Impact of Social Participation Types on Depression in the Elderly in China: An Analysis Based on Counterfactual Causal Inference

ADL and Cognitive Function in Chinese Elderly: Mediating Role of Social Participation and Moderating Role of Intergenerational Support

Purpose

This study aimed to explore the relationship between activities of daily living (ADL) and cognitive function in Chinese elderly, and to analyze in depth the mediating and moderating roles of social participation and children's intergenerational support in this relationship, in order to provide a reference basis for delaying cognitive decline in the elderly.

Patients and Methods

Based on data from the 2020 wave of China Health and Retirement Longitudinal Survey (CHARLS 2020), this study included 5612 subjects aged 60 years and older, and extracted main variables such as demographic information, ADL, social participation, cognitive function, and children's intergenerational support. Descriptive statistics and Pearson's correlation analysis in SPSS 27.0 were used to analyze the relationship between the main variables, and regression and Bootstrap analysis in SPSS 27.0 PROCESS macro (Model 4 and Model 14) were further used to analyze the mediating and moderating effects.

Results

Among Chinese elderly, ADL significantly positively correlated with social participation (r = 0.086, P < 0.001) and cognitive function (r = 0.193, P < 0.001), and social participation significantly positively correlated with cognitive function (r = 0.144, P < 0.001). Social participation partially mediated the relationship between ADL and cognitive function (β = -0.202, P < 0.001), accounting for 5.74% of the total effect. Moreover, children's intergenerational support negatively moderated the relationship between social participation and cognitive function (β = -0.182, P < 0.001). Thus, a moderated mediation model was developed.

Conclusion

ADL can affect cognitive function directly or indirectly through social participation in elderly. Furthermore, children's intergenerational support plays a negative moderating role in this mechanism. Therefore, governments, hospitals, communities, and families should provide personalized intervention strategies for elderly to delay cognitive decline and promote healthy aging through early prevention of ADL impairment, promotion of social participation, and optimization of family support.

The influence of intergenerational relationships on depressive symptoms in elderly patients with multiple chronic conditions: the mediating roles of self-rated health and well-being

BACKGROUND

The superimposition of multiple chronic conditions places a heavy physical burden and life pressure on older adults, making them more prone to psychological distress and significantly increasing their risk of depression, which has become an urgent public health issue. Intergenerational relationships, as the main source of social support for older adults, have a profound effect on their mental health. This study aims to explore the potential mediating mechanisms by which intergenerational relationships influence depressive symptoms among older adults within the context of the Chinese "filial piety" culture, providing a theoretical foundation for optimizing intergenerational support and improving the psychological well-being of older adults.

METHODS

Data from the 2020 China Family Panel Study (CFPS) were used, and 739 elderly patients with multiple chronic conditions were selected as the study subjects. Data on intergenerational relationships, self-rated health, well-being, and depressive symptoms were also obtained. A chain mediation model was developed using SPSS PROCESS macro model 6, and one-way ANOVA, Pearson correlation analysis, and mediation effect tests were performed to investigate the effects of intergenerational relationships, self-rated health, and well-being on depressive symptoms in elderly patients with multiple chronic conditions.

RESULTS

Intergenerational relationships, self-rated health, and well-being were found to be significantly correlated with depressive symptoms (P < 0.05). Intergenerational relationships negatively predicted depressive symptoms (β = -0.610, P < 0.01). Self-rated health (β = -1.115, P < 0.001) and well-being (β = -0.653, P < 0.001) mediated the effect of intergenerational relationships on depressive symptoms. Additionally, self-rated health and well-being were identified as chain mediators in this relationship for elderly patients with multiple chronic conditions (β = -1.118, P < 0.001).

CONCLUSION

Intergenerational relationships can reduce depressive symptoms among elderly patients with multiple chronic conditions by enhancing self-rated health and well-being. These findings highlight the importance of family support and emotional communication in mental health interventions for older adults. Therefore, healthcare professionals should incorporate family support and encourage positive intergenerational relationships when designing interventions to foster a supportive environment and improve quality of life.

Research on the social integration and depression risk of middle-aged and older adults with multiple chronic conditions in China

Objective

The aging of the global population is intensifying, and the issue of depression among middle-aged and older individuals in China has garnered significant attention. Social integration is considered closely related to the risk of depression in patients with multiple chronic conditions (MCCs). This study aims to explore the relationship between different dimensions of social integration and depression in middle-aged and older individuals.

Methods

This study utilized data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), including 2,901 middle-aged and older individuals with MCCs. Depression risk was assessed using a depression scale. Social integration was measured across three dimensions: economic integration, relational integration, and community integration. Statistical analyses were conducted using Logit and Tobit models to explore the relationship between social integration and depression among middle-aged and older individuals.

Results

There was no significant association between overall social integration and the risk of depression, but economic integration and community integration were negatively correlated with the risk of depression, and relational integration was positively correlated with the risk of depression, and this relationship was heterogeneous among different demographic characteristics. Sensitivity analysis and subgroup analysis further confirmed the robustness of the results.

Conclusion

Mental health interventions for middle-aged and older adults MCCs patients should consider the multi-dimensional characteristics of social integration. It is recommended to improve the economic status of the middle-aged and older adults, improve the quality of family and social interactions, and pay attention to the construction of the community environment. And further explore the interaction of each dimension and its applicability in different contexts.

