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Abstract Background In this study, we explored the relationship between social isolation, loneliness, and functional impairment in 50-year-old participants, by sex. Methods Using longitudinal data from the China Health and Retirement Longitudinal Study (2018 and 2020), 6,524 participants meeting the inclusion criteria were analyzed. A cross-lag model was established to explore the associations between social isolation, loneliness, activities of daily living (ADL), and instrumental ADL (IADL) disability over time, with results stratified by sex. Results Social isolation was not significantly associated with ADL and IADL disability, but loneliness was. Autoregressive associations indicated that social isolation, loneliness, and functional disability in 2018 predicted their exacerbations in 2020 (p

ObjectiveThis study aims to examine the association between home-based community care services (HBCCS) and mental health in older adults and specifically analyzes rural–urban differences in the association.MethodsThis cross-sectional study enrolled 852 older adults from Zhejiang Province, China. The Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder (GAD-7), University of California Los Angeles 3-item Loneliness Scale (UCLA-3), and the Mental Health (MH) component score of the 36-item Short Form (SF-36) were used to measure self-reported mental health status. Four categories of community care services were examined: daily, medical, social and recreational, and spiritual comfort. Satisfaction with community care services was assessed using self-reported measures. We used a multiple linear regression model.ResultsSatisfaction with daily care services, social and recreational services, and spiritual comfort services in rural older adults was significantly higher than in urban older adults (p = 0.016, p

Objectives: Allostatic load (AL) is an index that manifests as cumulative wear and tear on multiple physiological systems resulting from repeated adaptation to stressors throughout the life course. Higher AL was found to be associated with increased risk of adverse health outcomes, but studies on functional disability among large Chinese older population were limited. We aimed to investigate the associations of AL with functional disability among Chinese older adults. Research design and methods: This prospective cohort study included 5880 older adults who were at least 50 years old and participated in the CHARLS at baseline (2011 wave), with 3 follow-ups (2013, 2015 and 2018 waves). We selected 11 biomarkers from 4 physiological systems to construct AL. AL score was classified into three categories based on tertiles: 0–1 (low burden), 2–3 (medium burden) and 4–11 (high burden). Functional disability was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL). Multivariable logistic regression models examined the association between baseline AL, transitions of AL burden and incidence of functional disability. Results: In cross-sectional analyses, medium and high AL burden were associated with an increased prevalence of ADL disability, while association was only significant between high AL burden and IADL disability. During the 7-year follow-up, 1102 and 1777 participants incident ADL disability and IADL disability, respectively. Those with medium and high AL burden had an increased risk of new-onset ADL disability than those with low AL burden (“medium”: OR = 1.25, 95%CI = 1.01, 1.55; “high”: OR = 1.69, 95%CI = 1.32, 2.18). As for IADL disability, association was only significant in “high” group (OR = 1.50, 95% CI = 1.24, 1.83). We also found keep medium/high AL burden in 2011 and 2015 was associated with new-onset ADL (OR = 2.27, 95%CI = 1.50, 3.44) and IADL disability (OR = 1.51, 95%CI = 1.11, 2.05) in 2018. Conclusion: These results show that higher AL predicts functional disability among Chinese older adults. Monitoring AL and paying close attention to those with medium/high AL burden may aid prevention of adverse health outcomes, thus giving a healthier ageing experience to a large proportion of the population.

Abstract Background Mental health is a matter of quality of life among older adults. This study aimed to explore the association between the socioeconomic status (SES) perception and mental health of older adults using data from 2017 Chinese General Social Survey (CGSS). Methods Ordinary least squares (OLS) regression was used to analyse the association between SES perception and mental health, and the substitution model and variable methods were used to check the robustness of the results. Moreover, we adopted the Sobel model to analyse the mediating roles of social trust and justice. Results SES perception was positively associated with mental health, and this association was mediated by social trust and justice. This kind of positive association was mainly embodied in those groups with the highest or lowest objective SES. In other words, this study confirmed the phenomenon of “a contented mind is a perpetual feast” in Chinese society. Conclusions Higher SES perception is associated with improved mental health for Chinese older adults. It is imperative to prioritize efforts to enhance the perceptual abilities of older adults, particularly those with the highest or lowest objective SES, to promote their overall subjective well-being.

