Older Chinese People Research Articles

Cancer statistics in Chinese older people, 2022: current burden, time trends, and comparisons with the US, Japan, and the Republic of Korea.

Largely due to population ageing, the cancer burden from older people has been rising, which imposed considerable pressure on current Chinese healthcare system. We provide comprehensive information about cancer burden of Chinese older people based on the most recent data from National Central Cancer Registry of China. The logarithmic linear regression was used to project the current cancer burden in 2022, and Joinpoint regression was used for temporal trend analysis from 2000 to 2017. We also estimated cancer statistics of older people in the US, Japan and the Republic of Korea for comparisons. It is estimated that 2.79 million cases and 1.94 million deaths occur for Chinese older people, representing 55.8% and 68.2% of cases and deaths in all population in 2022. The overall cancer incidence rate gradually increased among older women, while the mortality rates declined for both sexes. Notably, approximately 10.0% of all cases and 17.7% of all deaths are from people aged over 80 years, and cancer incidence and mortality in this age group showed upward trends for women. Lung cancer and digestive cancers are the leading cancer types for Chinese older people. Compared with other countries, China has lower incidence rates but higher mortality rates for older people. The rapidly growing burden of prostate cancer, breast cancer, colorectal cancer, and declines in esophageal cancer, stomach cancer, and liver cancer among older people indicate the cancer pattern in China is being in a transition stage to that in developed countries. Our findings imply that it should be the national health priority to meet the growing demands for cancer diagnosis, treatment and care services from the older people as the rapid population ageing in next few decades.

Association between nut consumption and mortality among Chinese older people: A national cohort study based on CLHLS from 2008 to 2018.

Few quantitative studies have explored the associations between nut consumption and better health outcomes among a national cohort of community-dwelling older Chinese people. Given the need for more evidence to support the health benefits of nuts among Chinese people, we investigated whether nut consumption was associated with subsequent 10-year mortality. We analyzed data from the Chinese Longitudinal Healthy Longevity Survey. The data on nut consumption at baseline were collected using a questionnaire through face-to-face interviews. The vital status and date of death were ascertained by a close family member or village doctor of the deceased participant during the follow-up survey. Cox analyses were performed to explore the association between nut consumption and mortality. Subgroup analyses by age group (<80 or ≥80 years), sex (male/female), activities of daily living (impaired or normal), and physical exercise (yes or no) were performed to assess whether the association between nut consumption and mortality differed across different populations. The median survival time was 1,302 days for the 11,915 participants with complete information of survival time and nut consumption. The association between nut consumption and mortality was significant after the adjusting for significant factors in the univariate Cox analyses. The hazard ratios were lower in male participants, those who were <80 years old, and those who did not engage in physical exercise at baseline. The association between nut consumption and mortality was not significant among participants with normal activities of daily living. The association between nut consumption and mortality was not significant among participants who had normal activities of daily living but was significant among participants who had impaired activities of daily living. Including nuts in the diets cloud help to extend the lifespan in older Chinese people, especially those with impaired activities of daily living.

The association between personal social capital and health-related quality of life among Chinese older people: A cross-sectional study.

Lower health-related quality of life (HRQoL) can result in adverse effects on the health of older people. This study aims to explore the relationship between personal social capital (PSC) and HRQoL among Chinese elderly people from rural-and-urban perspective. 4,802 samples were included from China's health-related quality of life Survey for Older Adults 2018 (CHRQLS-OA 2018). The PSC, including bonding and bridging social capital (BOC and BRC), was measured by the Chinese version of the Personal Social Capital Scale (PSCS-16). The HRQoL was evaluated by the European Five Dimensions Questionnaire (EQ-5D-3L). Linear and Tobit regression models were conducted to examine the relationship between PSC and HRQoL. The BOC and BRC of rural older people were significantly lower than those of urban older people. Pain/discomfort and anxiety/depression were the most significant health problems affecting the older samples. In the five dimensions, the proportion of rural older people with problems was higher than that of urban older people. Among rural older people, BOC was significantly related to self-rated health and EQ-5D utility index (p < 0.05); while BRC was insignificantly associated with self-rated health (p > 0.05) but related to EQ-5D utility index (p < 0.05). Both BOC and BRC were significantly correlated with self-rated health and EQ-5D utility index (p < 0.05) among urban older people. Our study reveals older people's worrying PSC and HRQoL status. The relationship between PSC and HRQoL suggested that more social support and care of intimates should be encouraged to increase the PSC of older people, especially rural older people.

