Association of unhealthful plant-based diet and social isolation with multi-trajectories of frailty in surviving chinese older adults over a 10-year follow-up.

Dynamic intergenerational support and anxiety-depression in aging: Insights from latent transitions to symptom networks.

The global rise of the oldest-old (≥80 years) presents a critical challenge to healthcare systems. To evaluate 10-year changes in healthy life expectancy (HLE) among this population in China, assessing trends in morbidity compression and expansion by socioeconomic status (SES) and sex. We analyzed two community-based cohorts (1998-2008, n = 7160; 2008-2018, n = 7945) from the Chinese Longitudinal Healthy Longevity Survey. Using a Markov multi-state model, we estimated HLE at age 80 across four health dimensions: physical performance, activities of daily living (ADL), cognitive function, and self-perceived health (SPH). SES was assessed by education background, financial status, and occupation. Women consistently lived longer but with more unhealthy years. Between the two decades, we observed a compression of cognitive impairment across most SES and sex groups. Conversely, an expansion of poor SPH was observed across different SES and sex groups. Trends in physical performance and ADL disability were more heterogeneous, varying significantly by sex and SES, with socioeconomically advantaged groups and women generally experiencing better health spans. Extended lifespan in China's oldest-old over the past two decades coincides with improved cognitive health but an expansion of morbidity in other domains. These findings underscore the need for sex-specific and SES-tailored strategies to address the growing long-term care needs of this population.

The end-of-life experience is a multidimensional concept that involves multiple domains, such as physical, social, caregiving, and environmental aspects, but previous studies have examined only individual factors. Analyzing the heterogeneity of older adults' end-of-life experiences via comprehensive evaluation indicators can enhance understanding of the end-of-life process and inform the development of personalized care strategies. To identify end-of-life experience patterns among older adults via comprehensive evaluation indicators.Design, setting/participants:In this cross-sectional study, Chinese Longitudinal Healthy Longevity Survey (CLHLS) data were used. Older adults (aged 65 years and older) who died between 2008 and 2018 were selected. Data on the physical condition, family support, caregiving, and place of death of older adults were extracted to perform a latent class analysis to identify end-of-life experience patterns. A multinomial logistic regression was employed to explore the association between demographic characteristics and class membership, and an ordinal logistic regression was used to examine the relationship between class membership and pain near death. A total of 15,844 deceased older adults were included in the study. Latent class analysis identified three end-of-life experience patterns: 'limited companionship-institutional death' (14.28%), 'functional disability-family care' (60.70%), and 'living well-affordable caregiving' (25.02%). Females who lived in cities were more likely to belong to the functional disability-family care class. The living well-affordable caregiving class was associated with the lowest level of pain near death. Further strategies need to be implemented to address gender and urban‒rural inequities in end-of-life care. It is crucial to prioritize expanding access to community-based healthcare resources and offering comprehensive training for family caregivers.

Healthy lifestyles and survival beyond age 100: Evidence from a national cohort of Chinese centenarians.

Although prior research indicated that indoor ventilation might have supported mental health in older adults, evidence remained scarce for those with disabilities, who represented a particularly vulnerable population. This study investigated the association between indoor window ventilation frequency and anxiety symptoms among older adults with disabilities in China using nationally representative data. A cross-sectional analysis was conducted using the Chinese Longitudinal Healthy Longevity Survey. Anxiety symptoms were assessed using a validated scale, and indoor window ventilation frequency was examined across multiple seasons. Multivariable linear regression models were used to evaluate associations. Frequent indoor window ventilation was significantly associated with lower anxiety symptoms. Compared with low frequency ventilation, medium (B = -0.651, 95% confidence interval = -1.119, -0.183) and high (B = -0.793, 95% confidence interval = -1.243, -0.342) frequency ventilation showed stronger protective effects. Seasonal ventilation patterns also demonstrated consistent negative associations with anxiety symptoms. This study added scientific value by identifying a low-cost, environmental strategy to alleviate anxiety in disabled older adults. Our findings called for greater policy attention to indoor ventilation practices, including public awareness campaigns and improvements to living environments to promote mental health in aging populations.

