Chinese Longitudinal Healthy Longevity Survey Research Articles

Associations between sleep duration, depression status, and cognitive function among Chinese elderly: A community-based study

BackgroundThe associations of sleep duration and depressive status on cognitive function among the elderly remain controversial. This study aimed to investigate the associative effects and mediating mechanisms between sleep duration and depressive status on cognitive function in elderly adults. MethodsParticipants were recruited from cross-sectional and cohort surveys of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We identified thresholds for sleep duration and depression and used logistic regression to explore their independent and joint effects on cognitive impairment. Further, we analyze the mediating effects of depressive status on the association between sleep duration and cognitive function. ResultsOf 13840 elderly (median age: 84 years, female: 54.6 %), 2835 (20.5 %) had cognitive impairment. Compared with those who slept 6–8 h, the ORs (95%CIs) for those who slept < 6 h and > 8 h were 0.98 (0.85, 1.12) and 1.48 (1.32, 1.66). Compared with non-depressed, the OR (95%CI) for the depressed participants was 1.74 (1.53, 1.98). Compared with those with sleep 6–8 h and none-depression, those with sleep > 8 h and depression had the highest odds of cognitive impairment (OR = 2.40, 95%CI: 1.88–3.07). Additionally, Compared with those who slept 6–8 h, the associations between depression-mediated short and long sleep and cognitive impairment were 51.1 % and 6.5 %, respectively. LimitationsCross-sectional studies require caution in the interpretation of causal associations. ConclusionsLong sleep and depression were independently and jointly associated with higher odds of cognitive impairment among the Chinese elderly, and short sleep increased the risk of cognitive impairment by promoting the prevalence of depression.

The impact of community services usage on geriatric depression: a ten-year follow-up study

BackgroundThis study explores whether the impact of environmental factors (community services usage, CSU) on geriatric depression is mediated by psychological resilience and moderated by the COMT (catechol-O-methyltransferase) gene val158met polymorphism.MethodsThe data consists of 13,512 entries from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) collected in the years 2008, 2011, 2014, and 2018. The study employed a Random Intercept Cross-Lagged Panel Model (RI-CLPM) to examine the relationship between CSU and geriatric depression, including the mediating effect of psychological resilience and the moderating role of the comt gene val158met gene polymorphism in this relationship.ResultsLower CSU at earlier assessments were significantly associated with more severe geriatric depression in subsequent evaluations.Psychological resilience was found to partially mediate the relationship between CSU and depression.Differential impacts were observed among various gene genotypes; specifically, the val genotype demonstrated a significantly greater influence of CSU on subsequent psychological resilience and on subsequent depression compared to the met genotype.ConclusionEnhancement in CSU can predict subsequent geriatric depression. The relationship between the CSU and depression can be mediated by psychological resilience, with genetics modulating the pathway from CSU through psychological resilience to depression. Multidisciplinary interventions focused on enhancing community service quality, boosting psychological resilience, and mitigating depression are likely to benefit the older adults’s emotional and psychological well-being.

A latent profile analysis and network analysis of anxiety and depression symptoms in Chinese widowed elderly

BackgroundWidowhood, as a traumatic event in the aging process, may lead to adverse psychological consequences such as anxiety and depression. However, the heterogeneity of anxiety and depression comorbidity patterns in widowed elderly and the interrelationships between symptoms have not been adequately studied. Method10,239 elderly aged 65 years and older were screened from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2017–2018), to assess depression and anxiety using the Center for Epidemiologic Studies Depression Scale (CESD) and the 7-item Generalized Anxiety Disorder Questionnaire (GAD). The subgroups of widowed elderly with similar patterns of symptoms were identified by latent profile analysis (LPA). The structure of anxiety-depressive comorbidity network was characterized using “bridge expected influence” as centrality indices. Network stability was tested using a case drop bootstrap program. A network comparison test (NCT) was performed to examine the differences in network characteristics across LPA subgroups. ResultLPA identified dichotomous profiles: low comorbid (n = 4457) and high comorbid (n = 692). NCT revealed a significant difference in the global strength between networks (S = 0.631, p < 0.001). GAD1 (Nervousness or anxiety) is the common bridging symptom for both networks, while the bridging symptom for the high comorbidity network also includes GAD3 (Generalized worry). LimitationsCross-sectional methods are unable to verify causal relationships, and further randomized controlled trials are warranted. ConclusionAnxiety-depressive pattern in Chinese widowed elderly can be categorized into a low comorbid or a high comorbid group. GAD3 (Generalized worry) can be used as the core intervention target during intervention.

