Indoor window ventilation and anxiety symptoms among older adults with disabilities in China: A cross-sectional study.

The impact of indoor environmental quality on the health of older adults is becoming increasingly evident in the context of an aging population. Mold exposure, a common source of residential environmental hazards, may pose a significant threat to self-rated health in older adults. This study aimed to investigate the relationship between mold exposure and self-rated health in older adults, considering the mediating role of anxiety and the moderating role of indoor ventilation frequency. Data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) were used, including 9435 subjects aged 65 and above. These relationships were explored by using Spearman correlation analysis and moderated mediation analysis. Mold exposure has a direct negative impact on the self-rated health of the old adults (β= -0.217, 95%CI= -0.266, -0.167). Anxiety partly mediates this relationship. The frequency of indoor ventilation is a moderating factor for mold exposure and anxiety (β= -0.053, p < 0.01). Mold exposure was found to be significantly negatively associated with self-rated health among older adults. Anxiety plays a mediating role in it, and the indoor ventilation frequency moderates the relationship between mold exposure and anxiety. The findings suggest that a combination of implementing mental health interventions and increasing the frequency of indoor ventilation may be effective in moderating the path of association between mold exposure and self-rated health status in older people.

With the increase in aging in China, the health problems of older adults, especially mental health problems, have become a concern for the whole society. This article selected urban and rural older adults and analyzed the impact of social support on their mental health using a binary logistic model. It was found that under the current urban–rural dichotomy, the effects of social support on the mental health of urban and rural older adults are significantly different. In social support, first, the fairness and satisfaction with the social security system only had a significant effect on the mental health of urban older adults and had no significant effect on the rural older adults. Second, the closeness of contact with grassroots community workers had a significant impact on the mental health of older adults in urban and rural areas. From informal social support, the mental health of rural older adults was mainly influenced by the support of their children, reflecting the influence of the traditional culture of “filial piety”. Furthermore, the mental health of urban older adults was mainly influenced by neighborhood support, reflecting the importance of “close neighbors are better than distant relatives”. Based on the results of the empirical study, this article suggests that to promote the mental health of older adults, we should start by strengthening the formal social support system, establishing high-quality community service facilities, and emphasizing the role of informal social support.

Health promotion is a top priority worldwide. This includes mental health in older adults, who are at risk due to the ageing process, associated with deteriorating health status. Notwithstanding the importance of the topic, psycho-social factors are often neglected in the implementation or formulation of advanced age health promotion programs. In this context, it is imperative to reach a better understanding of the main psycho-social aspects involved in mental health promotion in older adults. The main objective of this narrative review was to identify documents that made a core contribution to the understanding of psycho-social factors related to mental health in community-dwelling older adults. To achieve this, a narrative review was carried out that included a total of 40 articles published between 2018 and 2022. This review was performed through an interpretive stance. Ethical approval was not required for this review. Three main categories were derived from thematic analysis: (i) mental health interventions; (ii) mental health and frailty in older adults, and (iii) social support in older adults. To conclude, understanding the main protective psycho-social factors involved in mental health in community-dwelling older adults is of paramount importance. Identifying the implications of the psycho-social factors in this population is vital to elaborate specific interventions, therefore enhancing their mental health.

The mental health of older adults has become one of the major health challenges facing society today, which has attracted wide concerns from scholars in urban areas, but research in rural areas has been neglected. Therefore, this paper took rural older adult residents of 11 sample villages in Jintang County, Chengdu City, Sichuan Province, as the research object. After controlling the demographic characteristics of older adults in rural areas, this paper attempted to explore the effects of the rural built Environment on the mental health of older adults. Through field investigation in the sample villages, 515 valid questionnaires were obtained. The results from the Binary Logistic Regression Model show that good marital status, physical health, education level, well-constructed roads, and safe neighborhoods had significant positive effects on the mental health of rural older adults. Rural older adults who prefer to walk, cycle, and use public transport have better mental health, and accessibility to the periodic market, health station, bus station, village committee, supermarket, and the main road is positively correlated with the mental health of rural older adults, while the distance from home to the town center and coach terminal has a significant negative impact on the mental health of rural older adults. The research results provide a theoretical reference for further construction of rural aging environments.

