Rural Older Adults Research Articles

Temporal dynamics of unmet long-term care needs in China: an age period cohort analysis

Abstract Rapid demographic changes and heavy reliance on informal care pose significant challenges to meeting long-term care (LTC) needs in China. Understanding changes in unmet LTC needs across different times and places can inform future LTC system planning and care resource allocation, identifying emerging care needs and services gaps in different regions. Drawing on data from 6,030 urban and 5,070 rural residents in the Chinese Longitudinal Health Longevity Survey 2005–2017/18, this study investigates variations in unmet LTC needs across different age groups, periods and birth cohorts among Chinese older adults and their place-based rural–urban differences. We applied the age-period-cohort interaction model to disentangle the three temporal processes, and found that, overall, rural older adults experienced higher risk of unmet LTC needs and had larger variation in age effects, yet the age, period and cohort effects on unmet needs among rural older people differed from their urban counterparts. Although ‘younger’ older adults (aged below 85) had fewer care needs than older adults, they had a higher risk of experiencing unmet needs. The risk of having unmet needs did not change significantly over the 12 years, though unmet LTC needs were more pronounced among more-recent cohorts than previous generations, especially in urban areas. The findings contribute to the social gerontology debate regarding changing patterns in unmet LTC needs, and provide crucial policy insights, underscoring the necessity of targeted interventions to address ‘younger’ older adults’ care needs and increased investmed in the formal LTC system to tackle the escalating care gap.

Telehealth Challenges, Opportunities, and Policy Recommendations for Rural Older Adults Living with HIV in the United States

ABSTRACT Over one million people in the United States (U.S.) are living with HIV. People living with HIV in the rural South experience delayed HIV treatment and increased mortality risks. Access challenges and HIV stigma exacerbate care disengagement for rural people living with HIV (PLH). This study examines the applicability and feasibility of telehealth to provide HIV care for older adults in the rural U.S. South. Semi-structured interviews were conducted with 27 key informants with expertise in HIV care and community engagement in high rural HIV burden states. Results indicate that telehealth challenges exist for older rural PLH to receive HIV care, such as lack of internet access and low technology literacy. Phone calls can be a simple and effective telehealth option for older rural PLH, as they align with their care preferences, mitigate care barriers, and show promise increasing care engagement. When warranted, complex telehealth options for older rural PLH require tailored approaches, such as portable medical instruments allowing real-time data sharing during home visits or tablet distribution from the clinic. Findings suggest that policy makers and providers support the reimbursement and use of audio-only telehealth services, expand broadband infrastructure and affordability in rural areas, and implement tailored telehealth interventions.

The influence of healthy eating index on cognitive function in older adults: chain mediation by psychological balance and depressive symptoms

BackgroundThis study aims to investigate the relationships between the Chinese Healthy Eating Index (CHEI), psychological balance, depressive symptoms, and cognitive function in the rural older population. Additionally, it examines the impact of CHEI on cognitive function and the potential chain mediating roles of psychological balance and depressive symptoms.MethodsThe study utilized data from 2,552 rural older adults aged 65 and above, drawn from the Chinese Longitudinal Healthy Longevity Study (CLHLS). The CHEI was self-reported, with scores ranging from 0 to 50, representing adherence to healthy eating habits. Psychological balance was assessed using status and personality-emotion characteristics recorded in the database, with scores ranging from 6 to 30. Cognitive function was measured using the Mini-Mental State Examination (MMSE), with scores ranging from 0 to 30; higher scores indicated better cognitive function. Depressive symptoms were evaluated using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), with scores ranging from 0 to 30, where higher scores reflected more severe depressive symptoms.ResultsThe median CHEI score was 40.0 (IQR: 34.0–45.0), reflecting moderate adherence to healthy dietary practices. The median Psychological Balance score was 19.0 (IQR: 17.0–21.0), and the median Depressive Symptoms score was 13.0 (IQR: 10.0–15.0), indicating mild depressive symptoms among participants. Additionally, the median Cognitive Function score was 28.0 (IQR: 27.0–29.0), suggesting relatively stable cognitive abilities within the sample. Correlational analysis revealed the following: (1) Depressive symptoms were negatively correlated with both cognitive function (rs = -0.100, p < 0.001) and CHEI (rs = -0.206, p < 0.001), as well as with psychological balance (rs = -0.142, p < 0.001). (2) CHEI was positively correlated with both cognitive function (rs = 0.144, p < 0.001) and psychological balance (rs = 0.131, p < 0.001). (3) Cognitive function was also positively correlated with psychological balance (rs = 0.096, p < 0.001). Mediation analysis demonstrated that both psychological balance and depressive symptoms partially mediated the relationship between CHEI and cognitive function, forming a chain-mediating effect.ConclusionThe Chinese Healthy Eating Index was found to have a direct positive impact on cognitive function in rural older adults. Furthermore, it exerted an indirect effect through the independent and chain-mediating roles of psychological balance and depressive symptoms. These findings suggest that dietary adherence can influence cognitive health not only directly but also by improving psychological well-being and reducing depressive symptoms.

