The impact of adult children's support on the psychological health of rural older adult people in China

Background

Family old-age care is dominant in Chinese rural society, and children's support is an important force in family old-age care. However, the migration of a large number of young and middle-aged rural laborers has undermined the traditional arrangements for old-age care in rural areas and affected the psychological health of the older adult.

Methods

2014 China Longitudinal Aging Social Survey targets Chinese citizens aged 60 or older and covers 28 provinces in mainland China. In this paper, the database of the CLASS was selected for empirical analysis to explore the impact of children's support on the depression level and loneliness of rural older adults through multiple linear regression, and was divided into two groups according to children's migration to analyze heterogeneity.

Results

Children's financial support facilitates the maintenance of mental health among rural older adults. Children's support promotes mental health among rural older adults, but this association does not exist among older adults without children's migration. Individual characteristics of older people have a greater impact on mental health.

Discussion

Our study firstly compares the differences of children's migration status between children's support and mental health among the older adult in rural China. In order to improve the mental health of the older adult, it is necessary to create a favorable atmosphere of love and respect for the older adult, improve the social security system in rural areas, and give full play to the strengths of the social forces, so as to ensure that the older adult have a sense of worthiness and enjoyment in their old age.

Does Early Parental Conflict Impact Current Depression Among Older Adults in Rural China? A Chain-Mediated Model Analysis

Purpose

The study aimed to investigate the relationships between early parental conflict, marital and parent-child relationships, and current depression among rural older adults, and to examine its gender differences.

Methods

Using data obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2018, we selected 2347 adults aged 60 years and older in rural China and used a structural equation model to evaluate the mechanisms behind early parental conflict and current depression among such adults.

Results

Early parental conflict impacted current depression among rural older adults, and marital and parent-child relationships played mediating roles in the mechanism. However, there were gender differences in the paths: early parental conflict directly impacted older males' depression, but not among females; marital relationships acted as a mediator between early parental conflict and current depression among older females, but not among males.

Conclusion

Among older adults in rural China, early parental conflict can affect current depression through the indirect path of marital relationships as well as the chain mediating path between marital and parent-child relationships.

Association Between Sleep and Cognition of Older Adults in Rural Areas: A Cross-Sectional Study

Sleep is an essential physiological function for everyone. Limited evidence existed on the associations between multi-factor sleep patterns and cognition among older adults in rural areas. Aimed to assess that, We conducted a cross-sectional study on the living habits and cognitive status in rural areas of Qingdao and 1167 participants aged 65 to 96 years answered the questionnaire. The result showed that poor sleep quality, high sleep disturbance, daytime dysfunction, and hypnotic drug-dominated sleep patterns were related to the cognitive function, and there was no obviously associations between good sleep duration and cognition. In order to solve the sleep problems and preserve cognitive function, support and protection of physical and mental health should be the priority of government policies in helping older adults' group in rural areas.

A Multilevel Physical Activity Intervention Among Chinese Rural Older Adults (Stay Active While Aging): A Study Protocol for a Clustered Randomized Controlled Trial

Background

Although a large number of studies have confirmed the benefits of physical activity (PA) in preventing age-related diseases and disabilities, a growing number of older people spent more time in sedentary behavior as opposed to PA. To reverse the alarming trend, numerous studies have corroborated the effectiveness of PA interventions in improving PA among older adults. However, such research is scarce in rural China, where a majority of older adults do not meet the PA recommendation. The Stay Active While Aging (SAWA) aimed to conduct an intervention to improve the PA level among older adults in rural China.

Methods

The SAWA is designed as a single-blind, clustered randomized controlled trial carried out in rural Sichuan, China with an 8-week intervention and a 24-month follow-up. The intervention group will receive a multilevel intervention (individual, interpersonal, and community levels), while the control group will not. The primary outcome is the PA level. Secondary outcome measures include sedentary behavior level, self-efficacy, self-regulation, cognitive function, night-time sleep quality, and anthropometry. The difference-in-differences (DID) will be performed to investigate the between-group differences, adjusted for baseline data and covariates.

Discussion

The SAWA trial will provide a multilevel intervention based on the socio-ecologic model among older adults in rural China. We target the PA level and health status changes while also focus on the maintenance of such intervention during 24 months. If the SAWA produces positive results, it will be possible to recommend similar strategies to be implemented in other Chinese older adults and beyond.

Trial registration

ChiCTR2100045653 (https://www.chictr.org.cn/index.aspx).

The mediating effect of coping style on the relationship between perceived stress and mental health in Chinese rural older adults living alone: A cross-sectional study

AIM

Older adults living alone is becoming the main family structure in rural China. This study aimed to explore the mediating effect of coping style on the relationship between perceived stress and mental health in rural older adults living alone in China.

