Older People In China Research Articles

Dietary Pattern Is Associated with Obesity in Older People in China: Data from China Health and Nutrition Survey (CHNS).

Background: No studies have been conducted to explore the associations between dietary patterns and obesity among older Chinese people, by considering gender and urbanization level differences. Methods: We analyzed data from the 2009 China Health and Nutrition Survey (2745 individuals, aged ≥ 60 years). Dietary data were obtained using 24 h-recall over three consecutive days. Height, Body Weight, and Waist Circumference were measured. Exploratory factor analysis was used to identify dietary patterns. Multinomial and Poisson regression models were used to examine the association between dietary patterns and Body Mass Index (BMI) status/central obesity. Results: The prevalence of general and central obesity was 9.5% and 53.4%. Traditional dietary pattern (high intake of rice, pork and vegetables) was inversely associated with general/central obesity; modern dietary pattern (high intake of fruit, fast food, and processed meat) was positively associated with general/central obesity. The highest quartile of traditional dietary pattern had a lower risk of general/central obesity compared with the lowest quartile, while an inverse picture was found for the modern dietary pattern. These associations were consistent by gender and urbanization levels. Conclusions: Dietary patterns are associated with general/central obesity in older Chinese. This study reinforces the importance of a healthy diet in promoting healthy ageing in China.

Association between anemia and 3-year all-cause mortality among oldest old people in longevity areas in China

To explore the association between anemia and 3-year all-cause mortality among the oldest old people in longevity areas in China. In August 2012, questionnaire survey, health examination and blood test were conducted among 929 old people aged ≥ 80 years in 7 longevity areas in China, who were included in Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2009. Cox regression model was used to evaluate the association between anemia or different hemoglobin levels and mortality. Among the 929 subjects, the prevalence of anemia was 49.6%, the main form of anemia was normocytic anemia. During the three year follow-up period, a total of 447 subjects died, the overall mortality was 49.8% (56.0% in subjects with anemia and 43.3% in subjects without anemia). Compared with the subjects without anemia, the mortality risk increased by 25% in the subjects with anemia after adjusting confounding factors (HR = 1.25, 95% CI: 1.03-1.52). Macrocytic anemia, simplex microcytic anemia and microcytic hypochromic anemia were all associated with the increased mortality in the oldest old people. Compared with the subjects with low hemoglobin concentration, the subjects with high hemoglobin concentration had a lower mortality risk, and the association was more obvious in women. Anemia and low hemoglobin concentration were associated with higher mortality risk in the oldest old people in China, indicating the importance of anemia prevention and treatment among this population.

Fear of crime and older people in low- and middle-income countries

ABSTRACTThis paper analyses data from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) on the prevalence of reported fear of crime at home and on the street among older people in China, Ghana, India, Mexico, Russia and South Africa. SAGE provides nationally representative data for 35,125 people aged 50 and over. These reveal large national variations in reported crime fear: for example, 65 per cent of older South Africans felt unsafe on the street, compared to only 9 per cent of older Ghanaians. The paper examines factors potentially associated with crime fear, including age, socio-economic status and frailty, and relates these to different theoretical models of crime fear. Female sex and frailty are associated with higher rates of crime fear across the study countries. Other associations are less consistent, e.g. urban residence is associated with higher levels of fear in some countries and lower levels in others. The paper considers the potential effects of crime fear on mobility beyond the home, health status and quality of life. A strong association is found for mobility, but effects on health and quality of life are harder to interpret as the direction of causality can be two-way. Overall, the paper demonstrates the potential impact of crime fear on older people's wellbeing and highlights a need for further, more contextualised research.

The need for community care among older people in China

ABSTRACTThe social care system of China has come under close scrutiny from policy makers due to the rapid ageing of China's population. Unfortunately, there is very little Chinese research evidence that might be used to plan future service developments. This article is a contribution to filling that gap and it provides essential new information on the expressed demand among older people in China for various community care services. The data are from the 2008 wave of the Chinese Longitudinal Healthy Longevity Survey. According to the characteristics of the dependent variables, we used Binary Logistic Regression Analysis to analyse the need for community care among older people in China. The results show considerable need for such care, but China is still a developing country and there are insufficient resources to fund a Western-style social care system (even if that was desirable). Thus, it is argued that the development of social care in China should emphasise community-based care, in partnership with families, with institutional care as a last resort. In addition, it is argued that China (and other countries) should introduce measures to prevent the demand for social care.

