Older Adults In Rural China Research Articles

Deepening the understanding of complicated grief among Chinese older adults: A network approach.

Instead of understanding symptoms in a way where a latent cause exists and symptoms serve as its indicators, the network approach enables an innovative comprehension on psychological disorders that focuses on causal interactions. There is need to update the knowledge in this direction in Chinese context. This study strives to apply network approach to deepening the understanding of complicated grief (CG) among older adults in rural China. A sample of older participants (N = 352) who experienced spousal bereavement living in Zhejiang Province of China were administrated with face-to-face interviews. Networks analysis was conducted to realize the object of this study. The 19-item ICG network revealed that symptoms were both positively and negatively connected within the network. The most three central symptoms were "feeling longing for the person who died" and "memories of the dead", and feeling lonely". Edge-weights accuracy and centrality stability were tested in order to remind carefulness when interpreting the results. This study demonstrates the utility of a network approach in deepening the understanding of the structure of CG symptoms among Chinese older people. Strengths and limitations, as well as implications for informing the assessment and treatment of this disorder, were discussed.

Loneliness, hopelessness and suicide in later life: a case-control psychological autopsy study in rural China.

Loneliness is increasingly recognised as a serious public health issue worldwide. However, there is scarce research addressing the association between loneliness and suicide in older adults in rural China. We set out to examine loneliness and other psychosocial factors in elderly suicide cases and explore their interaction effects. Using a 1 : 1 matched case-control design, data were collected from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including demographic characteristics, loneliness, depression, hopelessness and social support. The chi-square automatic interaction detection (CHAID) tree model and multivariable logistic regression analysis were used to explore the relationships of these factors and suicide. The CHAID tree model showed that loneliness, hopelessness and depressive symptoms were closely associated with completed suicide and that loneliness and hopelessness interacted with each other. The result of multivariable logistic regression showed that individuals who were unemployed [odds ratio (OR) = 2.344; 95% confidence interval (CI): 1.233-4.457], living alone (OR = 2.176; 95% CI: 1.113-4.254), had lower levels of subjective social support (OR = 2.185; 95% CI: 1.243-3.843), experienced depressive symptoms (OR = 6.700; 95% CI: 3.405-13.182), showed higher levels of hopelessness (OR = 7.253; 95% CI: 3.764-13.974) and felt higher levels of hopelessness × higher levels of loneliness (OR = 2.446; 95% CI: 1.089-5.492) were significantly associated with an elevated suicide risk in older people in rural China. Regular evaluation of loneliness, hopelessness and depression can help detect older adults who are at risk of committing suicide. Interventions should target social support systems, particularly among people living alone, to alleviate feelings of loneliness and hopelessness. Treating depression is also key to preventing suicide among elderly people in rural China.

Exploring the Risk Factors for Depressive Symptoms Among Chinese Rural Older Adults.

The purpose of the current study was to examine risk factors for depressive symptoms among older adults in rural China. Data were derived from the National Health Services Survey in China. A total of 2,586 rural adults age ≥60 were included in the study. Sociodemographic factors, health risk factors, and behavioral factors were measured, along with self-rated depressive symptoms. Older age (>70 years), lower education level, and living without a partner were associated with depressive symptoms. After adjusting for socioeconomic status and social support, individuals who had at least one chronic disease, experienced pain, and were unable to take care of themselves or perform household chores were more likely to report depressive symptoms (all p < 0.001). Community health care and nursing services should focus on pain control, improvement of daily physical function, and social support for older adults in rural China. [Journal of Psychosocial Nursing and Mental Health Services, 58(2), 41-47.].

