Poor Self-rated Health Status Research Articles

Geographical accessibility of medical resources, health status, and demand of integrated care for older people: a cross-sectional survey from Western China

BackgroundThe World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to help healthcare providers cope with the population aging crisis. However, the relevant evidence on the demands of older people and the compensatory capacity of the environment is limited. This study reports for the first time the level of the ICOPE demand in Western China that includes the impact of geographic accessibility of medical resources (GAMR) on ICOPE demand and the potential mechanism of health status.MethodsA cross-sectional questionnaire survey was conducted among 1200 adults aged 60 years and older selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demand, health status, and GAMR. Propensity score matching (PSM) was used to analyze the impact of GAMR on ICOPE demand among older people and those with different health statuses.ResultsAmong the prospective research participants, 1043 were eligible for the study. The mean score of ICOPE demand among all participants was 3.68 (standard deviation [SD] = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (average treatment effect on the treated [ATT] = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345, p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of older people with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01).ConclusionsThe older population in Western China has a relatively high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both older people with multimorbidity and self-perceptions of health.

Prevalence and Correlates of Depressive and Generalised Anxiety Symptoms Among Female Adolescents in Nepal: Results of a Cross-sectional National Population-Based Survey in 2022

AbstractThe aim of this study was to assess the prevalence and associated factors of major depressive disorder symptoms (MDDs) and generalized anxiety disorder symptoms (GADs) among female adolescents in Nepal. In a national cross-sectional population-based survey of female adolescents (N = 1379; 15–19 years) in Nepal, MDDs was assessed with the PHQ-9 and GADs with the GAD-7. Logistic and Poisson regression were used to estimate predictors of MDDs and GADs. The prevalence of MDDs was 7.8% (4.5% with a cut-off of ≥ 10 scores), and the prevalence of GADs was 13.4% (5.6% with a cut-off of ≥ 10 scores). In multivariable models, older age (17–19 years), higher education, greater wealth status, poor self-rated health status, genital sore or ulcer, currently pregnant, pregnancy loss, alcohol use, and early sexual debut were positively associated with MDDs and/or MDD scores. Older age, greater wealth status, living in the Terai region, poor self-rated health status, current alcohol use, pregnancy loss, big problem with getting permission for medical help were positively associated with GADs and/or GAD scores. About one in ten female adolescents report MDDs or GADs, and several associated factors were identified which can be targeted in mental health interventions in this population.

Depression and generalized anxiety and associated factors among adult women and men in Nepal: Results of a national cross-sectional survey in 2022

ABSTRACT The aim of this study was to assess the prevalence and correlates of major depressive disorder (MDD) and generalized anxiety disorder (GAD) among adults in a national population-based survey in Nepal in 2022. MDD was assessed with the PHQ-9 and GAD with the GAD-7. Among women, the prevalence of mild and moderate or severe MDD was 16.2% and 5.9%, respectively, and the prevalence of mild and moderate or severe GAD was 20.6% and 8.2%, respectively. Among men, the prevalence of mild and moderate or severe MDD was 9.4% and 1.8%, respectively, and the prevalence of mild and moderate or severe GAD was 14.0% and 2.4%, respectively. Among women, in the multivariable model, poor self-rated health status, genital discharge, barriers to access health care, having two or more control issues with their husband or partner, experiencing one, or two or more forms of emotional violence, and exposure to two or three types of intimate partner violence were positively associated with MDD. Being widowed, divorced or separated, poor self-rated health status, genital discharge, barriers to access health care, having two or more control issues with their husband or partner, experiencing two or more forms of emotional violence, and exposure to two or three types of intimate partner violence were positively associated with GAD. Among men, poor self-rated health status, current tobacco use, genital sore or ulcer, sons and/or daughters had died, younger age and never internet use were positively associated with MDD, and being widowed, divorced or separated, poor self-rated health status, younger age and sons and/or daughters had died were positively associated with GAD. Low rates and several associated factors of MDD and GAD were found in Nepal.

