Value shift in response to aging: a longitudinal study based on healthy aging

BackgroundIntrinsic capacity (IC), as a comprehensive measure of an individual’s functional ability, has gained prominence in the framework for healthy aging introduced by the World Health Organization (WHO). As internet usage continues to integrate into daily life, it is imperative to scrutinize the association between internet use and IC to effectively promote healthy aging among the middle-aged and older population.ObjectiveThis study aimed to investigate whether daily internet use in middle-aged and older adults delays or accelerates the decline in IC.MethodsParticipants included in the China Health and Retirement Longitudinal Study (CHARLS) comprised individuals aged ≥45 years residing in China. We analyzed 4 years of CHARLS data from the first wave (May 2011-March 2012) to the third wave (July 2015-January 2016). Data from the first and third waves were used for longitudinal studies. Self-reported data encompassed internet use, frequency of use, and demographic baseline characteristics. In addition, the IC evaluation involved physical examination and blood test data. Initially, linear regression was used to assess the relationship between daily internet use and IC, followed by regression splines to explore potential nonlinear associations. Subgroup and sensitivity analyses were used to investigate the heterogeneity of IC in specific conditions and the robustness of our results. Mediation effect analysis was conducted to identify the factors that mediate the relationship between daily internet use and IC, focusing on social participation, physical activity, and health status.ResultsAmong the 12,826 participants included in the longitudinal analyses, 12,305 (95.9%) did not use the internet, while 521 (4.1%) reported daily internet use with a mean age of 52.62 (SD 7.67) years. After adjusting for demographic variables, socioeconomic factors, lifestyle behaviors, and health conditions and examining the impact of daily internet use and frequency on changes in IC, our findings indicated important associations. Specifically, daily internet use is significantly linked to a slower decline in IC over time (marginal effect 1.58, 95% CI 1.03-2.12; P<.001). Individuals with moderate and regular internet use frequency exhibit higher levels of maintenance in IC (marginal effect 0.74, 95% CI 0.45-1.03, P<.001). In addition, the relationship between IC changes and internet use frequency demonstrated a nonlinear inverted U-shaped curve (nonlinear P=.003). Subgroup analysis further revealed that improvements in IC vary based on age and gender. Furthermore, mediation analysis denoted that more than 28.78% (95% CI 21.24-40.33) of the observed association is mediated by social participation (P<.001).ConclusionsThe findings of our research underscore the potential benefits of consistent and moderate internet use in promoting and preserving IC, particularly in cognitive capacity, sensory, vitality, and locomotion. The observed effects may be related to social participation. These insights offer valuable guidance for crafting strategies aimed at fostering healthy aging within the middle-aged and older adult demographics.

Social isolation, healthy lifestyle, and intrinsic capacity among older adults in China: A longitudinal study

Exploring the relationship between intrinsic capacity and social participation in healthy ageing: Evidence from Singapore

Intrinsic capacity (IC) is a multidimensional construct defined by the World Health Organization. Although IC has been established as a significant predictor of functional decline in older adults, emerging evidence suggests that functional impairment may, in turn, accelerate the degradation of IC, indicating a potential bidirectional relationship. Therefore, this study aims to systematically examine the potential bidirectional relationship between IC and functional ability. This study analyzed longitudinal data from 2233 adults aged 60 and above from the China Health and Retirement Longitudinal Study (2011-2015). Cross-lagged panel models (CLPMs) and random-intercept cross-lagged panel models (RI-CLPMs) were used to examine bidirectional associations between IC and functional ability. Intrinsic capacity (0-100) was assessed across 5 domains: locomotion, cognition, psychological well-being, vitality, and sensory function. Functional ability was measured using scores for basic (basic activities of daily living [BADL]: 0-18) and instrumental (IADL: 0-15) activities of daily living at 3 timepoints. Models were adjusted for sociodemographic, health, and behavioral factors. Compared to CLPM, RI-CLPM better captured the dynamic trajectory of functional status in older adults. Intrinsic capacity decline significantly predicted BADL deterioration (β = 0.089-0.109, p < .05), but BADL changes did not significantly affect IC. A bidirectional relationship existed between IC and IADL, with IC's effect on IADL (β = 0.206-0.236, p < .001) being stronger than the reverse (β = 0.093-0.100, p < .001). This study employed CLPM and RI-CLPM to investigate the dynamic relationship between IC and functional ability. These results offer new directions for developing interventions to promote healthy aging.