DO WELFARE RECEIPTS CROWD OUT PRIVATE TRANSFERS FROM FAMILIES AND FRIENDS? EVIDENCE FROM PANEL DATA IN CHINA

Many countries are undergoing an unprecedented challenge to provide financial support to the older generation and guarantee their livelihood and wellbeing. China is no exception. Rural older adults in China have been becoming even more vulnerable to lack of care and inadequate financial resources as the growth of urbanization and labor migration has intensified. Therefore, it becomes increasingly difficult to follow the traditional family support model for the aged. Using the panel data of the China Health and Retirement Longitudinal Study 2011, 2013, and 2015 and a system generalized methods of moment (GMM), this paper examined the dynamic relationship between welfare receipts and monetary transfers from families and friends among rural and urban older adults (n=9,496) in China. The results show that the welfare receipts do not induce any “crowd-out” or “crowd-in” effects on rural older adults’ private transfer receipts. The incidence and amount of private transfers that occurred among rural older adults are more likely to be determined by the private transfers they received in prior waves. The intensity of catastrophic health expenditure itself does not affect the occurrence and size of private transfers. This study, on the one hand, confirms that among rural recipients, public transfers do not substitute private transfers, which most of the policymakers have long been concerned about. However, on the other hand, it also reveals the shortcoming of current public transfer policies—the generosity of public transfers does not enable rural older adults to be financially independent of intra-family transfers.

Social capital and the health of left-behind older adults in rural China: a cross-sectional study

ObjectiveTo examine the association between social capital and the health of male and female left-behind older adults in rural China.Study designThis cross-sectional study among the left-behind older adults aged 60...

Stage 1 hypertension defined by the 2017 ACC/AHA guideline predicts future cardiovascular events in elderly Chinese individuals.

The 2017 American College of Cardiology and American Heart Association (ACC/AHA) hypertension guideline updated stage 1 hypertension defined as systolic blood pressure (SBP) of 130‐139 mm Hg or diastolic blood pressure (DBP) of 80‐89 mm Hg. However, the impact of 1 hypertension that affects future cardiovascular risk remains unclear among older adults in rural China. The prospective cohort study included 7503 adults aged ≥60 years with complete data and no cardiovascular disease (CVD) at baseline. Follow‐up for the new adverse events was conducted from the end of the baseline survey to the end of the third follow‐up survey (2007.01‐2017.12). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for blood pressure (BP) classifications and adverse events with normal BP as reference (< 120/80 mm Hg). During the 57 290 person‐years follow‐up period, 2261 all‐cause mortality, 1271 CVD mortality, 1159 stroke, and 347 myocardial infarctions (MI) occurred. Patients with stage 1 hypertension versus normal BP had HRs (95% CI) of 1.068 (0.904‐1.261) for all‐cause mortality, 1.304 (1.015‐1.675) for CVD mortality, 1.449 (1.107‐1.899) for stroke, and 1.735 (1.051‐2.863) for MI, respectively. In conclusion, among adults aged ≥60 years, stage 1 hypertension revealed an increased hazard of CVD mortality, stroke, and MI, which is complementary evidence for the application of 2017 ACC/AHA hypertension guidelines in an older Chinese population. Therefore, BP control in patients with stage 1 hypertension may be beneficial to reduce the hazard of CVD in elderly Chinese individuals.

Suicide Means Used by the Older Adults in Rural China: A Comparison Between Those Using Pesticides and Other Means.

The most frequently used means of committing suicide was pesticide poisoning in rural China, yet little is known about the characteristics and risk factors for suicides committed with pesticides compared to those committed via other means in older adults. The participants were 242 older adults (aged 60 or older) who had committed suicide in the rural areas of 3 provinces (Shandong, Hunan, and Guangxi) in China. This study was conducted using the psychological autopsy (PA) method. In univariate analyses, no statistically significant differences were found between those who committed suicide with pesticide or with other means in terms of demographic and clinical variables except age, prevalence of mental disorders, suicidal intent, number of recent life events, social support, hopelessness, impulsivity, and depressive symptoms (P > .05); age, history of suicide attempts, having pesticides available at home, the total number of life events, and the number of long-term life events were significantly different (P < .05) between the 2 groups. In multivariate logistic regression model, the factors associated with committing suicide with pesticides were the availability of pesticides at home (odds ratio [OR] = 3.48, 95% confidence interval [CI]: 1.99-6.08) and the number of long-term life events (OR = 0.87, 95% CI: 0.78-0.97). The older adults who committed suicide by pesticides and those using other means are probably the same population. The main determinant of choosing pesticides as suicide means was likely the availability of pesticides at home. Suicide risk among older adults might be reduced by placing appropriate restrictions on access to pesticides.