Perceived balance and self-reported falls: A retrospective cross-sectional study using the National Health and Aging Trend Study.

To examine how perceived balance problems are associated with self-reported falls in the past month after controlling for known correlates of falls among older adults. Approximately 30% of adults age 65 and older fall each year. Most accidental falls are preventable, and older adults' engagement in fall prevention is imperative. Limited research suggest that older adults do not use the term 'fall risk' to describe their risk for falls. Instead, they commonly use the term 'balance problems'. Yet, commonly used fall risk assessment tools in both primary and acute care do not assess older adults' perceived balance. The Health Belief Model and the concept of perceived susceptibility served as the theoretical framework. A retrospective, cross-sectional secondary analysis using data from the National Health and Aging Trends Study from year 2015 was conducted. The outcome variable was self-reported falls in the last month. A subsample of independently living participants (N = 7499) was selected, and 10.3% of the sample reported a fall. Multiple logistic regression analysis revealed that the odds of reporting a fall in the past month was 3.4 times (p < .001) greater for participants who self-reported having a balance problem compared to those who did not. In contrast, fear of falling and perceived memory problems were not uniquely associated with falls. Using a mobility device, reporting pain, poor self-rated health status, depression and anxiety scores were also associated with falling. Older adults' perceived balance problem is strongly associated with their fall risk. Perceived balance may be important to discuss with older adults to increase identification of fall risk. Older adults' perceived balance should be included in nursing fall risk assessments and fall prevention interventions. A focus on balance may increase older adults' engagement in fall prevention.

The emergence of COVID-19 over-concern immediately after the cancelation of the measures adopted by the dynamic zero-COVID policy in China.

This study aimed to report the prevalence of COVID-19 over-concern and its associated factors after the relaxation of the health-protective measures in China. A team of seven experts in psychiatry and psychology specializing in COVID-19 mental health research from China, Hong Kong, and overseas reached a consensus on the diagnostic criteria for COVID-19 over-concern. Individuals had to meet at least five of the following criteria: (1) at least five physical symptoms; (2) stocking up at least five items related to protecting oneself during the COVID-19 pandemic; (3) obsessive-compulsive symptoms related to the COVID-19 pandemic; (4) illness anxiety related to the COVID-19 pandemic; (5) post-traumatic stress symptoms; (6) depression; (7) anxiety; (8) stress and (9) insomnia. An online survey using snowball sampling collected data on demographics, medical history, views on COVID-19 policies, and symptoms of COVID-19 over-concern. Multivariate linear regression was performed using significant variables from the previous regressions as independent variables against the presence of COVID-19 over-concern as the dependent variable. Breush-Pagan test was used to assess each regression model for heteroskedasticity of residuals. 1,332 respondents from 31 regions in China participated in the study for 2 weeks from December 25 to 27, 2022, after major changes in the zero-COVID policy. After canceling measures associated with the dynamic zero-COVID policy, 21.2% of respondents fulfilled the diagnostic criteria for COVID-19 over-concern. Factors significantly associated with COVID-19 over-concern were poor self-rated health status (β = 0.07, p < 0.001), concerns about family members getting COVID-19 (β = 0.06, p < 0.001), perceived usefulness of COVID-19 vaccine (β = 0.03, p = 0.012), impact on incomes, employment and studies (β = 0.045, p < 0.001) and impact on families (β = 0.03, p = 0.01). After removing measures associated with the dynamic zero-COVID policy in China, approximately one-fifth of respondents met the diagnostic criteria for COVID-19 over-concern.

