Chinese Longitudinal Healthy Longevity Survey Research Articles

Participation in mahjong and the associated smoking and alcohol consumption behaviors among Chinese older adults

This study examined the relationship of playing mahjong with smoking and alcohol consumption behaviors among Chinese older adults. We used a large and nationally representative dataset, the 8th wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Older adults who were 65 years old or above were included in the final analysis sample (n = 10,954). Multivariable logistic regressions were used to examine the associations of playing mahjong with current and former smoking/alcohol consumption status. Additionally, we used negative binomial and multiple linear regressions to investigate the number of cigarettes smoked per day and the amount of alcohol consumed per day. Compared with older adults who did not play mahjong, those who played mahjong at least once per month were more likely to report both current and prior smoking/alcohol consumption habits (all p < 0.05). The sub-analysis revealed that older adults who played mahjong at least once per week tended to smoke more cigarettes per day (all p < 0.05) than those who did not play mahjong at all. When public health practitioners advocate for the health benefits of playing mahjong, they should also consider its associations with smoking/alcohol consumption behaviors among Chinese older adults.

Residential proximity to major roadways and hearing impairment in Chinese older adults: a population-based study

BackgroundWith rapid urban sprawl, growing people are living in the vicinity of major roadways. However, little is known about the relationship between residential proximity to major roadways and hearing impairment (HI).MethodsWe derived data from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey, and included 13,775 participants aged 65 years or older. Multivariate logistic regressions were employed to examine the association between residential proximity to major roadways and HI. The effects of corresponding potentially modifiable factors were studied by three-way interaction analyses. Sensitivity analyses were performed to verify the robustness of the results.ResultsThe prevalence of HI was 38.3%. Participants living near major roadways were more likely to have a higher socioeconomic status. An exposure-response relation between residential proximity to major roadways and HI was observed (Ptrend < 0.05). Compared with individuals living > 300 m away from major roadways, the adjusted odds ratios (OR) were 1.07 (95% CI: 0.96–1.24), 1.15 (95% CI: 1.07–1.34), and 1.12 (95% CI: 1.01–1.31) for those living 101–200 m, 50–100 m, and < 50 m away from the roadways, respectively. Particularly, the association was more pronounced among individuals exposed to carbon monoxide (CO) pollution or opening windows frequently (Pinteraction < 0.05). Three-way interaction analyses confirmed that participants exposed to CO pollution and frequently leaving windows open had the highest OR of 1.73 (95% CI: 1.58–1.89).ConclusionsThis nation-wide cohort study suggested that residential proximity to major roadways was significantly associated with an increased exposure-response risk of HI in Chinese older adults. Exposure to CO pollution and opening windows frequently might strengthen the relations.

The Association between Dietary Protein Diversity and Protein Patterns with Frailty in Older Chinese Adults: A Population-Based Cohort Study.

Frailty is a pervasive condition among older people worldwide. Despite the association between higher protein intake and lower frailty risk has been well documented, older individuals encounter barriers to enhancing their protein consumption due to reduced appetite and impaired digestive capacity. This study aims to delve into the potential correlation between dietary protein diversity, protein patterns, and the risk of frailty among older Chinese individuals. Prospective cohort study. Community-based. 2,216 participants aged 65 and above and not frail at the baseline were recruited from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset spanning from 2014 to 2018. Dietary protein diversity was evaluated utilizing a protein diversity score (PDS), calculated based on the results of a food frequency questionnaire. Dietary protein patterns were identified by employing principal component analysis (PCA). Frailty was ascertained using a 40-item frailty index (FI) where FI > 0.21 indicated frailty. Logistic analysis was employed to investigate the association between dietary variables and frailty. 541 participants were identified as frail after a 4-year follow-up. After adjusting for confounders, each 1-unit increase in PDS was linked to a 10% decrease in frailty risk. Compared to individuals with PDS ≤ 1, those with PDS scores of 2-3, 4-5, and 6 had lower risks of frailty, with OR (95% CI) of 0.78 (0.58-1.06), 0.58 (0.38-0.87), 0.42 (0.20-0.81), respectively (P trend = 0.038). Individuals who consistently maintained high PDS demonstrated a lower frailty risk in contrast to those who maintained low PDS (OR = 0.60, 95% CI, 0.41-0.87). Additionally, the "meat-fish" pattern exhibited a protective association with frailty, with OR Q4 versus Q1 (95% CI) of 0.54 (0.40-0.74), P trend < 0.001. Maintaining a variety of dietary protein sources and following a "meat-fish" protein pattern might decrease the likelihood of frailty among the older Chinese population.