Abstract Background With the aging population, the number of individuals with dementia in China is increasing rapidly. This community-based study aimed to investigate the prevalence and risk factors for dementia and mild cognitive impairment (MCI) among older adults in China. Methods In this study, 20,070 individuals aged ≥ 65 were recruited between January 1, 2022, and February 1, 2023, from ten communities in Xiamen City, China. We collected data on age, sex, level of education, and medical history, as well as global cognition and functional status. The prevalence of dementia and MCI was examined, and the risk factors for different groups were assessed. Results The overall prevalence of dementia and MCI was approximately 5.4% (95% confidence interval [CI], 5.1–5.7) and 7.7% (95% CI, 7.4–8.1), respectively. The results also indicated that dementia and MCI share similar risk factors, including older age, female sex, hypertension, and diabetes mellitus. Compared with individuals with no formal education, those with > 6 years of education had an odds ratio for MCI of 1.83 (95% CI, 1.49–2.25). We also found that only 5.5% of the positive participants chose to be referred to the hospital for further diagnosis and treatment during follow-up visits. Conclusions This study estimated the prevalence and risk factors for dementia and MCI among individuals aged ≥ 65 years in Southeast China. These findings are crucial for preventing and managing dementia and MCI in China.

The COVID-19 pandemic has brought unprecedented challenges to the wellbeing of the older adults worldwide. Both social isolation and loneliness are associated with decreased subjective wellbeing, but it is uncertain whether their effects are independent or if loneliness represents the affective pathway through which social isolation impairs subjective wellbeing. We therefore assessed the extent to which the association between social isolation and subjective wellbeing is mediated by loneliness. We utilized data from the 2020 China Family Panel Studies (CFPS) and focused on a sample of 3,821 individuals aged 60 and above as the participants for our study. The results revealed a significant negative association between social isolation and subjective wellbeing among the older adults during the COVID-19 pandemic. Furthermore, loneliness was found to mediate this relationship, indicating that social isolation led to increased feelings of loneliness, which in turn negatively impacted subjective wellbeing. These findings highlight the detrimental effects of social isolation and loneliness on the wellbeing of the older adults in China during the pandemic. The implications of these results emphasize the need for interventions and support systems that address social isolation and loneliness among the older adults, promoting their wellbeing and overall mental health during challenging times such as the COVID-19 pandemic.

ObjectiveThis study aims to elucidate the heterogeneous cognitive trajectories among older adults in China through a comprehensive, nationally representative longitudinal study. Furthermore, it seeks to investigate the impact of multidimensional social isolation on heterogeneous cognitive trajectories among older adults in China.MethodsUtilizing data from three successive waves of the Chinese Longitudinal Aging Social Survey (CLASS) spanning 2016 to 2020, this investigation quantified baseline social isolation across three dimensions—family isolation, friend isolation, and subjective isolation—alongside cognitive function scores of older adults, measured across all three waves. Through latent class growth models, heterogeneous cognitive trajectories were delineated. The influence of family isolation, friend isolation, and subjective isolation on these cognitive trajectories was examined employing multinomial logistic regression analysis.ResultsThe study included 6,378 participants aged 60 and above, revealing three primary cognitive trajectories: High baseline stable group (68.8%), High baseline but declining group (21.7%), and Low baseline deteriorating group (9.5%). Adjusting for variables such as personal physical characteristics, social networks, living and working conditions, and the surrounding policy environment, the findings indicated that family isolation did not significantly affect cognitive function’s high-level decline or low-level deterioration. Conversely, friend isolation markedly increased the risk of high-level cognitive decline (OR = 1.289) and low-level cognitive deterioration (OR = 1.592). Similarly, subjective isolation significantly heightened the risk for both high-level decline (OR = 1.254) and low-level deterioration (OR = 1.29) in cognitive function.ConclusionMitigating friend and subjective isolation among older adults appears to be a more effective strategy in preventing or delaying cognitive decline, potentially reducing the strain on healthcare and social welfare systems.

