Non-housing assets and all-cause mortality in middle-aged and older Chinese adults: a National cohort study.

Cohort studies about the sleep duration on the risk of death among Chinese older adults are still lacking. The aim of this study was to examine whether extremely long or short sleep duration was associated with mortality in Chinese adults aged 65 years or older. We included participants aged 65 years or older in 2011 at baseline in 23 provinces from the Chinese Longitudinal Healthy Longevity Survey who were followed up in 2014/2018 in China. Sleep duration was categorized as short sleep duration (< 7 hours) and long sleep duration (> 8 hours). We used the Cox proportional hazards model and restricted cubic spline analysis to explore the association between sleep duration and mortality. Among 9578 participants, short sleep duration was associated with an 11% higher risk of death (adjusted hazard ratio [aHR]: 1.11; 95% confidence interval [CI]: 1.02-1.20) and long sleep duration was associated with a 24% higher risk of death (aHR: 1.24; 95% CI: 1.15-1.34), after adjustment for all covariates. There was a U-shaped association between sleep duration and all-cause mortality (nonlinear, P < .0001). Stratified analyses showed that the risk was higher among older people who smoked and with a higher level of education both for short and long sleepers than for those who never smoked and were illiterate (P value for interaction < .05). There was a U-shaped association between sleep duration and all-cause mortality in Chinese older adults, especially in more educated individuals and smokers. Du M, Liu M, Liu J. The association between sleep duration and the risk of mortality in the Chinese older adults: a national cohort study. J Clin Sleep Med. 2021;17(9):1821-1829.

Cardiorespiratory fitness: an independent and additive marker of risk stratification and health outcomes.

BackgroundThe prevalence of functional limitations is relatively high among the middle-aged and older adults. However, the contribution of functional limitations to subsequent incident cardiovascular diseases (CVD) and death is unclear. This study aims to examine the association between functional limitations and incident CVD and all-cause mortality among the middle-aged and older adults.MethodsThis is a nationally representative prospective cohort study. Participants were middle-aged and older Chinese adults from The China Health and Retirement Longitudinal Study. Functional limitations were measured using activities of daily living (ADL) scale and instrumental activities of daily living (IADL) scale. Incident CVD and death were recorded at followed-up from June 1, 2011, up until August 31, 2018. Cox proportional hazards model was used to assess the association between functional limitations and incident CVD and all-cause mortality.ResultsA total of 11,013 participants were included in this study. During the 7 years of follow-up, 1,914 incident CVD and 1,182 incident deaths were identified. Participants with functional limitations were associated with a 23% increased risk of incident CVD (HR, 1.23, 95% CI:1.08,1.39) after adjusting for age, gender, residential area, marital status, education, smoking, alcohol drinking, sleep duration, nap duration, depression symptoms, social participation, history of hypertension, diabetes, dyslipidemia, use of hypertension medications, diabetes medications, and lipid-lowering therapy. Moreover, participants with functional limitations were associated with a 63% increased risk of all-cause mortality (HR,1.63, 95%CI: 1.41,1.89) after adjusting for potential confounders.ConclusionsFunctional limitations were significantly associated with subsequent incident CVD and death among the middle-aged and older Chinese adults.

