Chinese Older Persons Research Articles

Effects of falls on self-rated health and anxiety in Chinese older persons with chronic multimorbidity : moderating role of psychological resilience

IntroductionThis study investigated the effects of falls on self-rated health and anxiety symptoms and the moderating role of psychological resilience in Chinese older persons with chronic multimorbidity.MethodsData were taken from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used a linear regression model to evaluate the associations among falls and self-rated health and anxiety symptoms, the moderating role of psychological resilience was verified by moderation analysis, and we also used a replacement model to test robustness. Finally, the results of the study were further verified via heterogeneity analysis through subgroup regression.ResultsA total of 2933 people aged 60 years or older with chronic multimorbidity were included in our study. The linear regression results revealed that falls were significantly negatively correlated with the self-rated health symptoms of older Chinese people with chronic multimorbidity (β = -0.1703, p < 0.01) and significantly positively correlated with anxiety symptoms (β = 0.5590, p < 0.01). Among the moderating effects, we found that psychological resilience played a moderating role between falls and anxiety symptoms (β = − 0.151 [-0.217, -0.084], p < 0.01). Finally, we found heterogeneity in the study results by sex, residence and number of chronic diseases.ConclusionFalls are associated with poorer self-rated health and higher anxiety levels among older persons with chronic multimorbidity in China. High levels of psychological resilience have a moderating effect on the development of anxiety symptoms.

Association between sleep quality and living environment among Chinese older persons: a cross-sectional study.

Sleep quality significantly affects the quality of life of older persons. Therefore, this study explored the relationship between sleep quality and living environment of older persons in China to provide a theoretical basis for therapies to alleviate sleep disorders in older persons. A total of 6211 subjects > 60years of age in Anhui Province, China, were evaluated using the Pittsburgh Sleep Quality Index and a self-reported questionnaire. Multivariate logistic regression analysis revealed that living alone (OR = 1.26, 95% CI 1.09-1.46) and living in a rural area (OR = 1.19, 95% CI 1.06-1.34) were significantly associated with a high incidence of sleep disorders in older persons. Living near a park or foot paths suitable for exercise or walking was significantly associated with a lower incidence of sleep disorders in older persons (OR = 0.87, 95% CI 0.77-0.96). Individual factors such as female sex (OR = 1.30, 95% CI 1.14-1.48) and depression (OR = 2.80, 95% CI 2.47-3.19) were also associated with sleep quality in older persons. These data indicate a correlation exists between living environment and sleep quality.

Association between specific social activities and depressive symptoms among older adults: A study of urban-rural differences in China.

Engaging in social activities can help older persons with their depressed symptoms. Few studies, however, have looked into the connection between social interactions and depressed symptoms in Chinese older persons. The aim of this study was to investigate differences in older Chinese individuals' social activity involvement and depressive symptoms across urban and rural settings. A cross-sectional investigation using information from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which was limited to older individuals aged 60 and over. Generalized linear models were constructed to assess the effects of participants' characteristics and specific social activities on CES-D scores. The association between specific social activities and depressed symptoms was investigated using multivariate logistic regression analysis. In this study, it was discovered that older individuals had a prevalence of depressed symptoms of 36.2%, with rural older adults having a greater prevalence of depressive symptoms (39.7%) than urban older adults (30.9%). Our results showed that for urban respondents, providing help to others (not regularly. OR = 0.753, 95% CI: 0.579-0.980, P = 0.035), going to a sport (not regularly. OR = 0.685, 95% CI: 0.508-0.924, P = 0.013), and using the Internet (not regular. OR = 0.613, 95% CI: 0.477-0.789, P < 0.001; almost weekly. OR = 0.196, 95% CI: 0.060-0.645, P = 0.007) were all significantly and negatively associated with depressive symptoms, while for rural respondents, interacting with friends (not regularly. OR = 1.205, 95% CI: 1.028-01.412, P = 0.021) and using the Internet (not regularly. OR = 0.441, 95% CI: 0.278-0.698, P < 0.001) were significantly and negatively associated with depressive symptoms. According to our research, there is a cross-sectional relationship between participating in a specific social activity and depressed symptoms in Chinese older adults, and this relationship varies across urban and rural older adults. This suggests that taking part in specific social activities may be crucial for reducing depression symptoms in older persons, developing more focused interventions that might support healthy aging, and offering a guide for policymakers and activists working to improve the mental health of seniors.