Latent transition of social participation and its effects on depression among older adults in China: A National Longitudinal Study

ObjectivesAs populations age, the issue of social participation among older adults has gained prominence. Studies indicate variability in social participation trajectories among this demographic, yet the transition patterns and their effects on depression remain unclear. This longitudinal study aims to explore the latent classes and transition patterns in social participation among older adults and to evaluate their effects on depression. MethodsData from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2014 (T1) and 2018 (T2) were analyzed, including 2293 older adults. Latent class analysis (LCA) and latent transition analysis (LTA) were employed to identify latent classes of social participation at T1 and T2, as well as the transition probabilities between these classes. Multinomial logistic regression was used to examine predictors of transitions, and depression levels at T2 were compared across transition patterns. ResultsThe LCA results supported a 3-class model labeled as low, moderate, and high social participation. The probabilities of remaining stable and transitioning to other classes were similar across the three classes (ranging from 0.50 to 0.54). Age, gender, and other baseline characteristics emerged as significant predictors of transition patterns. Older adults experiencing positive transitions exhibited reduced depression compared to those in their original class over time, while those with negative transitions showed increased depression. ConclusionsThis research prompts a deep understanding of social participation dynamics in older adults and their effects on depression. Identifying social participation classes and transition patterns could inform interventions to enhance social participation and reduce depression among older adults.

Leisure activity engagement attenuates the risks of cognitive impairment induced by unhealthy plant-based diets: a nationwide cohort study.

We intended to reveal the joint effects between LAE and uPDI on cognition in Chinese older adults. Data were collected from the Chinese Longitudinal Healthy Longevity Survey. In total, 10,617 individuals aged 65 years and above without cognitive impairment or dementia at baseline were enrolled in 2008 and followed up in 2011, 2014, and 2018. The uPDI and the scores of LAE were derived from survey responses, and both were categorized into three groups (low, intermediate, and high). Individuals with a Mini-Mental State Examination (MMSE) score lower than 18 were considered to have cognitive impairment. Cox proportional hazards models were employed to explore the joint association of uPDI and LAE on cognitive impairment, followed by restricted cubic spline (RCS) to observe the effects of the continuous-type variable of uPDI and the scores of LAE on the risk of cognitive impairment. Stratified analysis was applied to examine the association of LAE with cognitive impairment in uPDI groups (high uPDI vs. low uPDI). Compared to participants maintained low scores of LAE and high uPDI, those who maintained high scores of LAE and low uPDI had a decreased risk of cognitive impairment (HR = 0.52, 95% CI, 0.43-0.62). The findings of the stratified analysis demonstrated that the protective effects of high scores of LAE on cognition was pronounced in individuals with low uPDI (HR = 0.61, 95% CI: 0.47-0.79) and those with high uPDI (HR = 0.63, 95% CI: 0.51-0.78). In this cohort study, a higher score of uPDI, which indicated higher intake of salt-preserved vegetables, sugars, and refined grains, was associated with an increased risk of cognitive impairment, whereas this association may be mitigated by regular engagement in leisure activities.

Urban/Rural Disparity in Quality of Life among the Older Adults in China: Mediation Effect of Leisure Activity.

The current study revisits the urban/rural quality of life (QOL) disparity among the older adults in China. It aims to test the potential leisure activity mechanism. Data for this study come from the 2011 and 2014 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). Sample is restricted to the respondents who are 65 years old and older who are alive for both waves. Ordered logistic regression model is used to test the relationship between QOL and urban/rural residency. Mediation test is used to investigate the mediation effect of leisure activities. Findings from the analysis show that urban older adults have higher QOL, as well as higher frequency of participating leisure activities compare to their rural counterparts. Results also show that leisure activities, especially the cognitive stimulation activities mediate the relationship between urban/rural residency and QOL. The current study adds the role of leisure activities as an intervening variable between urban/rural residency and QOL among older adults in China. Policy application to reduce the QOL disparity through leisure activities is also discussed.

The effects of sleep quality on loneliness among older adults: cohort analysis from the life course perspective.

