Rural Older Adults Research Articles

Is patients' rurality associated with in-hospital sepsis death in US hospitals?

The focus of this study was to explore the association of patients' rurality and other patient and hospital-related factors with in-hospital sepsis mortality to identify possible health disparities across United States hospitals. The National Inpatient Sample was used to identify nationwide sepsis patients (n = 1,977,537, weighted n = 9,887,682) from 2016 to 2019. We used multivariate survey logistic regression models to identify predictors for how patients' rurality is associated with in-hospital death. During the study periods, in-hospital death rates among sepsis inpatients continuously decreased (11.3% in 2016 to 9.9% in 2019) for all rurality levels. Rao-Schott Chi-Square tests demonstrated that certain patient and hospital factors had varied in-hospital death rates. Multivariate survey logistic regressions suggested that rural areas, minorities, females, older adults, low-income, and uninsured patients have higher odds of in-hospital mortality. Further, specific census divisions like New England, Middle Atlantic, and East North Central had greater in-hospital sepsis death odds. Rurality was associated with increased in-hospital sepsis death across multiple patient populations and locations. Further, rurality in New England, Middle Atlantic, and East North Central locations is exceptionally high odds. In addition, minority races in rural areas also have an increased odds of in-hospital death. Therefore, rural healthcare requires a more significant influx of resources and should also include assessing patient-related factors.

Prevalence and Progression of Subjective Cognitive Decline Among Rural Chinese Older Adults: A Population-Based Study.

Few community-based studies have examined occurrence and progression of subjective cognitive decline (SCD). To investigate prevalence and progression of SCD among rural-dwelling Chinese elderly people. This cohort study included 2,488 cognitively unimpaired adults (age≥65 years) who were examined at baseline (2014-2015) and followed in 2018. Demographic, epidemiological, clinical, and neuropsychological data were collected via in-person interviews and clinical examinations following a structured questionnaire. At baseline, SCD was assessed using the self-rated Ascertain Dementia 8-item Questionnaire. At follow-up, Alzheimer's disease (AD) and vascular dementia (VaD) were clinically diagnosed following the international criteria. Data were analyzed using logistic regression models. The prevalence of SCD was 40.07%. SCD at baseline was associated with the multivariable-adjusted odds ratio (OR) of 1.51 (95% confidence interval 1.10-2.07) for incident cognitive impairment, no dementia (CIND) and 3.11 (1.64-5.93) for incident AD. Among people with SCD at baseline, the multivariable-adjusted OR of incident CIND was 0.55(0.32-0.96) for hyperlipidemia; the multivariable-adjusted OR of incident AD was 1.21 (1.14-1.30) for older age, 0.32 (0.12-0.88) for high education, 2.60 (1.11-6.08) for carrying APOEɛ4 allele, and 0.34 (0.13-0.86) for high social support, whereas the multivariable-adjusted OR of incident VaD was 6.30 (1.71-23.18) for obesity. SCD affects over 40% of rural-dwelling cognitively unimpaired older adults in China. SCD is associated with accelerated progression to CIND and AD. Older age, lack of school education, APOEɛ4 allele, and low social support are associated with an increased risk of progression from SCD to AD, whereas obesity is related to accelerated progression to VaD.

Current and Future Service Use, Satisfaction, and Potential Need for Services as Defined by Rural and Frontier Older Adults

This study focused on differences for service utilization and satisfaction, along with perceived future service use and need for rural versus frontier residing older adults. A sample of older adults (age 65+), stratified using United States government and State of Wyoming definitions for rural (n = 70) and frontier (n = 72) counties, were interviewed. Frontier respondents indicated less education, monthly income, fewer financial resources, less experience with technology, decreased potential for telehealth, fewer computers, and less Internet access. Differences were evident for the use and need of services between the comparison groups with policy concerns identified.