Genetic loci, rs17817449 and rs6567160, known for obesity and the risk of stroke events among middle-aged and older Chinese people.

Fat Mass and Obesity-Associated (FTO) and the Melanocortin-4 Receptor (MC4R) genes are strongly associated with obesity, an established risk factor for stroke. We aimed to assess the associations between rs17817449 at the FTO and rs6567160 at the MC4R and the risk of stroke events in middle-aged and older Chinese people. Study data were obtained from the Guangzhou Biobank Cohort Study; a total of 148 participants with a self-reported history of stroke and an equal volume of age- and sex-matched participants were selected as the cases and the controls in a case-control study; a total of 13,967 participants at the first follow-up and all participants with fatal stroke (up to April 2021) were included in a retrospective cohort study. Conditional logistic regression and the Cox proportional hazards regression analyses were used to assess the associations of the two genetic loci with the risk of stroke events. After adjusting for age, sex, education, job, smoking, alcohol consumption, body mass index, physical activity, hypertension, diabetes, and dyslipidemia, rs17817449 and rs6567160 shared minor alleles G and C, respectively, in the case-control analyses. The genotypes GG+GT of rs17817449 at the FTO were significantly associated with a decreased risk of fatal stroke occurrence, with fatal all strokes having an adjusted hazard ratio (aHR) of 0.71 (95% confidence intervals (CI) 0.52-0.97, P = 0.04) and fatal ischemic stroke having an aHR of 0.64 (95% CI 0.41-1.00, P = 0.05), when the genotype TT was taken as a reference and a series of multiplicities were adjusted; the risk of fatal all strokes was lowered by dyslipidemia (aHR = 0.63, 95% CI 0.39-1.00, P = 0.05) and non-diabetes (aHR = 0.68, 95% CI 0.46-0.99, P = 0.049) in the retrospective cohort analyses. Significances were observed neither in the associations between rs6567160 and the risk of stroke events nor in an interaction between rs17817449 and rs6567160 in the two-stage analyses. The G allele of rs17817449 at the FTO, not rs6567160 at the MC4R, was associated with a decreased risk of fatal stroke occurrence; its functional role in stroke should be explored in relatively healthy middle-aged to older Chinese people.

Nowcasting and forecasting the care needs of the older population in China: analysis of data from the China Health and Retirement Longitudinal Study (CHARLS)