PERCEIVED BALANCE IS ASSOCIATED WITH SELF-REPORTED FALLS IN COMMUNITY-DWELLING OLDER ADULTS

Abstract Accidental falls are a significant health threat among older adults. Approximately 30% of adults age 65 and older suffer one or more falls each year. Most accidental falls are preventable, and older adults’ engagement in fall prevention is imperative. Limited research suggest that older adults do not use the term “fall risk” to describe their risk for falls. Instead, they commonly use the term “balance problems.” The aim of this study was to examine how perceived balance problems is associated with self-reported falls in the past month after controlling for known predictors of falls among older adults. The Health Belief Model and the concept of perceived susceptibility served as the theoretical framework. A cross-sectional secondary analysis using data from a subsample of independently living participants (N = 7499) from the National Health and Aging Trends Study from year 2015 was conducted, with 10.3% of the sample reporting a fall. Multiple logistic regression analysis revealed that the odds of reporting a fall in the past month were 3.4 times (p &amp;lt; .001) greater for participants who reported having a balance problem compared to those who did not. In contrast, fear of falling and perceived memory problems were not uniquely associated with falls. Using a mobility device, reporting pain, poor self-rated health status, depression, and anxiety scores were also associated with falling. Older adults’ perceived balance problem is strongly associated with their fall risk. A focus on balance instead of fall risk may improve older adults’ engagement in fall prevention.

Menopausal symptoms in midlife Singaporean women: Prevalence rates and associated factors from the Integrated Women's Health Programme (IWHP).

Menopausal symptoms can substantially impact quality of life. We studied somatic, psychological, and urogenital symptoms and their associated factors. Cross-sectional study of healthy midlife Singaporean women from three major Asian ethnic groups. In 2014-16, women aged 45 to 69 attending well-woman clinics at the National University Hospital Singapore completed the Menopause Rating Scale (MRS). Sociodemographic, reproductive, medical, anthropometric, body composition, and physical performance characteristics were assessed using validated questionnaires and strict protocols. We analysed sub-scales and total scores by median split, and adjusted odds ratios using multivariable logistic regression. Of the 1054 eligible women, 62.6% reported at least one moderate to extremely severe symptom. The top five menopausal symptoms were joint and muscle discomfort, sleep problems, vaginal dryness, physical and mental exhaustion, and hot flushes. Higher total scores on the MRS were associated with moderate disability (adjusted odds ratio: 9.80, 95% confidence interval: 2.88-33.34), poorer self-rated health status (2.18, 1.60-2.97), menstrual irregularity at 25years (1.63, 1.07-2.49), and slower chair stands (1.49, 1.09-2.03). Age ≥65 (0.54, 0.30-0.94) and a lower level of education (0.45, 0.26-0.76) had significant inverse associations with total MRS score. Menopausal symptoms were associated with disability, poorer health status, and weaker lower-body muscle strength. These data add to the limited Asian evidence and raise the profile of this important area of health.

Longitudinal associations of loneliness with mental ill-health, physical ill-health, lifestyle factors and mortality in ageing adults in Thailand

ObjectivesThe aim of this study was to assess the longitudinal association between loneliness, mental and physical ill-health indicators, lifestyle factors and mortality among middle-aged and older adults in Thailand.MethodsWe analyzed prospective cohort data of participants 45 years and older from three consecutive waves in 2015 (n = 5616), 2017 (n = 3600), and in 2020 (n = 2863) of the Health, Aging and Retirement in Thailand (HART) study. Loneliness was assessed with a single item. To assess the longitudinal associations between loneliness and health outcomes between 2015 (baseline), 2017 (first follow-up) and 2020 (second follow-up), we conducted Generalized Estimating Equations analysis (GEE).ResultsThe proportion of loneliness was 21.6% in 2015, 23.8% in 2017 and 21.3% in 2020. In the adjusted GEE logistic regression model, loneliness was positively associated with mental ill-health (poor self-rated mental health status, poor quality of life/happiness, depressive symptoms, and insomnia symptoms), physical ill-health (poor self-rated physical health status, hypertension, kidney disease, osteoporosis, and ADL disability), and lifestyle factors (physical inactivity, and having underweight). Furthermore, in adjusted Cox proportional hazards regression, loneliness was associated with mortality. In adjusted logistic regression, compared to without loneliness in all three study waves, having loneliness in one wave and/or two to three waves was positively associated with incident mental ill-health (incident poor self-rated mental health status, incident poor quality of life/happiness, incident depressive symptoms, and incident insomnia symptoms), incident physical ill-health (incident poor self-rated physical health status, incident diabetes, incident kidney disease, and incident ADL disability), and incident lifestyle factors (having incident underweight).ConclusionWe found that loneliness was associated with several mental and physical ill-health indicators, lifestyle factors and mortality. Enhanced screening and treatment of loneliness may reduce mental and physical ill-health indicators in Thailand.

