Older Adults In Rural China Research Articles

Association between physical activity and falls among older adults in rural China: are there gender and age related differences?

BackgroundThe relationship between physical activity (PA) and falls among older adults is inconsistent, and little is known about the gender-specific association between falls and PA. Moreover, age may modify this relationship. This study aimed to test the association between PA and falls and to investigate the gender and age differences in the association among rural older adults.MethodsThis cross-sectional data were derived from the baseline survey of Shandong Rural Elderly Health Cohort (SREHC). In total, 3,242 rural older adults aged 60 years and above were included in the analysis. PA was measured by the International Physical Activity Questionnaire Short Form (IPAQ-S). PA levels were classified as low, moderate, elevated and high according to quartiles. Volume of moderate-to-vigorous physical activity (MVPA) was categorized into low, moderate, elevated, and high level based on global recommendations. Information on falls was determined from in-person interviews. Falling was defined to participants as ending up on the floor or ground because they were unable to stop themselves. Logistic regression analysis was employed to explore the association between falls and PA.ResultsOf 3,242 rural older adults, the incidence of falls was 13.1%. In older adults, high levels of PA [odds ratio (OR) = 0.65, 95% confidence interval (CI): 0.47–0.90] or MVPA (OR = 0.68, 95% CI: 0.50–0.94) were related to falls. Moderate (OR = 4.84, 95% CI: 1.68–13.94) or high (OR = 0.54, 95% CI: 0.30–0.99) levels of MVPA were associated with falls in older men. But elevated levels of PA were associated with falls (OR = 0.60, 95% CI: 0.42–0.87) in older women. Among older people younger than 75 years, elevated (OR = 0.54, 95% CI: 0.37–0.79) or high (OR = 0.68, 95% CI: 0.48–0.98) levels of PA were associated with falls.ConclusionsAmong Chinese rural older adults, PA and MVPA are associated with falls, and there are gender and age differences. To prevent falls, measures need to account for individuals’ gender and age to encourage rural older adults to participate more actively in PA. We will conduct longitudinal studies to clarify the causal relationship between PA and fall.

Association Between Frailty and Inpatient Services Utilization Among Older Adults in Rural China: The Mediating Role of Multimorbidity.

IntroductionDeveloped and developing countries have different health systems and disease patterns. There is little evidence that frailty is related to inpatient services utilization in developing countries. In addition, the underlying mechanism of this relationship also remains unclear. This study aimed to examine the association between frailty and inpatient services utilization, and further explore whether multimorbidity play a mediating role in this association.MethodsA total of 3,242 rural older adults aged 60 and older were included in the analysis. Frailty was measured by the physical frailty phenotype (PFP). Multimorbidity and inpatient services utilization was measured based on participants' self-report and validated by village doctors. Ordered logistic regression analyses were performed to examine the association between frailty, multimorbidity and inpatient services utilization. Bootstrap analysis was further to explore the mediation effect of multimorbidity on frailty and inpatient services utilization.ResultsThe utilization of inpatient services was 20.1% (one: 15.8%, two or more: 4.3%). The prevalence of prefrailty and frailty was 64.7 and 18.1%, respectively. Frail older adults experienced a higher risk of multimorbidity and inpatient services utilization. Multimorbidity partially mediated the association between frailty and inpatient services utilization [95% confidence interval (CI): 0.005-0.016, p < 0.001]. The mediating effect of multimorbidity accounted for 19.0% of the total effect.ConclusionsAmong Chinese rural older adults, frailty is associated with higher inpatient services utilization, and multimorbidity mediates this association. Recommendations are to increase frailty risk screening, chronic disease monitoring, and to do timely interventions.