Late-Life Informal Social Participation, Physical and Cognitive Functions Among the Chinese Elderly: A Life Course Perspective

Objectives: The current study aims to investigate how childhood conditions influence the reciprocal associations between informational social participation and the functions in cognitive and physical aspects in late life. Methods: A longitudinal dataset, merged from the 2016, 2018, and 2020 waves from the China Family Panel Studies, was employed. It comprised 4686 individuals aged 60 or older in the 2016 wave. A cross-lagged structural equation model was estimated to examine the influences of health and family socioeconomic status in childhood on the cross-lagged associations between informational social participation (i.e., contact with child(ren), grandparenting, and digital access) and functions in cognitive and physical aspects (i.e., cognitive function and personal activities of daily living) in late life. Results: The results revealed that poor health in childhood was associated with less informal social participation in late life, particularly in contact with families. Moreover, internet access appeared to have a temporal and reciprocal association with cognitive function in late life. Conclusions: The current study highlighted the impact of childhood health on late-life informal social participation and emphasized the crucial role of engaging in social activities through the internet in preserving the elderly's cognitive function in later stages of life.

A cross-lagged analysis of the relationship between marital quality and depression among the older adults: gender effects of socioeconomic status

Objective

This study aimed to explore the mechanism and gender effect of socioeconomic status on the relationship between marital quality and depression among the older adults, with the intention of providing a practical foundation for enhancing the quality of life of the older adults.

Methods

The data sourced from the third (conducted in 2015, denoted as the first survey) and fourth (carried out in 2018, regarded as the second survey) installments of the China Health and Retirement Longitudinal Survey (CHARLS) were meticulously analyzed through the utilization of cross-lagged analytical techniques and moderating effect examination methodologies.

Results

Among the older adults, there exists a reciprocal causal relationship between marital quality and the level of depression. Specifically, the marital quality as measured in the first survey was found to significantly prognosticate the depression level in the second survey (β = 0.05, p < 0.05). Conversely, the depression level in the first survey was also demonstrated to significantly forecast the marital quality in the second survey (β = 0.15, p < 0.01). Regarding the moderating role of socioeconomic status, it was observed that among the older adult women, socioeconomic status exerted a moderating influence on the impact of depression on marital quality (β = 0.05, p < 0.05), whereas among the older adult men, their socioeconomic status failed to display a significant moderating effect (β = 0.02, p > 0.05). In a contrasting manner, for the older adult men, the socioeconomic status played a moderating role in the effect of marital quality on depression (β = -0.05, p < 0.01), while for the older adult women, it did not exhibit a moderating effect (β = -0.01, p > 0.05).

Conclusion

There exists a reciprocal causal nexus between the marital quality and depression among the older adults. To enhance the life quality of the older adults, it behooves communities and families to proactively focus more on the older adults with subpar marital quality or afflicted by depression, and to disrupt the cyclic interplay between these two variables.

The Impact of Accessibility of Community Elderly Care Services on Quality of Life of the Elderly

Background/Objectives: With the gradual increase in population aging and the prevalence of the empty nest, community elderly care services have become an effective service model for responding to population aging because they can alleviate the decline in family care function and meet the needs of elderly homecare patients. This paper aims to identify the influence mechanism of the accessibility of community elderly care services on the quality of life of the elderly. Methods: This paper surveyed a total of 949 elderly people and adopted the interview questionnaire survey method, and it used ordered logistic regression to analyze the impact of accessibility on the quality of life of the elderly. Results: The study finds that approachability, availability, acceptability, and accommodation affect the living environment satisfaction of the elderly. Accessibility affects environmental satisfaction by influencing the service utilization frequency, and accessibility affects the psychological health and environmental satisfaction of the elderly by influencing service utilization satisfaction. Conclusions: The improvement of accessibility can increase service utilization and, thus, improve the welfare of the elderly. So, the government should improve the accessibility of community elderly care services.

Relationship between leisure activity and depression in Chinese older adults: chain mediating effect of diet and cognition

BACKGROUND

Leisure activity was associated with depression in older adults. However, the specific processes by which diet and cognition mediate the role of leisure activities and depression remain uncertain. The study aims to investigate the relationship between leisure activity and depression in older people and the underlying mechanisms involved, while constructing a comprehensive model that links these variables.

METHODS

Data came from the 2018 Chinese Longitudinal Healthy Longevity Survey. Mini-Mental State Examination and CES-D-10 were used to assess cognition and depression, respectively. PROCESS macro was employed to assess the mediation effects of diet and cognition on the relationship between leisure activity and depression.

RESULTS

Leisure activity was negatively associated with depression, with 35.90% of the total effect mediated through dietary diversity and cognitive function, of which 1.28% was from the chain-mediated effect of dietary diversity and cognition. In addition, 20.94% of the total effect mediated through a plant-based diet and cognitive function, of which 0.43% was from the chain-mediated effect of plant-based diet and cognition.

CONCLUSIONS

Leisure activities are linked to depression, with diet and cognition acting as chain-mediating factors. Public health experts recommend that older adults engage in leisure activities, ensure a broad spectrum of dietary intake, and prioritize the augmentation of plant-based diets as preventative strategies against depression.

The impact of positive activities on mental health: the mediating role of positive emotion

Objective

Mental health has become a widely concerned topic worldwide. However, the impact and mechanism of positive activities on mental health still needed to be explored. This study aimed to apply the positive-activity model to investigate the effect of participation in positive activities on mental health and the mediating role of positive emotion.

Methods

This study used data from the 2021 China Comprehensive Social Survey (CGSS) and included 2,581 individuals. Ordinary Least Squares (OLS) and a three-step method was used for analysis.

Results

The average of positive activities was 15.83. The positive activities affected positively mental health (β = 0.0132, p < 0.001). The positive emotion played a mediating role (β =0.2281, p < 0.001). The effect of positive activities on mental health was significant in older adults group (β = 0.024, p < 0.001), female (β = 0.015, p < 0.01) and male group (β = 0.01, p < 0.01), unmarried/divorced/widowed group (β = 0.024, p < 0.01), cohabitation/first marriage with spouse/remarriage with spouse/separation without divorce group (β = 0.010, p < 0.001), middle(β = 0.013, p < 0.05), and upper-middle-level SES group (β = 0.054, p < 0.001).