The social convoy for depression among the older adults in rural China: A multilevel structural equation modeling analysis using a national sample

Rural older adults experience significant mental and physical health challenges. Social convoy theory offers insights into this by assuming functional limitations as antecedent factors of depression through multiple social-related levels. The combined panel data from 2011, 2013, 2015, and 2018 of the China Health and Retirement Longitudinal Study (1,354 individuals with 5,416 responses) was utilized to address the above assumption. The multilevel structural equation modeling was employed to examine whether social activity participation and parent-child interaction mediate the relationship between functional limitations and depressive symptoms at multiple levels. The results indicated that the mediation effects existed only at the between-person level. Specifically, older adults with more functional limitations participated in less social activity, leading to more depressive symptoms, but engaged in more parent-child interaction, reducing depressive symptoms. At the within-person level, depressive symptoms in a given older adult were correlated with functional limitations. In years with greater limitations, older adults participated less in both social activity and parent-child interaction. Interventions should be tailored to older adults’ functional limitations, focusing on social activities for those with typically greater limitations, intergenerational programs for those with fewer limitations, and a combination of both for those experiencing significant increases in limitations.

Associations between uric acid and depressive symptoms, and the mediating role of immunoinflammatory: Findings from rural older adults

Associations between uric acid and depressive symptoms, and the mediating role of immunoinflammatory: Findings from rural older adults

The Associations Between Social Support From Adult Children (SSAC) and the Risk of Later-Life Depression (LLD) Among Rural Older Individuals: A Longitudinal Study Based on 2011 to 2018 China Health and Retirement Longitudinal Study Data.

This study was designed to investigate the implications of perceived social support from adult children (SSAC) on the incidence of later-life depression (LLD) among rural older adults in China. A total of 1762 participants without depressive symptoms and aged ≥60years at baseline were recruited from three waves (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study (CHARLS) and followed up until 2018. After following-up for 2-7years (average 4.6years), a total of 746 participants (43.2%) were identified with LLD and the overall incidence of LLD was 128.5 per 1000 person-years. Univariate and multiple Cox regression analysis consistently indicated that receiving living care support was the sole form of SSAC that may significantly reduce the risk of LLD in rural older adults in China (HR: 0.81, 95% CI: 0.70-0.95, p = .008). These results may be of assistance in comprehensively understanding the role of SSAC in the mental health of older adults.

Evaluating the Predictive Power of Frailty and Bone Mineral Density on Fracture Risk in Rural Older Adults.

Evaluating the Predictive Power of Frailty and Bone Mineral Density on Fracture Risk in Rural Older Adults.

Choroid Plexus Volume in Rural Chinese Older Adults: Distribution and Association With Cardiovascular Risk Factors and Cerebral Small Vessel Disease.

The choroid plexus (CP) is involved in neurodegenerative diseases. However, the association of CP with cardiovascular risk factors and cerebral small vessel disease in older adults remains unclear. This population-based study included 1263 participants (60 years and older) from the MIND-China (Multimodal Interventions to Delay Dementia and Disability in Rural China) substudy (2018-2020), of which 111 individuals completed diffusion tensor imaging examination. CP volume was automatically segmented. White matter hyperintensities (WMHs), enlarged perivascular spaces (EPVS), cerebral microbleeds, and lacunes were assessed following the Standards for Reporting Vascular Changes on Neuroimaging 1. Peak width of skeletonized mean diffusivity and free water were derived from diffusion tensor imaging images. We used linear regression models to evaluate the association between CP volume and cardiovascular risk factors, WMH volumes, and diffusion tensor imaging metrics, and logistic regression models to examine the association between CP volume and EPVS, cerebral microbleeds, and lacunes. The CP volume increased with age (P<0.001). Men (β coefficient=0.47 [95% CI, 0.29-0.64]) and participants with diabetes (β coefficient=0.16 [95% CI, 0.01-0.31]) had larger CP volumes than women and individuals without diabetes, respectively (P<0.05). Greater CP volume was significantly associated with larger total and periventricular WMH volumes and moderate to severe EPVS in basal ganglia (P<0.05) but not with deep WMHs, EPVS in centrum semiovale, lacunes, or cerebral microbleeds. In the diffusion tensor imaging subsample, enlarged CP was significantly associated with higher peak width of skeletonized mean diffusivity and free water of periventricular and deep white matter (P<0.05). An enlarged CP is associated with larger global and periventricular WMH volume and higher likelihoods of EPVS in basal ganglia and impaired white matter integrity, suggesting that an enlarged CP may represent a precursor of cerebral small vessel disease.