Effect of Receiving Financial Support from Adult Children on Depression among Older Persons and the Mediating Role of Social Participation.

Older persons are vulnerable to depression SFduring the ageing process. Financial resources and social participation are expected to have an impact on depressive symptoms. This study investigated the relationship between financial support from children and depression among Chinese older persons, as well as the mediating effect of social participation in this relationship. Data from 7163 participants aged 60 and above were extracted from wave 2015 and 2018 of the China Health and Retirement Longitudinal Survey (CHARLS). A multivariate regression analysis was performed on both cross-sectional data and two-wave longitudinal data to test our hypotheses. The results revealed that financial support from children was negatively associated with depressive symptoms in both the short-term and the long-term. In addition, this relationship was partially mediated by social participation in the short-term association and fully mediated by social participation in the long-term, where financial support was positively related to social participation, and social participation was negatively associated with depressive symptoms. This study offers an in-depth insight into the relationship between financial support from children and depression among Chinese older persons. Policies and initiatives to stimulate social participation should be promoted to improve older persons’ mental health.

What factors influence older people’s intention to enrol in nursing homes? A cross-sectional observational study in Shanghai, China

ObjectivesGiven the increasing need of long-term care and the low occupancy rate of nursing homes in Shanghai, this study attempts to explore what factors influence older people’s intention to enrol...

Housing, health and wellbeing of older persons in China and India

Background This paper presents an analysis of the wellbeing of older persons in China and India, with a focus on the linkages between different features of housing and life satisfaction and self-rated health as elements of wellbeing. The motivation of the paper is drawn from the fact that housing is a critical aspect of living conditions in later life. Older persons experience decreasing functional capacities and require greater support in their times of rising frailty and vulnerability. Additionally, a large majority of Indian and Chinese older persons live in their own homes, without the obligation of an outstanding mortgage, and they are more likely to have emotional, subjective attachment with their homes than younger persons. Housing conditions can contribute to wellbeing both as a stressor and as an enabling factor. Therefore, one of the aims of this study is to assess in what way, positive or negative, housing conditions influence wellbeing of older persons in the context of India and China, two most populous countries in the world with the fastest ageing populations in the world. In 2015, persons aged 60 and over living in those two countries constitute 36% of worldwide population of 60+ and this share will grow to 39% in 2030. This paper also examines whether housing influenced one or both commonly used measures of older people’s wellbeing, namely life satisfaction and self-rated health. We also examine which housing features have the highest influence on subjective wellbeing. Method This paper uses micro data derived from the first wave of the WHO Study on Global AGEing and Adult Health ‘SAGE’ carried out in India and China during 2007. For the assessment of housing conditions, the paper constructs a composite index of housing quality (QoH) drawing from data on a number of housing attributes available in the SAGE survey. The relationship between housing conditions and wellbeing indicators is then examined using multivariate modelling methods (viz. ordered probit regression). The use of interaction terms allowed highlighting the differential impact of varying housing attributes for persons. Results and discussion Housing conditions vary significantly between the two countries analysed. Older population in China experienced much better conditions than those observed for India. The key findings confirmed the importance of housing conditions for the subjective wellbeing indicators of older persons. However, surprisingly, this relationship is stronger in the case of the life satisfaction measure, and rather limited for the self-rated health measure, leading to conclusion that housing features do not have influence on all aspects of wellbeing. Additionally, notable differences are found in these relationships between India and China, which implies that perception of housing and its importance may be dependent on other external public services as well as on the context of culture and environment.

Telomere length is associated with decline in grip strength in older persons aged 65years and over.