Conclusions

We concluded that the participation level of positive activities still needs to be improved and positive activities improve mental health through positive emotion, which implied that positive activities, as an easily implementable measure, should be greatly encouraged in mental health policies. And older adults, female, people without spouse, middle and upper-middle-income individuals need to be paid more attention.

Does internet use promote the health of empty-nest older adults in rural China? The mediating role of social participation using a propensity score matching approach

Background

The rapid growth of internet use among older adults in rural China offers a unique opportunity to examine its potential impact on their health. This study seeks to explore the relationship between internet use and the emotional, physical, and cognitive health of empty-nest older adults in rural China, while also considering the mediating role of social participation in this relationship.

Methods

A total of 3,478 empty-nest older adults were selected from the China Health and Retirement Longitudinal Survey (CHARLS) in 2020. Among them, 820 individuals were included in the study using a propensity score matching (PSM) method to reduce the impact of selection bias. The participants' depression, physical health, and cognitive health were measured using the Center for Epidemiological Studies Depression Scale (CES-D), the Activities of Daily Living (ADL) scale, and a composite cognition score, respectively. Social participation was assessed based on engagement in various activities over the past month.

Results

After controlling for confounding factors through PSM, it was found that older adults who used the internet exhibited significantly lower level of depression and higher physical health compared to older adults who did not use the internet. However, there was no significant difference in cognitive health between the two groups. The mediating effect analysis revealed that social participation partially mediated the relationship between internet use and physical health, but not emotional health.

Conclusion

The study suggests that internet use can improve emotional and physical health of older adults living in rural China without children at home, with social participation being a mediator in the relationship between internet use and physical health. Future research should explore the underlying mechanisms and develop targeted interventions to promote internet use and social engagement in this population.

The association between Internet use and intrinsic capacity among older adults in China: The mediating role of social participation

OBJECTIVE

This study aims to explore the relationship between Internet use and intrinsic capability among Chinese older adults, and the potential mediating role of social participation.

METHODS

We verified the correlation between Internet use and intrinsic capacity using multiple linear regression and verified the mediating role of social participation using the Sobel and Bootstrap tests.

RESULTS

The results of multiple linear regression show that there is a significant positive association between Internet use and intrinsic capacity (B = 0.717, p < .001); and social participation plays a mediating role, explaining a total of 20.5% of the association (indirect effect = 0.147, 95% CI: 0.067-0.227).

CONCLUSION

Our findings suggest that Internet use significantly improves intrinsic capacity among Chinese older adults, with social participation playing a mediating role. Increasing Internet adoption rates and promoting social participation may help improve intrinsic capacity among older adults.

Is disinformation more likely to spread? A fuzzy-set qualitative comparative analysis of emerging infectious diseases on China's short video platform

OBJECTIVES

This study aimed to develop a model for the dissemination of information on emerging infectious diseases (EIDs) by identifying the specific features of mpox (monkeypox)-related short video content that encourages public sharing.

DESIGN

This was an exploratory analysis of the dissemination of information on short video platform.

MAIN OUTCOME MEASURES

Focusing on Douyin (TikTok in mainland China), this study collected data from the top 500 most popular short videos using 'monkeypox' as the keyword from 1 May 2022 to 31 October 2022. Under the guidance of the health belief model, the videos were coded using two sets of conditional variables: information type variables and information content variables. The information type variables distinguish between fact-checking information and disinformation. Regarding information content variables, this study integrated the features of audiovisual media with the needs of the Chinese public, introducing efficacy information. The study then used fuzzy-set qualitative comparative analysis to analyse the correlation and consistency between the video contents and the level of public sharing, which was the outcome variable. Subsequently, a Poisson regression model was estimated to verify their significance on video-sharing volume.

RESULTS

The results showed that there were three configurations of short video content related to mpox which could trigger a high level of sharing among the general public. It was found that the number of fact-checked cases in the most widely disseminated short videos of mpox was 21.8:1 compared with the number of disinformation cases. Therefore, it can be concluded that fact-checked information was more likely to spread than disinformation in the case of an outbreak of EIDs on China's short video platforms. Based on the analysis of the three configurations, we also found that they separately formed three paths of the short video communication model, and each path had a more significant variable playing a central role. We named each pathway after the core variable: authoritative source path, personal efficacy path and disinformation path.

CONCLUSIONS

This study developed a model for information dissemination of EIDs and found that fact-checked content was more likely to spread on Chinese short video platforms instead of disinformation. It also explored public demand for guidance on EIDs precautions.

Impact of social, familial and personal factors on depressive symptoms in middle-aged and older adults from the national CHARLS cohort

BACKGROUND

This study aimed to evaluate whether social, familial and personal factors can predict incident and prevalent depressive symptoms in Chinese adults aged ≥ 45 years using data from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

Study subjects without depressive symptoms from CHARLS at baseline were enrolled. Depressive symptoms were defined by the 10-item Center for Epidemiologic Studies Depression Scale. Statistical adjustment, subgroup exploration and unmeasured confounding assessment were undertaken to derive reliable estimates.

RESULTS

1681 (27.04%) of 6215 subjects who had no depressive symptoms in 2011, suffered one or more depressive symptoms in 2018. Multivariate analyses showed that number of grandchildren (odds ratio [95% confidence interval]: 1.06 [1.02, 1.10]), social activity score (0.95 [0.91, 0.98]), instrumental activities of daily living (IADL) (1.35 [1.11, 1.65]) and number of comorbidities (1.16 [1.10, 1.22]) were independently and significantly associated with the presence of incident depressive symptoms. Further categorization revealed significance for social activity score (odds ratio [95% confidence interval]: 0.78 [0.69, 0.89] and 0.71 [0.53, 0.95] for 1-5 and > 5 vs. 0), IADL (1.35 [1.11, 1.65] for yes vs. no) and number of comorbidities (1.38 [1.20, 1.58], 1.44 [1.16, 1.81] and 2.42 [1.54, 3.80] for 1-2, 3-4 and > 4 vs. 0) associated with incident depressive symptoms. Restricting analysis to wave IV data in 2018 observed significant association of number of grandchildren, social activity score, IADL and number of comorbidities with prevalent depressive symptoms.