Ageing and China: Towards Theory, Policy and Practice

In the 21st Century, economists and social analysts around the globe are increasingly concerned about the rising numbers of older people in their society. There are genuine concerns about the inadequacy of pension funds, of growing pressures on welfare systems, and on the inability of shrinking numbers of younger people to carry the burden of their elders. This article focuses on such gerontological issues in China, where the older people have become a rapidly expanding proportion of the population. While resources do need to be targeted on the vulnerable older people, the presumption that older people as a whole are an economic and social burden must be questioned. This is an ageist view that needs to be combated by locating how bio-medical views on aging seep into policy spaces in China that position negative perceptions of aging as both individual and populational problems. The article then moves to observe the implications of bio-medicine for older people in China in terms of "vulnerable" aging but deconstruct such "fixed" explanations by juxtaposing active aging as key narrative that epitomizes "declining to decline" as espoused by bio-medical sciences.

Opieka nad osobami starszymi w Chinach w kontekście solidarności międzypokoleniowej

The aim of the paper is to show the problem of the responsibility for caring for the older people in China in the context of the cultural aspects of intergenerational solidarity. The high proportion of people aged 65 and over in the population of China has made the government and Chinese society face the challenges of coping with the problems of the ageing population. These problems are also associated with the wider care for older people, which in China has a strong cultural background expressed even in “the virtue of filial piety.” Addressing these problems or mitigating the effects of the lack of sufficiently effective solutions, involves the supporting of intergenerational solidarity.

Individual and province inequalities in health among older people in China: Evidence and policy implications

This paper uses multi-level modelling to analyse data from the nationally-representative Chinese Health and Retirement Longitudinal Study (CHARLS) in order to investigate the characteristics associated with poor health among older people, including individual and household characteristics as well as the characteristics of the provinces in which the older person lives (contextual effects). The results show that older Chinese women, rural residents, those with an education level lower than high school, without individual income sources, who are ex-smokers, and those from poor economic status households are more likely to report disability and poor self-rated health. Differentials in the health outcomes remain substantial between provinces even after controlling for a number of individual and household characteristics.

Who will care for older people in China? Exploring the implications of gender imbalance at birth

Purpose – The purpose of this paper is to provide evidence about the possible cause and effect of the problematic gender imbalance at birth in China. Much of the literature on this issue presents discussions based on the traditional assumption that Chinese sons are more involved in taking care of parents than Chinese daughters are, and thus, that Chinese parents prefer sons. Yet, empirical evidence is lacking. Design/methodology/approach – This paper verifies the assumption by using the “Preference Parameters Study in China 2011,” which conducted 652 face-to-face interviews with randomly selected individuals in six major Chinese cities. Findings – This paper first presents empirical evidence that Chinese sons (and their wives) are more likely, compared to daughters (and their husbands), to be primary caregivers for parents. The paper also reports the finding that Chinese parents’ dependencies on their children would not necessarily decrease with the development of social security, although that may be the case when a child has a highly educated spouse. Practical implications – The Chinese government needs to increase long-term care services for older people, especially since more women are being educated. Originality/value – Although this study has data collection limitations, with data collected in only six major cities, the problematic nature of gender imbalance at birth and the lack of available empirical evidence demand that researchers begin to construct a better understanding of the causes of, and possible solutions to, this phenomenon. With that in mind, this paper contributes to that construction of knowledge and insight.

General practitioners' knowledge of ageing and attitudes towards older people in China

To explore general practitioners (GPs)knowledge of ageing, attitudes towards older people and factors affecting their knowledge and attitudes in a Chinese context. Four hundred GPs were surveyed using the Chinese version of the Aging Semantic Differential (CASD) and the Chinese version of the Facts on Aging Quiz (CFAQ1) scale. The CASD scores indicated that GPs had a neutral attitude towards older people. The CFAQ1 scores indicated a low level of knowledge about ageing. GPs' awareness of the mental and social facts of ageing was poorer compared to that of physical facts. Male GPs had a significantly higher negative bias score than female GPs. No other variables had a statistically significant influence on knowledge and attitudes. The findings suggest the need for education interventions for GPs regarding knowledge of ageing and also provide evidence to guide future development of continuing medical programs for this group of medical doctors.