The effects of community-based home health care on the physical and mental health of older adults with chronic diseases.

This study aimed to explore the effects of community-based home health care (HHC) on the physical and mental health of older adults with chronic diseases in China. The study data were retrieved from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey. Ordinary least squares regression model was used to assess the effects of community-based HHC on the health. Entropy balancing was used to test the robustness of the regression results. A total of 5571 older adults with chronic diseases were included. The results showed that older adults who had received community-based HHC reported significantly better self-rated health (coefficient = 0.051, 95%CI [0.004, 0.098]), less physical discomfort (coefficient = - 0.021, 95%CI [- 0.042, - 0.001]), lower depression scores (coefficient = - 0.263, 95%CI [- 0.490, - 0.037]), and lower anxiety scores (coefficient = - 0.233, 95%CI [- 0.379, - 0.088]) compared with those who had not received community-based HHC. Overall, community-based HHC conferred greater positive effects on the health of rural older adults, older adults with multiple chronic diseases, and older adults with low incomes. Community-based HHC was beneficial for improving self-rated health and reducing physical discomfort, depression, and anxiety in older adults with chronic diseases, thus improving their quality of life. It is important to promote its development nationwide in China.

Decomposing the change in the cognitive function gap between older men and women over time in China: The Chinese Longitudinal Healthy Longevity Survey.

This study explored how modifiable social determinants of cognitive function can influence these gender gaps. We utilized six waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 56,127 individuals aged 65+. The Kitagawa-Oaxaca-Blinder decomposition approach was used for the analysis. Older women consistently had lower average levels of cognitive function than men in each period, but the gap is narrowing. From 2002 to 2018, the gender gap in cognitive function decreased by 1.45 (95% confidence interval (CI) = -1.843, -1.097) points. The coefficients for the endowment effects decreased from 0.387 (95% CI = -0.563, -0.211) to 1.789 (95% CI = -2.471, -1.107) from 2005 to 2018. Lifestyle changes, social participation, and physical health factors significantly contributed to explaining the changes in gender gaps in cognitive function. Among these contributing factors, lifestyle, social participation, and physical health have emerged as pivotal elements in reducing the gender gap in cognitive function. Targeted interventions for these variables are essential among older women to narrow the cognitive gender gaps effectively.

Blood pressure in the longevous population with different status of hypertension and frailty.

Blood pressure(BP) of the longevous population with hypertension and/or frailty was under-investigated. To investigate the association between age, BP, variation of BP, and survival among the old adults with different status of hypertension and frailty, the present study included adults ≥65 years in the Chinese Longitudinal Healthy Longevity Survey(2008-2018), defined frailty using the Fried criteria, and identified hypertension by self-report or SBP/DBP ≥ 140/90 mm Hg. The association between age and BP were investigated using linear regression models. Variation of BP was defined if annual change of BP lower than quartile1(sharp decrease) or higher than quartile3(sharp increase). The association between age and BP variation were investigated using multinominal logistic regression models. The association between BP and survival was analyzed using Cox regression models. Among 13,447 adults(centenarian: 1965[14.6%]), age was positively associated with SBP in robust hypertensive elderly but negatively associated with it in frail hypertensive elderly. Annual change of BP was more likely to be increment among the normotensive elderly, but be decrement among the hypertensive elderly, especially among those with frailty. SBP < 120 mmHg was the risk factor of mortality among the frail oldest-old(≥85 years) while SBP ≥ 150 mmHg was that among the robust young-old(65-84 years). DBP ≥ 90 mmHg was the risk factor of mortality both in the robust young-old and the frail oldest old. In conclusion, age and frailty might be the criteria to predict the change of BP to guide the BP management of the longevous population.

The Effect of Home Care Poverty on the Activities of Daily Living among Older Adults in China: A Propensity Score Matching Study.