The impact of suicidal death of rural older people to their relatives: Results from a national psychological autopsy study in China

ObjectiveThe suicide pattern in China is changing to a predominance of older people. However, little is known about the impact of suicide on the family members of elderly decedents. The aim of this study was to evaluate whether the suicidal death of rural older adults in China increases the odds of depression or suicidal ideation among their relatives and to explore the associated risk factors. MethodsIn a national psychological autopsy study in China, consecutive samples of suicide decedents aged 60 or above and matched living controls were enrolled in rural areas of three provinces. Univariate and multivariate analyses were performed to explore the occurrence and correlates of depression and suicidal ideation among relatives of elderly suicide decedents. ResultsA total of 242 suicide decedents and 242 living controls were identified. We enrolled 245 relatives of suicide decedents and 205 relatives of living controls. No significant differences in depression or suicide ideation were found between the relatives of suicide decedents and living comparisons after controlling for socio-demographic characteristics (depression: 26.5% vs. 21.5%; suicide ideation: 5.7% vs. 2.9%). A mood disorder diagnosis in the suicide decedent (OR = 1.93, 95% CI 1.12–3.52) and a spouse relationship (OR = 3.62, 95% CI 1.40–9.34) were independent risk factors for depression among relatives of suicide decedents. Spouses (OR = 5.91, 95% CI 1.49–23.38) were more likely to have suicidal ideation than other relatives. Limitationsthere are methodological limitations in psychological autopsy studies. ConclusionsIt seems that the suicide of an older adult 2–6 months ago has no significant impact on depressive symptoms and suicidal ideation in their relatives. Proactive support should be provided for spouses of suicide decedents and those whose relatives have a mood disorder diagnosis.

Targeted poverty reduction under new structure

PurposeThe purpose of this paper is to investigate the impact of social capital on the mental health of older adults in rural China. The authors also examine potential heterogeneous effects and two possible pathways from social capital increase to mental health improvement.Design/methodology/approachBased on a panel data of China Health and Retirement Longitudinal Study, this paper employs a fixed effect model to examine the impact of social capital on health. A two-stage instrumental variable approach is adopted to alleviate the issue of endogeneity.FindingsResults demonstrate that social capital has improved the mental health of older adults in rural China significantly. The beneficial effect is stronger for female, people with lower income, aged people and mainly observed in the central and western regions. Social capital affects the mental health of rural older adults through raising the awareness of healthy behavior and lowering the searching cost of health-related information.Practical implicationsSocial capital plays a vital role in improving the mental health of older adults in rural China and is necessary for the construction of beautiful countryside in China. The authority should increase the investment in both the hard and soft infrastructure to improve the mental health of rural residents and narrow the inequality in health status.Originality/valueThis study enriches the empirical literature on the relationship between social capital and mental health by providing new evidence from China. Also, we choose the social activities and communications of individuals to construct a standardized index for social capital, which can better capture the social capital at the individual level.

Moving beyond living arrangements: the role of family and friendship ties in promoting mental health for urban and rural older adults in China

Objective: This study examines the interplay among living arrangements, social networks, and depressive symptoms among Chinese older adults.Methods: Data are derived from the 2014 baseline survey of the China Longitudinal Aging Social Survey (CLASS), which provides a sample of older Chinese who had been married and had children (N = 7,662). This study examines the association between living arrangements and depressive symptoms (measured as CES-D scale, 0–18) of older adults, and addresses the moderating role of social networks (measured as family ties and friendship ties, 0–15) on this perceived association.Results: Our results show that older adults who live both with a spouse and adult children report superior mental health than those living alone (β = 1.240, p < 0.001), but no differences are seen from those living only with a spouse or children. Older adults living alone in rural areas are also more disadvantaged in comparison to those living alone in urban places (β = 0.535, p < 0.05). However, we find that the undesirable consequences associated with depression of older adults living alone can be reduced or even eliminated when older adults have strong friendship ties in rural China (β = −0.145, p < 0.01). We also find that for rural older adults living only with children, their mental health is highly contingent on their family ties, that is, they are extremely disadvantaged when having weak family ties, but benefit most significantly from strong family ties (β = −0.137, p < 0.05).Conclusions: Associations between living arrangements and mental health in later life are contingent on older adults’ social networks, and these moderating effects vary between rural and urban China.