BackgroundsEmerging evidence suggested that indoor air pollution caused long-term adverse effects on cognitive function among older adults who spend more than 85% of their time indoors. Although high indoor ventilation can mitigate the effect of indoor air pollution on cognition among the younger population, limited evidence revealed the association between indoor ventilation and cognition among older adults.MethodsA total of 11,853 participants aged 65 and over (female, 54.5%; mean age, 83.6 years) were included from the 2017–2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Indoor ventilation frequency was measured by the self-reported frequency of opening windows per week in each season. Cognitive function was evaluated by the Mini-Mental State Examination (MMSE). Multivariate Poisson regression with robust error variance was applied to assess the association between overall indoor ventilation frequency and cognitive function. We fitted in two adjusted models: Model 1 was adjusted for demographic; model 2 was further adjusted for lifestyle, socioeconomic status, health conditions, and environmental factors. The same models were also applied to measure the association between seasonal indoor ventilation frequency and cognitive function.ResultsOf 11,853 older adults, 3035 (25.6%) had cognitive impairment. A high overall indoor ventilation frequency (indoor ventilation frequency: 6–8) was significantly associated with a 9% lower likelihood of cognitive impairment than low overall indoor ventilation frequency (indoor ventilation frequency: 0–3) among Chinese older adults [Relative risk (RR): 0.91, 95% Confidential Interval (CI): 0.83–0.99] in the full adjusted model. In the subgroup analysis in four seasons, high and intermediate indoor ventilation frequency in winter were significantly associated with 8% (RR: 0.92; 95%CI: 0.86–0.99) and 16% (RR: 0.84; 95%CI: 0.78–0.90) lower probability of cognitive impairment than low indoor ventilation frequency in the fully adjusted model among Chinese older adults, respectively.ConclusionsIn this nationally representative cohort, a higher frequency of house ventilation by opening windows was significantly associated with a lower risk of cognitive impairment among Chinese older adults aged 65 and over. These results offered robust evidence for policymaking and health intervention to prevent older adults from cognitive impairment or dementia in developing regions.

BackgroundThere is a lack of research on the trajectories of cognitive functioning in older people with hypertension, as well as possible contributing factors and correlations between cognitive functioning and mental health.ObjectiveThis study aimed to conduct a secondary longitudinal analysis to examine cognitive functioning trajectories and their associated factors in older people with hypertension.MethodsThe data used in our study were retrieved from the Chinese Longitudinal Healthy Longevity Survey. The Chinese version of the Mini-Mental State Examination was used to assess cognitive functioning. The trajectories of cognitive functioning of older individuals with hypertension were determined by using group-based trajectory modeling. The binary logistic regression analyses were performed to examine how participant factors affected the trajectories of cognitive functioning in older individuals with hypertension. The relationships between cognitive functioning and mental health were investigated using multivariable linear regression models. Data were analyzed using SPSS (version 20.0; SPSS Inc) and Stata (version 16.0; StataCorp LLC).ResultsA total of 642 older people with hypertension were included. Cognitive functioning was categorized into 2 trajectories according to group-based trajectory modeling: “rapid decline” (48/642, 7.9%) and “slow decline” (594/642, 92.1%). Binary logistic regression results showed that older adults with hypertension aged equal to or greater than 80 years had an elevated risk of rapid decline in cognitive functioning (odds ratio 5.484, 95% CI 2.365‐12.719), and higher score in mental health was the protector of rapid decline in cognitive functioning during the following 13 years (odds ratio 0.918, 95% CI 0.852‐0.988). In the unadjusted model, mental health was positively associated with cognitive functioning (β=.246, 95% CI 0.125‐0.234, P<.001), and this association was maintained after partial or complete adjustment for covariates (β=.159, 95% CI 0.059‐0.174, P<.001; β=.138, 95% CI 0.043‐0.158, P=.001). Subgroup analyses by age showed that this positive correlation was only seen in the 60‐69 years age group (β=.183, 95% CI 0.036‐0.193, P=.004), while subgroup analyses by sex revealed that the association between these 2 indicators was no longer presented among males in the fully adjusted model (β=.082, 95% CI −0.024 to 0.119, P=.19), and BMI fully stratification demonstrated this association persisted in the healthy weight group (β=.125, 95% CI 0.039‐0.210, P=.004).ConclusionsOur research showed that the decline in cognitive functioning is associated with lower mental health and occurs more rapidly in older adults with hypertension who are older than 80 years.