Associations of lifespan cognitive reserve with mild cognitive impairment and dementia among older adults with low literacy: A population‐based cohort study

AbstractBackgroundEducational attainment in early life represents a major contributor to cognitive reserve (CR). High CR capacity derived from lifespan enriching factors could delay cognitive decline. We sought to investigate the longitudinal associations of CR capacity with mild cognitive impairment (MCI) and dementia among older adults with no or low literacy.MethodThis population‐based cohort study included 2141 rural participants (age≥60 years; 59.5% women; 84.8% illiteracy or elementary school) in the Shandong Yanggu Study of Aging and Dementia who were free of dementia at baseline (August‐December 2014) and who undertook follow‐up examinations in March‐September 2018. CR capacity was estimated by integrating early‐life education attainment, adulthood occupation and marital status, and late‐life physical activity and social support, and categorized into low, intermediate, and high levels using tertiles. MCI and amnestic MCI were defined according to the Petersen’s criteria that integrated clinical assessment with neuropsychological tests. Dementia and Alzheimer’s disease (AD) were diagnosed according to the DSM‐IV and NIA‐AA criteria, respectively. Data were analyzed using the structural equation and Cox proportional‐hazards models.ResultDuring an average of 3.7 (SD = 0.4) years of follow‐up, 102 of the 2141 dementia‐free participants were diagnosed with dementia, including 75 with AD. Compared to the low CR level, intermediate and high CR levels were associated with multi‐adjusted hazards ratios (HRs) (95% confidence intervals [CIs]) of 0.59 (0.37–0.94) and 0.47 (0.26–0.85) for dementia and 0.53 (0.31–0.92) and 0.38 (0.17–0.83) for AD, respectively. In addition, out of the 1727 MCI‐free participants at baseline, 330 developed MCI at follow‐up, including 270 with aMCI. Intermediate and high CR levels (vs. low) were associated with multi‐adjusted HRs (95% CIs) of 0.70 (0.53–0.92) and 0.60 (0.45–0.81) for MCI and 0.65 (0.48–0.87) and 0.58 (0.42–0.79) for amnestic MCI, respectively.ConclusionIn Chinese rural elderly, high CR capacity is associated with reduced risks of MCI, amnestic MCI, dementia, and AD. This suggests that the effect of CR capacity in delaying the onset of MCI and dementia exists even among rural older adults with no or very low literacy.

Neutrophil count, serum cytokines, and cognitive function among dementia‐free older adults: a population‐based cohort study

AbstractBackgroundPrevious research has suggested that neutrophils could release cytokines to be involved in low‐grade chronic inflammation, which might contribute to cognitive dysfunction. However, population‐based studies have not explored the relationship between neutrophils and cognitive function in older adults. Here, we examined the associations of absolute neutrophil count (ANC) with cognitive performance and cognitive decline among rural Chinese older adults and further explored the potential mediation role of serum cytokines in their associations.MethodThis population‐based longitudinal study included 1666 dementia‐free participants (age ≥60 years; 976, 58.58% women) in the substudy of MIND‐China who undertook the baseline examination in March‐September 2018; of these, 1087 were followed in November‐December 2019. At baseline, ANC was measured using a Mindray BC 6800 automated hematology analyzer. We used the neuropsychological test battery to assess global cognitive function, memory, attention, verbal fluency, and executive function. Serum IL‐6 and eotaxin3 concentrations were measured using Meso Scale Discovery (MSD). Data were analyzed using multivariable general linear models and mediation models.ResultThe cross‐sectional analysis of data at baseline (n = 1666) showed that ANC (range, 0.3 ‐ 24, 109/L) was significantly associated with a lower memory z‐score (multi‐adjusted β coefficient: ‐0.131; 95% CI: ‐0.254 ‐ ‐0.008), but not with attention, verbal fluency, and executive function. Mediating modeling analysis suggested that 22.35% and 10.33% of the association between ANC and memory function were mediated by serum IL‐6 and eotaxin3, respectively. The analysis of longitudinal data (n = 1087) suggested a nonlinear relationship between ANC and memory z‐score decline, with the fourth quartile of ANC (vs. the third quartile) being significantly associated with a multi‐adjusted β coefficient of 0.146 (95% CI: 0.009 ‐ 0.283) for decline in memory z‐score.ConclusionHigher ANC is associated with worse memory performance and faster cognitive decline in rural‐dwelling Chinese older adults, in which their association may be mediated partly by serum cytokines.

