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

Resiliency amid the COVID-19 pandemic: engagement in meaningful activities as a mediator between coping ability and depressive symptoms among older adults

OBJECTIVES

This study investigated the longitudinal association between coping ability and depressive symptoms from before to during and after the COVID-19 pandemic and whether engagement in meaningful activities plays a mediating role in this association.

METHOD

Individuals aged 75, 80, and 85 years (n = 1021) were interviewed in 2017-2018 (T1, pre-pandemic). Of these persons, 608 were interviewed in 2020 (T2, first wave) and 2021-2022 (T3, partly post-pandemic). Coping ability, depressive symptoms, and engagement in meaningful activities were assessed using the 10-item Connor-Davidson Resilience Scale, 10-item Center for Epidemiologic Studies Depression Scale, and 17-item activity subscore of the University of Jyväskylä Active Aging Scale, respectively. Structural equation modeling was used for the mediation analyses.

RESULTS

Higher coping ability was associated with decreased depressive symptoms, partly mediated by higher activity scores between T1 and T2. From T2 to T3, higher coping ability reduced the depressive symptoms, but the activity scores did not mediate the changes during this period.

CONCLUSION

Good coping ability may help older people sustain good mental well-being. With good coping ability, active engagement in meaningful activities contributed to the low level of depressiveness during the early phases of the pandemic, when many social activities were restricted.

Social Participation Patterns Among Community-Dwelling Older Adults Before and During the COVID-19 Pandemic: Roles of Community Social Cohesion and Health

The objectives of this study were to investigate groupwide variations in social participation among older adults before and during the COVID-19 pandemic and how such variations were associated with their community social cohesion and health. Data were from the National Health and Aging Trends Study (2019-2020; n = 2,597 adults aged 65 or older). Latent class analysis was used to identify groupwide variations in social participation. These variations were then incorporated into adjusted regressions to test relationships with social cohesion and health. Four participation patterns emerged: active, selective independent, occasional, and selective religious participants. Selective independent and occasional participants were likely to live in less socially cohesive communities. During the pandemic, active participants were likely to report better self-rated health and lower risks of depressive and anxiety symptoms and dementia. Findings highlight directions for policy and intervention design that can enhance social participation and support healthy aging.

Social participation patterns and associations with subsequent cognitive function in older adults with cognitive impairment: a latent class analysis

Background

Social participation (SP) has been associated with cognitive benefits among older adults; however, little is known about SP patterns and their relationships with cognitive function in cognitively impaired populations. This study aimed to identify SP patterns among cognitively impaired older individuals and evaluate their associations with subsequent cognitive function, specifically mental intactness and episodic memory.

Methods

Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), including 5,673 individuals aged 60 years and older with cognitive impairment from 2015 to 2018. Latent class analysis (LCA) was used to identify SP patterns, and hierarchical linear regression analyses were conducted to examine associations between these patterns and cognitive function.

Results

Four distinct SP patterns were identified: "Offline Social Participation Group" (Class 1), "Intellectual Social Participation Only Group" (Class 2), "Club and Volunteer Activities Group" (Class 3), and "Minimal Social Participation Group" (Class 4). The Class 4 comprised the majority (73%) and exhibited the poorest cognitive outcomes. Compared to the Class 4, Class 2 showed significant improvements in mental intactness (p < 0.001) and episodic memory (p = 0.022), while Class 3 demonstrated significant improvements in mental intactness (p = 0.032) but not episodic memory. Class 1 showed significant improvements in episodic memory (p = 0.023).

Conclusion

This study highlights the cognitive benefits of social participation, particularly intellectual activities, for older adults with cognitive impairment. Targeted interventions promoting SP, especially intellectual activities, are essential to mitigate cognitive decline and improve cognitive resilience in vulnerable populations.

Bidirectional changes in depressive symptoms and social functioning in older adults attending psychological therapy services

BACKGROUND

Impairments in the ability to carry out social activities commonly co-occur alongside depression. Improving social functioning is often overlooked in treatment. This is despite the high value placed by patients on social functioning and the potential for interventions focused on social functioning to have additional benefits in reducing depressive symptoms. In older adults the relationship between depressive symptoms and social functioning during treatment is poorly understood.