Using cohort analysis to examine the effects of sleep quality on loneliness among older adults from the life course perspective. The hierarchical age-period-cohort growth curve model was used to analyze the data from the 2005-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). (1) Loneliness has a 'U' curve relationship with age, but with the rate of increase gradually slowing down. (2) There were significant differences in loneliness across birth cohorts, with younger cohorts having higher predicted loneliness than older cohorts at the same age. (3) The influence of different sleep quality on loneliness showed a trend of increasing with age. (4) There were no significant differences in the impact of sleep quality on loneliness in different cohorts. This study has identified heterogeneity in loneliness, emphasising the need for a diversified intervention approach. Sleep quality has a protective effect on loneliness and is easy to assess, making it an important intervention tool. In addition, it is imperative to account for the influences of age and cohort effects when formulating intervention strategies.

Association between dietary diversity changes and frailty among Chinese older adults: findings from a nationwide cohort study

BackgroundDietary diversity has been suggested as a potential preventive measure against frailty in older adults, but the effect of changes in dietary diversity on frailty is unclear. This study was conducted to examine the association between the dietary diversity score (DDS) and frailty among older Chinese adults.MethodsA total of 12,457 adults aged 65 years or older were enrolled from three consecutive and nonoverlapping cohorts from the Chinese Longitudinal Healthy Longevity Survey (the 2002 cohort, the 2005 cohort, and the 2008 cohort). DDS was calculated based on nine predefined food groups, and DDS changes were assessed by comparing scores at baseline and the first follow-up survey. We used 39 self-reported health items to assess frailty. Cox proportional hazard models were performed to examine the association between DDS change patterns and frailty.ResultsParticipants with low-to-low DDS had the highest frailty incidence (111.1/1000 person-years), while high-to-high DDS had the lowest (41.1/1000 person-years). Compared to the high-to-high group of overall DDS pattern, participants in other DDS change patterns had a higher risk of frailty (HRs ranged from 1.25 to 2.15). Similar associations were observed for plant-based and animal-based DDS. Compared to stable DDS changes, participants with an extreme decline in DDS had an increased risk of frailty, with HRs of 1.38 (1.24, 1.53), 1.31 (1.19, 1.44), and 1.29 (1.16, 1.43) for overall, plant-based, and animal-based DDS, respectively.ConclusionsMaintaining a lower DDS or having a large reduction in DDS was associated with a higher risk of frailty among Chinese older adults. These findings highlight the importance of improving a diverse diet across old age for preventing frailty in later life.

Bidirectional association between attitudes toward own aging and quality of life in Chinese older adults: A prospective cohort study.

Although positive attitudes toward own aging (ATOA) have been shown to be associated with higher levels of quality of life (QoL) among older adults, the potential interrelationship between ATOA and QoL has not been fully explored. A sample of 2129 older adults aged 60 and above who participated in the three waves of the Chinese longitudinal healthy longevity survey was used. QoL was measured using three indicators, including self-rated health, loneliness, and life satisfaction. The cross-lagged analysis results showed that the bidirectional association between ATOA and QoL was not significant, while positive ATOA predicted better self-rated health, higher life satisfaction, and less loneliness. And there are no gender or age differences in the above relationships. In addition, economic status, sleep quality, and activity participation were common influences on self-rated health, life satisfaction, and loneliness, as well as important factors affecting ATOA. Several variables, such as demographic characteristics, health behaviors, and health status, also influenced QoL and ATOA. Measures to promote positive ATOA can help improve QoL. In addition, emphasis should be placed on improving economic status, sleep quality, and activity participation levels to enhance QoL and ATOA in older adults, with appropriate interventions targeting other factors affecting QoL and ATOA.

Associations between Plant-Based Dietary Patterns and Sensory Impairments among Chinese Older Adults: Based on the Chinese Longitudinal Healthy Longevity Survey

