Health Longitudinal Study Research Articles

Association of a novel nutritional index with cognitive impairment in middle-aged and elderly Chinese adults: a cross-sectional analysis from the China Health and Retirement Longitudinal Study

PurposeThe triglyceride-cholesterol-body weight index (TCBI), a novel and easily computable nutritional index, incorporates serum triglyceride (TG), total cholesterol (TC), and body weight (BW). This study explored the association between TCBI and cognitive impairment in middle-aged and elderly Chinese populations.Patients and methodsThis cross-sectional study employed data from the China Health and Retirement Longitudinal Study (CHARLS) baseline survey, including 7,145 participants. TCBI was calculated as TG (mg/dL) × TC (mg/dL) × BW (kg)/1,000. Cognitive function was assessed based on mental status and episodic memory, with a total score below 11 indicating cognitive impairment. The relationship between TCBI and cognitive impairment was examined using multiple logistic regression, smooth curve fitting, and subgroup analyses.ResultsAfter full adjustment, each 1-unit increase in log-transformed TCBI (Lg TCBI) was associated with a 29.7% reduction in cognitive impairment risk [odds ratio (OR) = 0.703, 95% confidence interval (CI): 0.529–0.933; p = 0.015]. When Lg TCBI was categorized into quartiles, the Q2, Q3, and Q4 groups exhibited a reduced risk of cognitive impairment by 19.9, 16.3, and 22.9%, respectively (p for trend = 0.043), compared to the Q1 group. Smooth curve fitting revealed a consistent decrease in cognitive impairment risk with higher Lg TCBI levels. Subgroup analysis indicated that the association was stronger among participants aged ≥60 years (OR = 0.655, 95% CI: 0.438–0.979), non-current drinkers (OR = 0.643, 95% CI: 0.451–0.917), and those who engaged in socializing (OR = 0.568, 95% CI: 0.371–0.871).ConclusionTCBI was significantly and negatively associated with cognitive impairment in Chinese middle-aged and elderly individuals, with the effect more pronounced in those aged ≥60 years, non-current drinkers, and socially active participants.

Association between remnant cholesterol and depression in middle-aged and older Chinese adults: a population-based cohort study

BackgroundThe focus on remnant cholesterol (RC) has intensified because of its association with various diseases. In this study, we investigated the association between RC and depression in middle-aged and older adults.MethodsThe study involved 7,305 participants from the 2015 and 2018 waves of the China Health and Retirement Longitudinal Study. Based on the 10-item Center for Epidemiological Studies Depression Scale (CESD-10), depression was indicated by scores ≥ 12. To assess the correlation between RC levels and depression, a logistic regression model that incorporated restricted cubic spline techniques was used.ResultsOf the study population, (mean age: 60.0 ± 9.5 years), 50.3% were female. From 2015 to 2018, the mean CESD-10 score increased from 6.31 ± 3.56 to 7.85 ± 5.23. Following adjustment for confounding factors, individuals in the higher RC level quartile exhibited a higher depression risk (Q3: odds ratio [OR]: 1.75, 95% confidence intervals [CI]: 1.29–2.39; Q4: OR: 2.68, 95% CI: 1.96–3.68, P for trend < 0.001), with a linear correlation between RC levels and depression (P for nonlinearity = 0.108). And the subgroup analysis yielded results consistent with the primary findings.ConclusionThis study revealed that in China, in middle-aged and older individuals, elevated RC levels were associated with a higher depression risk, suggesting RC is a promising target for depression prevention and treatment.