Prevalence and progression of subjective cognitive decline among rural Chinese older adults: A Population‐based follow‐up study

AbstractBackgroundFew studies have examined occurrence and progression of subjective cognitive decline (SCD) in rural China. We aimed to investigate the prevalence of SCD and explore factors associated with progression from SCD to cognitive impairment, no dementia (CIND) and Alzheimer’s disease (AD).MethodThis community‐based study included 2488 cognitively unimpaired participants (age ≥65 years; 55.18% women; and 39.87% illiterate) in the Shandong Yanggu Study of Aging and Dementia who were examined at baseline (2014‐2015), of these, 1843 were followed in 2018. Demographic, epidemiological, clinical, and neuropsychological data were collected following a structured questionnaire. SCD was defined based on the Chinese version of the self‐rated Ascertain Dementia 8‐item Questionnaire (AD8) score. CIND and AD were diagnosed following the international criteria. Data were analyzed with the multivariate logistic regression models.ResultAt baseline, 997 of the 2488 participants were defined to have SCD. The prevalence of SCD was 40.07%, and the prevalence was increased with age. Of the 1843 participants in the follow‐up examination in 2018, 189 were diagnosed with CIND and 58 with AD. Having SCD at baseline was significantly associated with the multi‐adjusted odds ratio (OR) of 1.55 (95% confidence interval = 1.14‐2.12) for incident CIND and 2.91 (1.56‐5.42) for incident AD. Of 745 participants with SCD at baseline, 97 progressed to CIND and 43 to AD during the average 3.79 years of follow‐up. Multivariable logistic regressions showed that the multi‐adjusted OR of incident CIND was 0.51 (0.26‐0.98) for high social support, whereas the multi‐adjusted OR of incident AD was 1.22 (1.14‐1.31) for older age (per 1‐year increment), 0.31 (0.11‐0.85) for high education, 2.77 (1.17‐6.57) for carrying the apolipoprotein E (APOE) ε4 allele, 0.29 (0.11‐0.75) for high social support, and 3.98 (1.37‐11.52) for mild depressive symptoms.ConclusionSCD affects over 40% of rural‐dwelling older adults in China who are free of cognitive impairment. Older people with SCD are more likely to develop CIND and AD. Older age, illiteracy, APOE ε4 allele, low social support, and depressive symptoms are associated with accelerated progression from SCD to CIND or AD.

The relationship between home and community-based healthcare services utilization and depressive symptoms in older adults in rural China: a moderated mediation model

BackgroundStudies have shown a close association between home and community-based healthcare services (HCBHS) utilization and depressive symptoms in older adults. However, no studies have explored the underlying mechanism of this relationship in rural China. This study was designed to evaluate the roles of instrumental activities of daily living (IADL) and marital status in the association between HCBHS utilization and depressive symptoms in Chinese rural older adults.MethodsData were obtained from the 2018 China Health and Retirement Longitudinal Study, and 5,981 rural respondents (≥ 60 years old) were included. Depression scores were calculated using the ten-item Center for Epidemiological Studies Depression Scale. Moderated mediation analysis was carried out applying Hayes’ PROCESS macro (Model 7).ResultsHCBHS utilization had a direct and negative effect on depressive symptoms. Furthermore, marital status moderated the association between HCBHS utilization and IADL, which belonged to the indirect influence of the first half on the association between HCBHS utilization and depressive symptoms. HCBHS utilization was associated with IADL in single but not in married respondents.ConclusionThe results demonstrated that marital status moderated the indirect relationship between HCBHS utilization and depressive symptoms, with HCBHS utilization being negatively associated with IADL among single but not married respondents. The government should focus on rural older adults, especially those who are single and have poor IADL function, and improve the provision of HCBHS to alleviate depressive symptoms.