Introduction: The aim of this study was to investigate the relationship between the plant-based dietary index and vision impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI) among Chinese aged 65 and older. Methods: Based on the 2018 data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a cross-sectional study was conducted on 14,859 samples. The assessment of dietary quality utilized the plant-based diet index (PDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI). Logistic regression analysis was used to examine the associations between PDIs and sensory impairments. Additionally, restricted cubic spline analysis was utilized to investigate the nonlinear association between PDIs and sensory impairments. Results: Participants in the highest quintile of PDI exhibited reduced prevalence of VI (OR 0.78, 95% CI: 0.67–0.90, ptrend <0.001), HI (OR 0.83, 95% CI: 0.70–0.99, ptrend <0.001), and DSI (OR 0.62, 95% CI: 0.51–0.77, ptrend <0.001) relative to those in the lowest quintile. Moreover, individuals who ranked in the highest quintile for hPDI exhibited a 25% reduced risk of VI disease. Conversely, those in the highest quintile of uPDI were associated with increased prevalence of VI (OR 1.37, 95% CI: 1.17–1.61, ptrend <0.001), HI (OR 1.36, 95% CI: 1.12–1.65, ptrend <0.001), and DSI (OR 1.56, 95% CI: 1.25–1.95, ptrend <0.001). The relationship between PDIs increasing by every 10 units and sensory impairments showed similar patterns. Notably, hPDI demonstrated a nonlinear relationship with HI (pfor nonlinearity = 0.001), while the others exhibited linear associations. Conclusion: The increase in PDI and hPDI correlates with a reduced prevalence of one or more sensory impairments. Conversely, an increase in uPDI is associated with an elevated prevalence of multiple sensory impairments. Our study findings emphasize the significance of plant-based food quality, advocating for adherence to a plant-based dietary pattern while reducing the intake of less healthy plant foods and animal-based products.

Network analysis of the relationships between depressive symptoms and social participation activities among Chinese older adults and its implications for nursing

ObjectiveNetwork analysis was used to explore the complex inter-relationships between social participation activities and depressive symptoms among the Chinese older population, and the differences in network structures among different genders, age groups, and urban-rural residency would be compared. MethodsBased on the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), 12,043 people aged 65 to 105 were included. The 10-item Center for Epidemiologic Studies Depression (CES-D) Scale was used to assess depressive symptoms and 10 types of social participation activities were collected, including housework, tai-chi, square dancing, visiting and interacting with friends, garden work, reading newspapers or books, raising domestic animals, playing cards or mahjong, watching TV or listening to radio, and organized social activities. R 4.2.1 software was used to estimate the network model and calculate strength and bridge strength. Results21.60% (2,601/12,043) of the participants had depressive symptoms. The total social participation score was negatively associated with depressive symptoms after adjusting for sociodemographic factors. The network of social participation and depressive symptoms showed that “D9 (Inability to get going)” and “S9 (Watching TV and/or listening to the radio)” had the highest strength within depressive symptoms and social participation communities, respectively, and “S1 (Housework)”, “S9 (Watching TV and/or listening to the radio)”, and “D5 (Hopelessness)” were the most prominent bridging nodes between the two communities. Most edges linking the two communities were negative. “S5 (Graden work) - D5 (Hopelessness)” and “S6 (Reading newspapers/books) - D4 (Everything was an effort)” were the top 2 strongest negative edges. Older females had significantly denser network structures than older males. Compared to older people aged 65–80, the age group 81–105 showed higher network global strength. ConclusionsThis study provides novel insights into the complex relationships between social participation and depressive symptoms. Except for doing housework, other social participation activities were found to be protective for depression levels. Different nursing strategies should be taken to prevent and alleviate depressive symptoms for different genders and older people of different ages.

Multimorbidity measures associated with cognitive function among community-dwelling older Chinese adults.

Older adults with multimorbidity are at high risk of cognitive impairment development. There is a lack of research on the associations between different multimorbidity measures and cognitive function among older Chinese adults living in the community. We used the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2018 and included data on dementia-free participants aged ≥65 years. Multimorbidity measures included condition counts, multimorbidity patterns, and trajectories. The association of multimorbidity measures with cognitive function was examined by generalized estimating equation and linear and logistic regression models. Among 14,093 participants at baseline, 43.2% had multimorbidity. Multimorbidity patterns were grouped into cancer-inflammatory, cardiometabolic, and sensory patterns. Multimorbidity trajectories were classified as "onset-condition," "newly developing," and "severe condition." The Mini-Mental State Examination scores were significantly lower for participants with more chronic conditions, with cancer-inflammatory/cardiometabolic/sensory patterns, and with developing multimorbidity trajectories. Condition counts, sensory pattern, cardiometabolic pattern, cancer-inflammatory pattern,and multimorbidity developmental trajectories were prospectively associated with cognitive function. Elderly individuals with a higher number of chronic conditions were associated with lower MMSE scores in the Chinese Longitudinal Healthy Longevity Survey data. MMSE scores were significantly lower for participants with specific multimorbidity patterns. Individuals with developing trajectories of multimorbidity were associated with lower MMSE scores and a higher risk of mild cognitive impairment.