METHODS

We analysed data across the first four treatment sessions of 3260 older adults receiving psychological therapy for depression at eight NHS Talking Therapies for anxiety and depression services in England. Random-intercept cross-lagged panel models were estimated, modelling bi-directional change between depressive symptoms, and impairments in (a) social leisure activities, and (b) close relationships, controlling for gender and diagnosis.

RESULTS

Over treatment sessions, depressive symptoms and impairments in social functioning decreased. A bi-directional relationship was observed whereby depressive symptoms were associated with future impairments in social functioning and vice versa. Changes in depressive symptoms appeared to have a greater association with future social functioning, compared to the reverse.

LIMITATIONS

Patients lived in Greater London and findings may not translate to other settings. We included older adults that attended at least four treatment sessions, and had no missing data at the first assessment, potentially biasing the sample and results.

CONCLUSIONS

Older adults receiving psychological therapy experience reductions in depressive symptoms and impairment in social functioning early in treatment. Treating core depressive symptoms and impairments in social functioning may benefit one another, and improve outcomes.

Socioeconomic status moderate the relationship between mental health literacy, social participation, and active aging among Chinese older adults: evidence from a moderated network analysis

OBJECTIVE

The aging population represents a formidable global challenge, with China experiencing an accelerated demographic shift. While previous research has established a directional link between mental health literacy, social participation, and active aging, the moderating effect of socioeconomic status (SES) on these associations remains underexplored. This study sought to address this gap by employing moderated network analysis, in contrast to the total score approaches commonly used in prior literature.

METHODS

A cross-sectional design was implemented, involving 1,032 Chinese individuals aged 60 and above, who completed the Mental Health Literacy Questionnaire, Active Aging Scale, Social Participation Questionnaire, and Socioeconomic Status Index Scale. The moderated network method was applied to explore the bidirectional relationships between mental health literacy, social participation, and active aging, while examining the moderating role of SES.

RESULTS

The analysis identified the strongest bidirectional relationships between attitudes toward mental illness and the development of spiritual wisdom. Seven interaction terms emerged involving mental health literacy, social participation, and active aging, moderated by SES. Notably, the most significant interaction terms were found between attitudes toward mental illness and engagement in active learning.

CONCLUSIONS

These results contribute novel insights into the bidirectional relationships among mental health literacy, social participation, and active aging, as well as the role of SES in moderating these relationships. The findings highlight the need for targeted policy interventions to address socioeconomic inequalities in later life, thereby fostering active aging.

Social participation and mental well-being: Does purpose in life mediate the association among older adults?

OBJECTIVES

We investigated the association of social participation with mental well-being among older people and whether purpose in life mediates the potential association.

METHOD

Cross-sectional (n = 1014) and longitudinal (n = 660, four-year follow-up) data comprised of three age cohorts (75, 80, and 85 years) of community-dwelling people. Life satisfaction was measured with the Satisfaction with Life Scale, depressive symptoms with the Centre for Epidemiologic Studies Depression Scale, and purpose in life with the Scales of Psychological Well-Being purpose in life subscale. Social participation was assessed with questions concerning the frequency of meeting close friends and acquaintances, and volunteering. The data were analyzed using structural equation modeling.

RESULTS

Higher social participation was associated with higher life satisfaction and fewer depressive symptoms both cross-sectionally and after a four-year follow-up. Higher purpose in life mediated the associations of more social participation with higher life satisfaction and fewer depressive symptoms cross-sectionally. In the longitudinal data, the mediation effect was not observed.

CONCLUSION

Older people with frequent social participation who had a sense of purpose in their lives will likely have higher mental well-being than those with less social participation. Enabling and supporting them to conduct purposeful actions in social contexts may help maintain their mental well-being.

Effects of activities participation on frailty of older adults in China

Objective

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

Methods

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

Results

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

Conclusion

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

Drivers of Depression in Chronic Post-Stroke Aphasia

Background

Approximately one third of stroke survivors develop post-stroke depression, which reduces quality of life. Previous studies have often focused on early phases of recovery and excluded people with significant aphasia. Here, we examine relationships of depression symptoms to demographic factors, and different types of stroke-related disability and impairment in adults with chronic left-hemisphere stroke and a history of aphasia.

