Population ageing and elderly care vulnerability in rural China from a multidimensional deprivation perspective: the mitigating role of social participation

Background Social disconnection is a public health concern among rural Australian older adults. While research suggests technology can enhance social wellbeing and protect against social disconnection, many older adults are not digitally literate, and little is known as to why and how technology adoption could be promoted in rural contexts. This study aimed to (1) explore the barriers and facilitators of technology adoption among rural older adults and (2) determine the potential utility of technology to promote social connectedness in the aged population. The Theoretical Domains Framework and the Behaviour Change Wheel (BCW) were employed to gain a comprehensive understanding of the digital and social behaviours of rural Australian older adults. Methods Semi-structured interviews were conducted with a convenience sample of 33 rural older adults aged between 65 and 87 years. Interviews were conducted over the phone, audio-recorded, and transcribed. Interview transcripts were coded and analysed using thematic analysis and the BCW. Results Numerous barriers and facilitators of technology adoption were identified, with the most prominent being knowledge, perceived value, perceived self-efficacy, and social support. Findings suggest that older adults’ technology adoption is not simply a technical matter, but influenced by various individual, social, and environmental contexts. Consideration of these factors during development, marketing, training and implementation may facilitate technology adoption among older adults. With regard to social connectedness, several rural barriers emerged, including low population density, geographic isolation, limited community opportunities and poor public transport infrastructure. Conclusion Technology was consistently identified as a facilitator of the social experience, indicating that technology is a promising tool to enhance social connectedness among older adults, particularly those living in rural areas. Future research should focus on enhancing the capability, opportunity and motivation of older adults in technology adoption, with reference to the rural contexts.

With the increasing in aging in China, there has been an increase in older adults suffering from chronic diseases. However, little is known about the differences in chronic disease conditions between rural and urban older adults. The objective of this study is to identify chronic disease conditions and investigate the factors that cause differences in chronic disease conditions between urban and rural older adults. The data are from the fourth wave of the China Health and Retirement Longitudinal Study. The coarsened exact matching (CEM) method was used to reduce the biases for a comparative study. After the CEM method, this study included 5,927 participants aged 60 and above. Chronic disease condition was used as the indicator to measure the health of older adults. Specifically, Fairlie's decomposition analysis was carried out to discover the differences in chronic disease conditions between urban and rural older adults. The study showed that the proportion of those suffering from chronic diseases was significantly higher among urban older adults (51.26%) than rural older adults (46.56%). In those suffering from chronic diseases, there were significant differences in gender, education level, minorities, religiosities, duration of sleep, drinking alcohol, social activity, insurance, and socioeconomic status between rural and urban older adults, while in those not suffering from chronic diseases, there were significant differences in age, education level, marital status, drinking alcohol, social activity, insurance, region, and socioeconomic status between rural and urban older adults. For rural older adults, those who were widowers [Odds ratios (OR): 1.267], who drink alcohol (OR: 1.421), and having government medical insurance (OR: 4.869) had higher odds of having chronic diseases. However, those who were in high school and above (OR: 0.802), reporting a duration of sleep of 4-8 h (OR: 0.745) or above 8 h (OR: 0.649), having social activity (OR: 0.778), and having the most affluent socioeconomic status (OR: 0.778) had lower odds of having chronic diseases. As for urban older adults, those who were aged 65-74 years (OR: 1.246) and had government medical insurance (OR: 2.362) had higher odds of having chronic diseases. Fairlie's decomposition analysis indicated that 23.57% of the differences in chronic diseases conditions could be traced to duration of sleep, drinking alcohol, social activity, and region. This study illustrated that the proportion of chronic diseases was higher among urban older adults than rural older adults. Considering duration of sleep, drinking alcohol, region, social activity, and region, the study demonstrated health differences between urban and rural older adults and provided evidence for policy-making to narrow the health gap between urban and rural areas.

Productive engagement in later life is a key predictor of subjective well-being (SWB) and a global strategic response to population aging challenges. Rural productive aging is an expansion of the connotation of productive aging in the cross-cultural framework. Using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS 2013, 2015 and 2018), this study examines the relationship between labor participation and SWB among rural older adults in China. Ordinary least squares (OLS) regression revealed a significant positive association between labor participation and SWB. Regardless of working hours, positive effects were observed, with low-intensity participation proving most beneficial. As participation intensity increased, this positive impact gradually diminished. Compared to those who never work, individuals who keep working report higher SWB. We employed several methods (PSM, fixed-effect model and IV) to address endogeneity issues and robustness tests. The KHB method identified the mediation mechanisms: self-rated health (73.46%), economic income (10.07%), and social interactions (5.60%). These findings demonstrate that rural older adults have productive value, which is an effective way to improve SWB. The study provides evidence-based guidance for policies addressing population aging in rural contexts.