Intergenerational support and depressive symptoms among older adults in rural China: the moderating roles of age, living alone, and chronic diseases

BackgroundWhile depressive symptoms are recognized as major mental health problems in later life, there is a lack of study in examining potential moderators in the association between intergenerational support and depressive symptoms, especially in social contexts with low socioeconomic status and inadequate formal public support. This study set out to examine the association between intergenerational support and depressive symptoms among older adults in rural Northeast China, and the potential moderating roles of age, living alone, and number of chronic diseases on this link.MethodsA quota sampling approach was used to recruit 448 respondents aged 60 and above from rural Chinese communities. Depressive symptoms were the dependent variable. Intergenerational emotional, instrumental, and financial support were the main independent variables. Age, living alone, and number of chronic diseases were the moderators. Multiple linear regression models with interaction terms were conducted to test the proposed model.ResultsThe results showed that intergenerational emotional support was significantly associated with depressive symptoms in older adults when instrumental and financial support and covariates were controlled (β = -0.196, p < .001). Age was found to have a significant moderating effect on the relationship between intergenerational instrumental support and depressive symptoms (β = -0.118, p < .05). Among older respondents aged 74.51 years and older, instrumental support was positively associated with depressive symptoms, but this association was not significant for younger respondents. Furthermore, living alone and number of chronic diseases suffered moderated the association between intergenerational financial support and depressive symptoms, which was statistically significant only for those living alone and with more chronic diseases (interaction term between living alone and intergenerational financial support: β = -0.082, p < .05; interaction term between number of chronic diseases and intergenerational financial support: β = -0.088, p < .05.ConclusionsThe findings not only highlight the important role of intergenerational support in promoting mental health in later life in rural Chinese contexts, but also identify within-population heterogeneity in the identified associations. Policy and intervention implications are discussed.

Association between social capital and sleep duration among rural older adults in China

ObjectiveSleep disturbances are great challenges to older adults’ health promotion. The study tested gender differences in the association between different dimensions of social capital and self-reported sleep duration of Chinese rural older adults.DesignThe data of rural older adults were extracted from a national cross-sectional survey of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and analyzed in this study.SettingCLHLS covered 23 provinces in China.ParticipantsThe 6552 rural respondents aged ≥65 years old were involved.Main outcome measuresGeneralized trust, informal social participation, formal social participation and social support were used to assess social capital. Self-reported sleep duration was measured as health outcome.ResultsLow level of generalized trust had harmful effect on insufficient sleep (AOR 1.110, 95% CI 1.018-1.324), and having no formal or informal social participation was significantly positively associated with long sleep (AORformal 1.424, 95% CI 1.007-2.013; AORinformal 1.241, 95% CI 1.016-1.516). Rural older female adults with no emotional social support had higher odds of insufficient sleep (AOR 1.502, 95% CI 1.258-1.978). Meanwhile, both informal and formal social participation showed inverse association with long sleep for females.ConclusionsThis study found the relationship between social capital, sleep duration and the gender differences in Chinese rural older adults. More targeted sleep disturbance interventions could be taken in social capital of rural older adults, and gender differences should be considered when making social capital-embedded health promotion policies and interventions.

Indoor solid fuel use and renal function among middle-aged and older adults: A national study in rural China

Solid fuel use is the main source of indoor air pollution, especially in rural areas of developing countries. Nevertheless, the evidence linking indoor solid fuel use and renal function is very limited. Therefore, we investigated the association between indoor solid fuel use and renal function among middle-aged and older adults in rural China. Cystatin C (CysC) concentration of each participant was used to calculate the estimated glomerular filtration rate (eGFR). We used the baseline data to investigate the associations between solid fuel use for cooking and heating and eGFR through a linear-mixed effects model. Then, we applied the generalized linear-mixed effects model with binary distribution to examine the relationship between renal function decline and cooking fuel switching from 2011 to 2015. A total of 4959 participants were included at baseline, and 3536 participants were included in the follow-up analysis. Compared to participants who used clean fuel for both cooking and heating, the eGFR was significantly lower among participants who cooked with solid fuel and heated with clean fuel (β: -2.81; 95% CI: -5.53, -0.09). In the follow-up analysis, the risks of renal function decline for participants using solid fuel for cooking were significantly higher in males (OR: 2.74; 95% CI: 1.68, 4.49), smokers (OR: 5.70; 95% CI: 2.82, 11.55), and drinkers (OR: 7.11; 95% CI: 3.15, 16.02) compared to females, non-smokers, and non-drinkers. Moreover, 45–65 years aged participants (OR: 0.54; 95% CI: 0.33, 0.89) and non-drinkers (OR: 0.61; 95% CI: 0.41, 0.92) who switched from solid to clean cooking fuel had a lower risk of renal function decline. In conclusion, our findings show that household solid fuel use is likely to be an important risk factor for renal function decline in rural China. And switching to cleaner fuel may provide significant public health benefits.