Telomere length (TL) attrition is associated with chronic diseases characterized by chronic inflammatory states. Inflammatory cytokines may play a role in sarcopenia. This study examines the association between TL and the diagnosis of sarcopenia based on appendicular skeletal mass index (ASMI), grip strength, walking speed, and chair stand in a prospective study over 5years of 976 men and 1,030 women aged 65years and over living in the community. TL in leukocytes was measured using the quantitative PCR method. TL was divided into quartiles, and analysis of covariance (ANCOVA) was adopted to examine its association with components of sarcopenia, adjusting for age, education, body mass index, smoking, physical activity, and probable dementia. In both men and women, the percentage decline in grip strength over the 5-year period of follow-up was slower in those in the highest quartile of TL than those in the lower quartiles (multivariate-adjusted p < 0.05). No association between TL and the diagnosis of sarcopenia, ASMI, walking speed, or chair stand was observed. In conclusion, longer TL was associated with slower decline in grip strength in Chinese older persons.

Family and social aspects associated with depression among older persons in a Chinese context

This study aims to explore the factors associated with depression among older persons in Macau, in relation to family and social aspects. Depression among community-dwelling older persons in Macau has been shown to be present at high rates. In Chinese culture, depression leads to social stigmatisation, suggesting a need to better understand depression as a sociocultural phenomenon. A mixed methods study was undertaken to identify the key influences on depression among Chinese older persons in Macau. Quantitative (standardised tests) and qualitative (collection of narratives) data were collected from 31 purposively selected participants, all community-dwelling older persons with depression. Depression was common among the participants. The paper reports on the family and social aspects, one of the findings of the study. Informants readily described their thoughts and judgements of themselves in graphic language. As they explored their life stories, family and social aspects emerged as significant influences that associated with depression. In a society and culture that relies on and values filial support, experiences of being widowed, having poor family support and weak social networks appeared to compound and exacerbate depression. These findings highlight that filial support, valued in Chinese culture, is seriously strained by the realities of contemporary society. Yet current government policies rely on and confirm the role of family support. Findings from this study suggest a need for such policies to be reviewed to address the realities of family and social support. The findings have several implications for clinical practice. Firstly, the cultural context of Chinese older persons should be considered and emphasised in nursing practice. Secondly, the root of depression among Chinese older persons is seen to lie in their social, family, cultural and day-to-day living issues.

NEDD9 Gene Polymorphism Influences the Risk of Alzheimer Disease and Cognitive Function in Chinese Older Persons

Neural precursor cell expressed, developmentally down-regulated (NEDD9) gene was a new candidate risk gene for Alzheimer disease (AD). The CC genotype of a single nucleotide polymorphism rs760678 within this gene was associated with increasing risk of AD in a large study with white population. Our study aimed to replicate the initial report in Chinese population and explore its effect on cognitive performance. A total of 262 patients with AD, 293 patients with mild cognitive impairment, and 434 cognitive intact controls were recruited in the study. The result showed that G allele had a greater risk of AD (χ for trend test=5.61, df 1, P=0.018). The effects were mainly observed among Apolipoprotein E (APOE) ε4 noncarriers (χ for trend test=4.30, df 1, P=0.038). After adjustment of sex, age, education year, and APOE ε4 status by logistic regression, significant association between NEDD9 GG genotype and AD remained [OR=2.04, 95% confidence interval (CI)=1.02-4.08, P=0.044]. The scores of Cantonese version of the Mini-mental State Examination and Alzheimer's Disease Assessment Subscale-Cognitive subscale were associated with N polymorphism after adjusting for sex, age, education year, and ApoE ε4 status (Linear regression model, P<0.05). Our study identified rs760678 within NEDD9 gene in association with the risk of AD and cognitive performance in Chinese older persons. The fact that different alleles accounted for the risk in different population might suggest that there were ethnic group specific haplotypes that were primarily responsible for the predisposition.