CONCLUSIONS

The present study findings support the marked contribution of social activity score, IADL and number of comorbidities to incident and prevalent depressive symptoms in Chinese middle-aged and older adults.

The association between hobby engagement and depressive symptoms among Chinese middle-aged and older adults: evidence from the China health and retirement longitudinal study

Background

It has been demonstrated that receptive cultural engagement, such as visits to theaters and museums, can reduce depression in older adults. However, the association between hobby engagement and lower rates of depressive symptoms (DS) remains unclear. The objective of this study was to investigate the potential relationship between hobby engagement and depressive symptoms.

Methods

The data for this prospective cross-sectional study were collected from participants in the China Longitudinal Study of Health and Retirement (CHARLS) wave 2020. To assess DS, a score of 10 or more on the Center for Epidemiological Studies Depression Scale was used to indicate depression. Hobby engagement was gaged by trained staff through the administration of a battery of standardized questions. Logistic regression and inverse probability of treatment weighting (IPTW) using the propensity score analyses were employed to investigate the relationship between hobby engagement and DS.

Results

A total of 16,057 participants were included, with a mean age of 62.4 ± 9.2 years. Of these, 7,699 were male and 8,358 were female. The proportion of individuals exhibiting depressive symptoms was 31.57% (1,286 out of 4,073) among those with hobby engagement, while it was 39.67% (4,754 out of 11,984) among those without hobby engagement. After adjusting for covariates, the odds ratio was 0.89 (95% CI: 0.82-0.97, p = 0.0109). Propensity-score analyses also supported these findings, with the odds ratio being 0.91 (95% CI: 0.84-0.99, p = 0.0204). The finding was consistent with multiple sensitivity analyses.

Conclusion

Our study found hobby engagement was associated with a reduced risk of depressive symptoms in Chinese middle-aged and older adults. Our findings need to be confirmed in future studies.

Impact of informal social support on the mental health of older adults

Objective

The role of informal social support in fostering active aging within the context of the "silver wave" is significant. This study investigated how such support influenced the mental health of older adults, with the goal of affirming its indispensable contribution to enhancing their psychological well-being.

Methods

Employing Principal Component Analysis (PCA) to construct the informal social support variable, this study rigorously analyzed the effects and underlying mechanisms of informal social support on mental health in older adults, utilizing data from the 2018 China Longitudinal Aging Social Survey (CLASS).

Results

Informal social support exerted a substantial positive influence on the mental health of older adults, particularly among younger, non-agricultural older adult populations who preferred cohabitation with their children. This form of support significantly enhanced mental well-being by elevating life satisfaction, improving access to medical services, and fostering active social engagement.

Conclusion

This study elucidates the role of informal social support in bolstering the mental health of older adults. Future efforts should focus on fostering a supportive environment that enhances older adult care experiences, reforming the healthcare system to better meet the needs of the aging population, and promoting avenues for social engagement, thereby achieving a balanced integration of their emotional and physical care.

Network analysis of the relationships between depressive symptoms and social participation activities among Chinese older adults and its implications for nursing

Objective

Network analysis was used to explore the complex inter-relationships between social participation activities and depressive symptoms among the Chinese older population, and the differences in network structures among different genders, age groups, and urban-rural residency would be compared.

Methods

Based on the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), 12,043 people aged 65 to 105 were included. The 10-item Center for Epidemiologic Studies Depression (CES-D) Scale was used to assess depressive symptoms and 10 types of social participation activities were collected, including housework, tai-chi, square dancing, visiting and interacting with friends, garden work, reading newspapers or books, raising domestic animals, playing cards or mahjong, watching TV or listening to radio, and organized social activities. R 4.2.1 software was used to estimate the network model and calculate strength and bridge strength.

Results

21.60% (2,601/12,043) of the participants had depressive symptoms. The total social participation score was negatively associated with depressive symptoms after adjusting for sociodemographic factors. The network of social participation and depressive symptoms showed that "D9 (Inability to get going)" and "S9 (Watching TV and/or listening to the radio)" had the highest strength within depressive symptoms and social participation communities, respectively, and "S1 (Housework)", "S9 (Watching TV and/or listening to the radio)", and "D5 (Hopelessness)" were the most prominent bridging nodes between the two communities. Most edges linking the two communities were negative. "S5 (Graden work) - D5 (Hopelessness)" and "S6 (Reading newspapers/books) - D4 (Everything was an effort)" were the top 2 strongest negative edges. Older females had significantly denser network structures than older males. Compared to older people aged 65-80, the age group 81-105 showed higher network global strength.

Conclusions

This study provides novel insights into the complex relationships between social participation and depressive symptoms. Except for doing housework, other social participation activities were found to be protective for depression levels. Different nursing strategies should be taken to prevent and alleviate depressive symptoms for different genders and older people of different ages.

The transformation of 20-year social participation policies of older people in China: Network analysis and text analysis

BACKGROUND

Social participation of older adults is a crucial component of China's aged care services and an important strategy for actively addressing the aging population. Analyzing policy texts on older people's social participation can inform future policy formulation and the development of relevant programs.

OBJECTIVES

This study aims to quantitatively analyze the transformation of China's social participation policies for older people from 1999 to 2023, employing institutional network analysis and policy text analysis.