Profile of non-invasive physical health indicators associated with cognitive performance in Chinese older adults: evidence from the China Health and Retirement Longitudinal Study

BackgroundExisting studies have indicated the potential role of non-invasive physical health indicators as an early detector of mild cognitive impairment (MCI) in older adults. However, evidence is lacking in determining the appropriate physical health indicators for early screening of cognitive decline in each domain. Therefore, the current study aimed to establish a comprehensive physical health indicators profile in association with cognitive performance.MethodsThe present study utilized a three-year longitudinal cohort design, with data from the China Health and Retirement Longitudinal Study (CHARLS). 4,869 participants aged 60–97 years from CHARLS wave 2015 and 2018 who were cognitively and physically healthy were included in analysis. Physical functions (BMI, grip strength, blood pressure, balance tests, course walking time, repeated chair stands, and pulmonary function) were objectively measured by physical tasks. Cognitive performance domains (general cognition, episodic memory, executive function, verbal fluency, orientation, and language-and-praxis) were measured through standardised interviews and cognitive tasks. Multiple linear regression models were conducted to explore the association between physical health indicators and cognitive performance. Subgroup analysis was conducted to identify sex-specific factors.ResultsPulmonary function was identified as associated with all domains of cognitive performance in older adults (β ranged between 0.05 and 0.08). Right grip strength was also identified as an important factor associated with all cognitive domains except general cognition (β ranged between 0.04 and 0.12). Subgroup analysis revealed that the association between physical health indicators and cognitive performance is more pronounced in males than in females.ConclusionsA profile of non-invasive physical health indicators associated with cognitive performance was established, which warrants future incorporation of non-invasive physical health indicators in early risk screening systems for MCI, enabling timely intervention and prevention in older adults. Future studies can delve deeper into the mechanisms underlying this full-dimensional relationship between physical and cognitive domains.

Spousal Caregiving Types and Cognitive Trajectories Among Middle-Aged and Older Adults in China.

Objectives: This study investigates the longitudinal association between spousal caregiving types and cognitive trajectories among middle-aged and older Chinese adults, with a focus on gender differences. Method: Data from the China Health and Retirement Longitudinal Study (CHARLS) (2011-2018) were analyzed, covering 4568 couples aged 45 and above. Caregiving types were Activities of Daily Living (ADLs) caregiving, Instrumental Activities of Daily Living (IADLs) caregiving, and both ADLs/IADLs caregiving. Cognitive function was assessed using tests of memory, orientation, numeric ability, and visuospatial ability. Latent growth curve modeling was used to examine associations between caregiving types and cognitive trajectories. Results: Spouses who only provided IADLs caregiving had slower cognitive decline compared to those who did not provide caregiving, regardless of gender. However, those who provided ADLs caregiving had faster cognitive decline compared to non-caregivers, especially in women. Discussion: These findings highlight the importance of caregiving types as well as the gendered effects of caregiving on cognitive trajectories.

Air pollution and entrepreneurship

We investigate the effect of exposure to air pollution on entrepreneurship using panel data from the China Health and Retirement Longitudinal Study. To address endogeneity arising from location choices and omitted variable bias, we employ a two-way fixed effects model with an instrumental variable approach. We find that adults exposed to high levels of air pollution are unlikely to become employer entrepreneurs or have diversified household entrepreneurial activities. Specifically, a one unit increase in air pollution leads to a decrease in the propensity for entrepreneurship by 1.6 percentage points and a decrease in the likelihood of household entrepreneurial diversity by 2.1 percentage points. We find that risk propensity, networking consumption, self-efficacy, and the city's highly educated migrants are the main channels through which air pollution impacts entrepreneurship. Our findings also reveal that air pollution has a more significant negative impact on individuals with lower education levels compared to their more educated counterparts.

Longitudinal association between ADL disability and depression in middle-aged and elderly: national cohort study.