Socioeconomic inequality in self-rated health and its determinants: an Oaxaca blinder decomposition in Ilam, West of Iran during 2023

AimTo determine inequality and decompose it’s in Self-Rated Health (SRH).MethodThis population-based cross-sectional study was undertaken on the entire population of the city of Ilam, Iran, in 2023. Multi-stage stratified cluster random sampling with proportion-to-size approach was used to select the participants. Oaxaca-Blinder decomposition technique was used to show the amount of inequity in SRH and to decompose of the gap of SRH between the poor and the rich group of participants.Results1370 persons participated in the study. The 59.38% of participants stated good SRH status and just 8.86% of participants had poor SRH status. The results of the Oaxaca-Blinder decomposition revealed a considerable gap (15.87%) in the poor status of SRH between the rich and the poor. A large proportion (89.66%) of this difference was described by explained portion of the model. The results of decomposition showed that economic status was directly responsible for explaining 27.98% of overall inequality gap between rich and poor people. Moreover, hopelessness to future (32.64%), having an underlying disease (18.34%) and difference in the education level (10.71%) were associated with an increase in inequality disfavoring the poor.ConclusionFor people suffering from underlying disease, it is suggested to devise policies to improve access to/and remove healthcare utilization barriers. To address hopelessness to future, it is recommended to carry out further studies to reveal factors which affect it in more details. This can help policy makers to formulate more realistic and evidence-informed policies on order to lessen the current socioeconomic inequity in SRH.

Oral health and self-rated health in community-dwelling older adults in Colombia

BackgroundThe relationship between oral health and specific health conditions, such as cardiovascular disease or cognitive impairment, has been extensively studied. However, the effect of oral health status on self-rated health has not been assessed. This could be relevant in older people considering that poor self-rated health status and oral diseases are highly prevalent in this population. The aim of this study was to determine the association between different parameters of oral health and self-rated health status (SRHS) in Colombian community-dwelling older adults.MethodsThis is a secondary analysis of the SABE-Colombia study performed in 2015. The dependent variable was defined as the SRHS status assessed by the question "Compared with other people, your age: Do you consider your health status to be better, equal, or worse?” We considered four independent variables: total edentulism considering the high prevalence in older people, the GOHAI score to assess self-rated oral health, and the use of fixed and removable dental prostheses as potential modifiers of oral health. An adjusted ordinal logistic regression was performed by each independent variable.ResultsAfter the exclusion of missing data, 17,945 persons were included in the final analysis. A total of 10.6% reported worse SRHS, 37.6% reported equal SRHS, and 51.6% reported better SRHS. The worse SRHS group was older and had a higher proportion of dependence, cognitive impairment, and depressive symptoms. The frequency of total edentulism and the lower mean score of GOHAI were significant in the worse SHRS group. An ordinal logistic regression for each independent variable was performed, finding that edentulism increases the probability of worse SHRS, while the GOHAI and use of removable or fixed dental prostheses increase the probability of better SRHS.ConclusionWe found an association between total edentulism, GOHAI Index, the use of dental prostheses (both removable and fixed), and self-rated health status, showing the relevance of oral health status to self-rated health status independent of comorbidities and geriatric syndromes. This result supports the inclusion of oral health evaluation in comprehensive geriatric assessment.