METHOD

A two-dimensional policy analysis framework was constructed based on the perspective of "policy tools and social participation stages." Using Rost Content Mining 6.0 and Nvivo 11.0 Plus software, 55 national-level policy texts were coded. Structural analysis of policy-issuing subjects and topic words was conducted to visualize the findings.

RESULTS

The analysis revealed that the policy-issuing subjects demonstrated strong authority but weak coordination, with a lack of communication and cooperation across subjects. The use of policy tools was imbalanced, with an over-reliance on supply-type tools and insufficient use of demand-type tools. Additionally, the lack of effective policy tools to support various social participation stages has limited policy implementation.

CONCLUSION

With technological advancement and changing needs of the elderly population, there is a need for a more systematic and forward-looking top-level design of elderly social participation policies: accelerating the systematization and precision of technological elements in policies for elderly social participation, integrating social organizations via technological platforms to mobilize diverse stakeholder engagement, and addressing the digital divide between the elderly and new technologies is imperative.

Relationship between social participation and depressive symptoms in patients with multimorbidity: the chained mediating role of cognitive function and activities of daily living

OBJECTIVE

The potential mechanisms linking social participation and depressive symptoms in Chinese individuals with multimorbidity are not yet fully understood. This study aims to explore how cognitive function and activities of daily living (ADLs) mediate the relationship between social participation and depressive symptoms in individuals with multimorbidity.

METHODS

We selected 3782 participants with multimorbidity from the 2018 China Health and Retirement Longitudinal Study. Data related to social participation, cognitive function, ADLs, and depressive symptoms were extracted. Regression and Bootstrap analyses were used to explore the sequential mediating effects of social participation, cognitive function, ADLs, and depressive symptoms.

RESULTS

(1) There was a significant correlation between social participation, cognitive function, activities of daily living, and depressive symptoms (p < 0.01). (2) Social participation directly affected depressive symptoms (β = -0.205, p < 0.05). (3) Cognitive function (β = -0.070, p < 0.01) and activities of daily living (β = -0.058, p < 0.01) played separate mediating roles in the effect of social participation on depressive symptoms. (4) Cognitive function and activities of daily living had a chain-mediated role in the relationship between social participation and depressive symptoms in patients with multimorbidity (β = -0.020, p < 0.01).

CONCLUSION

A chained mediating effect was found between cognitive function, ADLs, social participation, and depressive symptoms in patients with multimorbidity. Social participation was found to improve the cognitive function of patients with multimorbidity, which in turn enhanced their daily life activities and ultimately alleviated their depressive symptoms.

Physical activity and functional social support in community-dwelling older adults: a scoping review

BACKGROUND

Globally, the population of older people is increasing and is estimated to reach nearly 2.1 billion by 2050. Physical activity (PA) is one of the key components for successful ageing. However, PA decreases with age and many older adults do not meet PA guidelines. Previous research has shown that social support (SOSU) is related to PA in older people. The aim of this scoping review is to identify and map all of the available evidence and to explore the association between functional SOSU and PA in older adults. Functional SOSU consists of emotional, informational, instrumental and companionship SOSU and social comparison.

METHODS

A scoping review was conducted using the Joanna-Briggs manual. Quantitative and qualitative studies investigating associations between functional SOSU and PA levels in older adults (mean age ≥ 60 years) were identified through a systematic search in seven electronic databases up to August 2023. After removing duplicates, 20,907 articles were screened for titles and abstracts. The results were analysed separately for different types of SOSU.

RESULTS

116 articles met the inclusion criteria; 72% were quantitative studies and 28% were qualitative studies. Most studies used self-reported PA measures, only 23% of the studies used objective-reported PA measures. Most studies of SOSU for PA reported positive associations but the evidence is inconclusive when the source of support is considered. PA is positively associated with general, emotional, informational, and companionship SOSU, while instrumental support may occasionally be negatively associated. Companionship support is particularly influential on PA, especially in group settings, as it promotes social connectedness. Qualitative studies show that social comparison also supports PA. Different forms of SOSU generally show positive associations with PA.

CONCLUSIONS

While the evidence on the association between functional SOSU and PA is mixed, most studies show that there is a positive association. PA may also be a strategy for improving social contact and social integration. This study offers a comprehensive overview of measures for SOSU and PA and thereby informs future research and policy-making.

The longitudinal relationship between leisure activities and depressive symptoms among older Chinese adults: an autoregressive cross-lagged analysis approach

BACKGROUND

Existing studies have shown a correlation between leisure activities and depressive symptoms in older adults, but the direction of the longitudinal relationship is inconsistent. This study used an autoregressive cross-lagged model to examine the longitudinal relationship between leisure activity participation and geriatric depression.

METHODS

A total of 7,138 participants aged 60 years or older from the 2nd to the 4th wave of the China Health and Retirement Longitudinal Study (CHARLS) were analysed.

RESULTS

First, present depressive symptoms were significantly associated with future depressive symptoms (β2013-2015 = .893, p < .001; β2015-2018 = .946, p < .001), and the same rule applied to leisure activities (β2013-2015 = .402, p < .001; β2015-2018 = .404, p < .001). Second, current depressive symptoms negatively predicted future leisure activities (β2013-2015 = -.071, p < .001; β2015-2018 = -.085, p < .001), but the inverse relationship was not statistically significant (β2013-2015 = -.003, p > .05; β2015-2018 = -.003, p > .05).

CONCLUSION

These findings underscore the importance of interventions targeting depressive symptoms to potentially enhance engagement in leisure activities among older adults. The results contribute to the understanding of the complex dynamics between mental health and lifestyle choices in older populations, highlighting the potential of proactive mental health interventions to improve overall well-being.