Time Use, Gender, and Mental Health of Older Adults in Rural China

Time use is considered a valuable descriptor of people’s lifestyles, and studying how people spend their time is critical for understanding the determinants and consequences of individual well-being. In this study, we first develop a time use typology to characterize how older adults in rural Chinese families allocate their time in later life, and then examined how older adults’ time allocation influenced their mental health, with a special focus on differential implications for older women and men. Data derived from 2015 and 2018 waves of a longitudinal study of 1,007 older adults, aged 60 and older, living in rural areas of Anhui Province, China. We specifically focused on how social and solitary dimensions of time use, as well as time spent within and outside households, impacted depressive symptoms of older adults. Using the K-means cluster analysis, we identified four time use categories: “work-oriented,” “socially-active,” “homemaker/ caretaker,” and “socially-isolated.” Results from fixed-effects regression analysis demonstrated that older women involved in “socially-active” time-use category tended to report better mental than those in other time-use types, while the time spent on housework and caregiving was harmful to their mental health. For older men, more time spent on paid activities outside households (“work-oriented”) was associated with better psychological outcomes while solitary leisure time (“socially-isolated”) was associated with higher levels of depressive symptoms. These findings will be helpful for health policymakers and practitioners who seek to better identify vulnerable subpopulations and to design effective intervention strategies to reduce mental health problems.

The Mediating Role of Depressive Symptoms, Hopelessness, and Perceived Burden on the Association Between Pain Intensity and Late-Life Suicide in Rural China: A Case-Control Psychological Autopsy Study.

Background: Few studies have investigated the roles of psychosocial factors such as depressive symptoms and hopelessness on the relationship between pain and suicide with inconsistent results. The study aimed to analyze the impact of pain intensity on suicide death and to estimate the degree to which depressive symptoms, hopelessness, and perceived burden may explain the association in Chinese rural elderly.Methods: Using a 1:1 matched case–control design, we collected data from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including sociodemographic characteristics, pain intensity, depression, hopelessness, perceived burden, physical diseases, and social support. Conditional logistic regression was employed to assess the association between pain intensity and completed suicide. Mediation analysis using the KHB method was applied to explore the mediation effects from depressive symptoms, hopelessness, and perceived burden.Results: The result of multivariable logistic regression showed that unemployment [odds ratio (OR) = 5.06, 95% confidence interval (CI): 1.76–14.49], higher levels of hopelessness (OR = 7.72, 95% CI: 3.49–17.10), depressive symptom (OR = 15.82, 95% CI: 4.53–55.25), and severe pain (OR = 3.46, 95% CI: 1.31–9.13) were significantly associated with elevated suicide risk in older adults in rural China. Depressive symptoms, hopelessness, and perceived burden significantly mediated 43.71% of the pain–suicide association (p = 0.020), with 17.39% due to depressive symptoms, 17.63% due to hopelessness, and 8.69% due to perceived burden.Conclusions: Regular screening of pain, depressive symptoms, hopelessness, and perceived burden using simple but sensitive questions or scales for older adults with pain is vital for the prevention and early detection of suicide risk in Chinese rural areas. Moreover, the importance of pain management and psychological interventions targeted on depressive symptoms and hopelessness should be emphasized.

Association between functional disability and depressive symptoms among older adults in rural China: a cross-sectional study

ObjectivesThe aim of this study was to explore the relationship between functional disability and depressive symptoms, focusing on whether an interaction exists between functional disability, demographic characteristics and depressive symptoms...

Understanding the Reasons for Suicide Among Older Adults in Rural China Using In-Depth Interviews.

Background: Suicide is a complex public health problem. Suicide rates are higher in rural areas than in urban areas and among older adults than any other age group in China. Aims: This study aimed to acquire a comprehensive understanding of rural older adults' reasons for suicide through qualitative exploration and to provide additional insights for suicide prevention work. Method: In-depth interviews were conducted with people familiar with older adults who had died by suicide ("informants"). The data were analyzed using a thematic approach. Results: Data were available for 242 people who died by suicide. Informants identified two or more reasons for suicide among most people who had died. Physical illness, psychological distress, and interpersonal conflicts were the most common reasons. The rate of mental disorders as diagnosed by psychiatrists was higher than that reported by the informants. Limitations: Information bias is inevitable because of the use of proxy informants. Conclusion: The reasons for suicide are complex and diverse, and research on suicide should focus more on the mechanisms of interaction between reasons. Greater attention should be paid to physical and mental health as well as to improving interpersonal and problem-solving skills for older adults in China.