Social Network Types and Health among Older Adults in Rural China: The Mediating Role of Social Support.

This study aimed to identify social network types among older adults in rural China, to explore the relationship between social network types and the health of the older adults, and further, to examine the mediating role of social support in this relationship. A cross-sectional survey method was employed to investigate the health of adults aged 60 or older in rural areas of Hubei Province from 5 September 2018 to 15 October 2018; 405 samples were obtained. First, using k-means clustering analysis, we found five robust network types: diverse, restricted, family, friends and a specific type—family-restricted. Second, the results of multiple linear regression analysis showed that social network types were significantly associated with depressive symptoms and self-rated health in older adults. Older people with diverse friend networks were significantly associated with lower levels of depressive symptoms, whereas those with restricted and family-restricted networks were significantly associated with higher levels of depressive symptoms and lower levels of self-rated health. Finally, the results of multiple linear regression analysis confirmed that social support partially mediated the association of the identified social network types with depressive symptoms and self-rated health. Enriching the social network relationships of older adults and providing them with more social support should be conducive to promoting their mental and physical health.

Living Arrangements, Offspring Migration, and Health of Older Adults in Rural China: Revelation From Biomarkers and Propensity Score Analysis

Objective: We examine the combined effects of living arrangements and outmigration of adult children on rural older adults' health profiles, measured by biomarker data from the China Health and Retirement Longitudinal Study 2011. Method: We employ biomarker data and propensity score analysis which allows us to effectively deal with selection issues that are commonly observed in the literature. Results: We show complex health implications of living arrangements and offspring migration. Living in a traditional multigenerational household has limited health benefits to older adults. However, older parents of migrants who live in a multigenerational household have better fitness in blood pressure. Their advantage over parents of migrants in other living arrangements suggests added benefits of the presence of grandchildren. Discussion: This study bridges the living arrangement and migration literature on health by showing that health effects of adult children's migration on older adults are contingent upon their living arrangements.

A collection of marginalized two-part random-effects models for analyzing medical expenditure panel data: Impact of the New Cooperative Medical Scheme on healthcare expenditures in China

Marginalized two-part random-effects generalized Gamma models have been proposed for analyzing medical expenditure panel data with excessive zeros. While these models provide marginal inference on expected healthcare expenditures, the usual unilateral specification of heteroscedastic variance on one of the two shape parameters for the generalized Gamma distribution in these models fails to encompass important special cases within the generalized gamma modeling framework. In this article, we construct marginalized two-part random-effects models that employ the log-normal, log-skew-normal, generalized Gamma, Weibull, Gamma, and inverse Gamma distributions to delineate the spectrum of nonzero healthcare expenditures in the second part of the models. These marginalized models supply additional choices for analyzing healthcare expenditure panel data with excessive zeros. We review the concepts of marginal effect and incremental effect, and summarize how these effects are estimated. For studies whose primary goal is to make inference on marginal effect or incremental effect of an independent variable with respect to healthcare expenditures, we advocate empirical mean square error criterion and information criteria to choose among candidate models. Then, we use the proposed models in an empirical analysis to examine the impact of the New Cooperative Medical Scheme on healthcare expenditures among older adults in rural China.

Multidimensional Intergenerational Instrumental Support and Self-Rated Health Among Older Adults in Rural China: Trajectories and Correlated Change Over 11 Years.

This study investigated the dynamic relationship between multidimensional intergenerational instrumental support and health over time. This approach is of theoretical, methodological, and practical significance in gerontological research. Data came from The Well-Being of Older People in Anhui Province in 2001, 2003, 2006, 2009, and 2012. Of the 1,636 participants at baseline, a working sample of 1,557 older adults was used. Trajectories and correlated change were estimated using parallel latent growth curve modeling with maximum likelihood estimation. "Received household-chore help" decreased over time, whereas "received personal-care help" increased over time. "Provided household-chore help" and "provided personal-care help" increased and then decreased over time. Increasing receipt of "household-chore help" and "personal-care help" were associated with faster decline in health over time. Findings suggest distinctive patterns of changes for different dimensions of intergenerational instrumental support and their relationship with changes in perception of health over time in later life.