Level of malnutrition and associated factors among community-dwelling rural older adults in Fogera Zuriya district, Northwest Ethiopia

ObjectivesMalnutrition is very common among older adults. In rural Ethiopia, around 25% of women and 34% of men ≥65 y of age are malnourished. However, the risk factors for malnutrition among older adults in rural areas are not well understood. The aim of this study was to assess the level of malnutrition and associated factors among community-dwelling rural older adults in Fogera Zuriya district, Northwest Ethiopia. MaterialsThis was a community-based, cross-sectional study among randomly selected (N = 634) adults ≥65 y of age in Fogera Zuriya rural district. Participants were selected using a multistage sampling technique. A pretested full Mini-Nutritional Assessment (MNA) tool was used to classify as malnourished (MNA score <17), at risk for malnutrition (MNA score 17–23.5), or otherwise normal. A validated Geriatric Depression Scale form (15 items) was used to assess depression. Ordinal logistic regression was employed to identify factors of malnutrition and the PLUM procedure was used to produce an odds ratio (OR). P < 0.05 was considered statistically significant with the dependent variable. Both crude and adjusted ORs (COR and AOR, respectively) with a corresponding 95% confidence interval were computed. ResultsThis study included 634 older adults. According to the results of the study, the risk for malnutrition was 383 (60%), and being malnourished was 166 (268%). The following factors were significantly associated with the risk for malnutrition and malnutrition:• Age ≥85 y (AOR, 3.47; 95% CI, 1.270–9.465);• Skipping two meals daily (AOR, 6.36; 95% CI, 2.11–19.16);• Skipping 1 meal a day (AOR, 3.05; 95% CI, 1.82–5.12);• Having a poor appetite (AOR, 6.2; 95% CI, 2.50–15.36);• Being depressed (AOR, 4.04; 95% CI, 2.37–6.89);• Low physical activity (AOR, 3.81; 95% CI, 1.50–9.72);• Family size of three of less members (AOR, 1.9; 95% CI, 1.14–3.24); and• Low dietary diversity score (AOR, 1.91; 95% CI, 1.11–3.31) ConclusionsIn this study, the prevalence of malnourished (26%) was almost higher than the national average in Ethiopia (21%). Older age, skipping a meal, poor appetite, depression, low physical activity, and low dietary diversity score were factors significantly associated with the risk for malnutrition and malnutrition. Along with this, improving diet and exercise should be a top priority. Maintaining continuing psychological support, social support, and a balanced family size within the community should be additional interventions.

Does the Economic Status of Adult Children Influence Self-Rated Health Among Older Adults in China?

We aim to investigate the association between children's economic status and parents' self-rated health and examine the potential mediating mechanisms for this relationship. Utilizing nationally representative data in China in 2014, this study predicted parent's self-rated health from children's economic status using inverse probability of treatment weighting to account for selection and endogeneity bias. We further examined depressive symptoms, kin and nonkin social support networks, emotional closeness to children, and economic support from children, as potential mediators of this relationship. The study reveals that parents whose children had greater economic success tended to have better self-rated health. For both rural and urban older adults, depressive symptoms served as the most influential mediator. However, only among rural older adults did the size of their support networks mediate the relationship between children's economic status and perceived health. The results from this study suggest that children's economic success contributes to better self-rated health among older adults. In part, this relationship was explained by better emotional well-being and greater availability of support resources among parents in rural areas with successful children. This quasi-causal analysis demonstrates that adult children remain important for the well-being of their older parents in China, but also suggests that health inequalities in later life are exacerbated by the chance of having economically successful offspring.