An Innovative Continuing Nursing Education Program Targeting Key Geriatric Conditions for Hospitalized Older People in China

A lack of knowledge in registered nurses about geriatric conditions is one of the major factors that contribute to these conditions being overlooked in hospitalized older people. In China, an innovative geriatric continuing nursing education program aimed at developing registered nurses' understanding of the complex care needs of hospitalized older people with common geriatric conditions was conducted and evaluated. The program consisted of didactic sessions focused on evidence-based practice and unfolding case studies designed to simulate the care trajectory of an older person with a hip fracture and key geriatric conditions. Findings from the program evaluations revealed a significant increase in favorable attitudes towards older people and increased knowledge concerning common geriatric conditions. The satisfaction rate ranked by program participants was 90%. The study, therefore, drew the conclusion that effective geriatric continuing nursing education should target participants' learning needs, support evidence-based practice, and engage participants in active learning.

The prevalence and risk factors of OAB in middle‐aged and old people in China

To evaluate the prevalence of associated risk factors of over active bladder (OAB) in people ≥40 years old in mainland of China. A randomized community-based, cross-sectional study was performed on 10,160 residents (≥40 years old) in the mainland of China using a questionnaire. The overactive bladder symptom score (OABSS) was filled upon site. The chi-square test was used to determine the differences of prevalence between sex, age groups, body mass index (BMI) and people with and without diabetes mellitus (DM). A total of 9,805 (96.5%) subjects qualified for the final statistical analysis. The overall prevalence of OAB was 2.1% (209/9,805), of whom 1.0% had OABdry and 1.1% had OABwet . The prevalence of OAB was more common in men than in women over the age of 60 (4.6% vs. 2.6%, P < 0.05). The prevalence of OAB in subjects with DM was significantly higher than those without DM in patients with BMI ≥ 25 (P < 0.05). The subjects with a BMI over 29 were more likely to have OAB (3.2% vs. 1.8%, P < 0.05). In this population, the prevalence of OAB increased with age for both sexes, but was higher for males over 60 years of age. The study also showed that diabetics with BMI ≥ 25 and people suffering from obesity are more likely to have OAB.

Challenges in the provision of community aged care in China

<h3>Objective</h3> Population ageing in China is a significant challenge for the Chinese government, the society and Chinese people. The dramatic process of population ageing together with social and economic diversity in China has created issues in the availability, equality and sustainability of social and financial support for older people. The aims of this review are to identify the social and economic challenges to the traditional caregiving system in China, and to examine possible solutions to improve the care of older people in China using the framework of ageing in place. <h3>Methods</h3> Electronic literature searches were conducted in May and June 2013 using PubMed, CNKI, and MEDLINE. Statistical data and reports were retrieved from the United Nations, the World Health Organisation, the World Bank and National Bureau of Statistics of China. Government policy documents were found through government websites and formal publications. <h3>Results</h3> Family-centred care for older people in China is recognised as a cultural tradition in the Chinese community. However, driven by large-scale social, political and economic changes, this model of caring for older people has dynamically changed over the last 50 years. Traditionally the family has been the most important source of social support for older people followed by neighbour support and support from friends. Today family obligations of caring are still centred in a cultural and practical context; however, support from family and children has weakened incrementally. Community-based aged services are absent in most areas, while older people and their families have to pay out-of-pocket expenses for non-residential services. There is a severe shortage of aged care or nursing home resources in China and those that exist are of low quality and expensive. The staff who work in these facilities rarely have any formal training in aged care. In addition, a market approach to the funding of residential aged care has the potential to create a moral hazard due to the poor regulatory control of aged care in China. While the building of residential aged care homes is seen as the solution to the care of older people in China, older people prefer to age in their own homes and expect the restoration of the family care tradition as well as more government support for them to “age in place”. This approach has the potential to be more cost effective than expensive aged care facilities. <h3>Conclusion</h3> Given older people’s preferences, ageing in place, with the provision of community services and family support, potentially provides a fair and financially viable approach to promote healthy ageing and supportive care in China. Further studies are required to identify 1) how ageing in place can be supported by a national strategy, 2) the financial arrangements required to fund such an approach, and 3) how to train high quality community-based professionals in both rural and urban areas to support the care of older people.

Loneliness and social support of older people in China: a systematic literature review

Loneliness is a serious problem for older people, which can be alleviated by social support. The dramatic population ageing together with social and economic change in China increases the likelihood of loneliness and the availability of different sources of social support of older people. The aim of this review was to identify the prevalence of loneliness and its related factors and sources of social support of older people in China. Electronic literature searches were conducted in September 2011 using Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Twenty-six papers were identified and reviewed. The prevalence of loneliness varied across the studies, reflecting the different measurements and samples. Marital status, gender, age, educational level, economic level, living arrangements, health status and social support were significant factors related to loneliness. The family was the most important source of social support followed by friends. The receipt of family support improved subjective well-being and mental health, but the effects of support from friends were inconsistent. Chinese older people received relatively little support from neighbours, governmental or other social organisations. Further well-designed studies are needed to identify additional factors related to loneliness and to understand the support from friends, neighbours, formal organisations and other sources.