Methodological Challenges to Research Among Chinese

The article offers an example of using a mixed methods design that was implemented when investigating depression among Chinese older persons in Macau. A challenge in designing the study was that in light of literature on Chinese culture and somatization theory, the acceptability of the methodology was uncertain. Participants ( n = 31) were purposively selected and quantitative data were collected using multiple standardized measures. Questions raised by the quantitative approach were then reflected through in-depth interviews. Four dominant categories emerged: (a) negative thinking, (b) physical limitations and complaints, (c) present living conditions and social support, and (d) the lives participants have lived. There was a high level of congruence between quantitative scores and narratives. The research approach was acceptable to the participants, and the findings contributed to an understanding of depression and therapeutic interventions for that population within Chinese culture.

Could hypothetical scenarios enhance understanding on decision for life-sustaining treatment in non-demented Chinese older persons?

Background: With increasing longevity, there is an increasing need for medical professionals to face situations in which explanation for decision on life-sustaining treatment (LST) would be required. Objectives: As advance decision making for LST in case of severe medical illness may be unfamiliar for most of the Chinese elders, we aim to explore if procedures adopted to enhance the exposure to the issue concerned would bring about improvement in knowledge toward decision for LST. Method: This was a cross-sectional study. The design was divided into three sections: (i) a pre-scenario knowledge assessment, (ii) scenario exposure (relating issues of LST using case vignettes), and (iii) a post-scenario assessment. The pre- and post-scenario assessment comprises 10 questions, exploring the understanding toward basic issues related to LST. The scenario exposure comprises two hypothetical case vignettes describing situations demanding decisions for LST. The knowledge level toward LST was assessed and compared before and after the presentation of the two vignettes. Results: One-hundred community dwelling older persons (aged over 60 years) were recruited. The scenario exposure improved the knowledge level of participants (paired samples t-test, p < 0.05). Participants who were younger and better educated were more likely to perform better in the knowledge test (bivariate correlation and logistic regression, p < 0.05). Conclusions: The results demonstrated that hypothetical scenarios may help to enhance and facilitate the understanding of LST. The study should be carried forward to explore the applicability of enhancement procedure to facilitate the decision making for advance directives and LST in the older community.

Depression and progression of cognitive function in Chinese older persons with mild cognitive impairment: A 2-year follow up

Mild Cognitive Impairment (MCI) is a high risk condition for subsequent development of clinical dementia. Depression and apathy are common neuropsychiatric symptoms in subjects with MCI. However, reports concerning the significance of depression and apathy in predicting further cognitive deterioration are inconsistent. This study examined the association between depression and apathy with change in cognitive function in a group of Chinese subjects with MCI. 309 Chinese subjects (aged 60 or over) with MCI were recruited from community volunteers and population survey. Amnestic MCI were diagnosed according to the Mayo Clinic criteria, non-amnestic MCI were subjects with global Clinical Dementia Rating (CDR) <1 and >=2 CDR subscale in non-memory domains rated as 0.5 or more. They were followed up at an average of 22(3.8) months. Outcome was defined as either improved (not satisfied criteria for MCI), stable (MCI at follow up) or demented. The presence of depression and apathy was rated by the Chinese version of Neuropsychiatric Inventory (NPI). At follow up, 146(47%) remained stable, 116(38%) improved and 47(15%) became demented. Subjects with depressed mood compared with those without depressed mood at the baseline (25% versus 14%), had a higher chance of deterioration to dementia (Pearson Chi square=3.9, p=0.049). MCI subjects with depressed mood experienced a greater drop in MMSE scores at follow up (drop in z scores = 0.7(1.4)) (t=2.2, p=0.027). The presence of apathy did not correlate significantly with deterioration to dementia at follow up. The findings suggested that depressed mood in Chinese subjects with MCI may be associated with higher chance for further cognitive deterioration. While depressed mood may be a concomitant manifestation of incipient dementia, its effects in accelerating functional decline should be further evaluated.