Evidence on whether modifiable behaviours, leisure engagement, and subjective well-being jointly shape longevity in the oldest-old (≥80 years) remains limited, especially in China. We aimed to examine the associations between modifiable factors and survival after age 80 in China. This study comprised 30,398 participants aged 80 years and over, drawn from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 1998-2018). Lifestyles (smoking status, drinking status, physical activity, and plant-based diet index), leisure activities (mental, physical, productive, and social activity), and subjective well-being were assessed using structured interviews. Median age at death after age 80 was estimated using Laplace regression. During follow-up, 21,648 (71.2%) participants died. Having healthy lifestyles (never smoking [4.2 months], never drinking [1.6 months], engaging in physical activity [3.4 months], eating healthful diet [2.2 months]), engaging in leisure activities (mental: 3.2 months; physical: 8.7 months; productive: 2.0 months; social: 2.8 months), and reporting high subjective well-being (5.4 months), were found to have significantly longer survival times. The median survival of people with a low-risk profile (maintained at least three healthy lifestyles, engaged in at least one leisure activity, and reported medium or high subjective well-being) was 18 months (95% CI 15.5 to 19.8) longer than that of those with a high-risk profile (unhealthy lifestyle, engaged in no leisure activities, and reported low subjective well-being). The study findings have demonstrated that adopting a healthy lifestyle, engaging in leisure activities, and fostering subjective well-being are associated with longer life expectancy among the oldest old in China.

Previous research on the economic outcomes of widowhood for older adults has often treated spousal death as a single event rather than a process, thereby neglecting the temporal dynamics of economic well-being. This study investigates changes in economic well-being before, during, and after spousal death among Chinese adults aged 65 or older. It also examines how these changes are influenced by coresidence with adult children and vary by gender and occupational background. A sample of 5,451 individuals aged 65+ from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2002-2018) and fixed-effects regressions were used to assess changes in the likelihood of income adequacy around spousal death. Contrary to expectations, the likelihood of income adequacy increases across the process of widowhood. These gains are heterogeneous and contingent on coresidence with adult children. Men and individuals with agricultural backgrounds see larger improvements on average. For women and individuals with agricultural backgrounds, the improvement is far more dependent on coresiding with adult children. The observed improvement in economic well-being reflects how older adults, who often have limited personal income, depend on their adult children in a familistic welfare system lacking sufficient public support for older adult care. Women and those with agricultural occupational backgrounds emerge as particularly vulnerable and dependent within these economic well-being dynamics.

Abnormal sleep duration represents a significant contributor to dementia; however, this association has not been explored among the elderly Chinese population. Therefore, this study investigated the relationship between sleep duration and dementia among the Chinese elderly population. Data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). This study included 7,680 participants aged 65 years and older at baseline in 2011. Cox proportional hazards models were performed to determine the relationship between sleep duration and dementia risk in this patient population. Over a total follow-up period of 28,147 person-years, 398 dementia cases were identified. The mean age of participants was 85.55 ± 11.09 years, with female predominance (54.71%). Participants with optimal sleep duration (6-8h) had a significantly lower risk of dementia than those with excessive sleep duration (> 10h) (P < 0.001, log-rank test). In the fully adjusted Model 3, participants with excessive sleep durations at baseline were associated with an 82% higher risk of dementia (HR = 1.82, 95% CI = 1.25-2.65) compared with the reference group. Tests for nonlinearity between sleep duration and dementia were not significant (P = 0.06). No significant interactions were found between sleep duration and sex, age, residence, or marital status. Finally, the sensitivity analysis demonstrated the stability of these findings. Overall, the present study findings demonstrate that excessive sleep duration (over 10h) is an independent predictor of increased risk of dementia among older Chinese adults. Conversely, maintaining a moderate sleep duration of 6 to 8h appears to be a protective factor, correlating with a lower incidence of the condition.

ABSTRACT The effect of social security benefits on the relationship between instrumental activities of daily living (IADL) disabilities and subjective well-being remains unclear. This study explored the impact of baseline IADL on subjective well-being trajectories among older adults in China with the moderating role of social security benefits. Data derived from four waves of the Chinese Longitudinal Healthy Longevity Survey (n = 1,732 older adults). Multinomial logistic regression analyses were conducted with subjective well-being trajectories categorized as high, moderate, and low, stratified by the level of social security benefits (generous, moderate, none) for subgroup analysis. Results indicated none of participants in the generous social security benefits group followed a low social well-being trajectory and baseline IADLs showed no significant impact. By contrast, baseline IADLs predicted moderate and low social well-being trajectories in the moderate social security benefits group. Baseline IADLs predicted only a moderate social well-being trajectory in the group without any social security benefits. Findings highlight the effects of IADL disabilities on subjective well-being trajectories and social security benefits can mitigate this negative impact.