BackgroundTarget systolic blood pressure (SBP) levels for older adults with hypertension vary across countries, leading to challenges in determining the appropriate SBP level.ObjectiveThis study aims to identify the optimal SBP level for minimizing all-cause and cardiovascular disease (CVD) mortality in older Korean adults with hypertension.MethodsThis retrospective cohort study used data from the National Health Insurance Service database. We included older adults aged 65 years or older who were newly diagnosed with hypertension and underwent a National Health Insurance Service health checkup in 2003-2004. We excluded patients who had a history of hypertension or CVD, were not prescribed medication for hypertension, had missing blood pressure or any other covariate values, and had fewer than 2 health checkups during the follow-up period until 2020. We categorized the average SBP levels into 6 categories in 10 mm Hg increments, from <120 mm Hg to ≥160 mm Hg; 130-139 mm Hg was the reference range. Cox proportional hazards models were used to examine the relationship between SBP and all-cause and CVD mortalities, and subgroup analysis was conducted by age group (65-74 years and 75 years or older).ResultsA total of 68,901 older adults newly diagnosed with hypertension were included in this study. During the follow-up period, 32,588 (47.3%) participants had all-cause mortality and 4273 (6.2%) had CVD mortality. Compared to older adults with SBP within the range of 130-139 mm Hg, individuals who fell into the other SBP categories, excluding those with SBP 120-129 mm Hg, showed significantly higher all-cause and CVD mortality. Subgroup analysis showed that older adults aged 65-74 years had higher all-cause and CVD mortality rates according to SBP categories than those aged 75 years or older.ConclusionsThe SBP levels within the range of 120-139 mm Hg were associated with the lowest all-cause and CVD mortality rates among older Korean adults with hypertension. It is recommended to reduce SBP to <140 mm Hg, with 120 mm Hg as the minimum value for SBP, for older Korean adults with hypertension. Additionally, stricter SBP management is required for adults aged 65-74 years.

A U-shaped relationship between body mass index (BMI) and all-cause mortality has been reported, but there are few studies examining the association between BMI and cause-specific mortality and hospitalization. We carried out a longitudinal study to examine these associations in Chinese older adults with multiple comorbidities, which could provide a reference for the recommended BMI in this population. From 2004 to 2013, a retrospective cohort of Chinese older adults was selected from a geriatric day hospital in Hong Kong. They were divided into groups according to their BMI: BMI <16; BMI 16-18; BMI 18.1-20; BMI 20.1-22; BMI 22.1-24; BMI 24.1-26; BMI 26.1-28; BMI 28.1-30 and BMI >30. Other assessments included medical, functional, cognitive, social and nutritional assessment. A total of 1747 older adults (mean age 80.8 ± 7.1 years, 44.1% male, 46.1% living in nursing homes, Charlson Comorbidity Index 2.0 ± 1.6) with a median follow up of 3.5 years were included. Older adults with BMI 24-28 had the lowest all-cause, infection-related and cardiovascular mortality (P < 0.001). Multivariate analysis showed that there was an inverted J-shaped association between BMI and hazard ratio for all-cause and infection-related mortality in both nursing home and community-dwelling older adults. The rate of all-cause hospitalization was lower in older adults with BMI 22-28 (P = 0.002). Multivariate analysis showed that there was an inverted J-shaped association between the odds ratio of recurrent hospitalization and BMI. Chinese older adults with BMI 24-28 had lower all-cause mortality, infection-related mortality, cardiovascular-related mortality and all-cause hospitalization. This study provides a reference for the recommended BMI in this population.

Background: Aging increased the risks of cognitive impairment and depression. Then, these conditions can lead to poor quality of life by reducing one’s ability to perform activities of daily living. Recently, it is established that physical activity can decrease the cognitive decline and the risk of depression in older adults. Moreover, regular physical activity can improve physical and mental functions in populations of all ages. However, level and speed of cognitive decline occurs varies greatly among individual especially the difference between middle-aged and older adults. Objective: This study aimed to focus on the comparison of physical activity, cognitive function and depression between older and middle-aged adults, which has never been done before. Moreover, the associations of physical activity with cognitive impairment and depression were also investigated in older and middle-aged adults. The information in this study will provide an understanding regarding the design of physical activity program for different age groups. Methods: All participants were divided into two groups of 50 middle-aged adults and 50 older adults. The assessments of physical activity, cognitive function, and level of depression were conducted for all participants. Results: The total level of physical activity and cognitive function in older adults was decreased when compared with middle-aged ones. Moreover, each work and transportation domain of physical activity in older adults also was decreased when compared with that in middle-aged ones. However, the leisure domain of physical activity in older adults was increased via a decreasing depression level. In addition, the level of physical activity associated with both cognitive function and depression and depression alone in middle-aged and older adults, respectively. Conclusion: We suggested that total level of physical activity in older adults can increase via stimulating work and transportation activities in physical activity program. Moreover, the level of physical activity associated with both cognitive function and depression and depression alone in middle-aged and older adults, respectively.