Cholesterol 24‐hydroxylase (CYP46A1) polymorphisms are associated with faster cognitive deterioration in Chinese older persons: a two‐year follow up study

We previously found that the polymorphisms of cholesterol 24-hydroxylase (CYP46A1) gene were associated with the risk of Alzheimer's disease (AD) in Chinese. However, its effect in predicting progression of cognitive decline remains unknown. Two hundred and eighty-one Chinese subjects (121 cognitively intact, 101 with mild cognitive impairment and 59 with mildly dementia) were followed-up with a mean (SD) duration of 25.22(5.74) months. Association between the CYP46A1 gene polymorphisms and 2-year cognitive deterioration were evaluated. At follow-up, 225(80.0%) subjects were reassessed. Sixty-three subjects were diagnosed as AD, 68 were MCI and 94 were cognitively intact. Among them, 158 had improved or remained stable while 67 deteriorated. The 'deteriorated' group was older than 'improved or stable' group (t-test, t = -2.87, p < 0.001). IVS2-150 polymorphism was associated with a higher risk of cognitive deterioration. Subjects with T allele were more likely to deteriorate compared with those without T allele (Pearson chi(2) = 8.98, df 2, p = 0.011). IVS3-128 CC genotype was higher in 'improved or stable' group (Likelihood Ratio = 6.55, df 2, p = 0.038), suggesting a protective role for this allele. The two other polymorphisms, IVS1-192 and IVS4-122, did not show any significant association with cognitive function. CYP46A1 gene may act to modulate the course of cognitive deterioration in late life.

Volunteering: impacts on the psychological well-being of Chinese older persons

Volunteering: impacts on the psychological well-being of Chinese older persons

Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong

In this report, the results of a household survey were used to examine the prevalence of very mild and mild dementia in Chinese older persons in Hong Kong. The study adopted a two-phase design. At Phase 1, 6100 subjects were screened using the Cantonese version of the Mini-mental State Examination (MMSE) and a short memory inventory. At Phase 2, 2073 subjects were screened positive and 737 were evaluated by psychiatrists. Clinical Dementia Rating (CDR) and cognitive assessment were used for diagnosis of dementia. Very mild dementia (VMD) was defined as a global CDR of 0.5, with memory and non-memory subscale scores of 0.5 or more. Mild dementia was classified for subjects with a CDR of 1. The overall prevalence of VMD and mild dementia for persons aged 70 years or above was 8.5% (95%CI: 7.4-9.6) and 8.9% (95%CI: 7.8-10.0) respectively. Among subjects with clinical dementia, 84.6% had mild (CDR1) dementia. Logistic regression analyses revealed that older age, lower educational level and significant cerebrovascular risk factors were risk factors for dementia, while regular physical exercise was a protective factor for dementia. A sizable proportion of community-living subjects suffered from milder forms of dementia. They represent a high risk for early intervention to reduce potential physical and psychiatric morbidity.

Withdrawal, apathy and lack of vigor in late life depression: Factorial validity and relationship to diagnosis

Withdrawal, apathy and lack of vigor (WAV) describe a pattern of lack of vitality and dropping of interests and activities in later life, which may or may not indicate depression. This study examines (a) whether the Geriatric Depression Scale (GDS) contains a measure of this symptom cluster, and if so, (b) whether the presence of WAV leads to more false positive predictions by the GDS. A total of 444 Chinese older persons responded to the GDS and the Mini-Mental State Examination (MMSE), and were independently assessed by psychiatrists for depression and other diagnoses. Confirmatory factor analysis showed that six WAV symptoms formed a distinct cluster on the GDS. WAV was positively correlated with age and MMSE but most other symptom clusters measured on the GDS were not. Nonetheless, the ROC curves were essentially the same, regardless of whether the WAV items were included or not. Further analysis revealed that the optimal cutoff for the GDS without WAV produced fewer false positives, but also missed more true cases, than the full scale. The extent to which false positives become an issue depends on the specific threshold chosen (which entails a tradeoff with sensitivity) rather than the presence of WAV items.

Characteristic profiles of instrumental activities of daily living in Chinese older persons with mild cognitive impairment.