As the population of older adult in China keeps growing, the degree of aging is becoming increasingly serious and the health of older adults is a growing concern. Comparing the personal characteristics and health levels of urban and rural older adults and determining the relationship between these factors are of great significance in maintaining their health. In addition, exploring how these relationships differ between urban and rural areas is important. This study conducted a literature review to examine the impact of various factors on the physical and mental health of older adults in urban and rural areas in China. Moreover, based on cross-sectional data from the 2017 Chinese General Social Survey (CGSS), urban-rural differences in the factors' degree of influence on the perceived health of older adults were studied using multiple logistic regression. Regular physical exercise had a powerful protective effect on urban older adults' physical and mental health, whereas regular participation in social activities had a positive impact on rural older adults' health. Low income, low educational level, low social trust, lack of a partner, and having more than one child negatively affected the physical health of rural older people. Low socioeconomic status had a negative impact on rural people's health both in mind and body. Overall, the rural adults' health status was found to be relatively low and deserves more attention. This study demonstrated that older people's physical and mental health levels can be significantly affected by the frequency of daily activities and individual and family characteristics. Furthermore, urban-rural differences were observed. These findings could provide feasible suggestions for governments, communities, and older adults' family members to help alleviate health inequality.

Active aging has been listed as an important indicator to measure the quality of life of the older adults and the construction of the senior care system. There is an imbalance between the supply and demand of senior care services for the disabled older adults in rural areas, and the quality of life needs to be improved. We aimed to analyze the current situation of active aging and the influencing factors of the rural disabled older adults, in order to provide a reference basis for improving the quality of life of the rural disabled older adults. We conducted a multicenter and cross-sectional study, using the Barthel Index Scale and Chinese version of the Active Aging Scale, to facilitate the selection of 304 rural older adults with disability in 26 villages under Henan Province for a questionnaire survey. The mean score for the level of active aging of rural older adults with disability was 1.87 (SD 0.36), with the highest score for the dimension of being self-reliant (Mean2.29, SD 0.61) and lower scores for the dimension of active contribution to society (Mean 1.37, SD 0.55) and building up financial security (Mean 1.37, SD 0.57). The results of the multiple regression analysis showed higher levels of active aging among the disabled older adults with retirement pay, mild disability, and longer time per activity/rehabilitation exercise (p < 0.05). Active aging of the rural disabled older adults is at a low level, with insufficient economic security and social participation. The national government should help improve the quality of primary health care in rural areas, build a friendly environment for senior communities, and improve policies to protect the welfare of the older adults, so as to collaboratively empower the disabled older adults in rural areas at three levels: health, participation, and protection.

With the continuous deepening of China's aging population, the high prevalence of chronic diseases, high disability rate and significant medical expenses among older adults have brought huge burdens to individuals, families and the entire social development. Compared with urban areas, the aging population in rural areas is severe and the population's health status is worse. Therefore, how to scientifically address the issue of population aging in rural areas and minimize the negative effects of aging has become a focus of common concern in all sectors of society. As an important non-medical health intervention, exercise has been proven effective by scientific research and is also a common experience of developed countries in actively responding to the issue of population aging. However, the traditional one-way government supply model of rural public products has led to inefficient or ineffective supply of public sports services for a long time, making it difficult to meet the growing personalized needs of rural older adults. Therefore, a comprehensive understanding of the actual demands of rural older adults for public sports services, clarifying their demand types, structural characteristics and influencing factors, is the prerequisite for achieving an effective supply of public sports services for rural older adults and promoting their regular participation in sports. To comprehensively understand the demand situation for public sports services for rural older adults, a sociological survey was conducted on the demand characteristics, influencing factors and satisfaction of public sports services for rural older adults aged 50 and above living in townships, corresponding towns and villages in the eastern, central and western regions of China. The research methods included a literature review, questionnaire survey, interview survey and statistical analysis. Rural older adults have the most urgent demand for establishing sports fitness organizations, improving sports exercise guidance services and strengthening the construction of elderly sports systems; the demand for public sports services among rural older adults is influenced by multiple factors such as demographic characteristics, health status, individual lifestyle and sports exercise cognition level; the overall utilization rate of public sports services for rural older adults is low, and their satisfaction is at a medium level. To meet the public sports service demands of rural older adults, in the future, it is still necessary to enhance the demand subject consciousness of rural older adults, clarify the subjective demand picture of rural older adults, and improve the quality of public sports services for rural older adults.