BackgroundDepression is a significant burden on individuals and society, which requires our attention and action. As the aging wave collides with digitalization, further research is needed to understand how internet use relates to depression in older adults. This study aimed to investigate whether volunteer activity participation and friend networks played a chain mediating role in this relationship from the perspective of the socioemotional selectivity theory.MethodThis study’s data was derived from the 2018 China Longitudinal Aging Social Survey (CLASS), comprising 5,558 samples. The study employed the OLS model for benchmark regression and multiple robust check methods, including altering variable settings and utilizing the instrumental variable model. In addition, the generalized structural equation model (GSEM) was used to analyze the mechanism.ResultUsing the internet was significantly associated with reduced depression in older adults (coefficient = −0.9321, p

Abstract Background Marital status is a potentially essential factor for cognitive impairment. Relevant research examining the potential pathways through which the marital status of spouseless older people is associated with cognitive impairment needs to be more adequate. Therefore, this study aims to investigate the serial mediating effects of various forms of social support and depression between marital status and cognitive impairment in older Chinese people. Methods This study involved a secondary analysis of data from the 2014–2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with a total of 2,647 Chinese older adults and 53.6% being males. Mediation analysis using the SPSS process macro was conducted. Results The results indicated that marital status was significantly predictive of cognitive impairment among older people, and those with a spouse exhibited higher cognitive functioning. Informal social support and depression were found to play partial mediating roles in the association between marital status and cognitive impairment. The findings also revealed that marital status was unrelated to formal social support, and no association between formal social support and cognitive impairment was found. Conclusions The study findings highlight the need for social service providers to design programs for promoting connections associated with informal support to reduce their risk of depression and cognitive impairment and for policymakers to develop effective formal social support systems for older people without spouses. This study indicated that older people could regain the benefits of marriage to lower the risk of depression and improve their mental health.

Abstract Background Evidence remains limited and inconsistent for assessing cognitive function in Chinese older adults (CFCOA) and inequalities in cognitive function in Chinese older adults (ICFCOA) and exploring their influencing factors and gender differences. This study aimed to identify influencing factors and inequality in CFCOA to empirically explore the existence and sources of gender differences in such inequality and analyse their heterogeneous effects. Methods Based on data from the China Health and Retirement Longitudinal Study (CHARLS) for three periods from 2011 to 2015, recentered influence function unconditional quantile regression (RIF-UQR) and recentered influence function ordinary least squares (RIF-OLS) regression were applied to assess influencing factors of CFCOA, while grouped treatment effect estimation, Oaxaca-Blinder decomposition, and propensity score matching (PSM) methods were conducted to identify gender differences in ICFCOA and influencing factors, respectively. Results The results showed heterogeneous effects of gender, age, low BMI, subjective health, smoking, education, social interactions, physical activity, and household registration on CFCOA. Additionally, on average, ICFCOA was about 19.2–36.0% higher among elderly females than among elderly males, mainly due to differences in characteristic effects and coefficient effects of factors such as marital status and education. Conclusions Different factors have heterogeneous and gender-differenced effects on CFCOA and ICFCOA, while the formation and exacerbation of ICFCOA were allied to marital status and education. Considering the severe ageing and the increasing incidence of cognitive decline, there is an urgent need for the government and society to adopt a comprehensive approach to practically work for promoting CFCOA and reducing ICFCOA.

Geng Wang, Jian Xu School of Media & Communication, Shanghai Jiao Tong University, Shanghai, People’s Republic of ChinaCorrespondence: Jian Xu, School of Media & Communication, Shanghai Jiao Tong University, 800 Dongchuan Road, Minhang District, Shanghai, 200240, People’s Republic of China, Tel +86 13817505128, Email xujian@sjtu.edu.cnPurpose: In the intersection of the aging and information era, the development of digital aging significantly influences the well-being of older individuals. Given the divergent findings in various studies exploring the effects of social media use on mental health, this study specifically examined the impact of forwarding, a prevalent social media behavior among older individuals, focusing on the effects of use intensity on their subjective well-being (SWB) and the specific mechanisms involved.Materials and Methods: A total of 323 Chinese older adults completed the questionnaire. SPSS along with Hayes Process Models 4 and 7 was employed to test the hypotheses.Results: The results indicated that social media forwarding intensity significantly and positively predicted SWB of older adults. This association was partially mediated by perceived social support (PSS) and self-esteem. Gender served as a moderator, highlighting that the positive predictive effects of forwarding intensity on PSS and self-esteem were more pronounced for older men than for older women. Further, the findings confirmed the existence of the moderated mediating effect such that the impact of forwarding on SWB was mediated through both PSS and self-esteem for older men, while, for older women, it was solely mediated by PSS.Conclusion: This study revealed the positive impact of forwarding, a user-friendly social media function, on the well-being of older adults and elucidated the specific mechanisms through a moderated mediation model. In light of these findings, we propose customizing the development of age-friendly social media functions to address the diverse psychological needs of older adults, taking into account gender differences. These findings may offer valuable insights for constructing digital age-friendly platforms and fostering active aging development.Keywords: social media forwarding, Chinese older adults, well-being, perceived social support, self-esteem, gender