Cognitive impairment has emerged as a critical global public health issue. This study investigated the association between community and residential environments and the risk of cognitive impairment among Chinese middle-aged and older adults. The study included a final sample of 10,471 participants from the 2011–2020 The China Health and Retirement Longitudinal Study (CHARLS) cohort. Community and residential environment, and cognitive impairment, were assessed using several cognitive tests. The analyzed using the Cox Proportional Hazards Mode adjusting for age, gender, education level, marital status, residence areas, Body Mass Index (BMI), smoking status, alcohol consumption and chronic disease status. After adjusting for all Covariates, participants residing in relaxed community-based residential environments exhibited a 3.8% increased risk of cognitive impairment compared to those in crowded community environments (HR = 1.038). Middle-aged and older adults with access to garbage disposal services had a 19.3% reduced risk of cognitive impairment (HR = 0.807). Community environments featuring age-friendly facilities, such as open-air fitness equipment (HR = 0.834) and accessibility for handicapped individuals (HR = 0.948), were associated with a 16.6% and 5.2% reduction in the risk of cognitive impairment, respectively. In community social support environments, having a social organization for the older adults was associated with a 16.2% reduction in cognitive impairment risk among middle-aged and older adults (HR = 0.838). Regarding housing factors, concrete and steel buildings were associated with an 18.7% lower risk of cognitive impairment compared to adobe or other types of buildings (HR = 0.813). Domestic amenities, including running water supply (HR = 0.847), broadband connectivity (HR = 0.650), and use of clean energy (HR = 0.957), were associated with a 15.3%, 35%, and 4.3% reduction in the risk of cognitive impairment, respectively. Additionally, indoor tidiness (HR = 0.875) was associated with a 12.5% reduction in cognitive impairment risk. The good community and residential environment are correlated with the lower risk of cognitive impairment in middle-aged and older Chinese adults. Specifically, for the prevention and control of cognitive impairment, community and residential planning and construction should prioritize both the basic social and environmental factors and the internal built environment.

BackgroundLeisure activities serve as key measures to enhance the subjective happiness of middle-aged and older adults individuals and to positively address the challenges of an aging society; however, the trajectory of changes in their participation in leisure activities and how these changes relate to shifts in subjective happiness have not been adequately explored.MethodsThis study selected data from the China Health and Aging Longitudinal Study (CHARLS), which included a total of 5,190 middle-aged and older adults people. Linear and nonlinear latent growth models, parallel latent growth models and cross-lagged models were constructed to investigate the influence and lagged relationship between the trajectory of changes in the level of participation in leisure activities on the trajectory of changes in the subjective well-being of middle-aged and older adults people.ResultsThe initial level of physical activity participation of middle-aged and older adults people significantly predicted the initial level (β = 1. 203, p < 0.001) and rate of change (β = −0.138, p = 0.016) of their subjective well-being, and the trajectory of change of middle-aged and older adults people’s physical activity also significantly predicted the rate of change of their subjective well-being (β = 0.582, p = 0.003). Meanwhile, the initial level of social activity of middle-aged and older adults people also effectively predicted the initial level of their subjective well-being (β = 0.048, p < 0.001). At the same time, the covariates (gender, age, level of education, marital status, chronic disease) also predicted the initial level and rate of change of leisure activity participation level and subjective well-being. Finally, the cross-lagged model test confirmed the predictive effect of leisure activity participation level on subjective well-being of middle-aged and older adults people.ConclusionThis study confirms that the level of participation in leisure activities of Chinese middle-aged and older adults people has a significant predictive effect on their subjective happiness and that there is a significant correlation between the trajectory of changes in the level of participation in leisure activities and the trajectory of changes in subjective happiness.