An ageing population coupled with an increase in morbidity places a considerable burden on health and social care systems. The aim of our study was to estimate the trends in functional dependency and project future care needs for older people in China. We analysed data from the China Health and Retirement Longitudinal Study, a nationally representative survey of a cohort of Chinese people (aged ≥45 years) from 150 counties or districts and 450 villages or urban communities across 28 provinces, who were selected by use of multistage stratified probability-proportionate-to-size sampling. The baseline survey was conducted in 2011 and follow-up surveys were conducted in 2013, 2015, 2018, and 2020. We excluded people younger than 60 years or people who had missing variables on dependency in the five follow-up interviews. Three dependency levels were determined on the basis of activities of daily living (ADLs) and instrumental activities of daily living (IADLs): any ADL items (level 1 dependency); any ADL items or difficulty cooking, shopping, or taking medications (level 2 dependency); and difficulty in any ADL or IADL items (level 3 dependency). The dependency rates were extrapolated to derive the number of people older than 60 years with dependency in China from 2011 to 2020. We used a regression model to project future changes and forecast the size of the older population with dependency between 2021 and 2030. A total of 89 031 individuals across five waves completed the surveys, of whom 46 619 were eligible for inclusion. The prevalence of level 1 dependency among older Chinese adults declined from 11·7% (95% CI 10·6-12·8) in 2011 to 8·1% (7·5-8·7) in 2020. Level 2 and level 3 dependency also declined. The total number of older people requiring care in 2020 was 20·61 million (95% CI 19·01-22·20) with level 1 dependency, 36·33 million (34·27-38·40) with level 2 dependency, and 45·30 million (43·02-47·59) with level 3 dependency. Improved education, housing, and access to health care was associated with 41·84% of the decline in level 3 dependency prevalence between 2011 and 2020. By 2030, the projected dependency rates could decline to 8·04% for level 1 dependency, 13·28% for level 2 dependency, and 16·05% for level 3 dependency. Nonetheless, the cohort size will grow, resulting in more older Chinese people who need care (29·71 million [27·07-32·36] in level 1, 49·07 million [45·98-52·16] in level 2, and 59·32 million [55·94-62·70] in level 3) in 2030. By 2030, we estimate that 14·02 million more older Chinese people will need care than in 2020. Rapid ageing of the population could offset the decline in dependency and result in a substantial increase in the population with complex care needs. Promoting healthy ageing and investing in an age-friendly environment are important in reducing care burdens in China. National Institute on Aging, Natural Science Foundation of China, China Medical Board. For the Chinese translation of the abstract see Supplementary Materials section.

The relationship between physical exercise and subjective well-being in Chinese older people: The mediating role of the sense of meaning in life and self-esteem.

This study explores the relationship between physical exercise and older people's subjective well-being and the mediating role of a sense of meaning in life and self-esteem by using a structural equation modeling (SEM) approach, in order to provide some suggestions for improving older people's subjective well-being. In this study, a cross-sectional survey was conducted offline using a simple random method of collection, and the Physical Activity Rating Scale (PARS-3), the Subjective Well-being Scale (SWB), the Meaningfulness of Life Scale (MLQ), and the Self-Esteem Scale (SES) were applied to 419 older adults who participated in physical exercise from Chengdu (Qingyang District, Wuhou District, and Chenghua District), Sichuan Province, China, with the voluntary participation of the subjects. 197 males and 222 females, with a mean age of 72.49 (SD = 1.57). The study used SPSS 25.0 and Process 3.5 plug-in for statistical processing of the data, Cronbach's alpha coefficient for intra-variate consistency testing, Harman's one-way test for common method bias testing and multiple covariance diagnosis, and finally regression analysis and Bootstrap sampling test for significance of mediating effects. Physical exercise was able to have a positive effect on the level of subjective well-being of older adults (β = 0.0305; 95% confidence interval (CI): 0.0226, 0.0384; p < 0.05), and a mediation analysis of sense of meaning in life and self-esteem revealed that they were able to have independent and chained mediation effects, with four pathways: first, physical exercise directly affected subjective well-being of older adults (β = 0.0149; 95% CI: 0.0072, 0.0226; p < 0.05; β = 0.0149; 95% CI: 0.0072, 0.0226; p < 0.05); secondly, sense of meaning in life mediated the relationship between physical exercise and subjective well-being of older adults (β = 0.0075; 95% CI: 0.0041, 0.0115; p < 0.05); thirdly, self-esteem mediated the relationship between physical exercise and subjective well-being of older adults (β = 0.0075; 95% CI: 0.0041, 0.0115; p < 0.05). (β = 0.0061; 95% CI: 0.0034, 0.0094; p < 0.05); fourth, a chain mediating effect of sense of meaning in life and self-esteem in the relationship between physical exercise and subjective well-being in older adults (β = 0.0021; 95% CI: 0.0010, 0.0035; p < 0.05). As indicated by the results, physical exercise can enhance the subjective well-being of older adults through sense of meaning in life and self-esteem, therefore, in order to be able to enhance the subjective well-being of older adults, enhancing the level of sense of meaning in life and self-esteem of older adults is an effective means.