Background We examined whether dietary variety (DV) might alleviate poor mental health (MH) of living-alone (LA) older adults. Methods Cross-sensational data from 15073 (7566 men; 7507 women) residents aged 65-84 years were assessed using the WHO-Five Well-being Index to determine poor MH (defined by a score ≤ 12) and DV (low and high DV defined by a score ≤ 3 and ≥ 4, respectively). Participants were divided into living together with high DV (G1), living together with low DV (G2), LA with high DV (G3), and LA with low DV (G4). Logistic regression analyses stratified by gender were performed to examine the association of poor MH with LA and DV. Results Prevalence of LA, low DV, and poor MH were 13.6%, 63.3%, and 26.1%, respectively, in men, and 21.2%, 54.6%, and 24.8%, respectively, in women. Compared with the G1, the multivariate-adjusted odds ratios (ORs) (95% confidence intervals) for worse MH were 1.69 (1.49-1.93) for G2, 2.04 (1.50-2.78) for G3, and 3.34 (2.70-4.11) for G4 in men. Corresponding ORs were 1.73 (1.52-1.96), 1.02 (0.83-1.26), and 1.66 (1.36-2.01) in women. Conclusions The association of poor MH with LA was more apparent in older adults with low DV than in those with high DV; however, this association differed with gender. Key message Eating a variety of food may help alleviate the negative effects of living alone on mental health in older adults.

Reciprocity of informal social support is associated with improved mental health in older adults. While several studies have examined support provision or receipt separately, this study clarifies reciprocity's effect on mental health among older adults in Japanese urban areas. A 2014 survey targeted community-dwelling adults aged ≥ 65 years in Kashiwa City, Chiba, Japan. Quality of life was assessed using the WHO-Five Well-Being Index (0-25 points) with a cutoff of < 13 points indicating suspected depression. Independent variables included four mutually exclusive categories of receiving and providing emotional and instrumental social support. Sex-stratified multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CI) for suspected depression. Ethical approval was obtained from The University of Tokyo (No. 21-192). Data from 1302 participants were analyzed. The mean age was 74.7 (standard deviation, 5.5) years, and 623 (47.8%) were women. Suspected depression was identified in 93 men (7.1%) and 80 women (6.1%). Compared to those with no support exchange, the ORs for reciprocal emotional support were 0.16 (CI: 0.06-0.42; p < 0.001) for men and 0.44 (CI: 0.75-2.58; p = 0.365) for women. For instrumental support, ORs were 0.90 (CI: 0.28-2.86; p = 0.871) for men and 0.30 (CI: 0.11-0.80; p = 0.016) for women. Social support reciprocity positively influences mental health among older adults living in urban Japan. Facilitating environments for mutual social support helps maintain mental health in urban-dwelling older adults in Japan.

As the world population ages, practitioners use community-engaged interventions to help older adults stay healthy. Engaging in arts programs (e.g., dance or music) reportedly improves physical and mental health, but little research exists examining these effects in community-dwelling older adults. Our purposes were to examine how taking part in 10-week, twice per week community arts programs (dance and music) and control (social conversation) affected physical and mental health in community-dwelling older adults and their perceptions after program participation.<br/> Methods: In this randomized controlled trial, 64 older adults over 65 years of age (71.3 ± 4.6 years, 166.9 ± 8.3 cm, 78.1 ± 18.1 kg) took part in community-engaged arts programs: ballroom dance (n = 23), music (ukulele-playing, n = 17), or control (social conversation n = 24), two times per week for 10 weeks. Participants' physical health using the Short Physical Performance Battery (SPPB; score 0 = worst to 12 = best) and mental health using the Montreal Cognitive Assessment (MoCA; score = 0 to 30, where less than 26 = normal) were tested three times: 1. before (pre), 2. at the end of 10 weeks (post-1), and 3. 1 month after intervention (post-2). Separate 3 (group) x 3 (time) ANOVAs and adjusted Bonferroni pairwise comparisons as appropriate examined changes across groups and time. Focus group interviews and surveys were audio recorded, transcribed, and analyzed using inductive thematic analyses to examine participants' perceptions.<br/> Results: Across all groups, participants had an 87.8% attendance and an 87.5% retention rate. Participants' SPPB performance improved over time (pre = 10.5 ± 1.4, post-1 = 10.7 ± 1.3, post-2 = 11.3 ± 1.0; p < 0.001), but similarly across groups (p = 0.40). Post-hoc analyses revealed that performance improved from pre to post-1 (p = 0.002) and pre to post-2 (p < 0.001). Participants' cognition improved over time (pre = 26.3 ± 2.8, post-1 = 27.3 ± 2.6, post-2 = 27.5 ± 2.5, p < 0.001), and similarly across groups (p = 0.60). Post-hoc analyses revealed that cognition improved from pre- to post-1 (p = 0.002), and pre- to post-2 (p = 0.001). Participants consistently mentioned increased social engagement as the major reason for participation.<br/> Conclusions: Overall, taking part in community-engaged arts (dance and music) and social conversation programs positively influenced physical and mental health in older adults. Still, as all groups improved equally, the results may partly be due to participants having normal physical and mental function pre-participation and due to them learning the test over time. These study findings imply that providing fun and free community-engaged programs that empower participants to be more engaged can positively influence physical and mental health and promote successful aging in older adults.