METHODS

356 rural older adults living alone were recruited in Huzhou, China. Subjects were investigated using the Chinese Perceived Stress Scale (CPSS), Chinese Coping Style Questionnaire (CCSQ), and Mental Health Questionnaire (MHQ). Data were analysed using a structural equation. Bootstrapping was used to validate the mediation effects.

RESULTS

Mental health showed significant correlations with a sense of nervousness, of uncontrollability, and with positive and negative coping styles (P < 0.05). The results of structural equation modeling showed a good fit for the total sample (χ² /df = 2.684, NFI = 0.927, GFI = 0.944, RMSEA = 0.069). Perceived stress (sense of nervousness and uncontrollability) impacted the mental health of rural older adults living alone mainly through two mediating variables, including positive and negative coping styles. The double mediating contribution rates were 42.11%, and 61.82%.

CONCLUSION

Coping style partially mediated the relationship between perceived stress and mental health of rural older adults living alone in China. Consequently, to improve the mental health of rural older adults living alone, perceived stress and coping styles should be the focus. Geriatr Gerontol Int 2022; ••: ••-••.

WITHDRAWN: Health risk assessment of rural older population

Ahead of Print article withdrawn by publisher.

Social support, self-worth, and subjective well-being in older adults of rural China: a cross-sectional study

This study explored the relationship between social support and subjective well-being of the rural Chinese older adults and investigated whether self-worth could mediate this association. A total number of 356 older adults from rural areas of China were investigated using three scales. The results were as follows: there were significant correlations between social support, self-worth, and subjective well-being (where P < 0.01 in all of them). Bootstrapping mediation analyses indicated that self-worth partly mediated the association between social support and subjective well-being. Accordingly, social support and self-worth are important targets for improving the subjective well-being level of the rural older adults.

Effect of an Integrated Healthcare Program for Korean Rural Older Adults: A Quasi-Experimental Study

Studies have been conducted on the development of healthcare programs for older adults in rural areas, not only in Asia but also in Europe and the United States. However, these reports have been limited by largely non-comprehensive results, lack of demand surveys, or programs with no systematic development. The purpose of this study was to develop an integrated healthcare program for rural older adults and investigate the effects of the program. A nonequivalent control group pretest–posttest design was used. Subjects were aged over 65 and lived in the rural community. The integrated healthcare program involved 12 three-hour sessions over 12 weeks. Compared with the control group, the experimental group demonstrated significant differences in both upper extremities strengths (t = 2.74, p = 0.008; t = 2.03, p = 0.047), static balance (z = −2.38, p = 0.017), dynamic balance (t = −4.82, p < 0.001), loneliness (t = −3.02, p = 0.003), and role self-efficacy (t = 2.39, p = 0.020), but no differences for ego integration (t = 1.51, p = 0.137). To improve physical, mental, and social health of the rural older adults, we developed an integrated healthcare program. The program improved physical functions, loneliness, and role self-efficiency of the rural older adults. Therefore, it is recommended that healthcare professionals actively apply this program in primary healthcare institutes and elsewhere.

Social Network Types and Health among Older Adults in Rural China: The Mediating Role of Social Support

This study aimed to identify social network types among older adults in rural China, to explore the relationship between social network types and the health of the older adults, and further, to examine the mediating role of social support in this relationship. A cross-sectional survey method was employed to investigate the health of adults aged 60 or older in rural areas of Hubei Province from 5 September 2018 to 15 October 2018; 405 samples were obtained. First, using k-means clustering analysis, we found five robust network types: diverse, restricted, family, friends and a specific type—family-restricted. Second, the results of multiple linear regression analysis showed that social network types were significantly associated with depressive symptoms and self-rated health in older adults. Older people with diverse friend networks were significantly associated with lower levels of depressive symptoms, whereas those with restricted and family-restricted networks were significantly associated with higher levels of depressive symptoms and lower levels of self-rated health. Finally, the results of multiple linear regression analysis confirmed that social support partially mediated the association of the identified social network types with depressive symptoms and self-rated health. Enriching the social network relationships of older adults and providing them with more social support should be conducive to promoting their mental and physical health.

Examining Rural Older Adults' Perceptions of Cognitive Health

Existing cognitive health literature focuses on the perspectives of older adults with dementia. However, little is known about the ways in which healthy older adults without dementia understand their cognitive health. In rural communities, early dementia diagnosis may be impeded by numerous factors including transportation challenges, cultural obstacles, and inadequate access to health and support services. Based on participant observation and two waves of 42 semi-structured interviews, this study examined healthy, rural older adults' perceptions of cognitive health. By providing an innovative theoretical foundation informed by local perspectives and culture, findings reveal a complex and multidimensional view of cognitive health. Rural older adults described four key areas of cognitive health ranging from independence to social interaction. As policy makers, community leaders, and researchers work to address the cognitive health needs of the rural aging demographic, it is essential that they listen to the perspectives of rural older adults.

The Association of Complementary Therapy Use With Prescription Medication Adherence Among Older Community-Dwelling Adults

Medication adherence is a major health concern, particularly among older adults who have one or more chronic conditions. We examined the association between complementary therapy use and medication adherence among older community-dwelling adults. In a bi-ethnic sample of 165 adults aged 65 years and older, anthropometric variables, data on chronic medical conditions, and medication use were assessed. Medication adherence was modeled as a score (<50%, 50%-75%, and >75%) and complementary therapy use was categorized as a binary variable. Over half of the participants (50.3%) were female, and 47.3% were African American. Complementary therapy use was prevalent (87.9%) and did not differ by sex, ethnicity, income, and educational attainment. Medication adherence score was >75% in 84.8% of complementary therapy users and 80.0% of non-users ( p = .61). Despite a high use of complementary therapy in this population, there was no apparent association with low medication adherence.

Late-life depression in Rural China: do village infrastructure and availability of community resources matter?

OBJECTIVES

This study aimed to examine whether physical infrastructure and availability of three types of community resources (old-age income support, healthcare facilities, and elder activity centers) in rural villages are associated with depressive symptoms among older adults in rural China.

METHOD

Data were from the 2011 baseline survey of the Chinese Health and Retirement Longitudinal Study (CHARLS). The sample included 3824 older adults aged 60 years or older residing in 301 rural villages across China. A score of 12 on the 10-item Center for Epidemiologic Studies Depression Scale was used as the cutoff for depressed versus not depressed. Village infrastructure was indicated by an index summing deficiency in six areas: drinking water, fuel, road, sewage, waste management, and toilet facilities. Three dichotomous variables indicated whether income support, healthcare facility, and elder activity center were available in the village. Respondents' demographic characteristics (age, gender, marital status, and living arrangements), health status (chronic conditions and physical disability), and socioeconomic status (education, support from children, health insurance, household luxury items, and housing quality) were covariates. Multilevel logistic regression was conducted.

RESULTS

Controlling for individuals' socioeconomic status, health status, and demographic characteristics, village infrastructure deficiency was positively associated with the odds of being depressed among rural older Chinese, whereas the provision of income support and healthcare facilities in rural villages was associated with lower odds.

CONCLUSION

Village infrastructure and availability of community resources matter for depressive symptoms in rural older adults. Improving infrastructure, providing old-age income support, and establishing healthcare facilities in villages could be effective strategies to prevent late-life depression in rural China.

Correlates of physician trust among rural older adults with diabetes

OBJECTIVES

To examine the demographic, health and diabetes management correlates of physician trust in a rural, multiethnic population with diabetes.

METHODS

563 older (≥ 60 years) African American, American Indian and White adults completed in-home surveys, including the 11-item General Trust in Physicians Scale.

RESULTS

Higher trust scores were seen among: older (>75) participants (p < .01), those with fewer (<3) chronic health conditions (p < .01), and those who adhered to physical activity (p < .05) and dilated eye exam (p < .01) guidelines; the latter remained significant (eye exam, p = .019) or approached significance (physical activity, p = .051) after adjustment for potential confounders.

CONCLUSIONS

Physician trust may influence patient adherence to diabetes management recommendations. Efforts should be made to build trust in the patient-provider relationship to enhance patient outcomes.

Medical skepticism and complementary therapy use among older rural African-Americans and Whites

PURPOSE

This study documents demographic, health, and complementary therapy (CT) correlates of medical skepticism among rural older adults.

METHODS

Older (≥65 years) African Americans and Whites in rural North Carolina (N=198) were interviewed. Medical skepticism was assessed using the four items from the Medical Expenditure Survey. Bivariate associations between medical skepticism and demographic and health characteristics and CT use were assessed, and independent effects on CT use.

FINDINGS

Positive responses to medical skepticism questions ranged from 19.7% (can overcome illness without help) to 59.6% (believes own behavior determines their health). Medical skepticism indicators were associated with few demographic and health characteristics, and one CT category.

CONCLUSIONS

This study shows a high degree of medical skepticism among rural older adults, but limited associations with demographic and health characteristics and CT use. Further research is needed to understand relationships of attitudes towards conventional care and CT use in this population.