Subjective poverty, mental health, and mortality among Chinese older people: a prospective cohort study from 2008 to 2018.

The associations of duration of subjective poverty and poverty status with mortality among older people remains inconclusive, and the underlying mechanisms of mental health on them are rarely discussed in population-based epidemiological studies. We used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2008-2018). The Cox regression model was used to estimate hazard ratio (HR) and 95% confidence intervals (CIs) for mortality. Mediation analysis was applied to assess the effect of mental health. When compared with participants without subjective poverty, those who reported subjective poverty at one time point (2008 or 2011) or two time points (2008 and 2011) had a higher risk of death, with multivariable-adjusted HR (95% CIs) of 1.08 (1.00-1.16) and 1.22 (1.06-1.39), respectively. For poverty status, the multivariable-adjusted HR (95% CIs) of mortality were 0.81 (0.66-0.98) for "just objective poverty" and 0.78 (0.62-0.98) for "neither subjective nor objective poverty" compared with participants who reported "just subjective poverty", while there was no statistically significant association between "poverty subjectively and objectively" and mortality (HR = 0.88, 95% CI 0.72-1.07). Besides, we found that the proportion mediated by mental health was 26.6%, and age was a significant effect modifier. Subjective poverty may be associated with a higher risk of death among Chinese older people. This study showed that promoting mental health alone may not substantially reduce socioeconomic inequality in health. Further explorations of measures to tackle the social determinants of health are still needed.

Mediating effects of resilience on frailty and depression among older Chinese people living with HIV/AIDS: a cross-sectional study in Hunan.

Little is known about the ambiguous and complex relationship between frailty, resilience and depression in older adults living with HIV (OALHIV). Thus, the current study aimed to further clarify the relationship, as well as to investigate whether resilience plays a mediating role and to quantify the mediating effect. A cross-sectional study was conducted on patients who were aged ≥50 y with HIV/AIDS at the First Hospital of Changsha City from June to August 2019. The sociodemographic characteristics of participants, depression, resilience and frailty were evaluated by the self-developed questionnaire, the 10-item Center for Epidemiological Studies Depression Scale, the 10-item Connor-Davidson Resilience Scale and Tilburg Frailty Indicator, respectively. SPSS macro model 4 was used to analyse the mediation of resilience between frailty and depression. A total of 175 OALHIV (120 males and 55 females) were investigated in this study. The prevalence of frailty and depression was 31.4% and 30.9%, respectively. Additionally, the mediation analysis model showed that frailty could contribute to depression directly, and that it also affected depression through resilience, suggesting that resilience partially mediated the relationship between frailty and depression among OALHIV. Our findings suggest that resilience appears to be a protective factor for depression. Effective and targeted intervention on resilience is available and is crucial to improve the life quality of OALHIV.

A Design Framework of Medical Wayfinding Signs for the Elderly: Based on the Situational Cognitive Commonness.

Older people in China have a poor understanding of hospital signage. To address this problem, in this study, we combined the theories of situated cognition and cognitive commonness in order to introduce the three main factors that affect the generation of situational cognitive commonness: composition of the situation, familiarity, and concreteness. We used these theories to construct a methodological framework for the design of geriatric hospital wayfinding signs that were based on situational cognitive commonness. The design of nine healthcare signs for Chinese national standards were used as examples in the study. First, users who were familiar with medical scenarios were asked to draw concrete cognitive conception graphics for the purposes of individual wayfinding targets from both physical and social situations. Next, we coded and grouped the generated graphics based on their situational features in order to extract groups of representative common graphics. Finally, we reorganized the common graphics and developed concrete designs, which were tested by the judgment test. The wayfinding signs designed according to the methodological framework of this study effectively improved the understanding of hospital signage among older Chinese people. This study took geriatric hospital wayfinding signs as the examples to provide a feasible theoretical basis and research reference for symbol design.