Estimates of multidimensional poverty and its determinants among older people in rural China: evidence from a multicenter cross-sectional survey

BackgroundIn 2020, China declared that the absolute poverty in the country had been eradicated, but older people in rural areas are deprived in multiple domains. Poverty is multidimensional and involves deprivations in health, social welfare, living standards, and income. This study focused on assessing the poverty status of rural older persons and providing a basis for decision-making at all levels of government in China.MethodsA multicenter cross-sectional survey was conducted in four rural areas of China. Individuals aged 60 years and older were selected through stratified sampling. People with aphasia and severe cognitive impairment were excluded. An electronic questionnaire was used to collect older people’s information, including basic demographics, major illnesses, disabilities, chronic diseases, functional disorders, and ability to perform activities of daily living. It also asked about the medical, financial, and social security assistance that respondents received, food and clothing standards, safe housing, clean energy, safe drinking water, and reliable electricity. Specific questions were asked regarding income sufficiency, financial support from children, and pension income. Multidimensional poverty measurements were used to compare regional disparities and indicators differences. Logistic regression was used to identify the risk factors influencing poverty.ResultsA total of 1272 older people were analyzed. Of them, 704 (55.35%) were women and 652 (51.26%) were aged between 60 and 69 years. The most frequently mentioned causes of poverty were illness, a lack of employment, inadequate technology, and poor transportation. We found that as multidimensional poverty indicators increased (from 6 to 10), the number of poor older people decreased (from 1218 to 437), as did the poverty incidence (from 95.75 to 34.36%) and multifaceted poverty index (from 53.41 to 25.06%). Xuanwei had the highest incidence of poverty (66.61%) and multidimensional poverty index (0.66) among the four provinces studied. Regarding the contribution of indicators, financial alleviation made the greatest contribution to multidimensional poverty among rural older adults (up to 70.51%). Age, marital status, education level, awareness of poverty alleviation policies, and region were significant predictors of multidimensional poverty among older rural residents(P < 0.05).ConclusionsChina’s subsidy system and financial support must be enhanced. Particular attention should be given to the re-education of rural older individuals, basic vocational education should be strengthened in rural areas, and social participation should be encouraged.

Chronic condition change and its longitudinal association with health care utilization among rural older adults: intergenerational financial support as a possible moderator?

BackgroundThe prevalence of chronic conditions increases rapidly among older population. However, it is unclear how different chronic conditions progression contributes to the health care utilization, and whether intergenerational support modified this relationship. This study aimed to explore the longitudinal link between chronic condition progression and health care utilization, and examine whether intergenerational financial support is a moderator in this relationship among Chinese rural older people.MethodsData was derived from the Shandong Rural Elderly Health Cohort (SREHC), which was conducted from 2019 to 2020. A total of 2,785 participants were included in this study. Kruskal-Wallis rank tests and generalized estimating equation (GEE) models were employed to analyze the association between chronic condition progression and health care utilization. Moderating effect analysis was performed using GEE model and margins plot.ResultsOlder people with progressive chronic conditions used more outpatient (no chronic condition to emerging multimorbidity: OR = 1.83; p = 0.028; one chronic condition to emerging multimorbidity: OR = 2.17; p < 0.001; remained multimorbidity while chronic conditions increased: OR = 3.26; p < 0.001) and inpatient services (no chronic condition to emerging multimorbidity: OR = 2.76; p < 0.001; one chronic condition to emerging multimorbidity: OR = 3.40; p < 0.001; remained multimorbidity while chronic conditions increased: OR = 5.32; p < 0.001) than those remained no chronic conditions. Intergenerational financial support may alleviate outpatient utilization of older people with multimorbidity (remained multimorbidity × intergenerational financial support: OR = 0.40; p = 0.013; remained multimorbidity while chronic conditions increased × intergenerational financial support: OR = 0.35; p = 0.019).ConclusionThis study showed that the changes of chronic condition were associated with health care utilization, and intergenerational financial support moderated this relationship. It is vital to continuously monitor and timely intervene the chronic condition progression among rural older people.