The validity of proxy-based data on loneliness in suicide research: a case-control psychological autopsy study in rural China

BackgroundThere is a lack of evidence for the role of loneliness on suicide using psychological autopsy method, and the validity of proxy informants’ reports on loneliness is not well established. This study aimed to investigate the validity of proxy respondent reports on loneliness, and the reliability and validity of the University of California Los Angeles Loneliness Scale-6 (ULS-6) as used in psychological autopsy method with rural elderly people in China.MethodsTwo hundred forty-two suicide cases and 242 normal community controls were selected, and the psychological autopsy method was utilized to collect information. Data from proxy respondents of the living controls were compared with data reported by the targets (gold standards).ResultsSubject-proxy concordance for ULS-6 was fair (ICC = 0.447) in the living controls. The suicide cases were more likely to have a higher score of ULS-6 than the living controls. Additionally, our data supported that ULS-6 had adequate psychometric properties in both suicide and control groups: factor analyses yielded one-factor component solution; Cronbach’s alpha (both > 0.90) demonstrated excellent internal consistency; the Spearman correlation analysis indicated that the ULS-6 score was positively correlated with depression; and negatively correlated with QOL and social support.ConclusionsResults support proxy-based data on loneliness in research of suicide in older adults in rural China, and the ULS-6 is a psychometrically sound instrument for measuring loneliness in psychological autopsy studies.

Social support and depressive symptom disparity between urban and rural older adults in China

BackgroundDepressive symptom disparity between urban and rural older adults is an important public health issue in China. Social support is considered as an effective way to alleviate depression of older adults. This study aimed to investigate the extent to which social support could explain the depressive symptom disparity between urban and rural older adults in China. MethodsThis study used data drawn from the 2011 China Health and Retirement Longitudinal Study with 6,772 observations. Multiple data analysis strategies were adopted, including descriptive analyses, bivariate analyses, regression analyses and decomposition analyses. ResultsThere were significant depressive symptom disparities between urban and rural older adults in China. Social support had significant association with depressive symptom of older adults while adjusting for covariates. About 25%–28% of the depressive symptom disparities could be attributed to urban–rural gaps in social support, in which community support contributed 21%–25%. Educational level and physical health status also contributed to the disparities. LimitationThis study only established correlations between social support and depressive symptom disparity rather than casual relationships; and the self-reported measurement of depressive symptom and the unobservable cultural factors might cause limitations. ConclusionsThe urban–rural gap in social support, especially community support was a prime explanation for depressive symptom disparities between urban and rural older adults in China. To reduce the depressive symptom disparities, effective community construction in rural China should be put into place, including improving the infrastructure construction, strengthening the role of social organizations, and encouraging community interpersonal interactions for older adults.

Frailty index and its associations with self-neglect, social support and sociodemographic characteristics among older adults in rural China.

The frailty index is used to measure the health status of older individuals. However, its association with self-neglect, social support and sociodemographic characteristics of older adults is underexplored. The purpose of the present study was to explore such associations among the rural older adults in Anhui Province of China, and to provide scientific evidence for policy-makers to improve the health and well-being of older adults in rural China. A cross-sectional survey was undertaken among 3048 older adults in rural China. The frailty index was measured by an accumulation of deficits of 40 items. Ordinal logistic regression models were carried out to explore the associations of self-neglect, social support and sociodemographic characteristics with the frailty index. The frailty rate was 15.8% among the participants. Older adults who showed self-neglect, were female, had a lower education level, had a lower monthly income and did not drink alcohol were more prone to having frailty in the 60-76 years age group, whereas older adults who showed self-neglect, had poor social support, were female, were not smokers and did not drink alcohol were more likely to have frailty in the ≥77 years age group (P < 0.05). The interaction effect on frailty between self-neglect and social support was found in the 60-76 years age group. Age differences were shown in the associations between self-neglect, social support, sociodemographic characteristics and frailty index, which suggests different measures should be used accordingly for frailty prevention and management. Geriatr Gerontol Int 2018; 18: 987-996.