Whose migration matters? The role of migration in social networks and mental health among rural older adults in China

AbstractThe dual demographic changes in massive rural-to-urban labour migration and population ageing have significantly impacted the lives of older adults, who have either been left behind in rural regions or migrated to urban areas. While many extant studies on migration and wellbeing of older adults have focused on either migrating or left-behind older adults, a very limited number of studies have directly compared these two groups. Utilising data from the China Longitudinal Ageing Social Survey, this study examines the impacts of different migration patterns (i.e.migrating older adults, left-behind older adults and non-migrating older adults) on the social networks and mental health of older adults in rural China. Structural equation modelling results showed that older adults who have been left behind reported weaker family ties and poorer mental health than the other older adults. Moreover, weakened family ties increased older adults’ risk of developing mental health problems. Older migrants reported the lowest level of depressive symptoms among the three groups of older adults. However, migration may be associated with poorer mental health among the older migrants due to the shrinking/weakening of family/friendship ties.

Social capital, perceived neighborhood environment, and depressive symptoms among older adults in rural China: the role of self-rated health.

This study examined the relationships between social capital, perceived neighborhood environment, and depressive symptoms among older adults living in rural China, and the moderating effect of self-rated health (SRH) in these relationships. A quota sampling method was applied to recruit 447 participants aged 60 years and older in rural communities in Jilin province, China in 2019. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale. Structural equation modeling was used to build latent constructs of social capital and test the proposed model. Multiple group analysis was used to test the moderation effects. Cognitive social capital and structural social capital were both associated with depressive symptoms controlling for participants' demographics, socioeconomic status, and health status. After adding perceived environment variables in the model, the relationship between cognitive social capital and depressive symptoms became nonsignificant, while structural social capital remained became a significant factor (β = -.168, p < .01). Satisfaction with health care was significantly associated with depressive symptoms among those with poor SRH (β = -.272, p < .01), whereas satisfaction with security and transportation were strongly associated with depressive symptoms among those with good SRH (security: β = -.148, p < .01; transportation: β = -.174, p < .01). Study findings highlighted the importance of social capital and neighborhood environment as potential protective factors of depressive symptoms in later life. Policy and intervention implications were also discussed.

Intergenerational Emotional Cohesion and Psychological Well-Being of Older Adults in Rural China: A Moderated Mediation Model of Loneliness and Friendship Ties.

Although researchers have linked intergenerational emotional cohesion (IEC) to psychological well-being (PWB) among older adults, the mechanisms and conditions under which IEC is related to PWB-particularly in rural areas-are less well understood. This study analyzed data from rural China to examine whether loneliness mediated the relationship between IEC and PWB, and whether friendship ties moderated the strength of the direct and indirect relationships between IEC and PWB. Mediation and moderated mediation models were tested using a sample of rural adults aged 60 and older (N = 958) from the Longitudinal Study of Older Adults in Anhui Province, China. Measures included IEC, friendship ties, loneliness, and 2 PWB indicators-depressive symptoms and life satisfaction. The results revealed that IEC was negatively related to loneliness, which in turn was associated with depressive symptoms and life satisfaction. Furthermore, this indirect pathway linking IEC and depressive symptoms (but not life satisfaction) was positively conditioned on the size of friendship ties. This study advances our understanding of the mechanism through which IEC influences PWB in older adults. Alleviating loneliness could help boost PWB. Other implications for practice and future research are discussed.