Home- and community-based services (HCBS) may contribute to lowering mortality and enhancing quality of life among older adults. Limited research, however, has examined this relationship in the Chinese context. This study explored the longitudinal association between perceived availability of HCBS and all-cause mortality among Chinese older adults. This cohort study included 8,102 individuals aged 65 years and older from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. HCBS included daily life assistance, medical care services, emotional support and social services, and reconciliation and legal aid services. The association between perceived availability of HCBS and all-cause mortality was investigated using Cox proportional hazards models. Emotional support and social services were negatively associated with all-cause mortality (HR = 0.86, 95% CI: 0.78 ~ 0.95, P = .004). Daily life assistance, medical care services, and reconciliation and legal aid services were not significantly associated with all-cause mortality. Providing community-level emotional support and social services may reduce the risk of death. Focusing on the mental health and social well-being of older adults is just as important as caring for their physical health.

Insufficient individual outdoor activity is common among older adults, yet research on the association between individual outdoor activity frequency and all-cause mortality among older adults remains limited. Therefore, we aimed to explore the association between individual outdoor activity frequency and all-cause mortality among older Chinese adults. We conducted a prospective cohort study using data from 8117 participants aged 65 years or above from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Accelerated failure time (AFT) models were used to assess the longitudinal association between individual outdoor activity frequency and all-cause mortality by using time ratios (TRs) and 95% confidence intervals (CIs). Subgroup analyses of the association were conducted by age, sex and residence. In addition, sensitivity analyses were performed to assess the robustness of main results. During a median follow-up period of 5.11 years, a total of 3893 (47.96%) participants died. Compared with participants who never engaged in individual outdoor activity, those who engaged rarely or sometimes (TR: 1.24, 95% CI: 1.10-1.40) and those who engaged regularly or almost every day (TR: 1.59, 95% CI: 1.48-1.70) had a statistically significant longer survival time in the fully adjusted model. Subgroup analyses showed consistent associations in nearly all strata. Sensitivity analyses confirmed the robustness of main results. Frequent participation in individual outdoor activity was significantly associated with longer survival time among older Chinese adults. Our findings support encouraging older adults to engage in regular individual outdoor activity for longevity benefits.

Introduction Associations of sleep duration with health outcomes could differ depending on whether sleep is restorative. Age-related changes in the relationship between sleep need and sleep opportunity could also influence these associations. Methods Using data from 5804 participants of the Sleep Heart Health Study, a multicenter population-based prospective cohort study, we examined the longitudinal association of feeling rested after sleep combined with in-home polysomnographymeasured total sleep time (TST) or time in bed (TIB) with allcause mortality. Results A total of 223 (7.1%) and 991 (37.0%) deaths were reported in 3128 middle-aged (40–64 years) and 2676 older adults (≥ 65 years) with a mean (standard deviation) age of 54.5 (6.6) and 73.3 (5.7) years at baseline over a median (interquartile range) follow-up time of 12.3 (11.3–13.5) and 11.3 (8.2–12.2) years, respectively. Among middleaged adults, compared with the interquartile TST range (331 to &amp;lt; 414 min) with feeling rested, the lowest TST quartile (&amp;lt; 331 min) with feeling unrested was associated with higher mortality (adjusted hazard ratio [aHR], 1.54; 95% confidence interval [CI] 1.01–2.33); the highest TST quartile (≥ 414 min) with feeling rested was associated with lower mortality, independently from health and sleep covariates (aHR, 0.55; 95% CI 0.32–0.97). Among older adults, TIB, but not TST, was consistently associated with mortality. Compared with the interquartile TIB range (404 to &amp;lt; 482 min) with feeling rested, the highest TIB quartile (≥ 482 min) with feeling unrested was associated with higher mortality (aHR, 1.57; 95% CI 1.23–2.01). Conclusion The results suggest the role of restorative sleep in differentiating the effects of sleep duration on mortality outcomes for middle-aged and older adults. Our findings further suggest that there is a need to change the way to optimize sleep hygiene according to age groups: in middle-aged adults maintaining a substantial amount of sleep is more critical, whereas in older adults optimizing sleep opportunity is more critical to determine the sleep–mortality relationship. Support (if any) This work was supported by the Ministry of Health, Labor and Welfare, Government of Japan (Grant numbers #19FA1009 and #21FA1002).