Methods

92 chronic left-hemisphere stroke survivors with a history of aphasia and 70 controls participated in this cross-sectional study. The Beck Depression Inventory-II (BDI-II) measured depression symptoms. The Stroke Impact Scale 3.0 (SIS) assessed stroke-related disability in Cognitive, Physical, and Social Participation domains, as well as self-perceived Recovery. The Western Aphasia Battery Aphasia Quotient and the NIH Stroke Scale total motor score measured language and motor impairment. Spearman correlations examined bivariate relationships between variables. Ordinal regression models examined group differences in BDI-II scores (Model 1), and disability and impairment factors that predicted BDI-II scores (Model 2), accounting for demographic factors and antidepressant medication status.

Results

BDI-II scores were on average 3.4 points higher in stroke survivors than controls. Model 1 confirmed that this difference was significant, and found that age was inversely related to BDI-II scores. Bivariate correlations demonstrated that higher BDI-II scores were related to lower SIS Cognitive, Social Participation, and Recovery scores. Model 2 found that these three measures independently predicted BDI-II scores.

Conclusions

The factors related to depression may differ depending on the nature of the stroke, the types of deficits experienced, and the phase of recovery. In the chronic phase of left hemisphere stroke with aphasia, cognitive and communication disabilities, social participation, and self-perceived recovery are the primary correlates of depression symptoms. These findings highlight the importance of assessing for depression even long after left hemisphere stroke, and suggest potential targets for psychotherapy to improve depression.

Understanding Major Depressive Disorder in Singapore: Insights from the second Singapore Mental Health Study (SMHS 2016)

BACKGROUND

Major Depressive Disorder (MDD) poses significant public health challenges globally and in Southeast Asia, with substantial impairment and disease burden. Understanding its prevalence and associated risk factors is crucial for effective intervention.

METHODS

This study aims to describe the prevalence shifts, correlates, and comorbidities of MDD in Singapore. Data were collected from the second Singapore Mental Health Study (SMHS 2016), a national cross-sectional survey comprising 6126 adult residents. The WHO Composite International Diagnostic Interview assessed MDD and comorbidities. Statistical analyses, including logistic regression, were conducted to examine the associations and trends.

RESULTS

The lifetime weighted prevalence of MDD in SMHS 2016 was 6.2 %, with an overall increase from 5.8 % in 2010. Significant associations were found between MDD and age, marital status, and comorbid physical disorders. Young adults and divorced/separated individuals exhibited higher MDD prevalence. Chronic pain was significantly associated with MDD.

LIMITATIONS

The study's cross-sectional design limits causal inference, and selective non-response might affect prevalence estimates. However, the study benefits from a large, nationally representative sample and standardized methodologies.

CONCLUSIONS

Young and middle-aged adults, and divorced/separated individuals demonstrate elevated MDD prevalence, warranting targeted interventions. Individuals with comorbidities, particularly chronic pain, constitute a high-risk and vulnerable population. Comprehensive assessment and treatment plans should involve multidisciplinary teams and integrated care approaches to better address the complex needs of these individuals. Our study also highlights specific interventions for schools, families, communities, and workplaces. Despite Singapore's relatively low prevalence compared to Western nations, MDD remains cross-culturally valid emphasizing the need for early intervention and preventive public health measures.

The relationship between square dance exercise and quality of life in middle-aged and older adults: chain mediated effects of negative emotions and attitudes toward aging

Background

With the continuous development of society and the economy, population aging has become an inevitable global development trend, triggering a series of social problems and having a more serious impact on the physical and mental health of middle-aged and older adults. Physical exercise is one of the key factors for improving the overall health and quality of life of individuals, but the role of square dance exercise and the quality of life of middle-aged and older adults have not yet been clarified.

Purpose

This study aimed to investigate the associations between square dance exercise and the quality of life of middle-aged and older adults and its mechanism of action, including its effects on physical health and mental health, with negative emotions and attitudes towards aging as mediating variables.

Method

This study adopted a cross-sectional research method, using the Physical Activity Rating Scale (PARS-3), Depression-Anxiety-Stress Scale in Simplified Chinese (DASS-21), Attitudes toward Aging Questionnaire (AAQ), and 12-item Short Form of the Health Survey (SF-12), and launched an online survey on the QuestionStar platform from August-September 2023 for 4,636 middle and older adults aged 45-74 years. The survey results were analyzed via Pearson correlation analysis via SPSS 27.0 and structural equation modeling analysis via Mplus 8.3 to test the model fit and mediation effects.