In the context of home care being valued by the Chinese government and the increasing number of disabled older adults, it is of great significance to explore the effect of home care poverty of the older adults on their ability to perform activities of daily living. A research sample of 2583 older adults from the Chinese Longitudinal Healthy Longevity Survey data in 2018 was adopted. There were 422 participants in the treatment group and 2161 participants in the control group. According to the framework of counterfactual analysis, the kernel matching method was used to match the treatment and control groups to calculate the values of average treatment effects on treated (ATT). The results of the kernel matching method showed that the factual ADL score of the treatment group was 6.886, the counterfactual ADL score of the control group was 8.520, and the ATT value was -1.634 (P<0.05). There were gender and urban-rural differences in the relationship between home care poverty and activities of daily living among older people. In gender samples, there was a significant correlation between the two, and the absolute value of ATT in male samples was higher than that in female samples (P<0.05). In the rural samples, there was a significant correlation between the two variables (P<0.05). But in the urban samples, there was no significant correlation between the two variables. Home care poverty could significantly reduce the ability to perform activities of daily living among older adults in China. Based on the conclusions, the study puts forward several suggestions to solve the home care poverty for the older adults in China.

Association between secondhand smoke exposure across the life course and depressive symptoms among Chinese older adults

BackgroundThere are limited data on the association between secondhand smoke (SHS) exposure across the life course and depressive symptoms among older adults. We aimed to investigate the association of childhood household SHS exposure, adulthood household SHS exposure, lifetime social SHS exposure, and their coexistence with depressive symptoms in older adults. MethodsData were from the 2011–2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey. About 4000 participants (aged 60 years or older) were recruited in a randomly selected half of the counties and cities in China. Data on SHS exposure, past-year depressive symptoms, and covariates were collected using a questionnaire. The chi-square test (for categorical variables) and t-test (for continuous variables) were used to assess differences in the participant characteristics across groups of SHS exposures. We estimated the odds ratios (ORs) and 95 % confidence intervals (CIs) of depressive symptom according to different types of SHS exposure. ResultsChildhood household SHS exposure (OR = 1.42, 95%CI = 1.22–1.66), adulthood household SHS exposure (OR = 1.41, 95%CI = 1.21–1.63) and lifetime social SHS exposure (OR = 1.35, 95%CI = 1.14–1.58) were associated with higher odds of depressive symptoms. Additionally, those with a higher SHS exposure score had higher odds of depressive symptoms (1 point: OR = 1.56, 95%CI = 1.22–2.00; 2 points: OR = 1.77, 95%CI = 1.39–2.25; 3 points: OR = 1.83, 95%CI = 1.45–2.31). The results were similar when stratified by lifetime nonsmoking, former smoking, and current smoking. LimitationsRetrospective design may introduce recall bias. ConclusionsSHS exposure was associated with higher odds of depressive symptoms in older adults, with the effect seeming to be addictive.

Associations between activities of daily living, leisure activities and subjective well‐being in Chinese older adults

ObjectivesThe study aimed to explore the internal pathway of the association between activities of daily living and subjective well‐being among Chinese older adults using a large and representative sample.BackgroundThere is still a lack of systematic investigation into the association between activities of daily living and subjective well‐being among Chinese older adults.Materials and methodsThe study included 10 578 participants from the Chinese Longitudinal Healthy Longevity Survey. We applied multiple linear regression analysis and Spearman correlation analysis to examine the association between activities of daily living and subjective well‐being and PROCESS macro to determine the mediating effect of leisure activities on the relationship between them.ResultsThe mean total score of subjective well‐being was 30.5 ± 4.4. The prevalence of basic activities of daily living and instrumental activities of daily living limitations was 18.0% and 60.8%, respectively. Correlation analysis showed that activities of daily living score were negatively correlated with subjective well‐being. Leisure activities were positively correlated with subjective well‐being. The effect of instrumental activities of daily living on subjective well‐being was partially mediated by leisure activities and leisure activities completely mediated the association between basic activities of daily living and subjective well‐being.ConclusionsThe effect of instrumental activities of daily living on subjective well‐being was partially mediated by leisure activities and leisure activities completely mediated the association between basic activities of daily living and subjective well‐being.