Association of vision and hearing impairment and dietary diversity among the oldest old in China: findings from the Chinese longitudinal healthy longevity survey

BackgroundThe presence of sensory impairment among older age cohorts exerts a significant impact on both individuals and society generally. Although the impact of dietary patterns on health is vital across all stages of life, there still a paucity of comprehensive research on the association between dietary variety and sensory impairments.ObjectiveTo investigate the potential relationship between dietary diversity and the prevalence of visual and hearing impairment or dual sensory impairments (visual and hearing impairment) among the oldest old population.MethodsThis is a cross-sectional study relied on data obtained from the 2018 survey conducted by the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Subjects aged 80 and older with complete vision and hearing data were included in the study. Multivariate logistic regression models were developed to examine the association between dietary components and visual and hearing impairment while controlling for age, gender, socioeconomic demographic factors, living habits, other food habits, and general health status.ResultsThe study included 10,093 participants, with an average age of 92.29 ± 7.75 years. Vision and hearing function were assessed based on the ability to distinguish the direction of the break in the circle and the requirement for hearing aids, respectively. Upon controlling for confounding variables, individuals with a greater Dietary Diversity Score (DDS, the number of food groups, range: 1–11) had a reduced likelihood of experiencing visual impairment (odds ratio [OR] = 0.944, 95% confidence interval [CI], 0.915—0.974) and dual sensory impairment (OR = 0.930, 95% CI, 0.905—0.955). In comparison to the low dietary variety group (insufficient dietary diversity, DDS < 4), the high dietary diversity group (sufficient dietary diversity, DDS ≥ 4) exhibited a decreased risk of visual impairment (OR = 0.820, 95% CI, 0.713—0.944) and dual sensory impairment (OR = 0.751, 95% CI, 0.667—0.846). However, no statistically significant correlation was observed between dietary diversity and the presence of only hearing impairment (OR = 0.924, 95% CI, 0.815—1.047) (P < 0.05).Conclusions and implicationsThe synthesis of research findings suggests that following diverse dietary patterns and healthy nutritional practices may be an effective and affordable way to prevent age-related decline in visual impairment and dual sensory impairment.

Association of psychological resilience with all-cause and cause-specific mortality in older adults: a cohort study

BackgroundPsychological resilience has been associated with increased longevity in the oldest old; however, its significance in the broader older adult population has not been thoroughly explored. There is a lack of understanding regarding its relationship with cause-specific mortality in older adults. This study aims to address these gaps by investigating the association between psychological resilience and both overall mortality and cause-specific mortality in individuals aged 65 and older.MethodsWe enrolled 4,935 participants aged 65 and older in the Chinese Longitudinal Healthy Longevity Survey, with baseline assessments conducted in 2014 and follow-up surveys in 2018. To evaluate the associations between psychological resilience and mortality, we used Cox proportional hazards models. Additionally, we employed restricted cubic spline plots to illustrate the dose-response relationships between these variables.ResultsDuring a mean (Standard Deviation) follow-up of 3.2 years (1.2), 1726 participants died. Higher psychological resilience was independently associated with lower all-cause mortality risk (Hazard ratio [HR] 0.74, 95% confidence interval [CI]: 0.67–0.82) and cause-specific mortality from cardiovascular disease (HR 0.74, 95% CI: 0.59–0.93), respiratory diseases (HR 0.63, 95% CI:0.45–0.87), and other causes (HR 0.69, 95% CI: 0.60–0.78), excluding cancer-related mortality. Similar effects were evident when examining the psychological resilience score. The dose-response analysis further indicated a gradual decrease in mortality risk corresponding to higher psychological resilience scores. Interaction analyses revealed that psychological resilience has a more pronounced effect on mortality from other causes among economically independent older adults (P-interaction = 0.02).ConclusionsEnhanced psychological resilience is independently associated with reduced all-cause and some cause-specific mortality in older adults. These findings underscore the importance of addressing psychological factors in the promotion of healthy aging and longevity.