Empty nest but better off? Association between empty nest status and cognitive function among older adults with chronic diseases in rural China

BackgroundThe increasing prevalence of cognitive impairment poses substantial risks to older adults, particularly those with chronic diseases. While existing studies have examined the connection between the empty nest phenomenon and cognitive function, few have attempted to consider endogeneity issues within this relationship, with limited attention given to older adults with chronic diseases. This study investigates the impact of empty nest status on cognitive function among rural Chinese older adults with chronic diseases and explores the possible mechanisms underlying this effect.MethodsA cross-sectional study involved 365 older adults aged 60 or above with chronic diseases in rural areas of Shaanxi province, northwest China. Cognitive function was measured using the Mini-Mental State Examination. Multiple regression models and the instrumental variable (IV) method were employed to examine the association between empty nest and cognitive function.ResultsAmong the 365 older adults aged 60 or above with chronic diseases, 43% experienced cognitive impairment. Results from both multiple regression and IV analyses consistently demonstrate a significant association between empty nest status and higher cognitive function scores (β = 1.757, p = 0.007; β = 3.682, p = 0.034, respectively). Mechanism analysis further supports that the positive association may arise from empty nesters receiving more social support from children and friends, and perceiving loneliness experiences as inadequate. Heterogeneity analysis reveals that the association between empty nest status and cognitive function is more pronounced among male adults with chronic diseases.ConclusionsThis study challenges the notion that empty nest status is a risk factor for cognitive decline in older adults with chronic diseases in rural China. The positive impact is attributed to the robust social relationships of empty nesters, encompassing sustained support from their social network, and the absence of an increase in loneliness. Therefore, future interventions aimed at improving cognitive function in older adults may benefit from promoting the development of social relationships.

Sources of perceived social support and cognitive function among older adults: a longitudinal study in rural China.

Studies have shown the positive impact of perceived social support on cognitive function among older adults in rural areas. However, existing studies often overlook the impact of different support sources. This study aimed to explore the relationship between the diverse sources of perceived social support and cognitive function. Participants were drawn from the Guizhou Rural Older Adults' Health Study (HSRO) in China. We included 791 participants who participated in a baseline survey in 2019 and a 3-year follow-up survey. Perceived social support was investigated from the six main sources (friend, relative, children, spouse, sibling, and neighbor). Hierarchical linear regression models were used to observe the effects of diverse sources of perceived social support and their combinations on cognitive function. Cognitive function was positively associated with perceived support from children, friends, and neighbors. A positive association was found between cognitive function and increases in each additional source [β = 0.75 (95%CI: 0.51, 0.98), p < 0.001]. Older adults who perceived support from both children and friends showed better cognitive function [β = 2.53 (95%CI: 1.35, 3.72), p < 0.001]. The perception of support from spouse, siblings, and relatives did not show a statistically significant association with cognitive function among older adults in rural areas. This study found that the association between different sources of perceived social support and cognitive function was varied. This study provides scientific evidence that personalized support strategies may benefit in promoting cognitive health in rural older adults.

The association between living alone and depressive symptoms in older adults population: evidence from the China Health and Retirement Longitudinal Study.

The goal of this research was to reveal the association between living alone and depressive symptoms in older adults. It also aims to explore the mediating role of social activity and adult children's relationship satisfaction. Ultimately, the study seeks to add to the body of knowledge for lowering the risk of depression among older people and promoting positive aging. Based on information from the 2020 China Health and Retirement Longitudinal Study, the ordinary least square (OLS) regression model and propensity score matching (PSM) were used to investigate the association between living alone and depressive symptoms in older adults and to explore possible heterogeneity in different groups. Utilizing the SPSS PROCESS macro application, the mediation model was constructed. The significance of the mediation effect was investigated using the Bootstrap technique. The average level of depressive symptoms of older people living alone (10.55 ± 6.962) was higher than that of older people who do not live alone (8.80 ± 6.363). The baseline regression analysis revealed a significant connection between living alone and the depressive symptoms of older people (β = 0.842, p < 0.001). The association between living alone and the level of depressive symptoms was significantly higher in those aged 60-74 years (β = 1.698, p < 0.001) than in those aged 75 and older (β = 0.953, p < 0.05). The association between living alone and depressive symptoms was significantly higher in rural older adults (β = 1.512, p < 0.001) than in urban older adults (β = 1.141, p < 0.001). Between living alone and the level of depressive symptoms experienced by older people, there was a substantial mediation impact on social engagement and adult children's relationship satisfaction, which contributed to 2.91 and 13.62% of the overall effect. For older age groups, living alone is associated with higher levels of depressive symptoms. This effect is stronger in older adults aged 60-74 or rural areas. In older age groups, the association between living alone and depressive symptoms is mediated by social activity and adult children's relationship satisfaction.