Living arrangements, activity participation and depression among older Chinese adults

ObjectivesWe examined the relationship among living arrangements, activity participation and depression and the mediating effects of activity participation on the relationship between living arrangements and depression. Study designThis was a cross-sectional study based on nationally representative data. Methods9647 older adults aged 60 years and over were recruited from the 2018 Chinese Longitudinal Healthy Longevity Survey. Three-step regression and mediation analysis methods were used. ResultsCompared with older adults living with family members, those living in institutions attended fewer activities and experienced higher depression rates, and those living alone attended more activities and experienced higher depression rates. In the group living with family members, living with a spouse was an important way to increase activity participation and reduce depression. Mediation analysis suggested that activity participation mediated the impact of living arrangements on depression. Attending more activities could alleviate depression for older adults who are living alone, living in institutions and living without a spouse. ConclusionOur findings suggest an emphasis on the role of spouses and activity participation during depression interventions among older adults.

Dietary fruits and vegetables and risk of cardiovascular diseases in elderly Chinese

Abstract Background Evidence regarding the potential effect of fruit and vegetable consumption on cardiovascular diseases (CVD) was limited and inconsistent among Asian people. Purpose We aimed to investigate the association between fruit and vegetable consumption and risk of CVD, including total CVD, hypertension, heart disease and stroke. Methods We followed 9,740 Chinese elderly population (≥65 years, mean baseline age: 88 years) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) during a follow-up of 10 years (2008-2018). Dietary data were collected using a validated food frequency questionnaire. We examined the associations of fruit and vegetable consumption with risk of CVD using Cox proportional hazard models. Results During 37,366 person-years of follow-up, a total of 3,738 CVD cases were recorded. After adjusting for demographics, dietary, lifestyle, and economical social factors, higher intakes of total fruits and vegetables were associated with lower risk of CVD (comparing with extreme quintiles, hazard ratio (HR) and 95%CI: 0.84 (0.74, 0.95)). The inverse association was mainly driven by vegetable consumption (0.86 (0.77, 0.95)). Furthermore, the inverse association was stronger for risk of hypertension (0.84(0.72, 0.98)). These associations were consistent across age, sex, BMI, residence, exercise status, smoking, drinking and health status. Conclusion This study suggests that higher intakes of total fruits and vegetables are associated with lower risk of CVD among elderly Chinese people, supporting the current recommendations of increasing fruit and vegetable consumption as part of healthy diet for the prevention of CVD.

Dietary patterns from mid-through later-life in relation to sarcopenia risk over 20 years among Chinese community-dwelling oldest old individuals

Evidence regarding how dietary patterns (DPs) from mid- (60 years old) to later-life (over 80 years old) affect sarcopenia risk in old age is scarce. We included 7267 participants aged ≥80 years from the Chinese Longitudinal Healthy Longevity Survey in 2018. The Simplified Healthy Eating Index (SHE index) based on nine dietary variables was used to measured DPs and changes in DPs, with a higher score indicating better diet quality. The term "Mid-life" DPs denoted dietary habits at the age of 60 whereas "Later-life" DPs referred to dietary habits acquired over 80 years old. Sarcopenia risk was evaluated using the SARC-CalF questionnaire. We applied multivariable adjusted logistic regression models to investigate the cross-sectional association between DPs in a life course and sarcopenia risk in 2018 after adjusting for potential confounders including sociodemographic characteristics, lifestyle risk factors, and unfavorable health conditions. Several sensitivity analyses were conducted to verify the robustness of the results. We found that healthier DPs during both mid- and later-life were associated with a decreased odds of sarcopenia risk, with adjusted odds ratios (ORs) of 0.69 (95% confidence interval [CI]: 0.54-0.88) and 0.84 (95% CI: 0.71-0.99), respectively. The odds of sarcopenia risk were also decreased among those with healthier DPs over a period of 20 years (OR=0.80, 95% CI: 0.69-0.93). For each nutrient consumption, participants who had high-quality fish consumption both in mid- and later-life had a 23% decreased odds of sarcopenia risk (OR=0.77, 95% CI: 0.67-0.88) compared with those who had low-quality fish consumption all the time. The results were largely unchanged in sensitivity analyses. Our findings highlight the importance of maintaining healthy dietary habits throughout life to reduce the risk of sarcopenia in old age.

Taste preferences, cardiometabolic diseases and mild cognitive impairment: a prospective cohort analysis of older Chinese adults.