Dietary Habits and Depression in Community-Dwelling Chinese Older Adults: Cross-Sectional Analysis of the Moderating Role of Physical Exercise

BACKGROUND

Healthy diets and physical exercise, two modifiable lifestyle factors, are protective against depression in older adults. This study aimed to investigate whether physical exercise may influence the associations of dietary habits with depression in Chinese community-dwelling older adults.

METHODS

In the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey, 12,708 community-dwelling older adults aged ≥65 years were included for analyses. Older adults' dietary habits (including daily intake of food components such as fruits, vegetables, animal oil, and so on) and physical exercise were assessed. Depression was evaluated via the 10 item Center for Epidemiologic Studies Depression (CES-D-10) scale. The influences of physical exercise on the associations of dietary habits with depression were estimated using logistic regression models adjusted for confounders.

RESULTS

Older adults who took physical exercise had a significantly decreased probability of depression (adjusted OR = 0.73, p < 0.001). As for dietary habits, the intake of fruits, vegetables, eggs, nut products, mushrooms or algae, and vitamins were inversely associated with the prevalence of depression (adjusted ORs = 0.61-0.81; p-values: from <0.001 to 0.025), while animal oil was positively associated with it (adjusted OR = 1.52, p < 0.001). When stratified by physical exercise, older adults who ate fruits or vegetables had consistent decreased risk of depression, no matter whether they took physical exercise or not (adjusted ORs = 0.52-0.70), while the intake of eggs, nut products, and vitamins were inversely associated, and animal oil was consistently positively associated with depression only in older adults who did not take physical exercise (adjusted ORs = 0.79, 0.68, 0.63, and 1.67, respectively).

CONCLUSIONS

Physical exercise may conceal the potential protective effects of some healthy dietary habits in terms of depression and counteract the detrimental effects of the unhealthy habits. Some dietary habits may be considered as alternative protective measures for depression in community-dwelling older adults when physical exercise cannot be performed.

Frailty index trajectories in Chinese older adults with diverse levels of social participation: findings from a national population-based longitudinal study

BACKGROUND

Aging and frailty pose significant challenges globally, placing a substantial burden on healthcare and social services due to their adverse consequences.

AIM

The primary objective of this study was to investigate the relationship between social participation and development of frailty transition and trajectory.

METHODS

This study utilized data from the CLHLS Cohort, a 10-year follow-up study involving 6713 participants, to investigate the association between social participation and development of frailty. Frailty reflects a comprehensive decline in various body functions. The study employed a group-based trajectory model to analyze the development trajectory of the frailty index and used logistic regression to assess the odds ratio (OR) of frailty risk.

RESULTS

We identified two distinct groups of frailty progression trajectories: the "stable development group" and the "rapid growth group." Individuals who engaged in social activities at least once a month, but not daily, exhibited a significant association with an increased risk of transitioning into the "rapid growth group" (OR 1.305, 95% CI 1.032-1.649). Those with social participation less than once a month had an even greater risk (OR 1.872, 95% CI 1.423-2.463). Moreover, low social participation frequency (occasionally/never) has a more pronounced impact on frailty progression in males.

CONCLUSION

A higher frequency of social participation is associated with a lower risk of being classified into the "rapid growth group" and a slower rate of frailty index progression. Preventing the progression of frailty can contribute to enhanced support for healthy aging among older adults.

An analysis of the influencing factors of depression in older adults under the home care model

Objectives

To explore and analyze the influencing factors of depression in older adults living at home, so as to propose suggestions for improving the quality of older adults living at home.

Methods

We conducted a cross-sectional study on 498 older adults living at home based on questionnaire survey on the general information, daily living ability, health status, and care perception (including self-care, care for cohabitants, and care for non-cohabitants) of older adults living at home, as well as their willingness to help each other, and analyzed the influencing factors of depression among older adults living at home.

Results

The results showed a willingness to help older adults, self-care, and total activities of daily living (ADL), health status was an influential factor for depression in older adults (p < 0.05).

Conclusion

It aims to take targeted measures, such as encouraging older adults at home to actively participate in mutual assistance activities for older adults and care for themselves, so as to prevent and reduce the occurrence of depression in older adults.

Living arrangements and depression of the older adults- evidence from the Chinese longitudinal healthy longevity survey

BACKGROUND

The mental health and living arrangements of older adults are worthy of attention. Previous studies have pointed out that the living arrangements may be related to older adults' depression. However, it has not been found that studies concern the relationship between actual living arrangements, living arrangement preferences, and the fit between living arrangement preferences and reality and depression in older adults, so we carried out this study.

METHODS

The data from the Chinese longitudinal healthy longevity survey were used in this study. With the older adults' depression as the dependent variable and the living arrangement related variables as the independent variable, we constructed three binary-logistic regression analysis models to explore the potential relationship between living arrangement related variables and depression in older adults.

RESULTS

We found that the actual living arrangements, living arrangement preferences, and the fit between living arrangement preferences and reality are significantly correlated with depression in older adults. Specifically, older adults living alone or only with the spouse are at greater risk of depression. Older adults who prefer living alone or only with the spouse are at relatively low risk of depression. Older adults whose living arrangement preferences do not match reality have a higher risk of depression.

CONCLUSION

The living arrangement related variables are significantly correlated with depression in older adults. In addition to the actual living arrangements, living arrangement preferences and whether the living arrangement preferences fit with reality are also related to the depression of older adults.

Prevalence and factors influencing depression among empty nesters in China: A meta-analysis

BACKGROUND

Empty nesters are older people who live alone or an older couple without children to care for them. In China, empty nesters make up a significant community and are more likely to experience emotional issues, particularly depression. This study investigated the prevalence of depression and the factors influencing depression among Chinese home-bound empty nesters using meta-analysis.