ABSTRACT Depression reduces the quality of life of older adults with disabilities, adversely impacting the healthy aging of the global population. This study examined whether social participation and self-rated health play a chain mediating role between socioeconomic status and depressive symptoms in elderly people with disabilities. The data were derived from the Chinese Longitudinal Healthy Longevity Survey (n = 1,354). Results indicate that total family income had a direct impact on depressive symptoms (β = −0.220, 95%CI: −0.417, −0.022) and an indirect impact through social participation (β = −0.040, 95%CI: −0.081, −0.009) and self-rated health (β = −0.149, 95%CI: −0.246, −0.055), with a significant serial mediation effect (β = −0.022, 95%CI: −0.040, −0.007). Policies should prioritize integrated delivery of economic support, social-participation facilitation, health security, and comprehensive services to provide targeted assistance to low-education disabled oldest-old adults, and should actively foster their sustained societal engagement through community-based, barrier-free, and low-tempo activity designs.

Frailty is a significant health issue among older adults. Oxidative stress (OS), indicated by elevated malondialdehyde (MDA) levels and reduced superoxide dismutase (SOD) activity, is implicated in age-related diseases. This study aims to explore the relationship between OS biomarkers, MDA and SOD, and frailty among older adults. This study investigated the association between MDA, SOD, and frailty in 3181 older adults from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Frailty was assessed using a 37-variable frailty index. Logistic regression and restricted cubic spline (RCS) analysis were employed to examine the relationship between OS biomarkers and frailty, adjusting for demographic, socioeconomic, lifestyle, and physically relevant factors. This study has found that higher MDA levels were significantly associated with increased frailty risk (OR = 1.06, 95% CI: 1.03-1.09), while SOD activity showed no independent association. The threshold point for MDA was 3.37 (P = 0.003). This study highlights that MDA is independent OS biomarker related to frailty in community-dwelling older adults, suggesting plasma MDA as OS biomarker could potentially aid in the identification and clinical management of frailty.

A recent disability study read the tea leaves to explore the connection between disability and dietary habits. Researchers from three Chinese universities examined whether tea drinking is linked to lower disability levels among older adults in China. Using data from a large, long‐running national study called the Chinese Longitudinal Healthy Longevity Survey, the survey followed adults over many years and collected detailed information about their health, lifestyle, and daily functioning.

With advancing age, physiological and social changes increase the risk of malnutrition among older adults. Dietary supplements are a prevalent strategy for maintaining nutritional balance, enhancing health, and preventing chronic diseases. This study analyzed data from 9,986 participants aged 65 and older, drawn from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), to compare supplement users and non-users. The data were analyzed using Mann-Whitney U test and Chi-square test. The results revealed that only 11.91% older participants used nutrient supplements, and Calcium was the most used nutrient supplements. The typical user was women without spouses living with family, reporting a moderate lifestyle, high life satisfaction, and good health. There were potential associations between nutrient supplement use with chronic diseases, e.g., hypertension, heart disease, stroke and cerebrovascular disease, diabetes, and pneumonia or bronchitis. These findings suggest that nutrient supplement strategies should be personalized based on an individual's chronic diseases. This research provides a crucial evidence base for health professionals to develop targeted interventions aimed at preventing the onset and deterioration of common chronic diseases in older adults.

IntroductionSocioeconomic status (SES) is a key risk factor for depression in older adults, while cognitive function, lifestyle and social participation also have an impact on depression. This study aimed to investigate the mediating role of cognitive function, lifestyle and social participation in the association between SES and depressive symptoms among older adults in China.MethodsData were derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2017−2018). A total of 7595 community-dwelling adults aged ≥65 years were included. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). SES was measured as a composite index incorporating education level, occupation, and self-rated economic status. Cognitive function was evaluated via the Mini Mental State Examination (MMSE). Lifestyle and social participation scores were constructed based on relevant questionnaire items. Mediation analysis was performed to explore the indirect effects of cognitive function, lifestyle, and social participation on the association between SES and depressive symptoms.ResultsThe prevalence rate of depressive symptoms (CES-D-10 score ≥10) was 41.1%. After adjusting for sociodemographic and health-related covariates, SES was negatively associated with depressive symptoms (β = −0.887, P < 0.001). SES had a significant mediating effect on depression in older adults respectively, through cognitive function (relative mediating effect = 8.0%, β = −0.071, 95%CI: −0.095 ~ −0.048), lifestyle (19.9%, β = −0.177, 95%CI: −0.213 ~ −0.140) and social participation (7.6%, β = −0.068, 95%CI: −0.095 ~ −0.042). Additionally, sequential mediating effects were observed for “cognitive function → lifestyle” (1.0%, β = −0.009, 95%CI: −0.012 ~ −0.006), “cognitive function → social participation” (1.0%, β = −0.009, 95%CI: −0.014 ~ −0.006), “lifestyle → social participation” (1.4%, β = −0.012, 95%CI: −0.018 ~ −0.007), and “cognitive function → lifestyle → social participation” (0.1%, β = −0.001, 95%CI: −0.001 ~ −0.001).ConclusionSES influences depressive symptoms in Chinese older adults through both direct and indirect pathways. The findings highlight the need for multifaceted interventions targeting cognitive function enhancement, healthy lifestyle promotion, and social participation facilitation, particularly among socioeconomically disadvantaged older populations, to mitigate depressive symptoms and promote healthy aging.