The decline in daily living abilities (ADL) among older adults is a notable predictor of depressive symptoms and the occurrence of disease. However, the effects of changes in ADL disability on the progression of depression have not been extensively studied. This research aims to examine the relationship between current ADL disability and depression in individuals aged 45 and older, as well as to explore how ADL disability influences the progression of depression in later life within China. This study analyzed 7-year data from the China Health and Retirement Longitudinal Study (CHARLS), involving 2,205 middle-aged and older adults. The ADL disability (BADL: such as eating, dressing; IADL: such as shopping, cooking) were obtained using ADL scale (scores 0-12, lower is better), and depression was measured by the Center for Epidemiologic Studies Depression Scale (scores 0-30, lower is better). The latent growth curve and cross-lagged models were analyzed after adjusting relevant control variables to study the effect of ADL disability on the progression of depression. The mean values for depression, basic activities of daily living (BADL), and instrumental activities of daily living (IADL) varied from 9.44 to 11.08, 6.45 to 6.81, and 6.86 to 7.29, respectively. The analysis indicated a potential association between depression and ADL. Specifically, the trajectory of BADL was a significant predictor of both initial depression (β = 0.138, 95%CI = 0.039-0.237) and its trajectory (β = 0.579, 95%CI = 0.403-0.754). Although IADL did not significantly predict the trajectory of depression, it was a significant predictor of initial depression (β = 0.471, 95%CI = 0.404-0.538). Additionally, cross-lag regression analysis provided further support for the relationship between depression and BADL disability. This research highlights how ADL disability can forecast future depression in Chinese middle-aged and older adults. The findings indicate a significant connection between ADL disability and both changes in and future instances of depression in this group. Therefore, it is crucial for the Chinese government to prioritize interventions that enhance physical functioning in the elderly, as such measures can effectively mitigate the worsening of depression and promote positive aging.

Social isolation and depressive symptoms among older adults with different functional status in China: A latent class analysis.

Social isolation is considered a risk factor for depression in older adults. Since there may be heterogeneity in the experience of social isolation, we aimed to investigate social isolation patterns and their association with depressive symptoms, for older adults with different functional status separately. This study used data from the fifth wave of the China Health and Retirement Longitudinal Study (CHARLS). A total of 8262 participants, defined as older adults aged 60 years and above, were included in the analysis, comprising 49.9 % (n = 4124) men and 50.1 % (n = 4138) women. Latent class analysis was conducted to identify social isolation patterns. Binary logistic regression was used to estimate the association between latent classes and depressive symptoms. Two distinct classes were identified in participants with functional dependency and three classes were identified in participants without functional dependency. The severely isolated with minimal family and social contact group was associated with a higher risk of depressive symptoms in both subgroups (participants with functional dependency: OR = 1.319, 95%CI: 1.032-1.686; participants without functional dependency: OR = 1.537, 95%CI: 1.209-1.953). No difference was found in the risk of depressive symptoms between the moderately isolated with family contact group and the low isolated group among participants without functional dependency (OR = 1.020, 95%CI: 0.83-1.252). Risk of depressive symptoms varies with different social isolation patterns among older people with different functional status.

Association between the triglyceride glucose-body mass index and memory-related diseases: A nationwide cohort study.

This study aimed to examine the longitudinal association between the triglyceride glucose-body mass index (TyG-BMI) index and memory-related diseases (MDs) among Chinese adults. Nationwide cohort study. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS), which is an ongoing nationally representative prospective cohort study. The exposure was the participants' TyG-BMI index at baseline from 2011 to 2012. MDs were acquired by self-reporting questions in 2018. Cox proportional hazards regression models were conducted to assess the relationship between the TyG-BMI index and MDs. During a median follow-up of 7.0 years, a total of 197 incident MDs events occurred. After multivariate adjustments for established MD-related risk factors, participants with the highest tertile of the TyG-BMI index had a higher risk of MDs (HR: 1.65; 95% CI: 1.02-2.09; P-trend <0.001) relative to individuals with the lowest tertile. Furthermore, the subgroup analyses of the association remained consistent. A high TyG-BMI index was associated with an increased risk of MDs. Our study suggests that monitoring long-term changes in the TyG-BMI index could assist with the early identification and prevention of MDs among individuals at high risk.

Re-Engagement in Physical Activity Slows the Decline in Older Adults' Well-Being - A Longitudinal Study.