Results

Square dance exercise was significantly correlated with negative emotions, attitudes towards aging, and quality of life (r = -0.042-0.878, p < 0.01). Square dance exercise significantly and positively predicted quality of life (β = 0. 202, p < 0.001). Negative emotions and attitudes towards aging are chain mediators of square dance exercise and quality of life, and the mediation consists of three pathways: separate mediation of negative emotions, separate mediation of attitudes towards aging, and chain mediation of negative emotions-attitudes towards aging.

Conclusion

This study is dedicated to deepening the scientific role of how square dancing, as a health-promoting activity, can optimize the quality of life of middle-aged and older adults through the mediating mechanism of negative emotion alleviation and positive attitudes towards aging and then optimize the quality of life of middle-aged and older adults. This process not only enriches the theoretical framework of the complex interactions between psychosocial factors and healthy aging but also provides a solid empirical foundation for the development of health intervention strategies aimed at enhancing the overall well-being and quality of life of the middle-aged and older adults.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The association between living alone and depressive symptoms in older adults population: evidence from the China Health and Retirement Longitudinal Study

Objective

The goal of this research was to reveal the association between living alone and depressive symptoms in older adults. It also aims to explore the mediating role of social activity and adult children's relationship satisfaction. Ultimately, the study seeks to add to the body of knowledge for lowering the risk of depression among older people and promoting positive aging.

Methods

Based on information from the 2020 China Health and Retirement Longitudinal Study, the ordinary least square (OLS) regression model and propensity score matching (PSM) were used to investigate the association between living alone and depressive symptoms in older adults and to explore possible heterogeneity in different groups. Utilizing the SPSS PROCESS macro application, the mediation model was constructed. The significance of the mediation effect was investigated using the Bootstrap technique.

Results

The average level of depressive symptoms of older people living alone (10.55 ± 6.962) was higher than that of older people who do not live alone (8.80 ± 6.363). The baseline regression analysis revealed a significant connection between living alone and the depressive symptoms of older people (β = 0.842, p < 0.001). The association between living alone and the level of depressive symptoms was significantly higher in those aged 60-74 years (β = 1.698, p < 0.001) than in those aged 75 and older (β = 0.953, p < 0.05). The association between living alone and depressive symptoms was significantly higher in rural older adults (β = 1.512, p < 0.001) than in urban older adults (β = 1.141, p < 0.001). Between living alone and the level of depressive symptoms experienced by older people, there was a substantial mediation impact on social engagement and adult children's relationship satisfaction, which contributed to 2.91 and 13.62% of the overall effect.

Conclusion

For older age groups, living alone is associated with higher levels of depressive symptoms. This effect is stronger in older adults aged 60-74 or rural areas. In older age groups, the association between living alone and depressive symptoms is mediated by social activity and adult children's relationship satisfaction.

Urban resilience reduces depressive symptoms among middle-aged and elderly adults: A multidimensional analysis based on China longitudinal healthy longevity survey

With the rapid urbanization and aging population, depression has become a severe public health issue globally, affecting millions of individuals and significantly impacting their quality of life and healthcare costs. Urban resilience refers to a city's ability to absorb, recover, and prepare for future shocks, ensuring sustainable development despite challenges. This study aims to explore the impact of urban resilience on depressive symptoms among middle-aged and elderly adults. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we analyzed five dimensions of urban resilience: economic, social, ecological, institutional, and infrastructural resilience. The results of cox proportional hazards model indicate that high levels of urban resilience significantly reduce the risk of depressive symptoms (HR = 0.875, 95% CI: 0.832-0.920, P < 0.001). Specifically, economic resilience (HR = 0.883, 95% CI: 0.846-0.921, P < 0.001), social resilience (HR = 0.916, 95% CI: 0.876-0.958, P < 0.001), ecological resilience (HR = 0.670, 95% CI: 0.516-0.869, P = 0.003), institutional resilience (HR = 0.922, 95% CI: 0.886-0.960, P < 0.001), and infrastructural resilience (HR = 0.875, 95% CI: 0.826-0.926, P < 0.001) all show significant negative correlations with depressive symptoms. Furthermore, the mitigation of depressive symptoms risk resulting from improved urban resilience disproportionately benefits vulnerable groups and those with healthy living habits. These findings provide scientific evidence for urban planning and policy formulation, contributing to the promotion of mental health and healthy aging among middle-aged and elderly populations.