Longitudinal change of intrinsic capacity and associated factors in older Chinese adults: China Health and Retirement Longitudinal Study

Functional ability (FA) and social participation (SP) are important indicators of healthy aging, both their trajectories are heterogeneous. It is little known about how the SP trajectories affects FA trajectories. FA was assessed by 20 items covering the ability of meeting basic needs and mobility. SP was assessed by frequency of participating in 10 social activities. Group-based trajectory modeling (GBTM) was used to identify the trajectories of FA and SP of the participants. Two FA trajectories were identified: low baseline-decline tendency (16.1%) and high baseline-stable tendency (83.9%) trajectories. Two SP trajectories were also identified: low baseline-stable tendency (58.5%) and high baseline-increase tendency (41.5%) trajectories. After controlling for the potential covariates, participants among the high baseline-increase tendency SP trajectory group also had significantly higher odds ratios to be belonged in high baseline-stable tendency FA trajectory group (ORs = 2.64, 95%CI = 1.98-3.05). High-increasing social participation had a protective effect to maintain high baseline-stable tendency functional ability among older adults. These findings suggest social participation appears to have great benefits on promoting healthy aging in China.

BackgroundWhile the relationship between internet usage and depression, and the mediating role of social participation in this association, has garnered significant attention, the COVID-19 pandemic has disrupted traditional forms of social participation. The extent to which this disruption has altered the association remains underexplored.ObjectiveThis study aims to examine the impact of internet usage on depressive symptoms among middle-aged and older adults and to assess how the mediating role of social participation differs before and during the COVID-19 pandemic.MethodsData for this study were sourced from the fourth wave (2018: 15,326 observations) and the fifth wave (2020: 15,758 observations) of the China Health and Retirement Longitudinal Study. A 2-way fixed-effects model incorporating an instrumental variable was employed to investigate the relationship between internet usage and depressive symptoms among middle-aged and older adults. Furthermore, a mediation effect model was applied following propensity score matching to assess changes in the mediating role of social participation on the relationship between internet usage and depressive symptoms before and during the pandemic, as well as to explore changes in 3 internet usage functions. Subgroup analyses based on age and urban-rural residence were performed to assess heterogeneity in this association.ResultsThe average Center for Epidemiological Studies Depression Scale (CESD-10) score among middle-aged and older Chinese people increased from 1.94 in 2018 to 1.98 in 2020. Internet usage was negatively associated with depressive symptoms (β=−.041; P<.01), with social participation serving as a partial mediator. The proportion of the mediating effect of social participation on the relationship between distinct internet usage functions and depression shifted during the pandemic: the social function declined from 12.55% in 2018 to 9.30% in 2020, while the informational and recreational function increased from 7.53% and 11.29% in 2018 to 8.85% and 16.37% in 2020, respectively. Both the total and indirect effects were statistically significant across subgroups, with a higher mediation proportion observed among rural residents and women than among urban residents and men.ConclusionsInternet usage was negatively associated with depressive symptoms among middle-aged and older adults. Despite a noticeable increase in depression scores in 2020 compared with 2018, the mediating effect of social participation diminished, while the direct effect of internet usage became more pronounced during the pandemic. These findings underscore the need to prioritize mental health recovery in this population, promote diverse forms of social participation, and leverage the internet’s potential to enhance social participation and mental well-being.

Health care for the rural elderly in and empty nest family is a major problem in such an ageing society such as China. Based on previous studies, China’s rural health care services only focus on the physical health of the elderly, while public health care services only provide primary services such as blood pressure and blood glucose measurement. This leads to the question of whether physical health is the most important issue for the Chinese rural empty nest elderly (CREE). It is necessary to find out their health status, nursing needs and influencing factors associated with healthy ageing (HA). Using the method of logistic regression, four dimensions of HA (adding psychological health, social participation and daily activities to physical health) among 618 respondents in total were analyzed based on public panel data from the national survey of the China Health and Retirement Longitudinal Study (CHARLS). Interesting results have been found; for example, the most important factor restricting the HA of the CREE is not physical health but social participation. The independence, health, good employment and economic conditions of their adult children play an important role in protecting the HA of the CREE.