Residential reasoning: how childless older adults choose between ageing in place (AIP) and institutionalisation in rural China

AbstractThe decision of whether to grow old in one's home (also referred to as ageing in place (AIP)) or relocating to an institution is an ongoing negotiation process, which involves residential decisions and adaptation. This research aims to explore how childless older adults in rural China choose between AIP and institutionalisation. Through a qualitative study conducted in rural China among childless older adults, we explored the reasons why they make certain residential choices and how they adapted during the decision process. Twenty-five childless participants (aged 60–83) were interviewed. Findings suggested that they referred to the term ku (literally meaning ‘bitterness’; and a metaphor referring to ‘conducting farming and farm-related activities’) to explain their residential decisions. If a person could endure ku – sustain food and basic living through farming and farm-related activities, they tended to choose to age in place; otherwise, they chose to relocate to institutions. Ku represents a sense of mastery, encompassing the stressfulness and suffering aspect that requires adaptation. Three adaptive strategies were identified: (a) positive reappraising of the negative aspect of ku, (b) routinising ku, and (c) transcending the narrative of ku into a toughness identity. Our findings suggest that childless older adults struggled to achieve residential mastery while making residential decisions, even though a sense of mastery was shaped by the individual and structural constrictions.

Community Social Capital, Family Social Capital, and Self-Rated Health among Older Rural Chinese Adults: Empirical Evidence from Rural Northeastern China.

This study investigated the relationships among community social capital, family social capital, and self-rated health of older adults in rural China. Data came from a community survey in Jilin Province, China, in 2019. Using a quota sampling method, 458 respondents aged 60 years or older were recruited. Two-step structural equation modeling was adopted to examine the proposed hypotheses. The relationships between community-based structural social capital, family social capital and self-rated health were statistically significant, whereas the relationship between community-based cognitive social capital and self-rated health was statistically nonsignificant. In order to enhance healthy aging, social capital policies and interventions should be developed to promote not only family social capital indicators (e.g., quality of family relationship and support) but also older adults’ structural social capital indicators (e.g., social participation and volunteering) in rural Chinese contexts.

The Reciprocal Relationship between Frailty and Depressive Symptoms among Older Adults in Rural China: A Cross-Lag Analysis.

(1) Objective: This study aimed to investigate the reciprocal relationship between frailty and depressive symptoms using longitudinal data among older adults in China. (2) Methods: Data derived from 2014 and 2017 waves of a longitudinal study of 1367 older adults aged 70–84 years, living in rural areas of Jiangsu Province, China. Cross-lagged panel model and a multiple group model were used to examine the temporal effect of frailty on depressive symptoms and vice versa. (3) Results: Frailty was associated with subsequent increase in depressive symptoms, such that participants with higher levels of frailty increase the risks of depressive symptoms (b = 0.090, p < 0.01). Depressive symptoms were significant predictors of increased frailty (b = −0.262, p <0.001). However, older men and older women had no significant differences in the reciprocal relationship between frailty and depressive symptoms. (4) Conclusions: In conclusion, we find a significant bi-directional relationship between frailty and depressive symptoms. This finding confirms the dyadic model of frailty and depression. Implications for interventions and policy to help frail and depressive older adults are discussed.

Cultural capital and mediatory role of meaning-making in post-bereavement depression among older adults in rural China

This research was conducted to test the direct effect of cultural capital and indirect effect of meaning making on depression among Chinese older adults in bereavement living in rural area. A sample of 352 older adults participated in this research. Confirmatory factor analysis was performed to secure the construct validity of cultural capital, and path analysis with multiple mediators was run to investigate the mediation model including cultural capital, depression, meaning making, and meaning making squared. Meaning making and it squared form (a high level of meaning making) were mediators in the direct relationship cultural capital and depression. The results revealed a significantly positive indirect effect of cultural capital on depression through meaning making and a significantly negative indirect effect through the square of meaning making. The direct effect of cultural capital on depression did not reach statistical significance. These findings suggested a full mediating role of high quality of meaning making. Enhancing the levels of cultural capital and meaning making by means of education programs was recommended, since Chinese traditional culture has features in helping the widowed older adults adapt to the death of their partners.

Associations of frailty, loneliness and the quality of life of empty nesters: A cross-sectional study in rural areas.

To explore loneliness, in association with frailty, in explaining the quality of life (QOL) of empty-nest older adults in rural China. A cross-sectional questionnaire survey was conducted. Data collection was performed from June to August 2017 in Changchun, the capital city of Jilin province, which consists of seven districts and three counties. In total, 304 older adults aged 60 years and above participated. The characteristics of older adults were evaluated in terms of frailty status, loneliness and the QOL. One-way and two-way analyses of covariance and the area under the receiver operating characteristic curves were used to explore the relationships of frailty, loneliness and the QOL. The one-way ANCOVA showed a significant difference among robust, prefrail and frail participants for loneliness. Moreover, an interaction effect of frailty with loneliness in determining the QOL was found. The receiver operating characteristic curves showed that loneliness and QOL could distinguish frail older adults, and the best cutoffs were 34.5 and 67.4, respectively. This study demonstrates a close relationship between frailty and loneliness, suggesting the need to simultaneously consider the two with regard to the QOL of empty-nest older adults in rural China.