METHODS

Based on previous studies, we used search terms relating to empty nesters and depression in English and Chinese. Databases, including China Journal Full Text Database (CNKI), Wanfang, Wipu, China Biomedical Literature Database (CBM), PubMed, Web of Science, Embase, The Cochrane Library, and UptoDate, were searched in April 2022, for relevant articles. Details including names of authors, year of publication, region of investigation, study type, sample size, depression detection scale, depression detection rate, and influencing factors were captured. The heterogeneity of the studies was assessed based on the I2 index, and data analysis was performed using Stata 16.0 software.

RESULTS

A total of ten research articles involving 5337 Chinese empty nesters were evaluated in the present meta-analysis. The overall prevalence of depression among empty nesters in China was 43%. The prevalence of depression among urban empty nesters was 38% (95% CI: 0.24,0.52), and 36% (95% CI: 0.18,0.55) among rural empty nesters. Many factors, including female, income, marital status, chronic illness, relationship with children, and social support were linked to depression among urban empty nesters.

CONCLUSION

The prevalence of depression among empty nesters was 43%. Therefore, based on the factors influencing depression, government departments can intervene early to improve the mental health of empty nesters.

LIMITATIONS

The meta-analysis only included cross-sectional studies. Therefore, there is a need for more future original studies investigating depression among empty nesters in China.

The correlation analysis of WeChat usage and depression among the middle-aged and elderly in China: the mediating role of social participation

BACKGROUND

We aimed to explore the association between WeChat usage and depression in the Chinese middle-aged and elderly and the role of social participation.

METHODS

Data were obtained from China Health and Retirement Longitudinal Study (CHARLS) of 2018. The dependent variable was depressive symptoms, measured with the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). We used the propensity score matching (PSM) to match the WeChat users with the non-WeChat users. Correlations between WeChat usage and depressive symptoms were verified by using logistic regression and linear regression, and the mediating role of social participation was verified by using stepwise regression and KHB method.

RESULTS

Four thousand five hundred forty-five samples were ultimately matched for analysis in this study. After including all control variables, results of logistic regression showed that WeChat usage was significantly associated with a lower prevalence of depression (aOR:0.701,95% CI: 0.605-0.812). And the results of linear regression showed that WeChat usage was associated with lower levels of depression which was significant (p < 0.001). The results of the stepwise regression and the KHB method showed a mediating role of social participation in WeChat usage and depressive symptoms. Among the four types of social participation, the mediating effect of recreational activities was significant, while the mediating effects of voluntary activities, cultural activities, and other activities were not significant. Meanwhile, the effect of WeChat usage on depression and the mediating effect of social participation were heterogeneous because of differences in age and gender.

CONCLUSION

Social participation partly mediated the effect between WeChat usage and depression in middle-aged and older adults. Among the four types of social participation, only recreational activities had a mediating effect. Encouraging more active social participation and other types of social activities should be considered to improve the mental health of the middle-aged and older adults in China through social media usage.

Community home elderly care services, multidimensional health and social participation of chronically ill elderly-Empirical analysis based on propensity score matching and multiple mediation analysis

Introduction

In recent years, China's aging process has deepened rapidly, the disease spectrum of the population has undergone major changes, the proportion and scale of elderly patients with chronic diseases are growing rapidly, and the multidimensional health problems of the chronically ill elderly are prominent, seriously affecting the participation of the chronically ill elderly in family, community, and social development. In response, China has implemented the "active response to population aging strategy," accelerated the development of community home elderly care services, and encouraged the chronically ill elderly to continue to play a role through social participation. So how does the community-based home-based medical care service affect the social participation of the chronically ill elderly? Is an important subject.

Methods

Based on the 2018 China Longitudinal Aging Social Survey and the propensity score matching method to measure the impact of community home elderly care services on the four types of social participation of chronically ill elderly, including economic participation, family participation, voluntary participation, and political participation, and group differences, and uses the multiple mediation analysis method to explore the mechanism and effect of community home elderly care services on the four types of social participation of chronically ill elderly.

Results

(1) Community home elderly care services have an asymmetric impact on the social participation of the chronically ill elderly, and have generally promoted the level of social participation of the chronically ill elderly. (2) Community home elderly care services change the social participation arrangements of the chronically ill elderly by driving and inhibiting effects, so that it has a tendency to reduce economic participation and increase voluntary participation and political participation as a whole. This feature shows group differences among the chronically ill elderly of different ages, education levels, living arrangements and community types. (3) Community home elderly care services have an asymmetric impact on various social participation of the chronically ill elderly through the multidimensional health mediation mechanism.

Conclusion

(1) With the continuous deepening of the interweaving between the growth of chronic diseases and the aging of the population in China, the development of a positive aging society must attach great importance to the important role of social participation for the chronically ill elderly. (2) Strengthen the development of physical, psychological, and social adaptation and other health abilities of the chronically ill elderly, shape their awareness of social participation, and give the chronically ill elderly a reasonable social role orientation. (3) Through policy incentives, promote the realization of fairness, justice, adequacy, and sustainability of community home elderly care services. (4) Pay special attention to the penetration, integration, and application of digital technology into the field of community home elderly care services to effectively protect the health of chronically ill elderly, ensure that the elderly with different chronic diseases participate in social activities of high quality, enjoy a high-quality happy life, and promote the high-quality development of the aging society.

Social norms and fertility intentions: Evidence from China

China’s low fertility rates are a major concern across all sectors of society. Fertility is a major issue related to economy, society and family development. Based on social norms theory, this paper explores the influence of social norms on individuals’ fertility intentions from two perspectives: spatial proximity and social proximity. Using data from the China Family Panel Studies, we found that individual’s fertility intentions were influenced by social norms; both neighborhood social norms and group social norms had significant effects. The role of social norms in shaping individual fertility intentions varied by gender, hukou, and life course; specifically, men, rural residents, and married individuals were more significantly influenced by social norms. This study improves the theoretical framework of fertility decision making by arguing that in addition to macro and individual factors, social norms have a very important influence on fertility intentions. Our findings suggest that reshaping social norms regarding fertility is essential to enhance fertility rates in China.