The Built Environment and Social and Emotional Support among Rural Older Adults: The Case for Social Infrastructure and Attention to Ethnoracial Differences.

Social and emotional support (SaES) is essential for older adult mental health and is shaped by individual-level factors and the built environment. However, much of the focus on the built environment, and specifically social infrastructure - the physical places that facilitate social interaction and social tie formation - relies heavily on urban settings or samples with limited diversity. Consequently, there is little understanding if social infrastructure matters for the SaES of older adults in rural America, and across race and ethnicity. Therefore, we use social cohesion as a conceptual lens and the community gerontology framework to determine if availability of social infrastructure is associated with SaES among older adults in rural America and if this relationship varies across race and ethnicity. Using data from 110,850 rural older adults from the Behavioral Risk Factors Surveillance System and data from the National Neighborhood Data Archive, we show that among rural ethnoracial minority older adults, higher densities of social infrastructure are associated with higher SaES. This is not true for rural non-Hispanic White older adults. Results highlight the importance of accounting for both social infrastructure as part of the built environment and heterogeneity across race and ethnicity in studies that examine older adult mental and emotional health.

Rural-Urban Differences in Telehealth Utilization and Delayed Care During the COVID-19 Pandemic.

Purpose: Use of telehealth among older adults increased during the COVID-19 pandemic, but patterns and correlates of its use are poorly understood. The present study uses a representative sample of Medicare beneficiaries to examine rural-urban differences in telehealth utilization during the pandemic and to investigate the associations between the number and type of telehealth services utilized and delayed in-person care. Methods: The study sample (N = 3,257) came from Round 10 of the National Health and Aging Trends Study. Telehealth was measured in three modalities: phone calls, e-mails or portal messages, and video calls. Multivariable Poisson and logistic regressions were performed to test the study aims, adjusting for sociodemographic and health controls. Analytic weights and survey design factors were incorporated to generate population estimates. Findings: Results show that rurality is associated with lower rates (incidence rate ratio = 0.78, p < 0.001) and lower odds of telehealth use compared with urban older adults. Specifically, rural older adults were less likely to use e-mail or portal messages (adjusted odds ratio [AOR] = 0.43, p < 0.001) and video calls (AOR = 0.57, p = 0.004) to communicate with their usual health care provider. Use of any 2 forms of telehealth was associated with greatest increased odds of delayed in-person care among rural and urban populations during the pandemic. Conclusions: Future efforts are needed to expand the utilization of e-mail/portal messages and video call telehealth services among rural older adults. Telehealth may be an important mechanism to support care continuity during and beyond the COVID-19 pandemic for both urban and rural older adults when in-person modalities of care are not feasible.

Influencing Perception of Frailty Risk in Urban and Rural Older Adults

Aims To investigate the effect of frailty education on the perception of frailty risk for urban and rural older adults. Methods Forty adults completed a frailty perception survey, the Edmonton Frail Scale (EFS), and participated in a 6-week frailty intervention program. Results Urban older adults increased knowledge of frailty including identification of frailty risk (.0035, p < .05), importance of good nutrition as we age (.0015, p < .05) and confidence in accessing community resources (.000031, p < .05). Aggregate site results showed increased accessibility to frailty education including risk of frailty (2.24576E-12, p < .05), frailty criteria (3.29825E-12, p < .05), and reduction of frailty risk (1.21856E-09, p < .05) for rural and urban older adults. Fall prevention knowledge improved at both Urban and Rural A sites (.00021, p < .05). Conclusions The frailty education provided to urban and rural community dwelling older adults supported a change in the perceptions of frailty risk after participation in the program.

Physical activity's impact on rural older adult health: The multiple mediating effects of education, income, and psychological capital.