Physical activity is recommended for older adults; however, the benefits of previous active engagement in physical activity that can be sustained after one becomes inactive remain to be determined. This study investigated the longitudinal associations between physical activity engagement patterns and older adults' well-being. This population-based cohort study used data from the China Health and Retirement Longitudinal Study between 2015 and 2020. People aged 60 years and above were included, and they were categorized as active engagers if they reported engaging in at least 10 min of moderate and/or vigorous exercise consecutively per week in each survey year. Older adults' well-being was evaluated using the healthy aging score, and geographical variations were visualized. The generalized estimating equations model was adopted to examine the differences between various physical activity engagement patterns and older adults' well-being. Among the 3300 older adults (50.5% men; age 66.9 ± 5.7 years) during the five years of follow-up, engagement in physical activity increased from 31.7% to 59.6%. However, their well-being decreased gradually, especially among those who were inactive engagers (beta = -0.20 to -0.21). Physical activity engagement patterns appeared to slow decline in well-being. Geographical variations were noted, with more favorable healthy aging scores observed in northern China than in southern China. As older adults age, well-being deteriorates, and disengagement of physical activity accelerates the rate of decline. Re-engagement in physical activity can slow the rate of decline in well-being. Early identification of and intervention in inactive engagement in physical activity reduce the detrimental effects on older adult's well-being. A national health initiative is an effective strategy to create a supportive environment for older adults to continue and engage in physical activity. The participation of healthcare professionals and community parties is important to encourage and engage older adults in physical activity.

Association of depressive symptom trajectories with chronic kidney disease in middle-aged and older adults.

This study aimed to investigate the association between trajectories of depressive symptoms and the subsequent risk of chronic kidney disease (CKD) by measuring depressive symptoms repeatedly in older adults with normal renal function. A total of 9650 participants, comprising community-dwelling middle-aged and older adults from the China Health and Retirement Longitudinal Study, were included. Depressive symptoms were assessed at three time points: Wave 1 (2011-2012), Wave 2 (2013-2014), and Wave 3 (2015-2016). Trajectories of depressive symptoms were determined using latent mixed models, and the association between these trajectories and CKD was verified using COX proportional hazards models. Five trajectory patterns of depressive symptoms were identified: low CESD-10 score (Low-Stable, 3702 participants, 38.36%), moderate CESD-10 score (Moderate-Stable, 3602 participants, 37.33%), continuously increasing CESD-10 score from moderate initiation (Moderate-Increasing, 825 participants, 8.55%), continuously decreasing CESD-10 score from high initiation (High-Decreasing, 1032 participants, 10.69%), and stable high CESD-10 score (High-stable, 489 participants, 5.07%). During the two-year follow-up period from Wave 3 to Wave 4 (2017-2018), 420 CKD events occurred. Participants in the Moderate-Stable, Moderate-Increasing, High-Decreasing, and High-Stable groups had an increased risk of developing CKD compared to those in the Low-Stable group, with multivariable-adjusted hazard ratios (95% confidence interval) were 1.32 (1.02-1.71), 1.68 (1.15-2.45), 2.26 (1.63-3.13), and 3.73 (2.57-5.43), respectively, comparted to those with low-stable trajectory. Middle-aged and older adults with increasing (Moderate-Increasing) and persistent depressive symptoms (including Moderate-Stable, High-Decreasing, and High-Stable) face a higher risk of developing CKD over time.

Psychosocial predictors of problem gambling severity in males: findings from a longitudinal study of Australian men

ABSTRACT Gambling disorder has emerged as a significant public health issue in Australia. Men are more likely than women to gamble and to develop gambling disorder. This study aimed predict men’s problem gambling severity using a multivariate approach comprised of different indicators of psychosocial functioning, past gambling behavior, and demographics (age and socioeconomic disadvantage). This study reports on data from a subset of 2018 men aged 20–62 years who participated in Waves 1 to 4 of the Australian Longitudinal Study of Male Health (Ten to Men). Hierarchical negative binomial regression was used to predict problem gambling severity. All predictor variables were found to have significant bivariate associations with problem gambling severity. However, the final regression model found only two predictors could explain unique variance in problem gambling. Increased gambling frequency and lower rates of social support at Wave 3 were predicted greater levels of problem gambling severity at Wave 4 – collectively accounting for a moderate proportion of variance. The identification of these risk factors is consistent with past research and help identify potential targets for early identification and intervention for problem gambling in men.