Taste preference is a pivotal predictor of nutrient intake, yet its impact on mild cognitive impairment (MCI) remains poorly understood. We aimed to investigate the association between taste preferences and MCI and the role of cardiometabolic diseases (CMD) in this association. The study included older adults, aged 65-90 years, with normal cognitive function at baseline who were enrolled in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. MCI was measured by the Mini-Mental State Examination, and multivariable Cox regression models were applied. Among 6423 participants, 2534 (39·45 %) developed MCI with an incidence rate of 63·12 - per 1000 person-years. Compared with individuals with insipid taste, those preferring sweetness or spiciness had a higher MCI risk, while saltiness was associated with a lower risk. This association was independent of objective dietary patterns and was more pronounced among urban residents preferring sweetness and illiterate participants preferring spiciness. Notably, among sweet-liking individuals, those with one CMD experienced a significant detrimental effect, and those with co-occurring CMD had a higher incidence rate of MCI. Additionally, regional variations were observed: sweetness played a significant role in regions known for sweet cuisine, while the significance of spiciness as a risk factor diminishes in regions where it is commonly preferred. Our findings emphasize the role of subjective taste preferences in protecting cognitive function and highlight regional variations. Target strategies should focus on assisting individuals with CMD to reduce excessive sweetness intake and simultaneously receiving treatment for CMD to safeguard cognitive function.

Does frequent tea consumption provide any benefit to cognitive function in older adults? Evidence from a national survey from China in 2018.

This present study aims to investigate the effect of tea consumption on cognitive function and examine possible psychosocial mechanisms in older adults. The data of this study came from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey(CLHLS), and a total of 11,910 valid samples were included. We used ordinary least squares (OLS) to explore whether frequent tea consumption had significant effect on the cognitive function of older people. The problem of endogeneity was addressed by using a propensity score matching (PSM). Then we further explored the psychosocial mechanisms of the effect using a stepwise regression approach. Frequent tea consumption produced a positive effect on Mini-Mental State Examination (MMSE) score (coefficient = 0.340, p < 0.01), and PSM showed similar results. Specifically, the positive effect of green tea (coefficient 0.409, p < 0.01) was significantly greater than the other teas (coefficient 0.261, p < 0.1). Moreover, frequent tea drinkers were 59.7, 74.8, and 81.8% less likely to have severe, moderate and mild cognitive impairment respectively, compared to infrequent tea drinkers (p < 0.01). Levels of depression and sleep quality had partial mediation effect for frequent tea consumption on cognitive function, accounting for 27.6 and 3.5% of the total effect, respectively. Frequent tea consumption was found to have beneficial effects on cognitive function, especially in older people with green tea intake. Sleep quality and levels of depression partially mediated the association between frequent tea consumption and cognitive function among Chinese older adults.

Development and validation of a multimorbidity risk prediction nomogram among Chinese middle-aged and older adults: a retrospective cohort study

ObjectivesThe aim of this study is to establish a self-simple-to-use nomogram to predict the risk of multimorbidity among middle-aged and older adults.DesignA retrospective cohort study.ParticipantsWe used data from the Chinese...

Association between self-perception of aging and cognitive function in Chinese older adults: The mediation effect of health behaviors

ObjectiveTo investigate the association between self-perception of aging (SPA) and cognitive function in Chinese older adults, and to explore the mediating role of health behaviors. MethodsThis study included 5,445 Chinese older adults from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Correlation, linear regression and mediation effect analysis were employed to evaluate the association. ResultsSPA is significantly related to the health behaviors (r = 0.160, P < 0.01) and cognition (r = 0.086, P < 0.01), and health behaviors exhibited a positive correlation with cognition (r = 0.179, P < 0.01). SPA and health behaviors significantly impacted cognition (β = 0.032, P = 010; β = 0.103, P < 0.001). Health behaviors partially mediated the effect of SPA on cognitive function, accounting for 27.12 % of the total effect. ConclusionHealth behaviors mediate the association between SPA and cognitive function. Healthcare providers should prioritize addressing SPA of older adults and encourage them to engage in health behaviors for cognitive health.

Association between tea drinking and disability levels in older Chinese adults: a longitudinal analysis.