Community social capital and cognitive function among older adults in rural north-east China: The moderator role of income.

This study investigated the moderating role of income in the relationship between community social capital and cognitive function among community-dwelling older adults in rural China. Data were derived from a community survey conducted in Dongliao county, Jilin province, China, in 2019. Trained interviewers completed face-to-face interviews with 458 respondents. Multiple group analysis was applied to examine the proposed model. The latent constructs of cognitive social capital and structural social capital were established in low-income and high-income groups in rural Chinese contexts. Factor loading invariance of social capital constructs was established across the two income groups. The results showed that income has moderating effects on the relationship between social capital constructs and cognitive function. Social capital that was significantly associated with cognitive function was statistically significant in low-income group only. The findings highlight the important role of income in understanding the mechanism linking social capital to cognitive function in a rural Chinese context. Social policies and interventions should pay particular attention to older adults with low economic status. Policy and intervention implications are discussed.

Chipping In or Crowding-Out? The Impact of Pension Receipt on Older Adults' Intergenerational Support and Subjective Well-Being in Rural China.

With the introduction of the New Rural Social Pension Scheme (NRSPS), pension coverage in rural China has increased substantially during the last decade. We investigate how the new public pension benefits influence intergenerational transfers and subjective well-being of older adults in rural China using panel data from the 2011 and 2013 waves of the China Health and Retirement Longitudinal Study (CHARLS). The results of our first-difference regression models show that receiving a public pension goes along with an increase in intergenerational financial support and has a positive impact on the subjective well-being of older adults in rural China. Our analysis represents one of the first studies examining the effects of the introduction of the NRSPS from a longitudinal perspective. The results demonstrate that public pension benefits as a form of institutional financial support are beneficial to the well-being of older adults, while they do not hinder intergenerational exchange.

Social trust and emotional health in rural older adults in China: the mediating and moderating role of subjective well-being and subjective social status

BackgroundChina is becoming an aging society. The emotional health of the elderly is gaining importance. Social trust is an important factor affecting emotional health, but existing studies have rarely considered the various effects of different types of social trust on rural elderly emotional health. Few studies have analysed the role of subjective well-being and subjective social status in the relationship between social trust and elderly emotional health.MethodsUsing the data of the China Labor-force Dynamics Survey 2016 (CLDS 2016) and regression models, this study selected 2084 rural respondents aged 60 years and above to analyse the impact of social trust on their emotional health. Social trust was divided into three categories: trust in family members, trust in friends, and trust in neighbours. This study also examined the mediating and moderating effects of subjective well-being and subjective social status on the relationship between social trust and emotional health.ResultsTrust in family members was significantly and positively associated with emotional health (coefficient = 0.194, P < 0.01) and subjective well-being (coefficient = 0.177, P < 0.01). Trust in friends was significantly and positively associated with emotional health and subjective well-being (coefficient = 0.097, P < 0.01; coefficient = 0.174, P < 0.01, respectively). Trust in neighbours was significantly and positively associated with emotional health and subjective well-being (coefficient = 0.088, P < 0.01; coefficient = 0.177, P < 0.01; respectively). Subjective well-being effectively reduced the impact of social trust in family, friends, and neighbours on the emotional health of the elderly by 0.023, 0.022, and 0.023, respectively. Trust in friends and neighbours significantly and positively affected respondents’ subjective social status (coefficient = 0.120, P < 0.05; coefficient = 0.090, P < 0.10; respectively). Subjective social status effectively reduced the impact of social trust in friends and neighbours on the emotional health of the elderly both by 0.004. The positive relationship between trust in family members and emotional health is weakened by subjective well-being.ConclusionsSocial trust, especially family relationships, play an important role in maintaining the emotional health of the rural elderly. In response to population ageing, more social policies must be introduced to care for the rural elderly and help them lead a happy and satisfactory life.