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.

Dwelling characteristics and mental well-being in older adults: A systematic review

The increasing prevalence of mental health challenges in older adults underscores the need for a comprehensive understanding of the interplay between dwelling characteristics and mental health outcomes. This systematic review aims to investigate house characteristics associated with mental well-being in older adults. The review meticulously explores existing literature from databases such as PubMed, Scopus, Web of Science, and the Google Scholar search engine. The Newcastle-Ottawa Scale (NOS) was utilized to assess the quality of the included articles. Out of an initial 1182 references, 21 pertinent articles published between 2002 and 2023 were included in the study. While the geographical scope was global, a notable concentration of studies was observed in China. The synthesis of studies reveals that specific attributes of dwelling characteristics, such as high-rise and multi-floor houses, larger house size, high house quality, bathing facilities, and the use of clean fuels for heating and cooking, positively impact mental health outcomes in older adults. However, inconsistent results were found regarding the impact of construction materials on mental health outcomes. Further research is warranted to deepen our understanding of the intricate relationship between construction materials and mental health outcomes. These findings underscore the importance of considering specific dwelling characteristics in designing interventions to enhance the mental well-being of older adults, necessitating targeted strategies for creating age-friendly living environments.

Functional teeth and cognitive function among the Chinese elderly: The chain mediating effect of depressive symptoms and social participation

The objective of this study was to investigate the chain mediating effects of depressive symptoms and social participation between functional teeth and cognitive function based on the biopsychosocial model. Data from the 2018 China Health and Retirement Longitudinal Study were analyzed. The findings revealed a favorable connection between the lack of edentulism and cognitive function, persisting even when accounting for the mediating factors of denture usage, depressive symptoms, and social participation. Furthermore, the study identified six indirect pathways in this relationship. The present study has substantiated the correlation between edentulism and cognitive function, thereby proposing that interventions aimed at denture usage, depressive symptoms, and social participation could potentially serve as preventive measures against cognitive decline in elderly individuals afflicted with edentulism. This underscores the significance of addressing these factors to alleviate cognitive decline.

How is family health related to health-related quality of life among middle-aged and older adults in rural China? A cross-sectional study

BACKGROUND

Health-related quality of life (HRQOL) is unequal between countries and regions, and the emphasis on HRQOL of populations of low-income countries and regions is unprecedented.

OBJECTIVES

To examine the association between family health and HRQOL among middle-aged and older adults in rural China, and determine whether this association differs by age, gender and chronic disease subgroup.

METHODS

Cross-sectional survey carried out from July to September 2021. The participants were 1059 people aged 46 and over living in rural China. We used the European Quality of Life Five Dimension Five Level (EQ-5D-5L) and Family Health Scale-Short Form (FHS-SF) to assess health-related quality of life (HRQOL) and family health, respectively.

RESULTS

The mean EQ-VAS was 75.66, the mean EQ index score was 0.92, and the mean FHS was 37.90 in rural middle-aged and older adults. After Bonferroni correction, generalised linear regression models showed that FHS was significantly associated with the EQ-VAS (β = 0.829; 95% confidence interval [CI]: 0.660 to 0.997; p < .001) and the EQ index score (β = 0.003; 95%CI: 0.001 to 0.004; p < .001). Binary logistic regression models showed that FHS was associated with three dimensions of HRQOL (mobility, self-care and usual activities) (p < .01). Based on subgroup analyses, the effect of FHS on EQ-VAS and the EQ index score was significant in three subgroups after Bonferroni correction (p < .01), but the association between FHS and the dimensions of HRQOL differed by age, gender and chronic disease group (p > .01).

CONCLUSIONS

This study is the first to explore that family health and its dimensions are significant positive predictors of HRQOL among middle-aged and older adults in rural China. Family-based measures may have more potential and value because better family health significantly improves HRQOL.

IMPLICATIONS FOR PRACTICE

In the health strategy, the government and primary health care workers should include family health as an indicator and assess it before and after the implementation of the strategy.