Distribution characteristics of body mass index among Chinese oldest-old aged 80 years and above

Objective: To investigate body mass index (BMI) level, identify the main type of nutritional problem, and describe the population distribution characteristics of BMI among Chinese people aged 80 years or above. Methods: The data of 9 481 oldest-old individuals were obtained from the 2017-2018 Chinese Longitudinal Healthy Longevity Survey. The Lambda-Mu-Sigma method, weighted estimates of BMI, and comparisons by BMI quintiles were used to describe the BMI level and distribution characteristics among the oldest-old. Results: The average age of the participants was (91.9±7.7) years, with P50 of the weighted BMI at 21.9 (95%CI: 21.8-22.0) kg/m2. The result of BMI level showed a decreasing trend with age, with a rapid decline before age 100, and then the trend became slower. There are about 30% of the oldest-old classified as undernutrition, but the prevalence of overnutrition is only about 10%. The population distribution characteristics by BMI quintiles showed the oldest-old with lower BMI levels were likely to have the following characteristics: sociodemographically, to be older, female, ethnic minority, unmarried/divorced/widowed, rural residents, illiterate, with inadequate living expenses, located in Central, South, or Southwest China; regarding lifestyles, lower BMI levels were observed for participants who were smoking, not exercising, lack of leisure activities, or with poor dietary diversity; considering functional status, participants with lower BMI levels were those who have poor chewing ability, disability in activities of daily living, cognitive impairment, hearing loss, visual impairment, or poor self-rated health status. The oldest-old with higher BMI levels were likely to have heart disease, hypertension, cerebrovascular disease, and diabetes. Conclusions: The overall BMI level was low among the Chinese oldest-old and it showed a downward trend with age. Currently, the main nutritional problem among the Chinese oldest-old was undernutrition rather than overweight or obesity. Management of healthy lifestyles, functional status, and diseases would be helpful to reduce the risk of undernutrition among the oldest-old.

Association between impairment and self-rated health: a brazilian population study considering type, origin, and degree of limitation

BackgroundPerceived health is a well-known, low-cost measure in public health, and has been used in several studies on individuals with impairment. Although many studies have related impairment to self-rated health (SRH), few have considered the origin and degree of limitation of the impairment. This study examined whether physical, hearing, or visual impairments—when analyzed according to origin (congenital or acquired) and degree of limitation (with or without)—are associated with the SRH status.MethodsThis cross-sectional study used data of 43,681 adult individuals from the Brazilian National Health Survey (NHS, 2013). The outcome SRH was dichotomized into poor (including the regular, poor, and very poor responses) or good (including the good and very good responses). Crude and adjusted (for socio-demographic characteristics and chronic diseases history) prevalence ratios (PR) estimates were evaluated using Poisson regression models with the robust variance estimator.ResultsPoor SRH prevalence was estimated at 31.8% (95%CI:31.0–33.0) among the non-impaired population, 65.6% (95%CI:60.6–70.0) among individuals with physical impairment, 50.3% (95%CI:45.0–56.0) for people with hearing impairment, and 55.3% (95%CI:51.8–59.0) for the visually impaired. Individuals with congenital physical impairment—with or without limitations—presented the strongest association with the poorest SRH status. Participants with non-limiting, congenital hearing impairment showed a protective factor to poor SRH (PR = 0.40 95%CI: 0.38–0.52). Individuals with acquired visual impairment with limitations demonstrated the strongest association with poor SRH (PR = 1.48 95%CI:1.47–1.49). Among the impaired population, middle-aged participants showed a stronger association with poor SRH than older adult participants.ConclusionsImpairment is associated with poor SRH status, especially among people with physical impairment. The origin and degree of limitation of each type of impairment differently impacts SRH among the impaired population.