BackgroundGlobal population aging is reshaping social structures and health demands at an unprecedented pace. Existing research indicates that decision-making power is significantly associated with health outcomes in later life. However, the underlying pathways linking household financial decision-making power to mental health remain underexplored in population-based studies. Elucidating multi-pathway effects will provide pathway-based evidence for identifying vulnerable populations and developing clinical interventions.MethodsWe analyzed five waves (2005–2014) of the Chinese Longitudinal Healthy Longevity Survey(CLHLS), comprising 23,994 observations from 9,055 adults aged 65 years or older. Financial decision-making power was self-reported on a four-point ordinal scale. Mental health was assessed via five indicators: psychological resilience, subjective well-being, life satisfaction, self-rated health, and loneliness. Fixed-effects models were applied to control for time-invariant confounders, and inverse probability weighting was used to address attrition bias. Mediation pathways were tested using a bootstrapping approach (500 repetitions).ResultsA graded dose–response relationship was observed: lower financial decision-making power was associated with poorer mental health across all outcomes. Compared to those with full autonomy, older adults without decision-making power showed significantly lower psychological resilience (β = − 0.31, p < 0.001) and subjective well-being (β = − 0.51, p < 0.001). Mediation analyses revealed that activities of daily living (ADL) accounted for 13.0% to 31.8% of the total effect and leisure activities for 10.0% to 34.2%, with the strongest mediation observed for loneliness. Among the participants who were functionally independent at baseline, functional capacity exhibited dual mediating roles: a positive pathway for self-rated health and a suppression effect for loneliness. Heterogeneity analyses revealed more pronounced benefits among economically disadvantaged, financially dependent, female, and younger-old adults, with protective effects partially offsetting vulnerabilities in these populations.ConclusionsFinancial decision-making power is a significant and potentially modifiable factor associated with mental health among older adults, representing an underexplored pathway for promoting healthy aging, with effects partially mediated through ADL and leisure engagement. Mental health promotion strategies should seek to preserve older adults’ household financial decision-making power while supporting functional independence and social engagement.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-025-06961-y.

Arthritis is a prevalent condition among older adults, potentially influenced by environmental exposures. However, evidence on the relationship between household mold exposure and arthritis in aging populations remains limited. This study utilized data from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Logistic regression models estimated the association between mold exposure and arthritis, adjusting for demographic, lifestyle, and health-related covariates. Subgroup and interaction analyses explored potential effect modifiers. In the first sensitivity analysis, 1:2 propensity score matching (PSM) was applied to improve covariate balance, while the second (2018 wave) additionally adjusted for indoor ventilation, vitamin supplementation, and analgesic use. The prevalence of arthritis was 13.2%. Among older Chinese adults, participants with arthritis were more likely to be younger, female, reside in city, engage in physical activity, have higher BMI, and report mold exposure. Mold exposure was associated with higher odds of arthritis (Model 1: OR = 1.32, 95% CI: 1.05-1.65; Model 2: OR = 1.36, 95% CI: 1.08-1.71), and the association persisted after PSM (Model 1: OR = 1.33, 95% CI: 1.03-1.71; Model 2: OR = 1.34, 95% CI: 1.03-1.73). Drinking status significantly modified this relationship (P for interaction < 0.05). Sensitivity analyses confirmed robustness of the association between mold exposure and arthritis, and analgesic use was additionally found to be associated with arthritis. Our findings indicate that both mold exposure and analgesic use are associated with an increased likelihood of arthritis in older adults, underscoring the need to improve damp and deteriorating housing conditions and to promote the rational use of analgesics to support healthy aging.