Synergistic impact of plasma albumin and cognitive function on all-cause mortality in Chinese older adults: a prospective cohort study.

Hypoalbuminemia and cognitive impairment (CI) each independently increase the mortality risk in older adults. However, these two geriatric syndromes can occur simultaneously. In community-dwelling older adults, is the combination of hypoalbuminemia and CI linked to a higher mortality risk than either condition alone? We aimed to investigate the association between plasma albumin, cognitive function, and their synergistic effect on mortality in Chinese community-dwelling older adults. Data from the Chinese Longitudinal Healthy Longevity Survey (2012) included 1,858 participants aged ≥65. Baseline assessments comprised albumin levels and cognitive status. All-cause mortality was confirmed through 2014-2018 surveys. Cox proportional hazards models assessed associations, and restricted cubic splines explored albumin-mortality relationship. During a median follow-up of 48.85 months, 921 deaths. Albumin≥35 g/L vs < 35g/L [HR: 1.33 (95%CI, 1.10, 1.62)] and CI vs normal cognition [HR: 1.69 (95%CI, 1.43, 1.99)] independently predicted mortality. A dose-response relationship with mortality was observed for albumin quartiles (p < 0.001). Each SD increase in MMSE or albumin correlated with 22% and 15% lower mortality risk, respectively. Combined hypoproteinemia and CI increased the mortality risk by 155%, with a notably higher risk in males, those aged <85 years, and individuals living in rural areas. Interaction effects of albumin and CI on mortality were observed (p < 0.001). In the single CI group, older adults had a 61% increased risk of mortality in the hypoproteinaemia group compared with the albumin-normal group. Restricted cubic spline revealed a reverse J-shaped association, particularly for participants without CI. For individuals with CI, albumin levels were inversely associated with mortality risk. Hypoproteinemia and CI, individually and combined, increased all-cause mortality risk in Chinese older adults, with stronger effects observed in males, younger older adults, and those living in rural areas. These findings emphasize the importance of targeted adjustments and early nutrition programs in health prevention and clinical care for older adults.

What factors preventing the older adults in China from living longer: a machine learning study

BackgroundThe fact that most older people do not live long means that they do not have more time to pursue self-actualization and contribute value to society. Although there are many studies on the longevity of the elderly, the limitations of traditional statistics lack the good ability to study together the important influencing factors and build a simple and effective prediction model.MethodsBased on the the data of Chinese Longitudinal Healthy Longevity Survey (CLHLS), 2008–2018 cohort and 2014–2018 cohort were selected and 16 features were filtered and integrated. Five machine learning algorithms, Elastic-Net Regression (ENR), Decision Tree (DT), Random Forest (RF), K-Nearest Neighbor (KNN), and eXtreme Gradient Boosting (XGBoost), were used to develop models and assessed by internal validation with CLHLS 2008–2018 cohort and temporal validation with CLHLS 2014–2018 cohort. Besides, the best performing model was explained and according to the variable importance results, simpler models would be developed.ResultsThe results showed that the model developed by XGBoost algorithm had the best performance with AUC of 0.788 in internal validation and 0.806 in temporal validation. Instrumental activity of daily living (IADL), leisure activity, marital status, sex, activity of daily living (ADL), cognitive function, overall plant-based diet index (PDI) and psychological resilience, 8 features were more important in the model. Finally, with these 8 features simpler models were developed, it was found that the model performance did not decrease in both internal and temporal validation.ConclusionsThe study indicated that the importance of these 8 factors for predicting the death of elderly people in China and built a simple machine learning model with good predictive performance. It can inspire future key research directions to promote longevity of the elderly, as well as in practical life to make the elderly healthy longevity, or timely end-of-life care for the elderly, and can use predictive model to aid decision-making.

Increasing the frequency of plant-based food intake in daily diets reduces the risk of cardiovascular disease among elderly Chinese: a cohort study.