As the global population ages, disability among the elderly presents unprecedented challenges for healthcare systems. However, limited research has examined whether dietary interventions like tea consumption may alleviate and prevent disability in older adults. As an important dietary therapy, the health benefits of tea drinking have gained recognition across research disciplines. Therefore, this study aimed to investigate the association between tea drinking habits and disability levels in the elderly Chinese population. Leveraging data from the 2008 to 2018 waves of the Chinese Longitudinal Healthy Longevity Survey, we disaggregated tea drinking frequency and activities of daily living (ADL) measures and deployed fixed-effect ordered logit models to examine the tea-disability association for the first time. We statistically adjusted for potential confounders and conducted stratified analyses to assess heterogeneity across subpopulations. Multivariable fixed-effect ordered logistic regression suggested tea drinking has protective effects against ADL disability. However, only daily tea drinking was associated with lower risks of basic activities of daily living (BADL) disability [odds ratio (OR) = 0.61; 95% confidence interval (CI), 0.41-0.92] and lower levels of instrumental activities of daily living (IADL) disability (OR = 0.78; 95% CI, 0.64-0.95). Stratified analyses indicated heterogeneous effects across age and income groups. Daily tea drinking protected against BADL (OR = 0.26 and OR = 0.28) and IADL disability (OR = 0.48 and OR = 0.45) for adults over 83 years old and high-income households, respectively. We found that drinking tea almost daily was protective against disability in elderly people, warranting further research into optimal dosages. Future studies should utilize more rigorous causal inference methods and control for confounders.

A longitudinal study of self-report tooth loss impacting functional status among Chinese older adults: Moderated mediation of social relationships and psychological resilience

ObjectivesThis study aimed to discern the longitudinal association between tooth loss and subsequent functional status, specifically investigating the moderated mediation effects of social relationships and psychological resilience. MethodsData from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were analyzed, we included 2834 older adults aged 65 and over in the study. The longitudinal relationship between tooth loss and functional status was analyzed using the generalized estimating equation. Hayes’ PROCESS macro for SPSS was utilized to study the mediating and moderating effects. ResultsIn the fully adjusted model, the number of natural teeth at T1 was positively associated with instrumental activities of daily living (IADL) score at T3, but not activities of daily living (ADL) score. Compared with 20+ teeth, participants with complete tooth loss at T1 had a higher risk of developing ADL and IADL disability. Participants with 1–9 teeth at T1 had a 38 % risk of developing IADL disability at T3 (OR = 1.38, 95 % CI = 1.07–1.76, p = 0.012). Social relationships mediated the association between tooth loss and IADL only among participants whose psychological resilience was average (B = 0.0006, 95 % CI = 0.0001–0.0014) or high (B = 0.0013, 95 % CI = 0.0003–0.0026). ConclusionPsychological resilience moderated the mediating effects of social relationships on the association between tooth loss and functional ability. Clinical significanceThis longitudinal study contributes to elucidating parts of social-psychological mechanisms underlying tooth loss and functional disability. It suggests that by cultivating positive social relationships and enhancing psychological resilience, the adverse impacts of tooth loss on functional disability may be mitigated.

Longitudinal Association Between Perceived Availability of Home- and Community-Based Services and All-Cause Mortality Among Chinese Older Adults: A National Cohort Study

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

Association of anxiety, depression symptoms and sleep quality with chronic kidney disease among older Chinese.

This study aimed to explore the association of anxiety, depression symptoms and sleep quality with chronic kidney disease (CKD) among older Chinese adults. A total of 1025 participants from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2011-2012) were included in our study. The Generalized Anxiety Disorder scale was used to assess anxiety and the Center for Epidemiologic Studies Depression Scale was used to evaluate depressive symptoms. Logistic regression models were conducted to explore the odds ratios (ORs) and 95% confidential intervals (CIs). We found that anxiety, depression symptoms and poor sleep quality were positively associated with albuminuria, impaired estimated glomerular filtration (eGFR) and CKD, after adjusting for other covariates. For anxiety symptom, the ORs and 95% CIs were 1.20 (1.15-1.38) for albuminuria, 1.16 (1.12-1.35) for impaired eGFR and 1.18 (1.12-1.36) for CKD, respectively. For depression symptom, the ORs and 95% CIs were 1.15 (1.05-1.23) for albuminuria, 1.14 (1.05-1.20) for impaired eGFR and 1.14 (1.05-1.22) for CKD, respectively. Compared with good sleep quality, the OR and 95% CI of poor sleep quality were 1.12 (1.04-1.35) for albuminuria, 1.10 (1.02-1.30) for impaired eGFR and 1.11 (1.03-1.32) for CKD, respectively. And the positive association was more evident among females, body mass index ≥ 28, smoking and drinking adults. Anxiety, depression symptoms and poor sleep quality are positively associated with CKD. Future cohort studies are needed to confirm the results.