Poor Self-Rated Oral Health Status and Associated Factors Amongst Adults in Algeria

BackgroundUnderstanding the proportion and correlates of self-rated oral health (SROH) can assist in prioritising interventions. The aim of this study was to assess the prevalence of poor SROH and associated factors in a national community survey amongst adults in Algeria. MethodsThis World Health Organisation (WHO) STEPS cross-sectional survey in Algeria in 2016 and 2017 included 6989 people (18–69 years; median age, 37 years) selected by multistage cluster sampling. The assessment included questionnaire information, physical measures, and biochemistry tests. The measures included questions on SROH, oral conditions, oral health behaviour, general health behaviour, and measures of health status. ResultsThe sample included 6989 people aged 18 to 69 years. Of the total sample, 17.1% had removable dentures, 35.5% had 0 to 19 natural teeth, 43.9% had dental pain in the past year, 40.5% had impaired oral health–related quality of life (OHRQoL), 26.9% cleaned their teeth 2 times/d or more, 79.6% used toothpaste, and 41.2% had visited a dentist in the past year. The prevalence of poor SROH was 37.3%. In the final logistic regression model, older age (45–69 years) (adjusted odds ratio [AOR], 1.34; 95% confidence interval [CI], 1.09–1.65), having removable dentures (AOR, 1.46; 95% CI, 1.14–1.87), dental pain (AOR, 2.16; 95% CI, 1.82–2.57), impaired OHRQoL (AOR, 2.69; 95% CI, 2.26–3.20), current smokeless tobacco use (AOR, 1.45; 95% CI, 1.12–1.89), and inadequate fruit and vegetable intake (AOR, 2.69; 95% CI, 2.26–3.20) increased the odds of poor SROH. Men (AOR, 0.76; 95% CI, 0.65–0.90), having 20 or more teeth (AOR, 0.35; 95% CI, 0.28–0.42), twice or more a day teeth cleaning (AOR, 0.72; 95% CI, 0.60–0.86), and using toothpaste (AOR, 0.67; 95% CI, 0.55–0.82) were protective against poor SROH. ConclusionsAdults in Algeria reported a high prevalence of poor SROH, and several associated factors (sociodemographic, oral conditions, oral and general health–compromising behaviour) were found that can guide in oral health promotion strategies in Algeria.

Prevalence and associated factors of incident and persistent loneliness among middle-aged and older adults in Thailand

BackgroundThe aim of the study was to assess the prevalence and associated factors of incident and persistent loneliness in a prospective cohort study among middle-aged and older adults (≥ 45 years) in Thailand.MethodsLongitudinal data from the Health, Aging, and Retirement in Thailand (HART) study in 2015 and 2017 were analysed. Loneliness was assessed with one item from the Center for Epidemiological Studies Depression scale. Logistic regression was used to calculate predictors of incident and persistent loneliness.ResultsIn total, at baseline 21.7% had loneliness, 633 of 3696 participants without loneliness in 2015 had incident loneliness in 2017 (22.2%), and 239 of 790 adults had persistent loneliness (in both 2015 and 2017) (30.3%). In adjusted logistic regression analysis, low income (aOR: 1.27, 95% CI: 1.03 to 1.57), poor self-rated physical health status (aOR: 1.64, 95% CI: 1.27 to 2.12), hypertension (aOR: 1.34, 95% CI: 1.09 to 1.65), depressive symptoms (aOR: 1.97, 95% CI: 1.11 to 3.49), and having three or chronic conditions (aOR: 1.76, 95% CI: 1.19 to 2.60) were positively associated and a higher education (aOR: 0.74, 95% CI: 0.55 to 0.98) and living in the southern region of Thailand (aOR: 0.43, 95% CI: 0.30 to 0.61) were inversely associated with incident loneliness. Poor self-rated physical health status (aOR: 1.91, 95% CI: 1.26 to 2.88), and having three or more chronic diseases (aOR: 1.78, 95% CI: 1.07 to 2.98), were positively associated, and living in the southern region (aOR: 0.40, 95% CI: 0.25 to 0.65) was inversely associated with persistent loneliness.ConclusionMore than one in five ageing adults had incident loneliness in 2 years of follow-up. The prevalence of incident and/or persistent loneliness was higher in people with a lower socioeconomic status, residing in the central region, poor self-rated physical health status, depressive symptoms, hypertension, and a higher number of chronic diseases.