The relationship between social participation and depressive symptoms among Chinese middle-aged and older adults: A cross-lagged panel analysis

Objectives

This study examined the mutual effects of social participation and depressive symptoms in middle-aged and older Chinese adults from offline and online perspectives. Reciprocal relationships between depressive symptoms and the four subtypes of offline participation were also examined.

Methods

Based on China Health and Retirement Longitudinal Study data (CHARLS), this study conducted ID matching for three waves of data from 2013, 2015, and 2018. One thousand nine hundred ninety-nine samples for individuals over 50 were obtained. A series of cross-lagged analyses were conducted to examine the mutual influence of social participation and depressive symptoms. Depressive symptoms were assessed using the short version of the Center for Epidemiologic Studies Depression Scale (CESD-10). The social participation questionnaire included nine items referring to offline participation (eight items) and online participation (one item). Several demographic variables were adjusted when conducting the cross-lagged analyses.

Results

Social and offline participation had significant two-way associations with depressive symptoms. Depressive symptoms had greater impacts on social and offline participation than in the opposite direction. Online participation has a significant one-way impact on depressive symptoms. The relationship between specific types of offline participation and depressive symptoms varied in existence and direction.

Discussion

Overall, there was significant bidirectional causality between social participation and depressive symptoms. Social participation, both offline and online, played a positive role in alleviating depressive symptoms. Depressive symptoms also affected the level of social participation to some extent among middle-aged and older Chinese adults over time.

Effect of Receiving Financial Support from Adult Children on Depression among Older Persons and the Mediating Role of Social Participation

Older persons are vulnerable to depression SFduring the ageing process. Financial resources and social participation are expected to have an impact on depressive symptoms. This study investigated the relationship between financial support from children and depression among Chinese older persons, as well as the mediating effect of social participation in this relationship. Data from 7163 participants aged 60 and above were extracted from wave 2015 and 2018 of the China Health and Retirement Longitudinal Survey (CHARLS). A multivariate regression analysis was performed on both cross-sectional data and two-wave longitudinal data to test our hypotheses. The results revealed that financial support from children was negatively associated with depressive symptoms in both the short-term and the long-term. In addition, this relationship was partially mediated by social participation in the short-term association and fully mediated by social participation in the long-term, where financial support was positively related to social participation, and social participation was negatively associated with depressive symptoms. This study offers an in-depth insight into the relationship between financial support from children and depression among Chinese older persons. Policies and initiatives to stimulate social participation should be promoted to improve older persons' mental health.

The Impact of Social Pension Schemes on the Mental Health of the Chinese Elderly: A Mediating Effect Perspective of Two-Way Intergenerational Support

With the rapid decline in China’s fertility rate, the acceleration of aging, the continuous miniaturization and nucleation of China’s family structure, and the deterioration of the elderly’s living conditions and mental states, the elderly’s mental health has emerged as a major public health issue and a major social problem. Pensions are the elderly’s primary source of income, and they can help them meet their basic needs while also promoting family harmony and improving their mental health. Based on the data of the 2012, 2016, and 2018 Chinese Family Panel Studies (CFPS), we empirically examined the impact of pensions on the elderly’s mental health by using the fixed effects model, mediating effect model, and so on. The results show that receiving pension benefits can significantly reduce the level of depression and improve the mental health of the elderly. Receiving pension benefits causes reverse intergenerational economic transfer, which reduces the effect of pensions on the elderly’s mental health to some extent, but the life care and mental comfort provided by children increases when the elderly share pensions with their children. Overall, receiving pension benefits improves the mental health of the elderly. In addition, the effect of pensions on the elderly with different characteristics is heterogeneous. The older elderly, women, the elderly living with their children, and the elderly in rural areas all benefit more from receiving pension benefits. Moreover, the worse the mental health of the elderly is, the stronger the influence of pensions on their mental health is. Our discussion has important policy implications.

Global hotspots and prospects of perimenopausal depression: A bibliometric analysis via CiteSpace

BACKGROUND

Perimenopausal depression (PMD) is characterized by affective symptoms as well as menopause-specific somatic complaints and has attracted increasing attention over the past few decades. Using a bibliometric tool, this study aims to evaluate the origin, current hotspots, and research trends on PMD.

METHODS

Articles with research on PMD were retrieved from Web of Science Core Collection (WoSCC). We used the bibliometric method to analyze publication years, journals, countries, institutions, authors, research hotspots, and trends. We plotted the reference co-citation network and used keywords to analyze the research hotspots and trends.

RESULTS

A total of 209 publications related to PMD were identified from WoSCC on May 8, 2022. The number of publications concerning PMD every year shows an upward trend. Further analysis indicated that 209 articles were contributed by 45 countries, 288 institutions, and 501 authors. The United States contributed the most significant number of publications, followed by China. Harvard University is the core institution of PMD research, and Cohen's work has had an important impact on another research. The occurrence and pathological mechanisms of depression during the menopausal transition from the knowledge base of PMD. All of them belong to the category of gynecology and psychosis, which reflects the focus of the research topics. Major depression, postmenopausal women, symptoms like hot flashes, and prevalence and risk factors are research hotspots in the PMD field. The frontiers in PMD field that will impact future research are anxiety, meta-analysis, association, and Beck Depression Inventory-II (BDI-II).

CONCLUSION

These findings provide us with the core countries, institutions, and authors in PMD research and point out the direction of attention in this field. The current research focuses on depression, postmenopausal women, hot flashes, and other symptoms, as well as the prevalence and risk factors. The frontiers will be anxiety, meta-analysis, related factors, and depression assessment in future research.