Relationship between social participation and life satisfaction in community-dwelling older adults: Multiple mediating roles of depression and cognitive function

BACKGROUND

Numerous studies have explored the relationship between social participation, depression, cognitive function, and life satisfaction in community-dwelling older adults. However, the results of these studies were not consistent. Therefore, the in-depth excavation of the complex relationship mechanism between these four variables is limited. This study aims to explore whether depression and cognitive function act as the multiple mediators between social participation and life satisfaction in community-dwelling older adults.

METHODS

This study used the meta-analytic structural equation modeling (MASEM) approach. Six databases were comprehensively searched to investigate the relationship between social participation, depression, cognitive function, and life satisfaction in community-dwelling older adults from inception to March 1, 2023.

RESULTS

The analysis included 50 articles that reported 66 effect sizes (N = 161,854). The MASEM found the relationship between social participation and life satisfaction was mediated by depression [β = 0.085, 95 % CI (0.053, 0.126)] and by cognitive function [β = 0.015, 95 % CI (0.002, 0.033)], respectively. Depression and cognitive function also played multiple mediating roles between social participation and life satisfaction in community-dwelling older adults [β = 0.005, 95 % CI (0.001, 0.012)].

CONCLUSIONS

There was not only a direct association between social participation and life satisfaction, but also an association through multiple mediating roles of depression and cognitive function in community-dwelling older adults. In the process of using diverse interventions to promote social participation in community-dwelling older adults, more attention should be paid to their psychological status and cognitive function to eliminate intrinsic barriers so as to improve life satisfaction effectively.

Personal benefits of older adults engaging in a participatory action research (PAR) project

Participatory action research (PAR) is the process of conducting research with people rather than for them and is perceived as an empowering activity for older adults who participate in it. However, there is little evidence that outlines and explains the reasons why older adults engage in PAR. Thus, the aim of this study was to better understand the personal benefits for older adults participating in PAR. We based our study on the experiences of four older adults who volunteered for CareComLabs, a Swiss-based PAR project, for more than two years. A constructivist grounded theory design was used to explore the benefits of participating in CareComLabs by conducting in-depth, semi-structured interviews. The analysis yielded four categories of personal benefits of participating in CareComLabs: (a) enriching relationships; (b) broadening horizons for older age; (c) keeping in touch with one's profession; and (d) interacting in a nurturing community. Our findings may have implications for policies and frameworks focused on the identification of the potential of participatory action research as a community resource.

Decomposition and comparative analysis of depressive symptoms between older adults living alone and with others in China

Objective

This research dealt with investigating and measuring the contribution of the factors that impact depression in older adults living alone vs. those living with others (hereafter referred to as "not alone") in China.

Design

This investigation adopts a cross-sectional research design. The dataset employed for this study comprises data from 2018 the Chinese Longitudinal Health Longevity Survey (CLHLS).

Setting

The research involved data sourced from China, specifically from 23 of its provinces. From the 8th CLHLS, 12,197 older adults were selected who met the study requirements.

Measures

Binary logistic regression models were established to delve into the primary factors impacting the depressive symptoms of the individuals. Furthermore, Fairlie models were employed to assess these factors between older adults living alone and those not living alone. This approach facilitated an in-depth analysis of their respective contributions.

Results

It was observed that the demographic of Chinese older adults exhibited depressive symptoms at a rate of 11.92%. Older adults who resided alone (15.76%) exhibited a higher prevalence of depressive symptoms in comparison to their counterparts living in not-alone settings (11.15%). Employing Fairlie decomposition analysis, it was determined that this observed disparity in depressive symptoms, amounting to 55.33% of the overall difference, could be primarily attributed to distinct factors. This encompassed variance in marital status (20.55%), years of school (4.63%), self-reported local income status (7.25%), self-reported sleep status (17.56%), and self-reported health status (4.24%).

Conclusion

The resulting data indicated that depressive symptoms exhibited an elevated prevalence in older adults living alone than in those living not alone. This discrepancy was predominantly attributed to variance in socioeconomic marital status, years of school, self-reported local income status, self-reported sleep status, and self-reported health status by living alone vs. not alone. Mitigating these influential factors could help develop targeted and meticulous intervention strategies, precisely tailored to improve the mental well-being of older adults at high risk.