Introduction: It is crucial to comprehend the interplay between the center of mass (CoM) and base of support (BoS) in elderly individuals’ body movements, as it could have implications for fall prevention.Methods: The purpose of this study is to characterize age-related differences using the instantaneous location of the CoM and CoM velocity vector in relation to the dynamically changing BoS during walking. Thirty subjects participated in the experiments. Derivation formulas of feasible stability region and age-related statistical analyses were proposed.Results: The stability margin and distance to centroid for elderly group were found to be significantly different from the young group (p < 0.05). At heel strike, while the CoMv distance was similar for age-based groups (p > 0.05), older individuals demonstrated a greater CoMv distance to the border than the younger at right limb, which suggesting age-related differences in momentum control. In addition, Bland-Altman analysis indicated that the validity was substantial, making it feasible to capture stride-to-stride variability.Discussion: The CoM trajectories and feasible stability region could provide a better understanding of human momentum control, underlying mechanisms of body instability and gait imbalance.

Abstract Objective The associations between plasma vitamin B12 level and anemia under different dietary patterns in elderly Chinese people are poorly understood. We aimed to examine the associations between plasma vitamin B12 levels and anemia under different dietary patterns in adults aged 65 years and older in nine longevity areas in China. Methods A total of 2405 older adults completed a food frequency questionnaire at the same time as a face-to-face interview. The dietary diversity score (DDS) was assessed based on the food frequency questionnaire, with the low DDS group referring to participants with a DDS score ≤ 4 points. Vitamin B12 levels were divided into two groups of high (>295 pg/mL) and low (≤ 295 pg/mL) with the median used as the cut-off point. Sub-analyses were also performed on older adults divided into tertiles of vitamin B12 levels: low ( 375 pg/mL) to study the association of these levels with anemia. Results Six hundred ninety-five (28.89%) of these people were diagnosed with anemia and had a mean age of 89.3 years. Higher vitamin B12 levels were associated with a decreased risk of anemia (multi-adjusted OR, 0.59, [95% CI, 0.45 ~ 0.77] P

Abstract Background Smart nursing homes (SNHs) integrate advanced technologies, including IoT, digital health, big data, AI, and cloud computing to optimise remote clinical services, monitor abnormal events, enhance decision-making, and support daily activities for older residents, ensuring overall well-being in a safe and cost-effective environment. This study developed and validated a 24-item Expectation and Acceptability of Smart Nursing Homes Questionnaire (EASNH-Q), and examined the levels of expectations and acceptability of SNHs and associated factors among older adults in China. Methods This was an exploratory sequential mixed methods study, where the qualitative case study was conducted in Hainan and Dalian, while the survey was conducted in Xi’an, Nanjing, Shenyang, and Xiamen. The validation of EASNH-Q also included exploratory and confirmatory factor analyses. Multinomial logistic regression analysis was used to estimate the determinants of expectations and acceptability of SNHs. Results The newly developed EASNH-Q uses a Likert Scale ranging from 1 (strongly disagree) to 5 (strongly agree), and underwent validation and refinement from 49 items to the final 24 items. The content validity indices for relevance, comprehensibility, and comprehensiveness were all above 0.95. The expectations and acceptability of SNHs exhibited a strong correlation (r = 0.85, p