Impact of Internet Usage on Depression Among Older Adults: Comprehensive Study.

Depression is a widespread mental health issue affecting older adults globally, with substantial implications for their well-being. Although digital interventions have proven effective in high-income countries, research on the potential of internet usage to alleviate depression among older adults in high-income countries remains limited. This study aimed to examine the impact of internet usage on depression among older adults in high-income countries by developing a comprehensive theoretical framework and testing key hypotheses. Using data from the China Health and Retirement Longitudinal Study (CHARLS), a 2-stage instrumental variable approach was applied to address endogeneity and estimate causal relationships between internet usage and depression. The findings indicate that internet usage results in a 1.41% reduction in depression levels among older adults. This effect is mediated by four primary mechanisms: (1) enhanced social interaction, (2) increased physical activity, (3) improved intergenerational contact, and (4) expanded access to educational opportunities. A heterogeneity analysis revealed that these effects are more pronounced in urban areas, eastern regions, and regions with superior internet infrastructure. Internet usage plays a crucial role in alleviating depression among older adults in high-income countries, with regional variations. The findings highlight the need for targeted policy interventions to improve internet access and digital literacy, which can mitigate depression and enhance the mental health of older adults.

Long-term impacts of childhood neighborhood quality on depression in later midlife mediated by childhood domestic violence: A nationwide longitudinal analysis.

Depression affects 264 million people globally, with a high prevalence in China. Adverse childhood experiences, such as poor neighborhood quality and domestic violence, significantly contribute to depression in later midlife. This study aimed to examine the impact of childhood neighborhood quality (CNQ) and childhood domestic violence (CDV) on depression in later midlife and explore the mediating role of domestic violence. Data from the China Health and Retirement Longitudinal Study (CHARLS), involving 10,139 participants aged 45 and older, were analyzed. CNQ and CDV were assessed through surveys, and depressive symptoms were measured using the CES-D-10 scale. Multiple regression and Karlson-Holm-Breen method were conducted. Higher CNQ was associated with lower depressive symptoms (β=-0.317, p<0.001) and depression risk (β=-0.083, p<0.001), while higher CDV was linked to increased depressive symptoms (β=0.235, p<0.001) and depression risk (β=0.073, p<0.001). KHB analysis showed that childhood domestic violence partially mediated the relationship between CNQ and depressive symptoms (β=-0.032, p<0.001) and depression risk (β=-0.011, p<0.001). Improving neighborhood conditions and reducing domestic violence during childhood may mitigate the long-term risk of depression in later midlife. Community-level interventions and early support services are crucial.

Association between the cumulative estimated glucose disposal rate and incident cardiovascular disease in individuals over the age of 50 years and without diabetes: data from two large cohorts in China and the United States.

The estimated glucose disposal rate (eGDR) has been linked to incident cardiovascular disease (CVD) in individuals without diabetes. However, few studies have accounted for long-term cumulative eGDR exposure. The aim of this study was to explore whether long-term cumulative eGDR was independently associated with incident CVD in individuals over the age of 50 years and without diabetes. This study used data from the China Health and Retirement Longitudinal Study (CHARLS) and Health and Retirement Study (HRS). The cumulative eGDR was calculated as the summation of the average eGDR for each pair of consecutive examinations multiplied by the time between these two consecutive visits, in years. The outcome was incident CVD. Cox proportional hazards regression models and restricted cubic spline (RCS) regression models were used to evaluate the association between cumulative eGDR and incident CVD. A total of 2430 participants from CHARLS and 2008 participants from HRS were included in the analysis. The median age of the participants in CHARLS at baseline was 59 years [IQR: 55-65 years], and 1205 (49.59%) were men. The median age of the participants in HRS at baseline was 64 years [IQR: 57-70 years], and 705 (35.11%) were men. The RCS regression model showed a negative and linear association between the cumulative eGDR and incidence of CVD (CHARLS: P < 0.001, P for nonlinearity = 0.248; HRS: P = 0.013, P for nonlinearity = 0.121). After multivariate adjustment, the higher levels of cumulative eGDR were independently associated with a lower risk of CVD (per SD, CHARLS: HR: 0.802, 95% CI: 0.716-0.898, HRS: HR: 0.791, 95% CI: 0.665-0.940, pooled analysis: HR: 0.799, 95% CI: 0.726-0.878). A lower level of cumulative eGDR was associated with an increased risk of incident CVD in individuals over the age of 50 years and without diabetes. Continuous monitoring of cumulative eGDR exposure over time, based on consideration of traditional risk factors, may prove beneficial for the early identification and intervention of individuals at high risk of CVD. In regions with limited healthcare resources, among individuals with limited ability to access, process, and understand health information and services, cumulative eGDR may offer improved clinical applicability.