The digital divide is the difference between individuals who use the Internet and those who do not. Under the triple social environment of urban-rural dichotomy, population aging, and the digital era in China, the existence of digital divide among rural older adults has seriously affected their access to health information through the Internet, so it is urgent to bridge the digital divide problem they face. Based on Maslow's Hierarchy of Needs Theory and Stress Coping Theory, the impact of cultural capital on the digital divide among rural older adults was systematically analyzed using hierarchical regression and Chained Mediation Effect Tests using data from the Chinese Family Panel Studies (CFPS). Cultural capital has a significant positive effect on the digital divide among rural older adults (β = 0.178, p < 0.01). Cognitive ability and economic capacity both play independent intermediary effects between cultural capital and digital divide among rural older adults, and the intermediary chain formed by the two plays a chain intermediary effect. The increase in the cultural capital of rural older adults has led to an increase in their cognitive ability and economic capacity, which ultimately has a favorable effect on the bridging of the digital divide. Heterogeneity results suggest that cultural capital is more effective in bridging the digital divide among male rural older adults aged 60-69. Cultural capital is able to bridge the digital divide faced by rural older adults and is age and gender heterogeneous. At the same time, improved cognitive ability and economic capacity can also help rural older adults bridge the digital divide. Therefore, it is proposed that we increase the construction of public cultural service infrastructure in rural areas, liaise with community neighborhood committees and village committees to do a good job of publicity, improve training measures for key groups, and maintain the enthusiasm of rural older adults for learning, so as to provide references for the rural older adults in China and developing countries in general to bridge the digital divide.

The present study is intended to examine the multiple mediating roles of psychological resilience and subjective well-being in the relationship between social alienation and self-care ability in old age among rural empty-nest older adults. From February 17, 2021, to April 20, 2023, a questionnaire survey conducted using a multistage stratifed sampling method among 425 rural empty-nest older adults (60 years and over). These participants were recruited from a rural areas of Liaoning Province, China. The questionnaire included the Social Alienation Scale, the Psychological Resilience Scale, the Subjective Well-being Scale, the Self-care Ability In Old Age Scale. A descriptive analysis was performed to characterize the sample. Linear regression was utilized to evaluate the relationship between social alienation and self-care ability in old age. PROCESS macro (Model 6) was used to analyze the multiple mediated effects of psychological resilience and subjective well-being. Social alienation exerted a remarkable direct effect on the self-care ability in old age among rural empty-nest older adults (β = -0.678, 95% CI = -0.750- -0.607), which represented 56.45% of the total effect. Through three significantly mediated pathways indirectly affect the self-care ability in old age: (1) through the psychological resilience pathway (β = -0.431, 95% CI = -0.515- -0.350), which represented 35.89% of the total effect; (2) through the subjective well-being pathway (β = -0. 044, 95% CI = -0.089- -0.010), which represented 3.67% of the total effect; and (3) through both the psychological resilience and subjective well-being pathway (β = -0.048, 95% CI = -0.073- -0.029), which represented 3.99% of the total effect. The total mediating effect was 43.55%. Psychological resilience and subjective well-being mediate the relationship between social alienation and self-care ability in old age among rural empty-nest older adults. Therefore, healthcare professionals and stakeholders should be concerned about the psychological resilience status and mental health of rural empty-nest older adults, strengthen their attention to subjective well-being, and adopt necessary targeted intervention measures to enhance the psychological resilience and subjective well-being of rural empty-nest older adults.

Rural older adults experience a high burden of depressive symptoms and significant barriers to accessing mental health services. The Modified Behavioral Activation Treatment (MBAT) has been verified to be effective among rural older adults in China. Due to its structured format and skill-based learning, it is well suited for digital-based delivery. However, only a few studies were from developed countries, and the evidence to support its application in rural China still needs to be provided. Thus, based on the fact that digital health technology has the potential to address the shortage of healthcare resources and the constraints of community mental health services in rural China, the effectiveness of the digital MBAT (D-MBAT) program among rural older adults is worth further evaluation. A multi-center randomized controlled trial will be conducted among 216 rural older adults from Huayuan County and Fenghuang County in Western Hunan. The intervention group will receive the D-MBAT program, while the control group will receive routine care. Depressive and anxiety symptoms, social health, quality of life, and satisfaction will be measured at baseline, one-month, and three-month follow-ups to evaluate the digital MBAT program's effectiveness. Existing digital psychological intervention strategies seldom take into account the needs and preferences of the older adults in low-resource rural areas. Thus, this study aims to develop a D-MBAT program based on person-centered and community-engaged approach to maximize the mental health service of rural older adults with depressive symptoms.A successful D-MBAT program would be a feasible and scalable approach to the management of prevalent mental health conditions of rural older adults in resource-limited Western Hunan. Chinese Clinical Trial Registry ChiCTR2400091193. Registered on 23 October 2024.