Self-reported dual sensory impairment and related factors: a European population-based cross-sectional survey

BackgroundData on population-based self-reported dual vision and hearing impairment are sparse in Europe. We aimed to investigate self-reported dual sensory impairment (DSI) in European population.MethodsA standardised questionnaire was used to...

Income-related health inequality among rural residents in western China.

Health equality has drawn much public attention in both developed and developing countries. China, the largest developing country, has implemented a new round of health system reform to improve health equality since 2009. This study aims to examine the magnitude and sources of income-related health inequality in western rural regions of China. Data were obtained from the Survey of Rural Economic and Social Development in Western China conducted in 2014, in which 14,555 individuals from 5,299 households in 12 provinces were included. Health outcome variables of interest were self-rated health status, prevalence of chronic disease and four-week illness. Concentration index was calculated to assess magnitude of income-related health inequality, and nonlinear decomposition analysis was performed to identify the sources of health inequality. The Concentration indexes for poor self-rated health status, prevalence of chronic disease and four-week illness were -0.0898 (P<0.001),-0.0860 (P<0.001) and -0.1284 (P<0.001), respectively. Income and education were two main sources of health inequality, accounting for about 25-50% and 15% contribution to the inequality. Ethnicity made <10% contribution to income-related health inequality, and enrollment in New Rural Cooperative Medical Scheme contributed to <1%. This study found slight income-related health inequality among rural residents in western China, implying that although China has made substantial progress in economic development and poverty alleviation, health inequality in western rural region should still be concerned by the government. To achieve health equality further, the Chinese government should not only strengthen its reimbursement mechanism of the current health insurance scheme to improve affordability of primary healthcare for residents in western rural regions, but also implement health poverty alleviation policies targeting socioeconomically vulnerable population and ethnic minorities in future.

A longitudinal study of disability in activities of daily living andactivity restriction-induced fear of falling among Korean older people.

This study examined the effects of the fear of falling (FOF) alone and fear-associated activity restriction (FAR) on future activities of daily living (ADL) disability and analysed predictors of ADL disability among community-dwelling older people with and without FAR. This prospective study involved secondary data analysis of the Korean Longitudinal Study of Aging. We obtained data from 5074 community-dwelling older adults. Generalized estimating equations were used to identify the predictors of changes in ADL disability between 2008 and 2018. Compared with FOF alone, FAR was significantly related to changes in ADL disability. Being older, living with others and having poor self-rated health status were associated with future ADL disability in participants without FAR. Weakened grip strength and social engagement were associated with future ADL disability in those with FAR. Nurses must consider the impact of FAR on future ADL decline and implement tailored interventions. No Patient or Public Contribution.

Healthcare accessibility since and during Covid-19 pandemic among older individuals in Europe

Abstract Ensuring access to healthcare is critical to prevent illnesses and maintain health and functional abilities for older individuals. The Covid-19 pandemic is a major global public health threat that challenges healthcare availability and accessibility. The objective of the study was to compare healthcare accessibility for older individuals since and during Covid-19 pandemic. The study was based on a sample of individuals from wave 8 Covid-19 add-on and wave 9 Covid-19-add-on of the Survey of Health, Ageing and Retirement in Europe (SHARE) in the period from 2020 till 2021. The sample size was 44043 respondents from 26 European countries. Descriptive statistics, Chi-square and McNemar test was performed. Overall, in 2021 there is a statistically significant decrease in proportion of respondents who forwent medical treatment (from 12% to 8%, in Latvia from 14,6% to 7%), postponed medical appointment due to Covid-19 (from 27% to 13%, in Latvia from 14,6% to 3,2%) and to whom appointment was denied by healthcare facility due to Covid-19 (from 5,3% to 4,5%, in Latvia from 6.9% to 3,3%) (p &amp;lt; 0.001). More often forwent medical appointment in 2021 was reported from females as well as respondents younger than 75 years, with good or very good self-rated health status and with less or no limitations due to health. Forwent medical treatment was reported more often from respondents with diabetes and hypertension. Results indicate that remote consultations are used more often than in 2020 (number of remote consultations varied between 1 and more than 100) and more often were reported by younger respondents (50-74 years). No significant association was found in self-rated health changes since and during Covid-19 pandemic for respondents who reported healthcare accessibility issues. As those issues were reported also by individuals with poor or fair self-rated health status and serious health conditions it can lead to a more rapid decline in health and functional abilities in the future. Key messages