Increasing evidence suggests that performance of the instrumental activities of daily living (IADL) can be impaired at the mild cognitive impairment (MCI) stage. Our study aimed at investigating the profiles of functional impairment in Chinese subjects with MCI. Subjects with MCI were categorized into single-domain amnestic MCI (a-MCI) (n=54) and multiple-domain amnestic MCI (md-MCI) (n=93) groups. Their functional scores of Disability Assessment of Dementia (DAD) were compared with those of cognitively normal elderly controls (NC) (n=78) and those with mild Alzheimer's disease (AD) (n=85). Subjects with md-MCI had intermediate performance in IADL between the NC and those with mild AD. Subjects with a-MCI had functional scores similar to those of normal controls. Age, education, and global cognitive test scores were not associated with functional scores in MCI subjects. Our results demonstrated that Chinese older persons with md-MCI had impairment in IADL, as compared to NC and subjects with a-MCI. This finding suggests that assessment of IADL should be incorporated in the clinical evaluation of MCI.

Efficacy of aromatherapy (Lavandula angustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: a cross‐over randomized trial

Agitated behaviours among persons with dementia are distressing to both patients and their caregivers. As pharmacological interventions may be limited by their potentially adverse effects, the use of complementary therapies for treatment of agitation has become more popular and aromatherapy is the fastest growing one. This study investigates the effectiveness of lavandula angustifolia (lavender) in treating agitated behaviours of demented people in Hong Kong. It was a cross-over randomized trial. Seventy Chinese older adults with dementia were recruited; half were randomly assigned to the active group (lavender inhalation) for three weeks and then switched to control group (sunflower inhalation) for another three weeks; the other half did the opposite. Clinical response was evaluated using the Chinese versions of Cohen-Mansfield Agitation Inventory (CCMAI) and Neuropsychiatric Inventory (CNPI). The mean CCMAI total scores decreased from 24.68 to 17.77(t=10.79, df=69, p<0.001). The CNPI scores changed from 63.17 (SD=17.81) to 58.77 (SD=16.74) (t=14.59, df=69, p<0.001) after receiving Treatment A (Lavandula Angustifolia). There were no period and sequential effects noted. In summary, lavender is effective as an adjunctive therapy in alleviating agitated behaviours in Chinese patients with dementia. In a patient population particularly vulnerable to side effects of psychotropic medications, aromatherapy using lavender may offer an alternative option.

Filial Piety and Psychological Well-Being in Well Older Chinese

Chinese older persons (N = 164) recruited from social centers responded to a survey instrument tapping the perceived filial behaviors of children (close vs not close), and the degree to which these behaviors matched personal expectations (filial discrepancy). Across all kinds of filial behaviors, providing attention when the parent was ill or distressed was perceived to be the least performed and was most discrepant with expectations. Whether the children were paying respect and whether they were providing care in times of illness or distress were most important in determining a sense of filial discrepancy in the parent. However, after functional limitations and financial strain were controlled for, only respect emerged as a consistent predictor of psychological well-being. These findings were similar whether the target was the closest child(ren) or less close children. There was no evidence that a child's overdoing his or her filial role was detrimental to the parents' well-being among the Chinese individuals in this study.

Social support and self-rated health revisited:: Is there a gender difference in later life?

This study examines the physical, behavioral, emotional and social determinants of self-rated health among Chinese older persons, and investigates if the effect of social support varies by gender. A representative sample of 1589 elderly community dwellers in Hong Kong were interviewed using a structured questionnaire. Gender difference in the effect of social support was tested by an interaction term, ‘gender×social support’, in a hierarchical regression analysis. The frequency of falling ill, the number of chronic illnesses, sleep quality, mobility and positive emotions were most important determinants of self-rated health. The effect of social support was completely redundant when these factors were taken into account. The interaction term ‘gender×social support’ was significant and indicated a stronger effect for women, but the effect size was negligible (adding only 0.3% to the explained variance). This suggests that the effect of social support by and large is gender free. These findings suggest a high degree of similarity in the determinants of self-rated health between Western and Chinese older populations.