Association Between Level of Pain and Depression Among Chronically Ill Older Adults in Rural Alabama: A Pilot Study

There is a paucity of research on pain and depression among older adults in rural communities. To address such a gap, this study examined the association between pain and depression among older rural-community-dwelling adults. Recruited from rural senior centers, 100 chronically ill older adults (age 55 or older) experiencing pain completed a cross-sectional survey. Data were collected on their level of depression (a five-item version of the Center for Epidemiologic Studies Depression scale), pain (the six-item Philadelphia Geriatric Center Pain scale), and sociodemographic factors. A multiple linear regression was conducted. With sociodemographic variables controlled, those reporting higher pain scores were significantly more likely to have higher depression scores (p &lt; .05). Older participants had lower depression scores than younger participants (p &lt; .05). In view of poorer health outcomes and limited health care access in rural areas, our findings warrant interventions to promote better access to pain management and mental health services for rural older adults.

Assessing Self-Rated Health Among Rural Older Adults in Varanasi Amidst the COVID-19 Crisis: A Cross-Sectional Analysis

Assessing Self-Rated Health Among Rural Older Adults in Varanasi Amidst the COVID-19 Crisis: A Cross-Sectional Analysis

Barriers and facilitators for accepting health education of Chinese rural older adults in Henan Province: a qualitative study

BackgroundAs global aging continues to intensify, the health status of the older people requires urgent attention, and health education provides a pathway for active aging. However, the current outlook on health education for older people in rural areas of China is not optimistic. This study used Social Ecosystems Theory and explored the deep-rooted influencing factors on the acceptance of health education from the perspective of the rural older people.MethodsIn this study, a purposive sampling method was adopted, and eligible rural older individuals were selected from Hebi city, Henan Province, China, from March to May 2023 as the research participants. A semistructured interview method was used to explore the factors affecting the acceptance of health education by older people. The interview data were analyzed using the qualitative content analysis method to obtain relevant themes and subthemes.ResultsA total of 14 participants were recruited for the interviews; 8 were male, 6 were female, most had an elementary school education, and most were farmers. The results of the thematic analysis revealed a total of nine facilitators and nine barriers in micro, meso and macro levels. Among the findings, our important and unique finding is that inadequate intergenerational support somewhat hinders older adults’ exposure to health education.ConclusionThere are numerous and complex facilitators of and barriers to accessing health education for rural older adults; of these, a lack of intergenerational support is particularly important. In the future, health education needs to be centered on the families of older people with the assistance of village committees so that older people and their children can learn and communicate together.

Unveiling hope: how social support reciprocity shields against the shadows of intimate partner violence and suicidal ideation in rural Chinese older adults.

The paper titled "A systematic review of psychosocial protective factors against suicide and suicidality among older adults" by Ki and colleagues is a thought-provoking review that emphasizes the importance of improving protective factors for the development of suicide prevention and intervention in older adults, rather than just focusing on risk factors. Since the coronavirus disease 2019 (COVID-19) pandemic, media coverage of mental health and suicide has gained widespread attention. Suicide may become a more pressing issue due to the enormous economic and social toll of the spreading epidemic. Therefore, this systematic review is relevant in preventing suicide among older adults in the "post-pandemic" periods of COVID-19.In this study, the authors highlight the importance of examining the moderating or mediating role of protective factors in suicide, due to the fact that suicide prevention must take into account a variety of factors simultaneously. More importantly, most studies focused primarily on received support among interpersonal protective factors, neglecting the role of support given to others, which might be more beneficial for older adults' well-being. The thought that ensues is what role will social support reciprocity play in specific risk factors and suicidal behavior.