This study aims to explore the influence mechanism of rural older adult health. By examining the mediating roles of education, income, and psychological capital in physical activity's impact on health, this study provides a reference for lifestyle interventions to improve the health level of rural older adults. The analysis was conducted on a sample of 1778 rural older adults from CGSS2017, and data were analyzed using PROCESS V4.2 for multiple mediating effects. The findings indicate that physical activity impacts rural older adult health through multiple mediating pathways. The mediating role includes seven paths, comprising the independent effects of three mediating variables of income, education, and psychological capital, and the chain mediating effects generated together. Based on the influence mechanism of health on rural older adults, optimizing policy focus and developing a precise, interconnected, and sustainable health security system for older adults is necessary. These research results are of practical significance for advancing healthy aging in rural areas.

Impact of an Area Agency on Aging pharmacist-led Community Care Transition Initiative

BackgroundRural older adults are at risk of readmissions and medication-related problems after hospital discharge. ObjectivesThis study aimed to compare 30-day hospital readmissions between participants and nonparticipants and describe medication therapy problems (MTPs) and barriers to care, self-management, and social needs among participants. Practice descriptionThe Michigan Region VII Area Agency on Aging (AAA) Community Care Transition Initiative (CCTI) for rural older adults after hospitalization. Practice innovationEligible AAA CCTI participants were identified by an AAA community health worker (CHW) trained as a pharmacy technician. Eligibility criteria were Medicare insurance; diagnoses at risk of readmission; length of stay, acuity of admission, comorbidities, and emergency department visits score more than 4; and discharge to home from January 2018 to December 2019. The AAA CCTI included a CHW home visit, telehealth pharmacist comprehensive medication review (CMR), and follow-up for up to 1 year. Evaluation methodsA retrospective cohort study examined the primary outcomes of 30-day hospital readmissions and MTPs, categorized by the Pharmacy Quality Alliance MTP Framework. Primary care provider (PCP) visit completion, barriers to self-management, health, and social needs were collected. Descriptive statistics, Mann-Whitney U, and chi-square analyses were used. ResultsOf 825 eligible discharges, 477 (57.8%) enrolled in the AAA CCTI; differences in 30-day readmissions between participants and nonparticipants were not statistically significant (11.5% vs. 16.1%, P = 0.07). More than one-third of participants (34.6%) completed their PCP visit within 7 days. MTPs were identified in 76.1% of the pharmacist visits (mean MTP 2.1 [SD 1.4]). Adherence (38.2%) and safety-related (32.0%) MTPs were common. Physical health and financial issues were barriers to self-management. ConclusionAAA CCTI participants did not have lower hospital readmission rates. The AAA CCTI identified and addressed barriers to self-management and MTPs in participants after the care transition home. Community-based, patient-centered strategies to improve medication use and meet rural adults’ health and social needs after care transitions are warranted.

Divergent Experiences Reported by Rural and Frontier Older Adults Aging in Place

ABSTRACT Aging research tends to define rural as any area that is not urban without considering the diversity that exists within rural environments. Using government guidelines defining frontier and rural counties, the purpose was to identify similarities and differences in the aging experience reported by community-dwelling rural and frontier older adults. Individual interviews were completed in Wyoming with 142 older adults from frontier (n = 72) and rural counties (n=70). Summative content analysis was used to evaluate responses within the framework of social influences and nested environmental interactions of a socio-ecological model. Rural older adults reported needing more medical services and care, while frontier adults indicated an absence for many of these services. Similar response patterns were indicated with regard to grocery stores and general shopping. Current interview statements provide foundational information for future policies that recognize frontier aging in place that does not equate to aging in rural specific areas.

Malnutrition, Frailty, and Health-Related Quality of Life Among Rural Older Adults in Vietnam: A Cross-Sectional Study.