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver condition that affects a quarter of the global adult population. To date, only a few NAFLD risk prediction models have been developed for Chinese older adults aged ≥ 60 years. This study presented the development of a risk prediction model for NAFLD in Chinese individuals aged ≥ 60 years and proposed personalised health interventions based on key risk factors to reduce NAFLD incidence among the population. Methods A cross-sectional survey was carried out among 9,041 community residents in Shanghai. Three NAFLD risk prediction models (I, II, and III) were constructed using multivariate logistic regression analysis based on the least absolute shrinkage and selection operator regression analysis, and random forest model to select individual characteristics, respectively. To determine the optimal model, the three models’ discrimination, calibration, clinical application, and prediction capability were evaluated using the receiver operating characteristic (ROC) curve, calibration plot, decision curve analysis, and net reclassification index (NRI), respectively. To evaluate the optimal model’s effectiveness, the previously published NAFLD risk prediction models (Hepatic steatosis index [HSI] and ZJU index) were evaluated using the following five indicators: accuracy, precision, recall, F1-score, and balanced accuracy. A dynamic nomogram was constructed for the optimal model, and a Bayesian network model for predicting NAFLD risk in older adults was visually displayed using Netica software. Results The area under the ROC curve of Models I, II, and III in the training dataset was 0.810, 0.826, and 0.825, respectively, and that of the testing data was 0.777, 0.797, and 0.790, respectively. No significant difference was found in the accuracy or NRI between the models; therefore, Model III with the fewest variables was determined as the optimal model. Compared with the HSI and ZJU index, Model III had the highest accuracy (0.716), precision (0.808), recall (0.605), F1 score (0.692), and balanced accuracy (0.723). The risk threshold for Model III was 20%–80%. Model III included body mass index, alanine aminotransferase level, triglyceride level, and lymphocyte count. Conclusions A dynamic nomogram and Bayesian network model were developed to identify NAFLD risk in older Chinese adults, providing personalized health management strategies and reducing NAFLD incidence.

Abstract Background This study aimed to examine the association between tooth loss and frailty among Chinese older adults and the mediating role of dietary diversity in this association. Methods Data from five waves of the Chinese Longitudinal Healthy Longevity Survey conducted between 2005 and 2018 were used. Path analyses were employed to assess both concurrent and cross-lagged relationships between tooth loss and frailty index while accounting for intrapersonal correlation. Furthermore, the mediation effect of dietary diversity was also examined. Results In concurrent models, severe tooth loss was associated with frailty after adjusting for demographic characteristics (odds ratio [OR] = 1.82, p

ObjectiveThis study aims to investigate the impact of social isolation on the utilization of primary health services among older adults in China.MethodsData from the China Longitudinal Aging Social Survey (CLASS) conducted in 2018 were utilized. A binary logistic regression model was established, and propensity score matching (PSM) was employed for analysis.ResultsThe results of the binary logistic regression showed that family isolation within social isolation had a significant negative impact on the utilization of primary health services for older adults. In contrast, there was no significant association between friend isolation, community isolation, and the utilization of primary health services. Furthermore, the PSM results, using three matching methods (nearest neighbor matching, radius matching, and kernel matching), confirmed that family isolation significantly reduced older adults’ utilization of primary health services, consistent with the baseline regression findings.ConclusionReducing the occurrence of family isolation among older adults may be a cost-effective intervention measure. Efforts should be directed toward improving family support for older adults, promoting the utilization of primary health services, and strengthening disease prevention.

ObjectiveThe limitation of activities of daily living (ADL) affects the mental health of older adults. We distinguished activities of daily living into basic activities of daily living (BADL) and instrumental activities of daily living (IADL) and aimed to explore the relationship between the two limitations and depressive symptoms among Chinese older adults by using nationally representative cross-sectional data.MethodsData from the China Health and Retirement Longitudinal Study (CHARLS, wave 4) were used, and 9,789 older adults aged 60 years and above were screened. The 10-item Center for Epidemiologic Studies Depression (CES-D-10) scale was used to measure the depressive symptoms of older adults, and a 12-item scale for ADL was used to estimate functional limitations. Generalized linear mixed-effect models were employed to examine the relationship between BADL/IADL and depressive symptoms among older adults.ResultsThe prevalence of high-risk depression among older adults was 43.5%, and the rates of limitation in BADL and IADL were 19.02 and 25.29%, respectively. The prevalence of high-risk depression significantly differed among subgroups of smoking, drinking, chronic diseases, duration of sleep, having social activities or not, and the type of medical insurance. Older adults with limited BADL or IADL were at a higher risk of depression than those without limitations of BADL or IADL; BADL (OR-adjusted = 2.71; 95% CI: 2.40–3.06) and IADL (OR-adjusted = 2.68; 95% CI: 2.41–2.98) had various influences on the risk of depression in older adults.ConclusionADL was a related factor in the risk of depression among older adults in China. BADL and IADL had different effects on the risk of depression, suggesting that older adults with physical function limitations might be more likely to suffer from depression.