Regional and urban-rural disparities in prevalence of over-weight among old people in China: evidence from four Chinese provinces.

This study is a systematic analysis of regional and local (urban-rural) rates of over-weight among elderly people in China. The primary goal is to update the different trends in over-nutrition by gender and location among elderly Chinese. Data used for this study were obtained from the comprehensive longitudinal data collected in the most recent waves of the China Health and Nutrition Survey in 2000 and 2006. Comparative data on four provinces, two located in the poorer west (Guangxi, Guizhou) and the other two located in the richer east (Jiangsu, Shandong) were selected from the nine provinces of China participating in the survey. The study population included elderly adults aged 60 years or older interviewed during either of the two survey waves. A total of 1996 individuals (998 in 2000 and 998 in 2006) aged 60 years or older made up the sample for the analysis. We compared changes in body mass index (BMI) with changes in the prevalence of over-nutrition across the 6 years. The mean BMI values observed ranged from 20.8 kg/m² to 23.2 kg/m². The prevalence of over-weight ranged from 10.5% to 39.0% in both surveys. There were increases in the prevalence of overweight that were greater than the reduction in the prevalence of underweight among Chinese elderly people. Elderly people in the eastern regions and in urban areas were significantly more likely to be overweight compared with those in western regions and rural areas. This study found that the rates of overweight in elderly Chinese increased overall between 2000 and 2006. China must act quickly to curb continued increases in overweight and the associated economic costs, with particular focus on target groups.

Highly prevalent and poorly controlled cardiovascular risk factors among Chinese elderly people living in the rural community

The epidemiological scenario of cardiovascular risk factors (CRFs) among elderly people in rural China is unclear. We seek to describe the distribution, burden and management of major CRFs among older Chinese people living in the rural community. This cross-sectional study included 1538 participants in the Confucius Hometown Aging Project (2010-2011) of people ≥60 years of age (mean age 68.6 years; 59.1% women) who lived in a rural community nearby Qufu, Shandong, China. Data were collected through a face-to-face interview, a clinical examination and laboratory tests. We carried out descriptive analysis on the prevalence and management of major CRFs. The overall prevalence of current smoking, physical inactivity, hypertension, diabetes, high cholesterol and obesity were 13.8%, 83.7%, 76.0%, 26.6%, 42.4% and 13.1%, respectively: 82.8% and 50.4% of participants had ≥ 2 and ≥ 3, respectively, of the six CRFs. Prevalence of alcohol consumption was 18.7%. Men were more likely to smoke and consume alcohol than women, whereas women were more likely to be obese and physically inactive than men (p < 0.001). Prevalence of physical inactivity and hypertension increased with age, prevalence of alcohol intake and obesity decreased with age, and prevalence of smoking and diabetes was stable. Hypertension, diabetes and high cholesterol were treated in 60.6%, 68.1% and 41.1% of those with the disease, respectively, but only 11.3%, 13.7% and 31.7% achieved good control. CRFs are highly prevalent and poorly controlled among elderly people in rural China, where men and women have different CRF profiles. Intervention programs targeting major CRFs may improve the health of older people in China.

The impacts of health insurance on health care utilization among the older people in China

In an effort to solve the problems that exist in the current health care system, the Chinese government has announced three different types of health insurance programs. We examine the impacts of these programs (Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and New Cooperative Medical Scheme (NCMS)) on health care utilization among older people in two provinces of China – Zhejiang and Gansu. The data comes from the pilot survey of the China Health and Retirement Longitudinal Study (CHARLS) collected in 2008, which contains 2685 individuals in 1570 households. We use a two-part model to analyze outpatient care. The first part is a binary equation modeling the probability of any use of outpatient service; For the second part, we use a zero-truncated Poisson model and a generalized linear model with a gamma distribution and a log link to explain the number of outpatient visits and the level of out-of-pocket (OOP) payments conditional on at least one visit to a service provider, respectively. For the inpatient care, the logistic regression is employed to predict the probability of being hospitalized. All analyses are weighted and marginal effects are reported. We find that compared with people without health insurance, people with UEBMI and URBMI are more likely to use outpatient services and people with UEBMI have less OOP payments in Zhejiang while in Gansu province, people with NCMS are less likely to have outpatient visits, while people with UEBMI are more likely to be hospitalized. In addition, among those who have at least one outpatient visit, different insurance types do not make much difference in terms of the number of outpatient visits in both provinces. Our study indicates that although the health insurance programs have some positive impacts on the health care utilization, these impacts are still limited.