Rural older adults are more likely to be malnourished than urban older adults, particularly those living in lower-middle-income countries like Vietnam. Therefore, this study aimed to address the prevalence of malnutrition and its association with frailty and health-related quality of life in older rural Vietnamese adults. This cross-sectional study was conducted on community-dwelling older adults (aged ≥ 60 years) living in a rural province in Vietnam. Nutritional status was determined using the Mini Nutritional Assessment Short Form (MNA-SF), and frailty was evaluated using the FRAIL scale. The 36-Item Short Form Survey (SF-36) was used to evaluate health-related quality of life. Among the 627 participants, 46 (7.3%) were malnourished (MNA-SF score <8), and 315 (50.2%) were at risk of malnutrition (MNA-SF score: 8-11). Individuals with malnutrition had significantly higher rates of impairments in instrumental activities of daily living and activities of daily living than those without malnutrition (47.8% vs 27.4% and 26.1% vs 8.7%, respectively). The prevalence of frailty was 13.5%. Risk of malnutrition and malnutrition were associated with high risks of frailty, with odds ratios of 2.14 (95% confidence interval [CI]: 1.16-3.93) and 4.78 (1.86-12.32), respectively. Furthermore, the MNA-SF score was positively correlated with eight domains of the health-related quality of life among rural older adults. The prevalence rates of malnutrition, risk of malnutrition, and frailty were high among older adults in Vietnam. A strong association was observed between nutritional status and frailty. Therefore, this study reinforces the importance of screening for malnutrition and risk of malnutrition among older rural individuals. Further studies should explore whether early nutritional intervention reduces the risk of frailty among older adults and increase their health-related quality of life in the Vietnamese population.

Living Arrangements of Iranian Older Adults and Its Socio-demographic Correlates

Objectives In the context of family changes and population aging, changing the pattern of life arrangements of older adults has become a social and policy issue. In this regard, this article aims to investigate the patterns of living arrangements of older adults and its socio-demographic correlates. Methods &amp; Materials A secondary analysis of micro-census data for 2006 and 2016 was used. The study population include people aged 60 and over living in households. Multinomial logistic regression tests and SPSS26 were used to data analysis. Results Living with a spouse and children is the dominant form of living arrangements for older adults in Iran. However, the share of this pattern has been almost stable in the decade 2006-2016, and in contrast, the share of older adults living alone has increased from 12% to 15%. The results indicated a significant gender difference in the pattern of living alone and its prevalence in elderly women (24.1%) was four times higher for older than older men (5.6%). Also, the results showed that with increasing age, the probability of living alone increases and with increasing the level of education of the older adults, the probability of living alone decreases. In addition, rural older adults are more likely to live alone than urban older adults. Conclusion Although living with a spouse and children is still the dominant pattern, the living alone of older adults is increasing. Women are more likely to live alone than older men and face more problems. Therefore, paying attention to the issues and problems of the alone elderly women should be the headline of the country’s welfare programs and policies. In addition, by creating employment in rural areas, it is possible to prevent the migration of young people to the city to some extent and reduce the possibility of living alone among rural older adults.

Association between specific social activities and depressive symptoms among older adults: A study of urban-rural differences in China.

Engaging in social activities can help older persons with their depressed symptoms. Few studies, however, have looked into the connection between social interactions and depressed symptoms in Chinese older persons. The aim of this study was to investigate differences in older Chinese individuals' social activity involvement and depressive symptoms across urban and rural settings. A cross-sectional investigation using information from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which was limited to older individuals aged 60 and over. Generalized linear models were constructed to assess the effects of participants' characteristics and specific social activities on CES-D scores. The association between specific social activities and depressed symptoms was investigated using multivariate logistic regression analysis. In this study, it was discovered that older individuals had a prevalence of depressed symptoms of 36.2%, with rural older adults having a greater prevalence of depressive symptoms (39.7%) than urban older adults (30.9%). Our results showed that for urban respondents, providing help to others (not regularly. OR = 0.753, 95% CI: 0.579-0.980, P = 0.035), going to a sport (not regularly. OR = 0.685, 95% CI: 0.508-0.924, P = 0.013), and using the Internet (not regular. OR = 0.613, 95% CI: 0.477-0.789, P < 0.001; almost weekly. OR = 0.196, 95% CI: 0.060-0.645, P = 0.007) were all significantly and negatively associated with depressive symptoms, while for rural respondents, interacting with friends (not regularly. OR = 1.205, 95% CI: 1.028-01.412, P = 0.021) and using the Internet (not regularly. OR = 0.441, 95% CI: 0.278-0.698, P < 0.001) were significantly and negatively associated with depressive symptoms. According to our research, there is a cross-sectional relationship between participating in a specific social activity and depressed symptoms in Chinese older adults, and this relationship varies across urban and rural older adults. This suggests that taking part in specific social activities may be crucial for reducing depression symptoms in older persons, developing more focused interventions that might support healthy aging, and offering a guide for policymakers and activists working to improve the mental health of seniors.