Linear and non-linear associations of depressive symptoms with oral health knowledge, attitudes, and practices among rural older adults in China: a cross-sectional study

BackgroundDepression affects the oral health of older adults; however, little is known about its impact on oral health among rural older adults in developing countries, which warrants further research. Taking China as an example, there is a large population base of rural older adults suffering from depression, and many rural older people also have long-term oral health problems, which have seriously affected their quality of life in later life. Therefore, this study aimed to explore linear and non-linear associations of depressive symptoms with oral health knowledge, attitudes, and practices among rural older adults in China.MethodsFrom November 2020 to December 2020, 1,902 rural community-dwelling older people aged 60 years and older were investigated, via a cross-sectional survey. The general information, depressive status, oral health knowledge, attitudes, and practices of the participants were obtained through face-to-face structured questionnaires. Among them, the Zung Depression Self-Rating Scale was used to investigate the depressive symptoms of the participants in this survey. The generalized linear model and classification and regression tree model were used, separately.ResultsBased on linear analysis results, we found that minimal to mild depressive symptoms [regression coefficient (β) = -0.345; 95% confidence interval (CI): -0.582 to -0.109, P = 0.004] and depressive symptoms (β = -1.064; 95% CI: -1.982 to -0.146, P = 0.023) were significantly correlated with oral health knowledge. A negative correlation was observed between minimal to mild depressive symptoms (β = -0.385; 95% CI: -0.600 to -0.170, P < 0.001) and oral health attitudes. In addition, while both minimal to mild depressive symptoms (β = 0.018; 95% CI: -0.312 to 0.347, P = 0.916) and depressive symptoms (β = 0.604; 95% CI: -0.675 to 1.883, P = 0.355) were associated with oral health practices. Furthermore, the non-linear analysis showed a combined effect of depressive symptoms on oral health attitudes, indicating that older people of a younger age, not living alone, and not suffering from depressive symptoms are more likely to report better oral health attitudes.ConclusionBoth the linear and non-linear analyses in our study showed that depressive symptoms are significantly correlated with the poor oral health attitudes of older adults in rural communities. Furthermore, depressive symptoms were associated with oral health knowledge in the linear analysis. However, no statistically significant difference was found between depressive symptoms and oral health practices in either analysis. This research deepens our knowledge and understanding of relevant evidence in the mental and oral health of people in later life. In addition, analyzing the factors that affect the oral health of older people from the perspective of their depressive status provides new thinking directions and scientific references for improving the oral health of older adults in practical life.

Behavioral change in fruit and vegetable consumption and associated cognitive impairment among Chinese older adults.

Previous research has examined how fruit and vegetable consumption may affect cognitive impairment among older adults. However, knowledge regarding the behavioral change in fruit and vegetable consumption remains limited in the Chinese older adult population. This research aimed to fill the literature gap. We used data from five waves of the Chinese Longitudinal Healthy Longevity Study (2005-2018, observations = 18,856 from 11,388 participants) and selected older adult participants (65 years old or above). A behavioral change was defined as a consumption change in the study sample. Cognitive impairment was measured based on the mini-mental state examination. We used the Cox multi-state model as the major statistical analysis. Chinese older adults who transitioned from non-daily to daily consumption of vegetables had lower odds of reporting cognitive impairment deteriorating from normal cognitive function to severe, compared with those who did not change their consumption behavior (HR [hazard ratio] = 0.88, 95% CI 0.80, 0.97; p < 0.05). All transitions in fruit consumption were negatively associated with cognitive changes from normal cognitive function to mild-moderate cognitive impairment. In our additional stratified analysis examining rural-urban disparity, we observed similar significant findings among rural older adults (Vegetable consumption change:HR = 0.83, 95% CI 0.75, 0.93; p < 0.01) but not urban older adults. Behavioral change in consumption of vegetables may affect Chinese older adults' cognitive health. Future interventions should focus on the critical role of behavioral change in vegetable consumption in reducing older adults' cognitive impairment. However, the contradictory findings of fruit consumption warrant further investigation to draw a conclusive claim regarding its benefits for cognitive health.

Health-seeking behaviours of the families with older adults during the COVID-19 epidemic in rural China: a qualitative inquiry from the perspective of migration and social support networks

IntroductionHealth behaviours during a public health crisis for families with vulnerable ageing relatives are worth studying. After the Chinese government’s zero-tolerance policy on COVID-19 ended at the close of 2022,...