Quality of life of older people in China: a systematic review

SummaryThe quality of life (QoL) of older people is of increasing interest in China, due to its ageing population. A systematic review of published QoL studies was undertaken to examine different measurements and related factors of QoL of older people in China. Papers were identified by searching the following electronic databases: Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Fifteen studies were included in the review, using eight different QoL measurement tools. Health status, psychological well-being, social well-being, housing and socio-demographic factors were identified as important related factors of QoL. Further studies are needed using valid measurement tools to explore more factors, especially culturally specific contributors, to the QoL of older people.

Advancing Research on Productive Aging Activities in Greater Chinese Societies.

The public discourse on productive aging as a research and policy initiative has just begun in greater China. Two conferences in Mainland China in 2009 and 2011 and subsequent conferences in Taiwan and Hong Kong in 2012 have set it in motion. Because applied social science research has just started in greater China, researchers in Chinese societies will benefit from the experience and rich literature accumulated over the last three decades in the West. In this paper, I review and reflect on the research methods used in productive aging research in both Chinese societies and in the West. I believe that to advance productive aging research in greater China, we need to (1) discuss and agree upon a definition of productive aging, (2) identify and differentiate outputs and outcomes of productive aging activities in greater China, (3) develop precise measures for productive aging involvement, (4) focus on institutional (program and public policy) factors that promote productive aging involvement, (5) use a strong research design (such as a quasi-experimental design) to establish the internal validity of productive aging programs, and (6) be theory-driven. Lastly, productive aging should be seen as a choice, not an obligation for older people; otherwise, the productive aging agenda will be seen as exploiting older people. It is important that Chinese researchers and policy-makers have this in mind when they are advocating productive engagement of older people in China.

Correlates of life satisfaction among older people in China: An examination of two cultural variables

This article examines the relationships between the two cultural variables of having mianzi in social interactions and Chinese cultural beliefs of adversity and life satisfaction among older people in a coastal city in mainland China. The mediating effect of having mianzi in social interactions on the relationship between Chinese cultural beliefs of adversity and life satisfaction is also examined. The study applies a non-probability sampling and adopts a face-to-face interview approach using a questionnaire composed of close-ended questions. A total of 532 valid questionnaires are obtained. Multiple regression analysis is used to test the hypotheses. Findings indicate that the two cultural variables are associated significantly with life satisfaction, while controlling for socio-demographic variables. The variable of Chinese cultural beliefs of adversity is also indirectly associated with life satisfaction through its effect on having mianzi in social interactions. Older people with higher endorsement of positive Chinese cultural beliefs of adversity and higher degree of having mianzi in social interactions tend to have higher life satisfaction. Professionals working with older people should be sensitive to cultural variables that exert impacts on older people's life satisfaction.

Peer‐led diabetes self‐management programme for community‐dwelling older people in China: study protocol for a quasi‐experimental design

A protocol for a new peer-led self-management programme for community-dwelling older people with diabetes in Shanghai, China. The increasing prevalence of type 2 diabetes poses major public health challenges. Appropriate education programmes could help people with diabetes to achieve self-management and better health outcomes. Providing education programmes to the fast growing number of people with diabetes present a real challenge to Chinese healthcare system, which is strained for personnel and funding shortages. Empirical literature and expert opinions suggest that peer education programmes are promising. Quasi-experimental. This study is a non-equivalent control group design (protocol approved in January, 2008). A total of 190 people, with 95 participants in each group, will be recruited from two different, but similar, communities. The programme, based on Social Cognitive Theory, will consist of basic diabetes instruction and social support and self-efficacy enhancing group activities. Basic diabetes instruction sessions will be delivered by health professionals, whereas social support and self-efficacy enhancing group activities will be led by peer leaders. Outcome variables include: self-efficacy, social support, self-management behaviours, depressive status, quality of life and healthcare utilization, which will be measured at baseline, 4 and 12 weeks. This theory-based programme tailored to Chinese patients has potential for improving diabetes self-management and subsequent health outcomes. In addition, the delivery mode, through involvement of peer leaders and existing community networks, is especially promising considering healthcare resource shortage in China.