A qualitative exploration of Chinese rural older adults’ adaption experience to disability in Henan Province

BackgroundThe global population is ageing in a serious way and the number of disabled elderly people is increasing. Disability is a combination of physical and functional impairments, activity limitations, and social participation restrictions that significantly affect the quality of life of older adults. This study used the Roy adaptation model to examine the adaptive strategies of rural disabled elderly.MethodsAn interview outline was prepared based on the Roy Adaptation Model, in-depth interviews were conducted with eligible rural elderly with disabilities using purposive sampling. Interview data were analyzed using the colaizzi method to obtain relevant themes and sub-themes of the adaptation experience.ResultsFifteen eligible disabled elderly participated in the interview, with an average age of 73.7 years old, showing different adaptation experiences in different aspects, a total of 5 themes and 18 sub-themes were extracted: (a)physiological function adaptation: learning to monitor physiological indicators, active medical compliance behavior, active rehabilitation exercise, adjusting lifestyle and coping with failure, (b) self-concept adaptation: adjustment of gratitude mentality, self-consolation, transferring the attention, seeking emotional comfort, and negative emotional response, (c) role function adaptation: positive self-care role, negative family role and escape of social role, (d) interdependence adaptation: actively seeking support and complex social coping, and (e) adaptation influencing factors: personal factors, caregiver factors and the policy factors.ConclusionsThe disabled elderly show different adaptation strategies in four ways, and are affected by personal factors, caregiver factors and policy factors. A multi-faceted support system for the disabled elderly is recommended, and the caregivers should be trained in all-round care knowledge and skills.

Associations of macular microvascular parameters with cerebral small vessel disease in rural older adults: A population-based OCT angiography study.

To explore the associations of macular microvascular parameters with cerebral small vessel disease (CSVD) in rural-dwelling older adults in China. This population-based cross-sectional study included 195 participants (age ≥ 60 years; 57.4% women) in the optical coherence tomographic angiography (OCTA) sub-study within the Multimodal Interventions to delay Dementia and disability in rural China (MIND-China). Macular microvascular parameters were measured using the OCTA. We automatically estimated volumes of gray matter, white matter, and white matter hyperintensity (WMH), and manually assessed numbers of enlarged perivascular spaces (EPVS) and lacunes on brain magnetic resonance imaging. Data were analyzed with the general linear models. Adjusting for multiple confounders, lower vessel skeleton density (VSD) and higher vessel diameter index (VDI) were significantly associated with larger WMH volume (P < 0.05). Lower VSD and foveal density-300 (FD-300) of left eye were significantly associated with lower brain parenchymal volume (P < 0.05). In addition, lower areas of foveal avascular zone (FAZ) and FD-300 of left eye were significantly associated with more EPVS (P < 0.05). The associations of abnormal macular microvascular parameters with WMH volume were evident mainly among females. Macular microvascular parameters were not associated with lacunes. Macular microvascular signs are associated with WMH, brain parenchymal volume, and EPVS in older adults. The OCTA-assessed macular microvascular parameters can be valuable markers for microvascular lesions in the brain.