Social isolation, socioeconomic status, and development of functional impairments in Chinese older adults aged 70years and over: a cohort study.

BackgroundSocial isolation in older people has been increasingly regarded as a public health issue in the face of rapid population ageing. It is not clear whether social isolation mediates the relationship between socioeconomic status and functional impairment.MethodsWe used data from a cohort of Chinese older people aged 70 or older living in community (n = 1590). Socioeconomic status (SES) was operationalised as highest education attainment, monthly income at baseline and longest held occupation in lifetime. Functional abilities were measured using Barthel’s Index for activities of daily living (ADL) measured at 18 and 36 months of follow-up, from which impairment was defined as score ≤ 19. Social isolation was measured by six attributes, such as marital status, living alone, and social contact with others. A score of ≥ 3 was defined as being in social isolation. Causal mediation analysis using natural effect models was used to assess mediation by social isolation.ResultsWe found that lower monthly income at baseline was related to higher risk of social isolation [relative risk comparing lowest to highest income (RR) = 1.52, 95% confidence interval (95% CI) 1.01–2.28]. Social gradient of ADL impairment was not clearly present. The evidence for the mediating role of social isolation was not clear.ConclusionsOlder people with low SES, particularly those with lower income, were at greater risk of social isolation. Policymakers should strive to improve the current community services and pension scheme to mitigate the situation of social isolation in older people in Hong Kong.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40520-022-02259-w.

Older people's intention to use medical apps during the COVID-19 pandemic in China: an application of the Unified Theory of Acceptance and Use of Technology (UTAUT) model and the Technology of Acceptance Model (TAM)

Abstract Previous studies on older adults' intention to adopt medical apps during irregular circumstances like the COVID-19 outbreak are still in its infancy. In order to fill this knowledge gap, we developed a theoretical framework based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model and the Technology of Acceptance Model (TAM) to explain Chinese older people's willingness to use medical apps during the COVID-19 pandemic. We collected 1,318 online questionnaires during the first wave of the pandemic in China in early 2020. We employed structural equation modelling to analyse the data, and the results show that (a) attitudes towards using apps influence older people's intention to use apps significantly; (b) only two factors, perceived usefulness and facilitating conditions, which were proposed in the UTAUT model, significantly predicted the older adults' intention to use apps, but not others; and (c) perceived usefulness, perceived ease of use, subjective norm and facilitating conditions all significantly impact attitudes towards using apps. Further mediation analysis found that attitudes towards using apps significantly mediated the paths suggested in the original UTAUT model. Due to the online survey method we used, older people who do not use the internet were excluded from our sampling process. However, our timely research contributes to the existing literature by showcasing older people's usage of eHealth technology in public health emergencies. It also builds on the broader discussions on technology use by combining the TAM and the UTAUT model, highlighting the vital role of people's attitude towards using technology in shaping their intention to use it.

Groningen Frailty Indicator–Chinese (GFI-C) for pre-frailty and frailty assessment among older people living in communities: psychometric properties and diagnostic accuracy

BackgroundThe early identification of pre-frailty and frailty among older people is a global priority because of the increasing incidence of frailty and associated adverse health outcomes. This study aimed to validate the Groningen Frailty Indicator-Chinese (GFI-C), a widely used screening instrument, and determine the optimal cut-off value in Chinese communities to facilitate pre-frailty and frailty screening.MethodsThis methodological study employed a cross-sectional and correlational design to examine the psychometric properties of GFI-C, namely, internal consistency, stability, and concurrent and construct validities. The appropriate cut-off values for pre-frailty and frailty screening in the receiver-operating characteristic (ROC) curve were determined through sensitivity and specificity analysis.ResultsA total of 350 community older people had been assessed and interviewed by a nurse. The GFI-C showed satisfactory internal consistency (Cronbach’s α = 0.87) and two-week test-retest reliability (intra-class correlation coefficient = 0.87). Concurrent validity (r = 0.76, p < 0.001) showed a moderate correlation with Fried’s frailty phenotype. The known-groups method, hypothesis testing and confirmatory factory analysis (three-factor model; χ2/df = 2.87, TLI = 0.92, CFI = 0.93, GFI = 0.92, RMR = 0.014; RMSEA = 0.073) were suitable for the establishment of construct validity. Based on the ROC and Youden’s index, the optimal cut-off GFI-C values were 2 (sensitivity, 71.5%; specificity, 84.7%) for pre-frailty and 3 for frailty (sensitivity, 88.2%; specificity, 79.6%).ConclusionsThe result indicated that GFI-C is a reliable and valid instrument for pre-frailty and frailty screening among older Chinese people in communities. For optimal diagnostic accuracy, the cut-off values of 3 for frailty and 2 for pre-frailty are recommended.