This desk review evaluates the current state of interventions for mental health and cognitive functioning among older adults in Switzerland focusing on the features of these interventions as well as on Swiss-specific contextual factors that contribute to vulnerability and stigma. The goal is to guide the development of effective, evidence-based interventions and policies to ensure that older adults in Switzerland not only live longer but also enjoy better mental health and cognitive functioning. We searched PubMed, PsycINFO, and Scopus for eligible studies from January 2018 until October 2024. We included studies investigating interventions targeting mental health and/or cognitive functioning in older adults living in Switzerland. In addition, we searched for gray literature reporting on cognitive and mental health interventions, as well as mental health, cognitive functioning, stigmatization, and stigma mitigation strategies in the Swiss context. Core features of the interventions (intervention type, efficacy, delivery modes, recruitment, stigma-related aspects) and target populations (groups at risk of vulnerability, stigma sources) were extracted, descriptively summarized, and discussed. A comprehensive search resulted in 1200 records, with 26 peer-reviewed articles and five gray literature reports meeting the inclusion criteria. The findings suggest that individualized multidomain interventions, including behavioral change techniques and multifaceted stigma-mitigating strategies, might be required to sustainably improve mental health in older adults.

The aim of this study was to analyze the status quo and associated factors of care recipients' perceptions of caregivers' willingness to provide care among disabled older adults in China. Thus, this study contributes to our understanding of vulnerable older populations who are at a high risk of receiving support from informal caregivers who are unable or unwilling to take the caregiver role. We analyzed the cross-sectional data of 3,539 disabled older adults who received informal care at home from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression models were used to examine the variables associated with the respondents' perceived caregivers' willingness to care from five aspects: respondents' sociodemographic attributes, health-related data, family endowment, access to health care services and community-based long-term care services (CBLTCS). This study found that the majority of disabled older adults (90.9%) had a positive attitude toward their caregivers' willingness to care and the care they received; however, 7.0% of the adults were concerned about their caregivers' ability to handle the care. Moreover, there was a small number of disabled older people (2.1%) who felt that their caregivers were reluctant to care or lacked patience. The results from the multiple logistic regression showed that disabled older adults with socioeconomic disadvantages (living in rural areas, being poor and with no children who frequently visited) or high demand (with severe disabilities or cognitive impairment) were more likely to consider that their caregivers needed respite care. Those adults with anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were more likely to report that their caregivers were reluctant to administer care. This study found that living in rural areas, being poor, with no children who frequently visited, severe disabilities or CI were positively associated the care recipients' perception that caregivers needed respite care. While anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were significantly associated with care recipients' perception of caregivers' reluctance to care. Our findings highlight the awareness of monitoring informal carers' willingness to care or capability to enact caring tasks.

Depression and anxiety carry an important public health burden. Indoor air pollution is associated with depression and anxiety. Ventilation can reduce the concentration of indoor air pollution and improve indoor air quality. This study explored the relationship between indoor ventilation frequency and depression and anxiety in older adults using the data from the 2018 Chinese Longitudinal Healthy Longevity Survey. Compared with older people with low indoor ventilation frequency, those with high indoor ventilation frequency had 51% lower odds of depression (OR = 0.49, 95% CI: 0.43 to 0.57) and 37% lower odds of anxiety (OR = 0.63, 95% CI: 0.43 to 0.91), and those with intermediate indoor ventilation frequency had 35% lower odds of depression (OR = 0.65, 95% CI: 0.56 to 0.75) and 45% lower odds of anxiety (OR = 0.55, 95% CI: 0.37 to 0.82). The results were similar across the seasons. However, there were sex, age, lifestyle, and cooking fuel use‐specific differences in these associations. The findings emphasize that high ventilation frequency may be conducive to improving mental health in older adults, especially women, the old elder, nonsmokers, nondrinkers, and those who do not exercise and cooked at home.