Social participation during the COVID-19 pandemic in persons with a high risk for a severe course of COVID-19 - results of a longitudinal, multi-center observational study in Germany

Objective

The COVID-19 pandemic has affected how people go about their daily lives, often in various and substantial ways. This study aims to prospectively evaluate the changes in social participation during the COVID-19 pandemic in persons with a high risk for a severe COVID-19 course in Germany.

Methods

A paper-pencil-based survey was conducted starting at March 2021. Participants filled out questionnaires at four time points based on their COVID-19 vaccination status: before COVID-19 vaccination, one month, six months and twelve months after COVID-19 vaccination. Social participation measures included the Pandemic Social Participation Questionnaire (PSP-Q) and the Index for measuring participation restrictions (IMET). Repeated measures ANOVA and paired t-test were used to test for changes between time-points. Repeated measures correlation was used to assess the relationship between social participation and local COVID-19 incidences.

Results

Data from 245 participants was analyzed before and one month after COVID-19 vaccination. In addition, data from 156 participants was analyzed at time points one, six and twelve months after COVID-19. PSP-Q and IMET scores changed significantly after participants received a COVID-19 vaccination. Between one month and twelve months after vaccination, social participation improved significantly measured by PSP-Q. Social participation was negatively correlated with regional COVID-19 incidences before and after COVID-19 vaccination. Social participation was positively correlated with COVID-19 incidences between one month and twelve months after COVID-19 vaccination.

Conclusions

Social participation improved in persons with a high risk for a severe COVID-19 course during the pandemic. The local COVID-19 incidence showed a negative association with social participation only until the fall of 2021 when it was used as the sole metric to regulate COVID-19 protective measures. Although our data describes the trends in social participation, further studies are needed to identify the influencing factors for the observed increase in social participation.

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.

Spatial-temporal analysis of urban-rural differences in the development of elderly care institutions in China

Background

Aging is both a sign of rising life expectancy per capita and social progress, and a challenge for society. Due to the decline in physiological functions, the rate of illness has increased significantly, leading to a rise in demand for healthcare, life care and other elderly care. With the overlapping impact of an aging population, advanced aging, empty nesting families and the weakening of traditional elderly care functions, the issue of elderly care for the empty nesters, the elderly alone and the disabled has become more prominent and has become a focal point of concern for all sectors of society. As an important supplement to the elderly care service system, institutional care, together with home care, community care and rural care, are mutually complementary.

Methods

The study establishes a panel database of urban and rural elderly-care institutions in 276 cities from 2010 to 2016, and uses comprehensive measurements to reveal the spatial-temporal changes of urban and rural elderly care institutions in China.

Results

First, in terms of spatial pattern, the overall score of elderly care institutions in urban areas shows a "double-high" spatial pattern of higher scores in coastal areas than inland areas, and higher scores in urban areas than in rural areas. In terms of the differences in the scores of secondary indicators, the eastern urban areas have higher scores than the rural areas for the indicators of facilities construction and nursing staff of elderly institutions, while the eastern rural areas have higher scores than their urban counterparts for the indicators of service recipients of elderly institutions. Second, in terms of temporal change, there is a clear "urban progress and rural regression" in the evolution of China's elderly care institutions. Third, in terms of spatial and temporal evolution, there is a clear spatial autocorrelation in the composite scores of urban and rural elderly care institutions in China, and the spatial autocorrelation of the composite scores of elderly care institutions shows a clustering pattern.

Discussion

The contradiction between the limited ability to pay of the elderly people staying in elderly care institutions and the huge demand for elderly care services is bound to affect the sustainability of the development of public elderly care institutions in both urban and rural areas. Due to historical factors, the marketisation of elderly care institutions in China started late and the marketisation of elderly care is not high. As the population ages, China's elderly-care institutions have begun to transform from public institutions of a welfare nature to those with some market mechanisms, but the overall transformation has been slow, resulting in the service guarantee system of elderly-care institutions lagging far behind the actual needs of the elderly. The long-term development of elderly care institutions must introduce market mechanisms, enhance the endogenous dynamics of elderly care institutions, correctly handle the relationship between fairness and efficiency of elderly care services, and improve the professionalism, income and treatment of elderly care staff while compensating for the lack of development of elderly care institutions and the inadequate layout of space, so as to continuously improve the service quality of elderly care institutions.