Mental health status and associated contributing factors among the Hakka elderly in Fujian, China.

PurposeLittle is known about the mental health of the Hakka elderly. This study explores the status of, and factors associated with mental health among Hakka elderly populations from Fujian, China.MethodsThis is a cross-sectional, community-based survey study containing a total of 1,262 valid samples. The Chinese version Symptom Checklist-90-R (SCL-90-R) was used to assess the mental health status of the Hakka elderly. We used t-tests to compare the differences for 10 dimensions of SCL-90-R scores between the Chinese national norm and the Hakka elderly. Univariate and multivariate analysis were performed by using linear regression analysis to identify the main socio-demographic factors that were most predictive of the total score of SCL-90-R in the Hakka elderly.ResultsThe scores of somatization (1.78 ± 0.55 vs. 1.40 ± 0.46, P < 0.001) and phobic anxiety (1.21 ± 0.36 vs. 1.17 ± 0.31, P < 0.001) for the Hakka elderly in Fujian appeared to be significantly higher than the Chinese norm. The higher total scores of SCL-90-R were found among females (β = 0.030, P = 0.044), widowed persons (β = 0.053, P = 0.021), those with parent(s) alive (β = 0.047, P = 0.019), and those with poorer self-rated health status (β = 0.110, P < 0.001). The lower total scores of SCL-90-R were found among those who were currently living in town, those with lower education level, those with higher average annual household incomes, and those who were living with spouse or children.ConclusionThe worse mental health conditions of the Hakka elderly in somatization and phobic anxiety were detected. The overall mental health status was shown to be worse among females, widowed persons, those who were living in village, those with lower education, and those with father or/and mother alive.

Factors related to turnover intention among emergency department nurses in China: A nationwide cross-sectional study.

Turnover intention among nurses is high, especially in the emergency department. However, factors that are associated with Chinese emergency department nurses' turnover intention have been scarcely studied. The present study examined relationships between turnover intention and demographic characteristics, job-related factors, depressive symptoms, and organizational commitment among emergency department nurses. A cross-sectional study of emergency department nurses was conducted in China between July and August 2018. The questionnaire included demographic characteristics (age, gender, level of education, and self-rated health status), job-related factors (qualification title, job seniority, night shifts, and workplace violence), depressive symptoms, organizational commitment, and turnover intention. A hierarchical linear regression model was used to identify factors that are associated with turnover intention among emergency department nurses. A total of 17 582 emergency department nurses participated in the study. The response rate was 68.9%. The findings indicated that poor self-rated health status (β=0.25, p < .001), working more than 11 night shifts per month (β=0.14, p < .01), experiencing workplace violence in the past year (β=0.08, p < .05), and higher depressive symptom scores (β=0.07, p < .001) positively correlated with turnover intention. More years of service (β=-0.38, p < .001) and higher organizational commitment scores (β=-0.45, p < .001) negatively correlated with turnover intention. Health status, job seniority, night shift frequency per month, workplace violence, depressive symptoms, and organizational commitment were significantly associated with emergency department nurses' turnover intention. To reduce turnover intention in the emergency department nurses, hospital administrators and managers should implement measures to improve their physical and mental health, increase organizational commitment, develop staff acceptable shift schedules, and reduce incidences of workplace violence.