Although a new conceptualization of functional ability was proposed in the Decade of Healthy Aging, few studies attempted to understand functional ability among older adults from a holistic review. Based on the China Health and Retirement Longitudinal Study from 2011 to 2018, the study investigated the current situation of five domains of functional ability (ability to self-care, being mobile, building/maintaining relationships, contributing to society, learning, and growing), the overall functional ability score and their associated factors among older people. Compared to other functional ability domains, the ability to contribute to society and learn/grow has been largely underdeveloped. Rural respondents were 23% ~ 48% less likely to preserve the five functional ability domains than their urban peers. The findings in this study suggest that China should shift the paradigm to healthy aging by providing more opportunities for the aged to pursue their ability to contribute to society, and the ability to learn, grow and make decisions. Timely policies to maintain functional ability should target those with rural hukou, low education, and low income, especially those with poor cognition.

Household polluting cooking fuels and intrinsic capacity among older population: A harmonized nationwide analysis in India and China

The aim of this study was to explore the developmental trajectories of social participation and cognitive function, as well as their interaction. The study enrolled 6,242 participants from the China Health and Retirement Longitudinal Study, with a mean age (SD) of 58.81 (7.94) years and 45.3% being female. Linear mixed models (LMM) were used in the research to examine the association between social participation and cognitive function. Then, we performed latent growth curve models (LGCM) and cross-lagged panel models (CLPM) to explore the 5-year bidirectional causal relationship from 2015 to 2020. During the five-year follow-up (2015, 2018, & 2020), baseline social participation was related to subsequent cognitive function (β = 0.190, 95% CI: 0.138-0.244, P < 0.001), mental intactness (β = 0.092, 95% CI: 0.056-0.128, P < 0.001) and episodic memory (β = 0.099, 95% CI: 0.068-0.129, P < 0.001). Baseline cognitive function (β = 0.033, 95% CI: 0.021-0.045, P < 0.001), mental intactness (β = 0.035, 95% CI: 0.017-0.052, P < 0.001) and episodic memory (β = 0.050, 95% CI: 0.029-0.070, P < 0.001) were significantly related to subsequent social participation. LGCM showed that the level of social participation increases, while cognitive function remains stable, with the initial levels of both factors mutually influencing each other. The rate of change in social participation significantly predicts the rate of change in cognitive function, and vice versa. CLPM results further support the bidirectional causal relationship. Our study reveals the intricate dynamic association between social participation and cognitive function. The findings support the positive effects of social participation on healthy cognitive aging, while robust cognitive function enhances social participation in late midlife and older adulthood.

In 2015, intrinsic capacity (IC) was proposed by the WHO as a new measure for healthy aging. Evidence has shown that physical activity (PA) benefits the physical and mental health of older adults. However, the association between PA and IC among older adults was not well evaluated or reported. This study aims to investigate the association between PA and general and specific IC among Chinese older adults. The study included individuals aged 60 and above from the China Health and Retirement Longitudinal Study in 2015. The IC scores were constructed based on the WHO concept of five domains: psychological capacity, cognition, locomotion, vitality, and sensory abilities. Total PA and leisure PA were measured based on different activity purposes. Linear mixed-effects models and generalized linear mixed-effects models were developed to assess the associations between PA and IC. A total of 3359 participants were included in this study. Older adults who reported some PA were associated with a higher composite IC score, with a mean difference of 0.14 (95% CI: 0.09-0.18, p < 0.001) compared to those who reported no PA. In terms of leisure PA, physically active adults had a higher composite IC score with a mean difference of 0.06 (95% CI: 0.03-0.09, p < 0.001). Older adults with a high level of leisure PA also had a significantly higher composite IC score (diff. in mean = 0.07, 95% CI: 0.01-0.13, p < 0.05) compared to those with low-level leisure PA. In addition, PA was positively and significantly associated with three specific IC domains: locomotion, cognition, and vitality. Improving both general and leisure PA can be an effective way to prevent the decline in IC among older adults, thus reducing the personal and public load of primary healthcare for aging countries such as China.