The impact of perceived caregiver anxiety and stress during childhood on late-life depression: evidence from the China Health and Retirement Longitudinal Study

The impact of perceived caregiver anxiety and stress during childhood on late-life depression: evidence from the China Health and Retirement Longitudinal Study

Can travel relieve the loneliness of the elderly?

ABSTRACT This paper aims to investigate whether travel can alleviate the loneliness among the elderly. Empirical tests involving data from the China Health and Retirement Longitudinal Study database yielded notable findings. Based on Ecological Systems Theory, we investigated the mediating mechanisms of travel’s impact on loneliness among the elderly. Findings showed that self-evaluated health status and sleep time at the microsystem level, satisfaction with children’s relationships at the mesosystem level, and social interaction at the macrosystem level served as mediators. Subgroup heterogeneity analyses revealed practical implications.

Configurational effects of intergenerational support on older adults’ depression: an empirical study from CHARLS data

BackgroundThe influence of different dimensions of intergenerational support on depression in older adults has a configuration effect. Existing researches have only used linear analyses to examine the independent effects of each dimension of intergenerational support on depression in older adults, resulting in the nature of the effects of each dimension of intergenerational support on the presence of depression in older adults remaining highly controversial.ObjectiveTo explore the synergy and substitution effects (configurational effects) of dimensions of intergenerational support on depression in older adults.MethodBased on data from the 2018 China Health and Retirement Longitudinal Study(CHARLS), depression among older adults was used as the outcome variable, and intergenerational support (including three dimensions of emotional, economic, and caregiving support) was used as the antecedent variable. Qualitative comparative analysis (QCA) was used to analyze the configurational effects of intergenerational support on depression in older adults.ResultA single dimension of intergenerational support cannot be a necessary condition for depression in older adults.Factor configurations of different dimensions of intergenerational support as a sufficient condition for depression in older adults. The consistency parameter for all solution configurations in this study is 0.83, with a coverage of 0.61. The research identifies four types of configurational patterns associated with older adults’ depression: “Unidirectional Care Deficiency Type” (consistency mean of 0.84, coverage of 0.49), “Bidirectional Care Deficiency Type” (consistency mean of 0.86, coverage of 0.33), “Bidirectional Economic Deficiency Type” (consistency mean of 0.85, coverage of 0.48), and “Mixed Type” (consistency mean of 0.83, coverage of 0.23).ConclusionDepression in older adults is influenced by the configurational effects of intergenerational support. The complex link between intergenerational support and depression in older adults should be examined from a holistic perspective, paying attention to the dynamic balance of intergenerational support reception and provision.

Bidirectional relationship between afternoon naps and depressive symptoms in Chinese middle-aged and older adults: Evidence from a nationally representative cohort study.