The relationship of family proximity and social support to the mental health of older rural adults: The Appalachian context

Associations between social isolation, perceived ageism and subjective well-being among rural Chinese older adults: A cross-sectional study

Objectives This study examined the mediating effect of life satisfaction and the moderating effect of the availability of community recreational facilities (CRF) in the association between loneliness and depression in rural older adults and urban older adults, respectively. Methods Quantitative data collected from 7547 Chinese older adults were analyzed using the SPSS macro PROCESS to test a moderated mediation model with life satisfaction as the mediator and CRF availability and residency type (rural vs. urban) as moderators. Results Loneliness negatively predicted life satisfaction, life satisfaction negatively predicted depression, and loneliness positively predicted depression. The interaction of loneliness and CRF availability had a significant effect on depression for urban older adults but not for rural older adults. The direct impact of loneliness on depression differed significantly between rural and urban older adults. Conclusions Life satisfaction mediated the association between loneliness and depression in both rural and urban older adults; CRF availability unexpectedly boosted the effect of loneliness on depression in urban older adults but not in rural older adults. Given the same level of loneliness, urban older adults were more likely to be depressed than rural older adults. Clinical Implications Psychogeriatric practitioners may embed life satisfaction into intervention programs to minimize depression among older adults. Public administrators should examine the utilization of public facilities to avoid wasted resources and counterproductive effects on older adults. Lonely urban older adults deserve special attention.

Exploring patterns of social participation and its relationship with loneliness among older adults in rural China through a person-centered approach: A cross-sectional study using latent profile analysis.

Background: A fall is a ubiquitous event experienced by all but, in older adults, it leads to more adverse events. The International Classification of Functioning, Disability, and Health (ICF) framework offers a better understanding of the consequences of falls. Studies concerning the impact of falls on older adults living in rural and urban areas based on the ICF framework are sparse. Objectives: We examined the difference in the fall rate, fall characteristics, and the impact of falls based on the ICF framework in rural and urban older adults. Study Design: We did a cross-sectional survey among older adults living in rural and urban areas in a South Indian district from November 2017 to April 2018. Methods: We included 304 community-dwelling rural (n = 210) and urban (n = 94) older adults in the study. Self-designed data form was used to get the details on age, gender, educational level, visual problems, comorbidities, history, frequency, and fall-related injuries. Based on the ICF framework, we used measures such as the Berg Balance Scale (BBS), modified Barthel Index (MBI), Community Integration Questionnaire (CIQ), and World Health Organization Quality of Life Instrument (WHOQOL-BREF). Results: Out of 210 rural older adults, 101 (48%) experienced falls, and out of 94 urban older adults, 52 (55%) experienced falls. The fall rate did not differ significantly between the rural and urban older adults (odds ratio: 0.86, 95% confidence interval [CI]: 0.57–1.31,P= 0.507). The rural and urban older adult fallers differed significantly in gender (male: 95% CI: 0.06–0.39; female: 95% CI: 0.06–0.39;P= 0.007), education (&lt;10 years: 95% CI: 0.31–0.57; &gt;10 years: 95% CI: 0.75–0.94;P= 0.001), comorbidities (diabetes mellitus: 95% CI: 0.03–0.30; hypertension: 95% CI: 0.04–0.26; no comorbidities: 95% CI: 0.05–0.21;P= 0.001), problem in visual acuity (yes: 95% CI: 0.15–0.39; no: 95% CI: 0.15–0.39;P= 0.001), and frequency of falls (once: 95% CI: 0.01–0.33; recurrent: 95% CI: 0.01–0.33;P= 0.001) and did not differ in age, vocational status, and hospitalization. Except in CIQ scores (95% CI: 2.08–5.91;P= 0.001), they did not differ significantly in the fall-related injuries, BBS, MBI, and WHOQOL-BREF scores. Conclusion: The rural older women and the urban older adults with higher levels of education who had diabetes, hypertension, and visual problems experienced more falls. Although the urban older adults reported a higher frequency of falls, they showed a higher level of community reintegration than the rural older adults.

Social and emotional support (SaES) is essential for older adult mental health and is shaped by individual-level factors and the built environment. However, much of the focus on the built environment, and specifically social infrastructure - the physical places that facilitate social interaction and social tie formation - relies heavily on urban settings or samples with limited diversity. Consequently, there is little understanding if social infrastructure matters for the SaES of older adults in rural America, and across race and ethnicity. Therefore, we use social cohesion as a conceptual lens and the community gerontology framework to determine if availability of social infrastructure is associated with SaES among older adults in rural America and if this relationship varies across race and ethnicity. Using data from 110,850 rural older adults from the Behavioral Risk Factors Surveillance System and data from the National Neighborhood Data Archive, we show that among rural ethnoracial minority older adults, higher densities of social infrastructure are associated with higher SaES. This is not true for rural non-Hispanic White older adults. Results highlight the importance of accounting for both social infrastructure as part of the built environment and heterogeneity across race and ethnicity in studies that examine older adult mental and emotional health.