As a new generation of necessary terminals for future homes, smart homes have become one of the essential mediums for smart aging at home. This paper aims to explore how older adults who age at home can overcome the digital divide of the new medium and achieve social participation in the home context to realize active aging. Based on the theory of social compensation, we select the smart-home smart screen, a representative new medium product in China, and carry out open coding, spindle coding, selective coding, and theoretical construction of the original interview data through the grounded theory research method. The results show that the main factors affecting the social compensation of older adults to smart home social media include user interface quality, interaction quality, content quality, and service quality, and these four factors are used as external variables to compensate older adults socially, thereby stimulating the emotional experience and perception changes at the cognitive level of older adults and then affecting the adoption and acceptance of smart home social media by older adults. This study refines the factors influencing the older adults’ use of smart home social media from the perspective of social compensation. It explains the mechanism of acceptable behavior of older adults, bridging the gap in previous literature on the influencing factors and behavioral mechanisms of older adults of smart home social media. This paper provides a theoretical basis and guidance for the subsequent academic research and software development practice of social media under new technological devices to further help older adults in China achieve active and healthy aging.

ObjectiveTo compare the sex differences in cognitive function and its influencing factors among Chinese older adults.MethodWe conducted a cross-sectional study by using data from the China Longitudinal Healthy Longevity Survey (CLHLS). According to the 32 provinces and 4 municipalities directly under the Central Government of China, 3–5 counties or districts were randomly selected in each province or city (except Tibet), and then 1–3 villages or streets were randomly selected in each county or district, from which the target population was sampled. Mini Mental State Examination (MMSE) was used to assess the cognitive function of 9,262 older adults aged 65 and above in China. Descriptive analysis was applied to demonstrate the participants’ demographic characteristics, health-related behaviors, social and non-social activity, disease status, mental and sleep condition. And then, univariate and multifactor analyses were performed to validate different risk factors for cognitive function, respectively in the general population, male older adults and female older adults.ResultThe older adults with cognitive impairment accounted for 10.4% of the total population. There are significant differences in cognitive function between male and female older adults. The odds of cognitive impairment in older adult women was 1.291 times that of older adult men (OR = 1.291, 95%CI: 1.084–1.538). Among the male older adults, those who were older, highly educated, spouseless, had depressive symptoms, and lacked social activities were more likely to have cognitive impairment, whereas among the female older adults, those who were older, highly educated, and lacked social activities were more likely to have cognitive impairment.ConclusionOverall, there are subtle differences in potential influencing factors for cognitive function between the male older adults and female older adults. Attention should be paid to the different cognitive protection measures for the older adults with different sexes.

BackgroundSelf-rated health (SRH), interviewer-rated health (IRH), and objective health reflect the overall health status from different aspects. This study aimed to investigate the associations of SRH, IRH, and objective health with mortality among Chinese older adults.MethodsThis study used data from the 2008 (baseline), 2011, 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. SRH and IRH were evaluated by questionnaire. Objective health was evaluated by the Chinese multimorbidity-weighted index (CMWI), which incorporated 14 diagnosed chronic diseases. SRH, IRH, and CMWI were assessed as: (1) baseline levels; (2) longitudinal changes by subtracting the values obtained in 2008 from the corresponding values in 2014; (3) trajectories by Group-Based Trajectory Modeling, respectively. The Cox proportional hazards model was used to explore the associations of baseline SRH, IRH, and CMWI, their changes, and trajectories with mortality.ResultsA total of 13,800 participants were included at baseline (2008). The baseline SRH ([hazard ratio] 0.93, [95% confidence interval] 0.91–0.96), IRH (0.84, 0.81–0.87), and CMWI (0.99, 0.98–1.00) in 2008 were significantly associated with 10-year mortality (2008 to 2018). Among 3,610 participants, the changes of SRH (0.93, 0.87–0.98), IRH (0.77, 0.71–0.83), and CMWI (0.97, 0.95–0.99) from 2008 to 2014 were significantly associated with 4-year mortality (2014–2018). The trajectories were divided into “high SRH/IRH/CMWI” and “low and declining SRH/IRH/CMWI.” Compared with “low and declining SRH/IRH/CMWI,” “high SRH” (0.58, 0.48–0.70), “high IRH” (0.66, 0.55–0.80), and “high CMWI” (0.74, 0.61–0.89) from 2008 to 2014 were significantly associated with 4-year mortality (2014–2018).ConclusionBaseline SRH, IRH, and CMWI, their changes and trajectories are all associated with mortality in Chinese older adults. It is possibly necessary to promote the use of cost-effective indicators in primary medical institutions to improve the health management of the older adults.