Association of cumulative blood pressure with cardiovascular mortality in Chinese older people: A longitudinal prospective study.

Long-term cumulative blood pressure (BP) was associated with cardiovascular mortality in middle-aged to older people. Whether cumulative BP was associated with cardiovascular mortality is uncertain in Chinese older people. Data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationwide, ongoing, prospective cohort study of community-dwelling Chinese older people. A total of 3361 older participants from the CLHLS study were included (men: 46.68%, age: ≥65years, median age: 78.00years [IQR: 71.0-86.00years]). Cumulative BP, including systolic BP (SBP), diastolic BP (DBP) and pulse pressure (PP), was determined by the area under the curve based on three measurements of BP (waves 2008, 2011, and 2014). The outcome was cardiovascular mortality, which was followed from wave 2014 to wave 2018. During a median follow-up period of 3.98years, 211 cardiovascular death were recorded. The higher cumulative SBP and PP tended to be positively linearly associated with an elevated risk of cardiovascular mortality. For each SD increment, the adjusted HRs of mortality risk was 1.28 (95% CI: 1.11-1.47; p=0.001) and 1.24 (95% CI, 1.09-1.43; p=0.002) for cumulative SBP and PP, respectively. While there was no association between cumulative DBP and cardiovascular mortality. In addition, multiple sensitivity analyses suggested robustness of the results. Our results indicate that cumulative SBP and PP were associated with cardiovascular mortality in Chinese older people; however, there was no such association between cumulative DBP and mortality. Therefore, control of long-term SBP and PP may be required in those people.

The Effect of Playing Gateball Sports on Older Chinese People's Wellbeing in the Context of Active Aging-Based Mediation of Social Capital.

Participation in gateball sports may improve the well-being of older individuals in the context of active aging. However, the mechanisms of the effect need a social viewpoint. A random sample of 337 valid data points was gathered from seven cities in the Chinese province of Hunan. Structural equation modeling, fuzzy set qualitative comparative analysis, and other techniques examined the standard structure and causal links between involvement in gateball sports, social capital, and elderly people’s well-being. According to structural equation modeling, playing gateball sports may improve elderly people’s well-being, and social capital may influence this link to some extent. The engagement in gateball sports and social capital work in concert to promote well-being, according to a qualitative comparative study of the fuzzy sets that identified four patterns of “A, B, C, and D” antecedent constructs that do so in elderly people.

A study on the impact of Internet use on depression among Chinese older people under the perspective of social participation

PurposeThis study aimed to evaluate the role of social participation in the relationship between internet use and depressive symptoms among Chinese older adults and investigate how the internet use interact with social participation to reduce the risk of depressive symptoms.MethodsBased on the survey from the China Health and Retirement Longitudinal Study (CHARLS) in 2018, we identified 4645 subjects and used the Ordinary Least Square method (OLS) and Propensity Score Matching method (PSM) to identify the association between Internet use and depression of older people, and further test how social participation played a role in the relationship.ResultsThe level of depression of older people was significantly reduced in those who using internet in China, and the effect was still robust under different identification methods. The mental health was improved when using internet because of the increase of social participation and social capital. Further, The positive effect was stronger especially in those who were female, living in rural areas, has low education attainments and were 70–79 years old.ConclusionsThe popularity of internet use has a positive effect on the depressive symptoms of Chinese older adults. Effective measures were encouraged to improve the friendliness of internet for older people and promote the popularization of the Internet and older group, achieving the spiritual well-being of them in the Internet society.