The prevalence of depressive symptoms among older adults has become an increasingly important public health priority. Elevated depressive symptoms are well documented among elderly people with cardiovascular disease (CVD), but studies conducted among Chinese adults are scarce. To estimate the association between depressive symptoms and incident CVD among middle-aged and older Chinese adults. The China Health and Retirement Longitudinal Study is an ongoing nationally representative prospective cohort study that was initiated in 2011. This cohort study included 12 417 middle-aged and older Chinese adults without heart disease and stroke at baseline. Statistical analysis was conducted from April 25, 2018, to December 13, 2018. Depressive symptoms were assessed using the validated 10-item of Center for Epidemiologic Studies Depression Scale. Incident CVD (ie, self-reported physician-diagnosed heart disease and stroke combined) was followed-up from June 1, 2011, to June 31, 2015. The Center for Epidemiologic Studies Depression Scale total score ranges from 0 to 30, with a score of 12 or more indicating elevated depressive symptoms. Of the 12 417 participants (mean [SD] age at baseline, 58.40 [9.51] years), 6113 (49.2%) were men. During the 4 years of follow-up, 1088 incident CVD cases were identified. Elevated depressive symptoms were independently associated with an increased CVD risk (adjusted hazard ratio, 1.39; 95% CI, 1.22-1.58) after adjusting for age, sex, residence, marital status, educational level, smoking status, drinking status, systolic blood pressure, and body mass index; history of diabetes, hypertension, dyslipidemia, and chronic kidney disease; and use of hypertension medications, diabetes medications, and lipid-lowering therapy. Of the 10 individual depressive symptoms measured by the Center for Epidemiologic Studies Depression Scale, only 2 symptoms, restless sleep (adjusted hazard ratio, 1.21; 95% CI, 1.06-1.39) and loneliness (adjusted hazard ratio, 1.21; 95% CI, 1.02-1.44), were significantly associated with incident CVD. Elevated depressive symptoms overall and 2 individual symptoms (restless sleep and loneliness) were significantly associated with incident CVD among middle-aged and older Chinese adults.

The prevalence of periodontitis is increasing with the aging of the global population. Periodontitis has been suggested to accelerate aging and increase mortality. The present nationwide prospective cohort study aimed to determine whether periodontitis could modify the association of biological aging with all-cause and cause-specific mortality in middle-aged and older adults. Participants ≥40 y of age from the Third National Health and Nutrition Examination Survey (NHANES III) were included (n = 6,272). Phenotypic age acceleration (PhenoAgeAccel) was used to evaluate the biological aging process. Moderate/severe periodontitis was defined using a half-reduced Centers for Disease Control and Prevention and American Academy of Periodontology case definition. Multivariable Cox proportional hazard regression was conducted to estimate the association between PhenoAgeAccel and mortality risk, followed by effect modification analysis to test whether periodontitis modified the association. During a median follow-up of 24.5 y, 3,600 (57.4%) deaths occurred. The positive relationships between PhenoAgeAccel and all-cause and cause-specific mortality were nonlinear. After adjusting for potential confounders, the highest quartile of PhenoAgeAccel was associated with increased all-cause mortality in individuals with no/mild periodontitis (hazard ratio for Q4 vs. Q1 [HRQ4vs.Q1] = 1.789; 95% confidence interval [CI], 1.541–2.076). In contrast, the association was enhanced in patients with moderate/severe periodontitis (HRQ4vs.Q1 = 2.446 [2.100–2.850]). Periodontal status significantly modified the association between PhenoAgeAccel and all-cause mortality (P for interaction = 0.012). In subgroup analyses, the modifying effect of periodontitis was observed in middle-aged adults (40–59 y), females, and non-Hispanic Whites. Although cause-specific mortality showed a similar trend, the PhenoAgeAccel × periodontitis interaction did not reach statistical significance. In conclusion, periodontitis might enhance the association of biological aging with all-cause mortality in middle-aged and older adults. Hence, maintaining and enhancing periodontal health is expected to become an intervention to slow aging and extend life span.