There is limited research on the relationship between the frequency of plant-based food intake and the risk of cardiovascular disease (CVD) among elderly Chinese. This study aims to evaluate the association between plant-based dietary index (PDI) and CVD risks, providing evidence for elderly Chinese to reduce CVD risks by increasing the frequency of plant-based food consumption. This study analyzed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2011-2018, employing a multivariate modified Poisson regression model, trend tests, and restricted cubic spline (RCS) analysis to assess the linear and non-linear relationship between the PDI and CVD risks. Subgroup analyses and interaction tests were conducted to evaluate the robustness and population-specificity of the results. This study included a total of 1,414 elderly Chinese, and at the end of follow-up, 487 participants had developed CVD. The multivariate modified Poisson regression model revealed a negative association between PDI and CVD risks [RR = 0.983, 95%CI = (0.970, 0.997)]. Similarly, the multivariate trend test (p = 0.031) and RCS analysis (P for nonlinear = 0.600) indicated a linear relationship between PDI and CVD risks. Subgroup analyses showed that the relationship between PDI and CVD risk was not influenced by gender, BMI, smoking, alcohol use, or exercise. The PDI was negatively correlated with CVD risks, indicating that increasing the frequency of plant-based food intake in the diet may reduce CVD risks among elderly Chinese.

Frailty trajectories and determinants in Chinese older adults: A longitudinal study

ObjectivesThis study aimed to enrich the research on frailty trajectories by using FRAIL scale and frailty index (FI), and analyze the determinants of the different trajectories in older Chinese. Methods2268 older adults from the Chinese Longitudinal Healthy Longevity Survey were included. The FRAIL scale was constructed from 5 items and FI was constructed from 39 deficits. Latent Class Trajectory Model was used to depict frailty trajectories. Lasso - logistic model was applied to exploration of influencing factors. ResultsFour FRAIL trajectories and three FI trajectories were identified. Women, smoking, illiteracy, more than two chronic diseases, and poor instrumental activities of daily living (all p < 0.05) were associated with frailty trajectories, regardless of the frailty instrument employed. ConclusionsFrailty trajectories of older Chinese adults are diverse and they are influenced by different frailty measurement tools. Long-term assessment and management of frailty are recommended as routine care in community healthcare centers.

Associations of body mass index, waist circumference and the weight-adjusted waist index with daily living ability impairment in older Chinese people: A cross-sectional study of the Chinese Longitudinal Healthy Longevity Survey.

To investigate the associations of body mass index (BMI), waist circumference (WC) and the weight-adjusted waist index (WWI) with the impairment of activities of daily living (ADL) in older Chinese people. A total of 13 260 participants aged 65 years and older from the 2018 Chinese Longitudinal Healthy Longevity Survey were included in this cross-sectional study. BMI, WC and the WWI were calculated from measurements of height, weight and WC. Binary logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Non-linear correlations were investigated using restricted cubic spline curves. In multivariate logistic regression fully adjusted for confounding variables, our analyses revealed significant associations between WC and WWI and ADL impairment, with adjusted ORs (95% CI) of 1.01 (1.00, 1.01) and 1.08 (1.03, 1.12), respectively. Meanwhile, participants with a high WWI had a higher risk of ADL impairment compared with those with a low WWI, with an adjusted OR (95% CI) of 1.12 (1.02, 1.23). Subgroup analyses showed that only the association between WWI and ADL impairment did not differ in any of the different populations. In addition, we found that BMI, WC and WWI were non-linearly associated with ADL impairment. There are significant associations between WC and WWI and ADL impairment in older Chinese people. The findings show the ability of the WWI to serve as a comprehensive and effective indicator of obesity in older Chinese people and emphasize the importance of assessing WWI in screening and preventing ADL impairment in older people.

Trends and patterns of the healthy life expectancy of the elderly in China

This study analyzes the healthy life expectancy (HLE) of older adults in China since the 1990s, utilizing data from China's sixth (2010) and seventh (2020) National Population Censuses and the Chinese Longitudinal Healthy Longevity Survey (CLHLS), conducted from 1998 to 2018. By applying the Sullivan method for estimating HLE, the study examines trends in HLE and assesses the impacts of mortality and morbidity rates on HLE through counterfactual analysis. It differentiates measurements of health status: the census uses self-reported ability of living independently, while CLHLS uses the activities of daily living (ADL) scale. The results from both data sources indicate an increase in HLE as a proportion of overall life expectancy for the elderly in China since the 1990s, which suggests a “compression of morbidity”. The CLHLS findings align with those based on the census data. Monitoring HLE is crucial for tracking the health status of the elderly in China and can offer valuable insights for policymakers and healthcare providers in enacting strategies that enhance the health and overall well-being of the senior population.