BackgroundThere is evidence for a cumulative effect of adversities on mental health, however, less is known on the accumulating duration of exposure to adversity across the lifecourse on mental health in older adults. MethodsUsing data from the 1946 British birth cohort study (N = 2745), we examined associations between the accumulation of adversity (birth-63 years) and mental health (emotional symptom, life satisfaction, affective wellbeing) in older adults (63–69 years). Accumulation of adversity was assessed as the number of adversities and duration of exposure (number of lifecourse stages exposed to any, economic, psychosocial, or physical adversity). Linear regression tested their association with mental health, adjusted for sex, childhood cognition and emotional problems, and educational attainment. ResultsIncreased number of adversities was associated with increased emotional symptoms (β = 0.08 [0.06, 0.10]), decreased life satisfaction (β = −0.14 [−0.16, −0.12]) and decreased affective wellbeing (β = −0.08 [−0.10, −0.06]). Each additional duration of exposure was associated with a 0.38 [0.12, 0.65] standard deviation (SD) increase in emotional symptoms, and a − 0.68 [−0.96, −0.39] and −0.43 SD [−0.68, −0.18] decrease in life satisfaction and affective wellbeing, respectively. Life satisfaction showed stronger associations with economic and psychosocial compared to physical adversity. LimitationsSome limitations include selective drop-out and lack of ethnic diversity. ConclusionsEfforts to improve mental health in older adults should focus on reducing the number of adversities, as well as considering previous exposure across different lifecourse stages, to prevent adversities from becoming chronic. Future research should also consider the clustering and co-occurrence of different adversities across the lifecourse.

To examine associations between the 24-h composition of movement behaviors (sedentary behavior [SB], light physical activity [LPA], moderate-to-vigorous physical activity [MVPA], and sleep) and physical and mental health in older adults using compositional data analysis. Data came from 4,150 adults aged ≥ 60 in the 2015 China Health and Nutrition Survey. Multiple‑balance isometric log‑ratio regression and compositional isotemporal substitution models were used to assess relative associations and the effect of time reallocation. The 24‑hour geometric mean composition was 43.1% sleep, 30.6% SB, 21.8% LPA, and 4.5% MVPA. LPA was positively associated with physical (β = 0.062, p < 0.001) and mental health (β = 0.117, p < 0.001), while sleep showed negative associations. SB and MVPA were not significantly associated. Reallocating 30 min from SB or sleep to LPA significantly improved both physical and mental health. Dose‑response analyses indicated greatest physical health benefit when replacing SB with about 25 min of LPA, while mental health benefits increased non‑linearly with duration. Replacing sedentary time or sleep with LPA, even in small amounts, is associated with better physical and mental health in older adults, supporting integrated 24‑hour activity guidelines that emphasize light‑intensity movement.

BackgroundDepressive symptoms and memory problems are significant risk factors for dementia. Exercise can reduce depressive symptoms and improve cognitive function in older people. In addition, the benefits of horticultural activity on physical and mental well-being have been demonstrated in people with dementia. Although evidence of such non-pharmacological interventions is mounting, no studies have examined whether physical exercise and horticultural activity exert a positive impact on brain and mental health (e.g., depressive symptoms) in non-demented older adults at high risk of cognitive impairment and depression. Therefore, we propose a randomized controlled trial to assess the efficacy and efficiency of physical exercise and horticultural activity in improving brain and mental health in community-dwelling older adults with memory problems and depressive symptoms.Methods/DesignThe 20-week randomized controlled trial will include 90 community-dwelling adults aged 65 years or older with memory problems and depressive symptoms. Participants will be randomized to one of three experiments: exercise, horticultural activity, or educational control group, using a 1:1:1 allocation ratio. The combined exercise program and horticultural activity program will consist of 20 weekly 90-minute sessions. Participants in the exercise group will practice aerobic exercise, muscle strength training, postural balance retraining, and dual-task training. The horticultural activity program will include crop-related activities, such as field cultivation, growing, and harvesting. Participants in the educational control group will attend two 90-minute educational classes during the 6-month trial period. Depressive symptoms and memory performance will be measured by the Geriatric Depression Scale-15, and the Logical Memory subtests of the Wechsler Memory Scale-Revised will be used to measure depressive symptoms and memory performance as primary outcomes, at baseline (prior to randomization), immediately following intervention (6 months from baseline), and 6 months after intervention. Hippocampal volume will be measured at baseline and immediately after intervention, using magnetic resonance imaging. Secondary outcomes will comprise cognitive function, including language, attention/executive performance, and processing speed; brain-derived neurotrophic-factor serum levels; and health-related quality of life.DiscussionThis intervention study will determine the clinical importance and efficacy of physical exercise and horticultural activity as non-pharmacological interventions in community-dwelling older adults at high risk of poor brain and mental health.Trial registrationUMIN000018547; registered 7 August 2015.