Prevalence of Vision Impairment in Older Adults in Rural China in 2014 and Comparisons With the 2006 China Nine-Province Survey

To estimate the prevalence of vision impairment and blindness in 2014 among older adults in rural China with comparisons with the 2006 Nine-Province Survey. Population-based, cross-sectional study. Geographical cluster sampling was used in randomly selecting residents from a rural county or semi-rural district within 9 provinces: Beijing, Jiangsu, Guangdong, Heilongjiang, Jiangxi, Hebei, Ningxia, Chongqing, and Yunnan. Persons 50 years of age or older were enumerated through household visits and invited to examination sites for visual acuity testing and examination. Vision impairment and blindness in 2014 was compared with data from the 2006 survey. Among 51 310 examined persons, the prevalence of presenting vision impairment (<20/63 to ≥20/400) in the better-seeing eye ranged from 6.05% to 15.3% across the 9 study sites, with presenting blindness (<20/400) ranging from 0.66% to 5.35%. With best-corrected visual acuity, the prevalence of vision impairment ranged from 1.96% to 8.74%, and blindness from 0.47% to 5.01%. Vision impairment was associated with older age, female sex, and little or no education. The overall prevalence of presenting vision impairment and blindness decreased during the 2006-2014 interval by 6.31% and 29.0%, respectively; and by 16.1% and 38.0%, respectively, after standardization of 2006 prevalence rates to the 2014 population. Substantial progress has been made in the reduction of vision impairment in rural China. Nevertheless, vision impairment remains an important public health problem with substantial geographic disparities and with older age, female sex, and illiteracy as risk factors.

ACCESS TO HEALTH CARE IN RURAL CHINA: THE INFLUENCE OF TRAVEL DISTANCE ON HEALTHCARE DECISION-MAKING

In 2009, China established several new schemes to provide social health care coverage for the vast majority of its 1.3 billion citizens. However, continued separated healthcare system creates inequalities in access that disadvantage people in rural areas. Because public hospitals and clinics are insufficient to meet their needs, older adults with serious health problems often must travel great distances to obtain care. This study draws on the Andersen Behavioral Model to examine this trade-off between accessing quality of care and travel distance in health care decision-making.Based on nationally representative data from the Study on Global Aging and Adult Health (SAGE) (N =4,445), multinomial-logistic regression was used to examine the influence of distance traveled on health services utilization. Controlling for the effects of relevant predisposing, enabling and need factors, distance decreased older adults’ use of private (OR=0.48, P<0.01) and public (OR=0.22, P<0.01) clinics, but it had the opposite effect on use of public hospitals (OR=1.52, P<0.001). Health status and availability of high quality medical care in their home province moderated this relationship; in cases of poor health, distance played a less significant role in choice of clinics, but a greater role in choosing a high-quality hospital regardless of distance (OR=2.09, p<0.01), while the availability of local medical resources lessened the impact of distance (OR=2.221, P<0.01). In sum, distance reduced the probability of older adults’ clinic use, but not their decision to seek sophisticated hospital services, especially in cases of poor health and the absence of high-quality care locally. Feasible schemes must contend with this growing issue of distance to high-quality facilities in health care decision-making of older adults in rural China.

Intergenerational Relationships and Self-Rated Health Trajectories Among Older Adults in Rural China

The present study examined trajectory patterns of self-rated health (SRH) among older rural Chinese adults and gender differences in the relationship between intergenerational relationships and SRH trajectories. Using data from four waves of a longitudinal study on the well-being of older adults in Anhui province, a general growth mixture model was estimated to examine the SRH trajectory patterns and antecedents of SRH trajectory class memberships. A two-class model was selected to interpret the SRH trajectory patterns. The two classes were labeled remaining poor and good but declining. Intergenerational relationships were a significant antecedent of SRH trajectory class memberships among men but not women. Gender differences in the cumulative effects of intergenerational relationships on the health of older adults were identified in rural China. Policy implications regarding how to help rural families support their elderly members are discussed.