This article's objective was to compare demographic/medical history and multidomain clinical assessment outcomes between older and middle-aged adults following concussion. Seventy-six patients aged 50-80 years within 12 months of a concussion from a specialty clinic between October 2021 and August 2023 participated in the study. Participants were grouped into older (≥60 years) and middle-aged (50-59 years) adults. At their first clinic visit, participants completed multidomain clinical assessments comprising symptoms, cognitive, vestibular/ocular motor, psychological health, and quality of life domains. Older adults (n = 35) had less females (40.0% vs. 68.3%, p = .01), anxiety history (17.1% vs. 39.0%, p = .036), and employed individuals (57.1% vs. 82.9%, p = .002) than middle-aged adults (n = 41). Older adults had better Neuro-Quality of Life, F(1, 71) = 6.8, p = .01, ηp² = 0.09; Repeatable Battery for the Assessment of Neuropsychological Status recall, F(1, 71) = 12.6, p < .001, ηp² = 0.15; fluency, F(1, 71) = 5.7, p = .02, ηp² = 0.08; list recall, F(1, 69) = 5.2, p = .03, ηp² = 0.07; and list recognition, F(1, 69) = 5.3, p = .03, ηp² = 0.07, when controlling for sex, anxiety history, and employment status. Older adults also had lower odds of being impaired to borderline on Immediate Post-Concussion Assessment and Cognitive Testing verbal memory (OR = 0.05, 95% CI [0.01, 0.56], p = .01), visual motor speed (OR = 0.08, 95% CI [0.01, 0.73], p = .03), and reaction time (OR = 0.21, 95% CI [0.05, 0.89], p = .03), and lower odds of having moderate to severe impairment on Neuro-Quality of Life (OR = 0.32, 95% CI [0.11, 0.97], p = .04) than middle-aged adults. Older adults (≥60 years) exhibited fewer subjective cognitive difficulties and objective cognitive impairments compared to middle-aged adults (50-59 years) following concussion. There were no differences between groups in symptoms, vestibular/ocular motor functioning, or psychological health. Clinicians should consider these findings when evaluating and interpreting outcomes from older and middle-aged adults following concussion. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

BackgroundThe sarcopenia index (SI, serum creatinine/serum cystatin C × 100) is recommended for predicting sarcopenia. There were several studies showing that lower SI is associated with poorer outcomes in the older adults. However, the cohorts studied in these researches were mainly patients hospitalized. The aim of this study was to evaluate the correlation between SI and all-cause mortality among middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS).Materials and methodsA total of 8,328 participants meeting the criteria were enrolled in this study from CHARLS between 2011 and 2012. SI was calculated as [serum creatinine (mg/dL)/cystatin C (mg/L)] × 100. Mann-Whitney U-test and Fisher's exact test were used to assess balance in baseline characteristics. Kaplan-Meier, log-rang analysis, univariate and multivariate Cox hazard ratio regression models were used to compare the mortality between different SI levels. The dose relationship between sarcopenia index and all-cause mortality was further assessed by the cubic spline functions and smooth curve fitting.ResultsAfter adjustment for potential covariates, we found SI was significantly correlated with all-cause mortality [Hazard Ratio (HR) = 0.983, 95% confidence interval (CI) 0.977–0.988, P < 0.001]. Similarly, as SI was used as a categorical variable according to quartiles, higher SI was associated with lower mortality [Hazard Ratio (HR) = 0.44, 95% CI 0.34–0.57, P < 0.001] after adjustment for confounders.ConclusionsLower sarcopenia index was associated with higher mortality among middle-aged and older adults in China.