Through a longitudinal study, we explored the relationship between sensory impairments and depression in the elderly, and examined the mediating roles of daily activity capability and social participation within this relationship. Based on data from the China Health and Retirement Longitudinal Study (CHARLS) collected in 2015 and 2018, a total of 4,419 individuals aged 60 and above were selected as research participants. Sensory impairments (predictor variables) were assessed in 2015 through self-rated visual and hearing capabilities. Daily activity capability and social participation (mediator variables) were also assessed in 2015, with daily activities assessed using the Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL), and social participation assessed by the quantity of social activity participation. Depression status (outcome variable) was assessed in 2018 using the Center for Epidemiologic Studies Depression Scale (CESD-10). Statistical analysis was conducted using logistic regression and SPSS Macro PROCESS. First, there is a significant correlation between sensory impairments and an increased risk of depression among the elderly, including visual impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI), all of which increase the likelihood of depression. Second, DSI indirectly affect depression through the cascading mediating effects of daily activity capability and social participation. Finally, in contrast to DSI, when there is only a single sensory impairment, either VI or HI, the cascading mediating effects of daily activity capability and social participation on depression are not statistically significant. The elderly population with dual sensory impairments requires continued attention to help these individuals adopt preventive measures to halt the onset and worsening of depression.

Background/Purpose: Adverse childhood experiences (ACEs) have a significant impact on the developmental trajectory of healthy aging. The profound impact of ACEs on individuals may spill over to influence the informal social support and social participation (SP) of middle-aged and older adults. However, the precise influence of ACEs on SP and informal social support is not yet clear. Therefore, to fill the research gap, we examined the characteristics of different subgroups of ACEs and analyzed the effects of ACEs on SP and informal social support among middle-aged and older adults. Method: Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS, 2011 - 2018) and the 2014 Life History Survey (N=11070). Diverse aspects of SP frequency, informal social support, and ACEs were identified based on the CHARLS questionnaire items and ACEs were categorized using latent profile models. The fixed effects model was used to understand the impact of ACEs on SP and informal social support and to explore differences in ACE subgroups. Results: Three distinct subgroups of ACE were determined. It was found that in the group with excellent and good parental mental group, older adults with poorer parental mental health, lower quality family relationships, and better socioeconomic conditions were more likely to engage in SP with higher frequency (p &lt; 0.05). There was a clear correlation between ACEs and informal support (p &lt; 0.05), but no significant differences were found in the poor parental mental group. Conclusion/Discussion: In conclusion, the present study demonstrated that ACEs have an impact on SP and informal social support. To mitigate the adverse effects of ACEs, middle-aged and elderly individuals engage in SP and seek social support. As parents, it is crucial to take preventive measures during the child's formative years and particularly focus on mental health. Moreover, it is essential to pay attention to childhood SES and provide equal opportunities and resources to promote SP and development. This will ultimately improve mental and physical health in later life and foster healthy aging.

BackgroundArterial stiffness is recognized as a new risk factor for stroke. However, the association between estimated pulse wave velocity (ePWV), a well‐established indirect measure of arterial stiffness and stroke among older adults, remains incompletely investigated.MethodsThis study utilized data from 3 prospective, nationally representative cohorts: the Health and Retirement Study in the United States, the English Longitudinal Study of Aging in the United Kingdom, and the China Health and Retirement Longitudinal Study in China. ePWV was calculated based on age and mean arterial pressure. Cox proportional hazard models were used to compute hazard ratios and 95% CIs.ResultsThe final analysis included 6458 participants from the Health and Retirement Study (mean age: 66.99 years; 40.4% men), 6458 from the English Longitudinal Study of Aging (mean age: 66.32; 44.4% men), and 12 415 from the China Health and Retirement Longitudinal Study (mean age: 58.60; 46.2% men). Over follow‐up periods of 10.28 years in the Health and Retirement Study, 9.95 years in the English Longitudinal Study of Aging, and 6.30 years in the China Health and Retirement Longitudinal Study, 624 (9.7%), 374 (5.8%), and 656 (5.3%) participants developed stroke, respectively. Fully adjusted Cox regression analysis revealed a significant association between ePWV and incident stroke across all cohorts (Health and Retirement Study: hazard ratio, 1.29 [95% CI, 1.24–1.35]; English Longitudinal Study of Aging: hazard ratio, 1.37 [95% CI, 1.28–1.46]; China Health and Retirement Longitudinal Study: hazard ratio, 1.20 [95% CI, 1.15–1.25]).ConclusionsThis study demonstrated that higher levels of ePWV were associated with increased risks of incident stroke among middle‐aged and older populations. Arterial stiffness assessment through ePWV could potentially improve primary prevention and treatment strategies for stroke.