was considered as significant.

Results

The results showed that 4.1% older adults were frail and 31.0% were pre-frail. Ordinal logistic regression showed that age, consumptions of vegetables, exercise, sleep quality, depression, number of chronic diseases, chronic pain, and self-rated health were correlated with frailty. Spearman correlation analysis revealed that frailty was associated with depression and sleep quality. There was a mediation effect that sleep quality was a significant and positive predictor of frailty (total effect = 0.0545, 95% boot CI = 0.0449-0.0641), and depression was a mediator between sleep quality and frailty (mediation effect = 60.4%).

Conclusion

Depression and poor sleep quality may be early indicators of frailty in older adults. Improving the sleep quality and psychological state of older adults can improve frailty, which is beneficial for healthy aging.

Associations between breakfast skipping and outcomes in neuropsychiatric disorders, cognitive performance, and frailty: a Mendelian randomization study

BACKGROUND

Prior studies have identified a correlation between breakfast skipping and a heightened risk of mental health issues. This investigation aimed to employ a Two-Sample Mendelian Randomization (MR) approach to explore the potential causal links between breakfast skipping and various psychiatric, neurological disorders, cognitive performance, and frailty.

METHODS

Utilizing data from genome-wide association studies within European demographics, this research scrutinized the association between breakfast habits and several neuropsychiatric conditions and physical health outcomes, including Alzheimer's disease (AD), Attention Deficit Hyperactivity Disorder (ADHD), Bipolar Disorder (BD), Major Depressive Disorder (MDD), Narcolepsy, Insomnia, cognitive performance, and frailty. In this MR analysis, the Inverse Variance Weighted (IVW) method was primarily utilized for evaluation. Outcomes were reported as Odds Ratios (OR) and regression coefficients (β), and underwent validation through False Discovery Rate (FDR) corrections, thereby offering a rigorous evaluation of the effects of breakfast habits on both mental and physical health dimensions.

RESULTS

Findings demonstrate a significant causal link between skipping breakfast and an increased risk of ADHD (OR = 2.74, 95%CI: 1.54-4.88, PFDR = 0.003) and MDD (OR = 1.7, 95%CI: 1.22-2.37, PFDR = 0.005). Conversely, no substantial causal associations were identified between breakfast skipping and AD, BD, narcolepsy, or insomnia (PFDR > 0.05). Moreover, a notable causal relationship was established between skipping breakfast and a reduction in cognitive performance (β = -0.16, 95%CI: -0.29-0.04, PFDR = 0.024) and an increase in frailty (β = 0.29, 95%CI: 0.12-0.45, PFDR = 0.003).

CONCLUSION

The MR analysis reveals that skipping breakfast is associated with an increased risk of ADHD, MDD, decreased cognitive performance, and greater frailty, while showing no associations were found with AD, BD, narcolepsy, or insomnia. These findings warrant further investigation into the underlying mechanisms and emphasize the importance of regular breakfast consumption for mental and physical well-being.

General Self-Efficacy in Association With Insomnia Symptoms and Suicidal Ideation Among Chinese Community-Based Population

Previous studies supported the association between insomnia symptoms and suicidal ideation in patients with mental or psychological diseases. This study aimed to examine the associations between insomnia symptoms, general self-efficacy, and suicidal ideation among community-based adult population. Standardized questionnaire was distributed to 2051 community-dwelling adults in Lishui district of Jiangsu Province in China, to assess their socio-demographics, insomnia symptoms, general self-efficacy, and suicidal ideation. Multiple binary logistic regression or linear regression and mediation analysis with bootstrap resampling method were performed. Results showed that the weighted prevalence of lifetime suicidal ideation was 6.38%. Insomnia symptom was associated with higher odds of suicidal ideation after adjusting for sociodemographics and mental health status (odds ratio [OR] = 2.85, and the OR of insomnia symptom with suicidal ideation decreased but remained significant after additionally adjusting for general self-efficacy (OR = 2.62). Participants with insomnia symptom were also significantly associated with lower general self-efficacy (β = -0.96), whereas higher general self-efficacy was associated with a lower odds of suicidal ideation (OR = 0.92). In conclusion, general self-efficacy was associated with both insomnia symptom and suicidal ideation among the community-dwelling adult population.