Limited studies have investigated the association between depressive symptoms and napping habits. In this study, nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS) were employed to conduct cross-sectional and longitudinal analyses to investigate their associations among Chinese middle-aged and older adults. The study included 12,208 participants from the 2015 CHARLS. Depressive symptoms were measured using the Depression Scale. Napping duration was categorized into four groups: no napping (0min), short (<30min), moderate (30-89min), and prolonged (≥90min). Logistic regression analysis was used to assess bidirectional relationships, and dose-response patterns were analyzed via restricted cubic splines (RCS). A total of 2487 participants (32.0%) developed new-onset depressive symptoms, and moderate napping group exhibited the lowest incidence rate. Statistical analysis revealed that moderate napping was a protective factor for the depressive symptoms (OR, 95% CI, 0.689, 0.567-0.843). A total of 1742 participants (42.3%) newly experienced poor napping, and the incidence of poor napping gradually rose by the increase of the CES-D-10 score quartiles. Moreover, depressive symptoms were also found to be a risk factor for poor napping (OR, 95% CI, 1.149, 1.004-1.314). The RCS model revealed that there was an approximately U-shaped association between nap duration and depressive symptoms, and there was a negative linear association between CES-D-10 scores and nap duration. The observational design limits ruling out unobserved confounding factors. There was a significant bidirectional relationship and a dose-response association between napping and depressive symptoms in middle-aged and older adults.

The relationship between sarcopenia and mental health status in Chinese older adults: the mediating role of activities of daily living

BackgroundMost existing studies focus on either the relationship between sarcopenia and depressive symptoms or sarcopenia and cognitive functions. Few studies have examined depressive symptoms and cognitive functions simultaneously. This study aimed to analyze the relationship between sarcopenia and both depressive symptoms and cognitive functions in the elderly by introducing activities of daily living to explore the mediating role of activities of daily living between sarcopenia and mental health.MethodsThis study used data from the 2015 and 2018 China Health and Retirement Longitudinal Study, including a total of 3,552 older adults aged 60 and above. We conducted descriptive statistical analysis and correlation analysis on the data and used seemingly unrelated regression to examine the relationship between sarcopenia, depressive symptoms, and cognitive functions in older adults. Bootstrap mediation analysis was used to further explore the mediating role of activities of daily living in the relationship between sarcopenia and depressive symptoms and cognitive functions in the elderly.ResultsAfter adjusting for confounding factors, sarcopenia was positively correlated with depressive symptoms (β = 0.663, p < 0.001) and negatively correlated with cognitive functions (β=-0.748, p < 0.001), indicating a negative impact of sarcopenia on mental health. Activities of daily living mediated the relationship between sarcopenia and mental health, with a stronger mediating effect between sarcopenia and depressive symptoms (18.77%, β = 0.125, 95%CI (0.035, 0.222)) than between sarcopenia and cognitive functions (12.82%, β=-0.099, 95%CI (-0.162, -0.035)).ConclusionsActivities of daily living partially mediated the relationship between sarcopenia and mental health status in Chinese older adults. Interventions targeting sarcopenia and activities of daily living may be an effective way to prevent and improve the mental health status of older adults.

Enhancing cognitive accessibility in assessments for children with neurodisability: development and implementation of an adaptation tracking questionnaire

Purpose The range of impairments in children with neurodisability (ND) complicates data collection, yet individualising materials and procedures could enable more children to self-report. This study introduces the Cognitive Accessibility Tracking Questionnaire (CATQ), designed to monitor changes enhancing accessibility (“adaptations”) in interview-administered patient-reported outcome measures (PROMs). The CATQ is used in a longitudinal study of mental health and participation in children with ND investigating adaptation use and its utility in assessing the risk of bias introduced by these adaptations. Materials and methods The 13-item CATQ was developed with experts in ND and augmentative and alternative communication. Predictors of PROM adaptations were analysed using linear regression; the overall change was tested with a t-test and item-specific agreement with Cohen’s weighted kappa and proportion of agreement. Results Six interviewers conducted 69 interviews, interviewing 43 children once or twice. Common adaptations included explaining/replacing concepts (56.5% of interviews), exemplifying (60.9%), or repeating questions/instructions (50.7%). Child age, seizure history, verbal communication abilities, adaptive behaviour, and interviewer identity predicted adaptation use. Adaptation use did not differ between the two data collection points, 13 months apart. Conclusion The CATQ enhances methodological rigor by tracking adaptations and facilitating risk-of-bias-assessment by analysing adaptation changes and factors affecting their use.