ABSTRACTBackgroundCognitive frailty (CF) is the coexistence of physical frailty and cognitive impairment. Transition to institutional care (TIC) refers to the move from home to a long‐term care institution and represents a major change in living arrangement and care needs among older adults. Both CF and TIC are pressing challenges in ageing populations; however, evidence on their association remains limited.ObjectivesThis study aimed to explore the longitudinal relationship between CF and TIC among community‐dwelling older adults, using the Chinese population as an example.MethodsThis retrospective cohort study utilised data from four waves (2008–2018) of the Chinese Longitudinal Healthy Longevity Survey. Community‐dwelling participants aged between 65 and 100 years at baseline were included. CF was defined based on the modified Fried criteria and the Chinese version Mini‐Mental State Examination. The Fine‐Grey subdistribution regression models were used, treating mortality and lost to follow‐up as competing risks and controlling for gender, age, living area, marital status, living arrangement, multimorbidity, household income, and preference for institutional care.ResultsThe baseline prevalence of CF was 2.3% (95% CI: 2.0%–2.6%). During follow‐up, 1.2% (95% CI: 1.0%–1.4%) transitioned to institutional care, 47.1% (95% CI: 46.1%–48.2%) died before TIC and 32.1% (95% CI: 31.1%–33.0%) were lost to follow‐up. Incidence rate of TIC was 2.3 (95% CI: 1.9–2.8) per 1000 person‐years. Individuals with CF had a higher risk of TIC (SHR 3.51, 95% CI: 1.49 to 8.28; p = 0.004) compared to those without physical frailty and cognitive impairment.ConclusionOur findings demonstrated the positive association between CF and TIC, highlighting the need for appropriate and timely management of CF and personalised interventions for this vulnerable group to delay premature institutionalisation.

ABSTRACTSleep disorders represent major public health concerns with significant health consequences. While diet shows promise as a modifiable intervention, the differential effects of established dietary patterns on specific sleep phenotypes and the contributions of specific food groups remains unclear. Therefore, this study investigated how three established dietary patterns relate to distinct sleep outcomes, and further explored the contributions of specific food components. We combined four decades of data and analyzed 9040 US adults from NHANES with sampling weights. Five sleep outcomes were examined in relation to dietary pattern adherence, quantified through averaged 24‐h recall data from two consecutive days: including self‐reported sleep duration, sufficiency, OSA, daytime sleepiness, and stop breathing. For international validation, we used the Global Dietary Database (62 countries) linked to country‐level sleep apnea prevalence (191 countries). Cohort analysis employed the Chinese Longitudinal Healthy Longevity Survey (n = 6885). Causal associations between dietary components and sleep phenotypes were investigated using two‐sample Mendelian randomization with genome‐wide association summary statistics. Our results demonstrated that greater the Mediterranean Diet (MED) adherence was associated with longer sleep duration (β = 0.06, 95% CI: 0.03–0.10, p < 0.001) and sufficient sleep (OR = 1.10, 95% CI: 1.04–1.15, p < 0.001). Notably, dietary Approaches to Stop Hypertension (DASH) adherence offered the strongest protection against daytime sleepiness (OR = 0.89, 95% CI: 0.85–0.93, p < 0.001) and breathing cessation episodes (OR = 0.91, 95% CI: 0.85–0.96, p = 0.001). The Alternative Healthy Eating Index (AHEI) demonstrated balanced associations with improved sleep sufficiency (OR = 1.006, p < 0.05), reduced daytime sleepiness (OR = 0.995, p < 0.05), and fewer breathing episodes (OR = 0.989, p < 0.01). Furthermore, food‐component‐level analyses revealed consistent protective associations from legumes, nuts, and whole grains, while vegetables, fruits, meats, and SSBs showed variable effects—findings supported by both multi‐database analyses and Mendelian randomization. Importantly, MR further demonstrated specific causal associations for fruits and vegetables: pears and strong vegetable preferences protected against short sleep, while cabbage, grapefruit, and melon causally increased sleep disorder risk. Additionally, processed meats causally increased OSA and snoring risk, with food processing degree emerging as a critical causal determinant. In conclusion, this study makes three main contributions. First, we provide a direct comparison of multiple dietary patterns (MED, DASH, AHE) across diverse sleep phenotypes. Second, we identify specific protective food components, with genetic causal evidence supporting their effects on sleep. Third, we integrate multi‐national datasets to validate findings across diverse populations, substantially enhancing generalizability. Collectively, these findings support evidence‐based dietary interventions for sleep health improvement.

Synergistic impacts of physical activity and sleep on risk of dementia and all-cause mortality in Chinese older stroke survivors.