BackgroundThe association between the instrumental activities of daily living (IADL) score and the risk of initial cognitive function impairment is inconclusive. We aimed to identify distinctive IADL trajectories and examine their relationship with the onset of mild cognitive impairment (MCI) among Chinese older people.MethodsThe study used six-wave longitudinal data from the Chinese Longitudinal Healthy Longevity Survey conducted between 2002 and 2018. It included a total of 11,044 Chinese people aged 65 years or older. A group-based trajectory model was used to identify distinctive trajectories of the IADL score, and the Cox proportional hazards model was used to explore the hazard ratio of various trajectories at the onset of MCI. Interaction analysis was used to analyze individual modification between the IADL trajectories and the onset of MCI. Finally, we adopted four types of sensitivity analysis to verify the robustness of the results.ResultsDuring a median follow-up of 16 years, the incidence of MCI was 6.29 cases per 1,000 person-years (95% confidence interval [CI] 5.92–6.68). Three distinct IADL trajectory groups were identified: a low-risk IADL group (41.4%), an IADL group with increasing risk (28.5%), and a high-risk IADL group (30.4%). Using the Cox proportional hazards model after adjusting for covariates, we found that compared with the low risk IADL group, the hazard ratio of the IADL group with increasing risk was 4.49 (95% CI = 3.82–5.28), whereas that of the high-risk IADL group was 2.52 (95% CI 2.08–3.05). Treating the IADL group with increasing risk as the reference, the hazard ratio for the high-risk IADL group was 0.56 (95% CI 0.48–0.66). Interaction analyses showed that age and residence were significant moderators (P for interaction

Huan Guo,1,2 Yancui Zhang,3 Zhendong Wang,4 Heyong Shen2 1School of Human Resources, Guangdong University of Finance & Economics, Guangzhou, People’s Republic of China; 2Institute of Analytical Psychology, City University of Macau, Macau, People’s Republic of China; 3Postdoctoral Research Center of School of Psychology, Nanjing Normal University, Nanjing, People’s Republic of China; 4School of Basic Medical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of ChinaCorrespondence: Heyong Shen, Email shenheyong2018@hotmail.comObjective: This study aimed to examine the relationship between cognitive function and depressive symptoms and to explore the mediating role of sleep quality in the cognition-depression relationship in Chinese older adults (OAs).Methods: Data came from a nationally representative sample of 16,209 Chinese OAs (aged 65+) from 2008, 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A random intercept cross-lagged panel model (RI-CLPM) combined with mediation analysis was adopted to determine the relationship between cognitive function and depressive symptoms and the mediating effect of sleep quality on the ascertained cognition–depression relationship.Results: Poorer cognitive function at prior assessment points were significantly associated with severe depressive symptoms at subsequent assessments, and vice versa. Sleep quality partially mediated the prospective relationship of cognition on depressive symptoms, which accounted for 3.92% of the total effect of cognition on depression.Discussion: Cognitive decline may predict subsequent depressive symptoms, and vice versa. The impact of cognition on depression is partially explained by its influence on sleep quality. Multidisciplinary interventions aimed at reducing depression and cognitive decline per se as well as improving sleep quality would be beneficial for emotional well-being and cognitive health in OAs.Keywords: cognitive function, depressive symptoms, sleep quality, random intercept cross-lagged panel model, mediation, