From digital access to digital capability: Implications for physical and mental health among older adults in China

Depression is a major mental health challenge among older adults in China. Community senior canteens have been promoted as a way to support physical and psychological well-being, but their impacts and underlying mechanisms are not fully understood. We used data from three waves (2018, 2020, 2023) of the China Longitudinal Aging Social Survey, focusing on adults aged 60 and older. Fixed effects regression models estimated the associations between canteen availability, integrated service environments, use, affordability, and depressive symptoms. Mediation analysis examined the roles of personal and volunteer-based social participation. Subgroup analyses considered gender, urban-rural status, and age groups. Community canteen availability was significantly associated with lower depressive symptoms. The effect was stronger in amenity-rich communities. Mediation analysis showed that personal and volunteer-based social participation partly explained the mental health benefits of canteen availability, with the indirect effect of personal participation being larger. The protective effects were especially notable among women, rural residents, and younger elderly. Community senior canteens can play a key role in reducing depressive symptoms in later life, particularly when integrated into rich service environments. Enhancing opportunities for informal social participation may further strengthen these benefits. Policymakers should focus on both expanding service coverage and tailoring interventions to the needs of vulnerable groups.

BackgroundRapid population aging and the intensifying digitalization of everyday life are unfolding simultaneously in China. While prior studies have largely examined pairwise associations among digital inclusion, social engagement, mental health, and overall health status, few have evaluated an integrated, theoretically grounded pathway linking these domains in later life.ObjectiveThis study aims to quantify the direct and indirect pathways through which digital inclusion influences older adults’ overall health status, social engagement, and mental health, specified as sequential mediators.MethodsWe analyzed the newly released, nationally representative data from the 2023 wave of the China Longitudinal Aging Social Survey, comprising 9918 adults aged 60 years or older. Overall health status was assessed using 3 self-rated health (SRH) indicators: current SRH, SRH relative to age peers, and SRH relative to last year. Digital inclusion was measured through digital access, device proficiency, and digital ability. Social engagement captured social support, frequency of participation in community or voluntary activities, and nononline activities. Mental health included depressive symptoms, social adaptation, and life satisfaction. Analyses included descriptive statistics, multivariable hierarchical linear regressions, and structural equation modeling to estimate direct and mediated effects (2-sided; α=.05).ResultsOlder age, chronic disease, and functional limitations were associated with poorer overall health status, whereas higher education and current employment were associated with better health status. Digital inclusion was positively associated with social engagement (β=.50), which in turn was positively associated with mental health. Mental health showed the strongest association with SRH (β=.74). The direct path from social engagement to overall health status was nonsignificant (P=.34), indicating that participation influences health primarily through psychological pathways. In regression analyses, digital inclusion modestly improved model fit for health status outcomes, while adding mental health produced a greater increase.ConclusionsDigital inclusion promoted active aging indirectly, by expanding social engagement and enhancing mental health, thereby improving overall health status. Policy efforts should prioritize narrowing the digital divide by improving digital skills and capability, rather than access alone. Meaningful opportunities for social engagement should also be expanded to strengthen community-based mental health support. In addition, strategies should be tailored to the differing needs of urban and rural settings.

With the exacerbation of population aging, the health issues of middle-aged and older adults have increasingly become a focus of attention. The widespread use of the internet has created conditions for promoting the health of this demographic. However, little is known about the effects of information access in promoting the relationship between internet use and the health of middle-aged and older adults. This study aims to examine the relationship between internet use and multidimensional health in middle-aged and older adults, as well as the mediating effect of information access. Moreover, this study will explore the relationship between other dimensions of internet use (purposes and frequency) and health. Data were sourced from the China General Social Survey conducted in 2018. Health outcomes, including self-rated, physical, and mental health, were assessed using the 5-level self-rated health scale, the 5-level basic activities of daily living scale, and the 5-level depression scale, respectively. The ordinal logistic regression model was used to examine the relationship between internet use and health among middle-aged and older adults. Additionally, the Karlson-Holm-Breen decomposition method was used to examine the mediation effect of information access. To address endogeneity issues, the two-stage least squares approach was applied. In our sample, nearly half (n=3036, 46.3%) of the respondents use the internet. Regression analyses revealed that internet use was positively associated with self-rated health (odds ratio [OR] 1.55, 95% CI 1.39-1.74; P<.001), physical health (OR 1.39, 95% CI 1.25-1.56; P<.001), and mental health (OR 1.33, 95% CI 1.19-1.49; P<.001) of middle-aged and older adults. Various dimensions of internet use positively contribute to health. In addition, information access significantly mediated the relationship between internet use and self-rated health (β=.28, 95% CI 0.23-0.32), physical health (β=.40, 95% CI 0.35-0.45), and mental health (β=.16, 95% CI 0.11-0.20). Furthermore, there were significant differences in the relationship between internet use and health among advantaged and disadvantaged groups. The study showed that different dimensions of internet use are associated with better self-rated health, better physical health, and better mental health in middle-aged and older adults. Information access mediates the relationship between internet use and health. This result emphasizes the significance of promoting internet access as a means to enhance the health of middle-aged and older adults in China.

BackgroundThe reciprocal relationship between social isolation (SI) and self-rated health (SRH) among older adults remains insufficiently understood. This study investigates bidirectional associations between SI and SRH and explore their variation across demographic groups. Methods: Using longitudinal data from a nationally representative sample of older Chinese adults, this study applied a cross-lagged panel model to assess bidirectional links between SI and SRH, examining pattern variations across age, gender, education, marital status, and urban-rural residence. Results: Baseline SI predicted subsequent declines in SRH, and poorer SRH predicted increased SI over time. SRH influenced SI only among women and less-educated older adults. Unmarried individuals showed stronger SI–SRH links, and urban–rural differences revealed distinct directional pathways. Conclusions: SI and SRH are reciprocally linked in older adults, with meaningful variation across demographic strata. Tailored public health strategies that address both social and health dimensions are needed to support healthy aging.

Amid the backdrop of rural revitalization and a rapidly aging population, the health status of rural older adults in China has become a matter of growing social concern. While there is a significant correlation between the rural environment and the health status of rural older adults, less attention has been given to the underlying mechanisms by which the rural environment influences their health. Drawing on data from the 2020 China Longitudinal Aging Social Survey (CLASS), this study explores the complex relationships between the rural environment, social adaptation, physical activity, social participation, and the health status of rural older adults, and analyzes the differences across various age groups. The results indicate that the rural environment exerts a significant positive effect on both social adaptation and the health status of rural older adults. At the same time, social adaptation is a mediating variable of the rural environment's influence on the health status of rural older adults, namely that the rural environment partially enhances the health status of rural older adults by improving social adaptation capacity, while physical activity and social participation did not show a significant mediating effect. Additionally, the influence of the rural environment on both social adaptation and the health status of rural older adults increases with age, and the mediating role of social adaptation similarly becomes more pronounced with aging. This study highlights the differential impacts of the rural environment on social adaptation and the health status of rural older adults across age groups, offering a scientific basis for developing more targeted health intervention strategies for older adults.

Individuals enjoy better physical and mental health outcomes when engaged in supportive relationships with friends and family members, as opposed to being socially isolated. Although the links between social relationships and health have been extensively studied, specific aspects of these relationships – such as social participation (an objective measure) and perceived support (a subjective measure) – may affect health differently. The nature of social participation (formal and informal) and the sources of perceived support (friends and family members) are shaped by the context of the particular social contact individuals are performed within as well as the norms surrounding family obligations. Consequently, the health effects of different forms of social participation and sources of perceived support may differ. Theoretical perspectives and empirical findings on the relationships between social participation, perceived support, and health outcomes have been studied mostly in Western contexts, in particular the U.S. However, these findings may not be the case for older Chinese adults because family-oriented and filial obligation values strongly influence social relationships. For instance, such values lead older Chinese adults to devote more time and effort to maintaining intrafamily relationships, in contrast to Western contexts that place greater emphasis on the preservation of autonomy and independence, as well as on the importance of friendships and perceived support outside the family. Existing studies on the effects of social support on health (cognitive function in particular) among older Chinese adults mostly rely on cross-sectional data, small or non-national samples, and narrow conceptualization and measurement of social support (e.g., marital status, living arrangements). This may fail to capture how social relationships change in response to losses in social roles and a person’s support needs and resources over the life course. Further, social participation and perceived support are overwhelmingly treated as independent predictors of health outcomes, with relatively little research paid attention to their potential roles as moderator and mediators. Yet, early life experiences provide the context for examining later life outcomes, while later exposures can modify or explain these associations. Clarifying the moderating and mediating mechanisms is therefore essential to understanding under what conditions and through what mechanisms these resources exert protective effects on health in later life. This thesis addresses these gaps by applying a life course framework to examine the dual roles of social participation and perceived support in relation to health in Chinese older adults. All four papers rely on data from the China Longitudinal Aging Social Survey (CLASS). The first paper not only shows that childhood adversity exerts detrimental effects on late-life cognitive function, but also clarifies that formal social participation serve as a pathway linking childhood hunger to cognitive function, while informal social participation acts as a protective resource that buffers these negative effects. The second paper confirms that the long-term protective role of education on late-life cognitive function and further clarifies a reciprocal relationship between perceived support and cognitive function, with the effect size of the path from cognitive function to social support being larger than the opposite path. The third paper examines the effects of perceived support from friends on depressive symptoms may not be uniformly protective. The protective effects of friend support on depressive symptoms reduce with increasing age and greater family support. There is also a curvilinear relationship between friend support and depressive symptoms – the direction of the relationship depends on the perceived level of support. The fourth paper finds that social support mediates the relationship between internet use and cognitive functioning differently in rural and urban areas. Cognitive benefits derived from specific types of online activities also depend on residential contexts. These findings suggest that effort aimed at improving internet use among rural older adults may be more fruitful if they focus on building social opportunities for older adults. Overall, the thesis adopts a life course perspective and integrates relevant theoretical perspectives in each paper to provide a comprehensive view of how social participation and perceived support are associated with health outcomes. These associations should be considered in the context of early life experiences, later-life exposures (e.g., sources of social support and different types of activities), and contextual factors such as age and rural-urban residence settings.

ObjectivesOnline media has become an increasingly important part of older adults’ daily lives in the digital era. This study aims to examine the effects of online media use and its frequency on the mental health of older adults in China, with a particular focus on the mediating role of life satisfaction.MethodsUsing data from the 2020 wave of the China Longitudinal Aging Social Survey (CLASS), this study analyzed a nationally representative sample of 3118 Chinese older adults. A multiple indicators multiple causes (MIMIC) model was employed to assess the impact of both online media use types and usage frequency on mental health. Further mediation analysis was conducted to investigate whether life satisfaction mediates these relationships. Sensitivity analyses were performed using different estimators (maximum likelihood (ML), asymptotic distribution free (ADF), and generalized structural equation model (GSEM)), and robustness was tested with 2016 and 2018 CLASS data.ResultsFindings show that both online media use and online media use frequency are significantly and positively associated with mental health among Chinese older adults. Specifically, informational media (e.g. News reading app), entertainment platforms (e.g. TikTok and Kwai), and utility tools (e.g. Alipay and Taobao) exhibit strong positive effects, with news reading app showing the most prominent impact. A dose–response pattern was observed: older adults who engage with online media more frequently report better mental health outcomes. Notably, life satisfaction serves as a significant mediator in these relationships, accounting for 12.8% of the total effect of media use and 5.4% of the effect of use frequency on mental health.ConclusionOnline media use, especially frequent engagement with digital platforms, enhances older adults’ mental health, not only directly but also indirectly by improving life satisfaction. These results offer valuable empirical evidence for understanding the mechanisms through which digital participation promotes psychological wellbeing in later life and highlight the importance of fostering digital literacy and inclusive media environments for the aging population.

BackgroundBidirectional intergenerational support is linked to late-life mental health, yet the underlying mechanisms remain unclear. Guided by intergenerational solidarity and social support theories, we examined how distinct support profiles relate to mental health among Chinese older adults, testing self-rated health (SRH) as a mediator and social participation as a moderator.MethodsWe analyzed 7,843 adults aged ≥60 from the 2020 China Longitudinal Aging Social Survey. Latent profile analysis (LPA) identified bidirectional support profiles; group differences in mental health were assessed using the Bolck-Croon-Hagenaars (BCH) approach, followed by mediation and moderated-mediation models with bootstrap inference (5,000 resamples).ResultsFour profiles emerged—High Support-High Interaction-High Closeness (HS-HI-HC; 47.02%), Child-High Support-Low Interaction-High Closeness (CS-LI-HC; 33.46%), Moderate Support-Moderate Interaction-Low Closeness (MS-MI-LC; 10.37%), and Low Support-Low Interaction-Moderate Closeness (LS-LI-MC; 9.16%). Mental health differed across different profiles, with HS-HI-HC showing the best mental health levels (the lowest scores). SRH partially mediated these associations (for instance, HS-HI-HC indirect effect = −0.186, 95% CI -0.245 to −0.131). Social participation attenuated benefits of high family support but buffered risks under low support.ConclusionBidirectional intergenerational support is heterogeneous in China; profiles characterized by reciprocity and closeness show the most favorable mental health. SRH accounts for a modest but meaningful share of these associations, and social participation can substitute for—or amplify—the benefits of family support depending on profile. Findings inform profile-tailored community and family interventions to promote healthy aging.

More than 50% of older adults in China now use the Internet, making online learning a key approach for lifelong learning. With age, older adults tend to prioritize positive emotional experiences, indicating that online learning experiences may have a more direct relationship with mental health than learning performance. This study examines whether learning performance influences mental health through learning experiences, particularly focusing on the effect of online learning efficacy, as it aligns with higher psychological needs of older adults. A total of 998 community-dwelling older adults in China (age = 68.50 ± 5.37 years) completed questionnaires assessing self-rated learning performance, learning experiences (via the Online Learning Efficacy Scale), and mental health (via the Geriatric Depression Scale, Social Participation Scale, Subjective Cognitive Decline Scale). Hierarchical regression and mediation analyses were conducted. The results showed that sixty percent of older adults spent more than 1 hour daily on online learning. Learning performance negatively predicted depression, subjective cognitive decline, social participation with demographic variables controlled. After adding the online learning efficacy into the regression model, the regression model’s explanatory power significantly increased. Further analysis showed that online learning efficacy mediated the relationship between learning performance and mental health, with the strongest mediated effect observed on social participation. These findings suggest that for older adults, online learning efficacy is closely linked to their mental health, particularly for social health. Educational programs should prioritize fostering older adults’ sense of competence to promote mental health and positive ageing.

Psychosocial measures in relation to smartwatch alerts for atrial fibrillation detection

The role of formal volunteering in mental health promotion among older adults in China has been widely discussed during recent decades. However, the relationship connecting mental health with cross-level interaction (i.e., average levels of participation in the community vs. individual participation) is still unclear. This paper examined the effects of cross-level formal volunteering on depressive symptoms among older adults living in China. Using two waves of the China Longitudinal Aging Social Survey, a sample of 3128 Chinese older adults was surveyed in 2014 and 2016. Depressive symptoms were measured using the abbreviated CES-D-9. Individual fixed-effects ordinary least squares regression models assessed the associations between individual- and community-level formal volunteering and depressive symptoms in urban and rural areas separately. We found that in the urban sample, formal volunteering activities were negatively associated with depressive symptoms at the individual level (β= -0.49, SE= 0.22, p< 0.05). Higher community-level formal volunteering was positively associated with depressive symptoms (β= 2.82, SE= 1.42, p< 0.05). When adding interactions between individual and community levels, engagement in individual-level formal volunteering was associated with lower rates of depressive symptoms as community volunteering participation levels increased (β= -3.07, SE= 1.07, p< 0.01). High community-level volunteering participation was detrimental for non-volunteers. In rural areas, neither community- nor individual-level formal volunteering was associated with changes in depressive symptoms. The current findings demonstrate formal volunteering may not always benefit mental health for all. The effects may depend on the community context and individual choices. Social policies aimed to promote mental health through formal volunteering need to be tailored according to the specific community social environment.

Objective: This study examines the interplay among living arrangements, social networks, and depressive symptoms among Chinese older adults.Methods: Data are derived from the 2014 baseline survey of the China Longitudinal Aging Social Survey (CLASS), which provides a sample of older Chinese who had been married and had children (N = 7,662). This study examines the association between living arrangements and depressive symptoms (measured as CES-D scale, 0–18) of older adults, and addresses the moderating role of social networks (measured as family ties and friendship ties, 0–15) on this perceived association.Results: Our results show that older adults who live both with a spouse and adult children report superior mental health than those living alone (β = 1.240, p < 0.001), but no differences are seen from those living only with a spouse or children. Older adults living alone in rural areas are also more disadvantaged in comparison to those living alone in urban places (β = 0.535, p < 0.05). However, we find that the undesirable consequences associated with depression of older adults living alone can be reduced or even eliminated when older adults have strong friendship ties in rural China (β = −0.145, p < 0.01). We also find that for rural older adults living only with children, their mental health is highly contingent on their family ties, that is, they are extremely disadvantaged when having weak family ties, but benefit most significantly from strong family ties (β = −0.137, p < 0.05).Conclusions: Associations between living arrangements and mental health in later life are contingent on older adults’ social networks, and these moderating effects vary between rural and urban China.

The rapid population aging in China, characterized by a higher prevalence of illnesses, earlier onset of diseases, and longer durations of living with ailments, substantially engenders challenges within the domain of older adults' healthcare. Community home-based elderly care services (CHECS) are a feasible solution to solve the problem of older adults' care and protect older adults' health. The aim of this study is to investigate the relationship, heterogeneity effects and influential mechanisms between older adults' use of CHECS and their self- reported health. The study employs the Instrumental Variable technique and empirically investigates the relationship, heterogeneity effects and influential mechanisms between older adults using CHECS and their self-reported health using data from the China Longitudinal Aging Social Survey from 2018. The findings indicate, firstly, that using CHECS considerably improves older adults' self-reported health. Secondly, the heterogeneity test reveals that the effect is more pronounced for older adults who are under the age of 80, have functional disabilities, are free of chronic diseases, have never attended school, reside in lower-income households, are single, rarely interact with their children, and live in central urban or city/county regions. Thirdly, the mechanism test reveals that the "social network effect" and "family care effect" are the key influence channels of using CHECS. An empirical foundation for the policy reform of community home-based care for seniors is provided by this study with the limitations to discuss the other socioeconomic aspects such as government health expenditure and discuss the specific services aspects such as health care. The findings carry substantial implications for improving the health of older individuals and provide suggestions for establishing a socialized aged care system in China.

This study provides one of the first population-based investigations of the longitudinal association between social isolation and sleep difficulty among older adults in China. We analyzed three waves of longitudinal data from the China Longitudinal Aging Social Survey (2014-2018), in which 8456 respondents contributed 16,156 person-year observations. Results from multilevel logistic regression models showed that social isolation was related to a higher risk of sleep difficulty. We also found that socially isolated older adults were more likely to report higher levels of depressive symptoms, a greater prevalence of loneliness and pain, and more chronic diseases compared to their socially integrated counterparts, which in turn increased their risks of sleep difficulty. Moreover, socially isolated older adults with chronic diseases were particularly vulnerable to the risk of sleep difficulty. These findings provide helpful guidance for policymakers and practitioners to design effective intervention strategies to help older adults with sleep problems.

IntroductionChildhood family risks (CFRs) are believed to have long-arm effects on people's mental health. However, it is unclear whether age can alleviate these long-arm effects.AimThis study aimed to explore the relationship between CFRs and the mental health of older adults (mean [M] = 62.10, standard deviation [SD] = 8.02) in China and investigate whether age could moderate this relationship.MethodsThis cross-sectional, survey-based study used data from the Chinese General Social Survey conducted in 2015, and the data of 4,237 respondents were included in the final analysis. Mental health was measured by two items, namely negative and positive emotions. The step-by-step regression procedure and moderation analysis technique were used.ResultsFor older adults in China, CFRs were significantly negatively associated with their mental health (β = −0.046, t = −2.690, p < 0.01), age was positively correlated with their mental health (β = 0.115, t = 7.157, p < 0.01), and age significantly moderated the relationship between CFRs and mental health (β = 0.277, t = 2.172, p < 0.05). As age increases, the correlation between CFRs and mental health decreases, and when age is one SD above the M, CFRs are no longer significantly associated with the mental health level (bsimple = −0.01, t = −0.077, p > 0.05).ConclusionThis study showed that CFRs were negatively associated with the mental health level of older Chinese adults, and age could significantly moderate the association. Therefore, it is essential to take preventive measures in advance to protect people's mental health and teach older adults to use emotion-regulation techniques to weaken the association between CFRs and mental health.