Optimism and subjective well-being in nursing home older adults: The mediating roles of gratitude and social support

ObjectivesTo examine the level of subjective well-being (SWB) and the mediating roles of gratitude and social support in the relationship between optimism and SWB amongst older Chinese people in nursing homes. MethodsA total of 354 older adults in Chinese nursing homes completed the World Health Organization's well-being index, Life Orientation Test-Revised, Gratitude Questionnaire-Six-Item Form, and Multidimensional Scale of Perceived Social Support. Structural equation modeling was used to evaluate the relationships between optimism, gratitude, social support and SWB. ResultsThe mean SWB score of the older people was (63.14 ±15.31), with 21.0% of subjects reporting low SWB. Gratitude and social support in serial partially mediated the relationship of optimism with SWB (total indirect effect: Standardized β = 0.157, 95% CI [0.109,0.216], p<0.001). ConclusionThese findings provide good evidence for the inter-relationship mechanism amongst the protective factors of SWB, suggesting the need to prioritize positive psychological nursing interventions to promote SWB in older people in residential care.

Association between frailty and cognitive function in older Chinese people: A moderated mediation of social relationships and depressive symptoms

BackgroundTo date, few studies have focused on examining either the direct or indirect effect of physical frailty on cognitive impairment. This study aimed to investigate the moderating effects of social relationships, including their individual components in the role of depressive symptoms as a mediator between frailty and cognitive impairment. MethodsThis study included a total of 7525 Chinese older adults from the 2017–2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Mediation analyses and moderated mediation effect analysis fully adjusted for all potential confounding factors were conducted. ResultsSignificant correlations were found between frailty, depression, social relationships, and cognitive function. Depression partially mediated the association of frailty with cognitive function [B = −0.198; 95 % confidence interval (CI): (−0.258, −0.143)]. Social relationships moderated the effect of frailty on cognitive function through both path b (depression–cognitive function) [B = 0.137; 95 % CI: (0.045, 0.230)], and path c’ (frailty–cognitive function) [B = 0.870; 95 % CI: (0.562, 1.178)]. In addition, social activities and social networks moderated both the direct and indirect effect of the moderated mediation model. Social support only moderated the direct effect. LimitationsThe cross-sectional design of this study precludes any conclusion from the results as to the causality of cognitive impairment. ConclusionsSocial relationships moderated both the direct and indirect effects of depressive symptoms on the association between frailty and cognitive impairment. The findings suggest that interventions, such as paying attention to the mental health of old people and improving the quality of social relationships, may help break the link between frailty and cognitive impairment.

Long-term tea consumption reduces the risk of frailty in older Chinese people: Result from a 6-year longitudinal study.

BackgroundVast accumulative evidence suggests that the consumption of tea and its components have various potential health benefits. This study used a longitudinal study to examine the causality between tea consumption and frailty in older Chinese people.MethodsThis study employed the longitudinal data from 2008 to 2014 of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which were systematically collected through face-to-face interviews. Two thousand four hundred and seventy three participants completed six-follow-up surveys in 2014 and were analyzed in this study. The frailty index recommended by Searle and co-authors, including 44 health deficits, was used. A Generalized Estimating Equation (GEE) was applied to determine the risk ratio (RR) with a 95% confidence interval (CI) for frailty, and further subgroup analyses were conducted to investigate whether the risk differed stratified by age, sex, and socioeconomic status. Additionally, the interaction between tea consumption with sex and frailty was tested.ResultsOf the 2,473 participants, 14.1% were consistent daily tea drinkers, and 22.6% reported frailty at the 6-year follow-up. Compared to non-tea drinkers, consistent daily tea drinkers reported a significantly lower ratio of having frailty [risk ratio (RR) = 0.54, 95% confidence interval (CI): 0.38–0.78], adjusting for sociodemographic characteristics, health behavior, socioeconomic status, and chronic illnesses. In further subgroup analyses, consistent daily tea consumption significantly reduced the risk of frailty for males (RR = 0.53, 95% CI: 0.32–0.87) but not females (RR = 0.65, 95% CI: 0.37–1.12); in the young (RR = 0.40, 95% CI: 0.22–0.74) but not in the oldest (aged ≥ 80) (RR = 0.66, 95% CI: 0.40–1.06); informal education (RR = 0.48, 95% CI: 0.28–0.84) but not formal education (RR = 0.62, 95% CI: 0.37–1.03); financial dependence (RR = 0.42, 95% CI: 0.25–0.71) but not financial independence (RR = 0.71, 95% CI: 0.41–1.23). Additionally, females showed a lower tea-mediated risk of frailty in occasional tea consumers (RR = 0.51, 95% CI: 0.29–0.89) and inconsistent tea drinkers (RR = 0.58, 95% CI: 0.37–0.93).ConclusionsHabitual tea consumption can reduce the risk of frailty in older Chinese, and the benefit varied by age, sex, education, and financial support.

Subjective Social Status, Area Deprivation, and Gender Differences in Health among Chinese Older People.

This study examined the gender differences in the main and interactive effects of subjective social status and area deprivation on health among older adults in Hong Kong. Data for this study came from the baseline of MrOs and MsOs studies, including 4000 Chinese men and women ≥ 65 in Hong Kong. Subjective social status was assessed using the MacArthur Scale of subjective social status scale. Our results reaffirm that subjective social status is an independent indicator of health after adjusting for objective SES measures (e.g., education and income). Perceived rank on the community ladder was more closely related to health among older people than was the society ladder, particularly for women. Although area-level social deprivation was not significantly associated with the health of older people, it may moderate the effect of subjective social status on health. Women with a lower perceived status in the community were more likely to experience depressive symptoms but better grip strength when living in more deprived neighborhoods. The findings suggested that subjective social status provides important information for the physical and mental health of the older population. Policymakers may implement interventions to enhance the subjective social status of older adults. Given the greater contribution of relative status in the community to the health of women, these policies and interventions should target to improve women’s perceived status in the community.

Determining the association between different living arrangements and depressive symptoms among over-65-year-old people: The moderating role of outdoor activities.

BackgroundChina is presently facing the challenge of meeting enormous health demands because of its rapidly aging society. Enrolling older persons in eldercare institutions is a helpful alternative for relieving family caregivers and promoting healthy aging. However, changes in the living environment may negatively affect the mental health of the elderly.ObjectiveTo explore the association between different living arrangements and depressive symptoms among over-65-year-old people in China and the moderating role of outdoor activities.MethodThe 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) used a mixed sampling method to collect the health and demographic information of 15,874 older adults over 65 years from 23 provinces in China. After considering this study's inclusion and exclusion criteria, the final sample comprised 12,200 participants. The participants' risk of depressive symptoms was assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). The potential association between the two elements was tested using a regression model.ResultThis study's findings suggested a significant relationship between depressive symptoms and living arrangements (P < 0.001). Participants living alone and those living in eldercare institutions had 1.26-times (95%CI: 1.10–1.44) and 1.39-times (95%CI: 1.09–1.77) higher risks of depressive symptoms, respectively, than those living with household members. Outdoor activities play a moderating role between different living arrangements and depressive symptoms. Among participants who engaged in outdoor activities, no significant difference was observed in the risk of depressive symptoms between those living in eldercare institutions and those living with household members (adjusted odds ratio = 1.15, 95%CI = 0.81–1.64, P = 0.426).ConclusionThe high risk of depressive symptoms among older Chinese people living alone or in eldercare institutions requires considerable attention. The evidence from this study suggests that older people living alone and those living in eldercare institutions should regularly engage in appropriate outdoor activities.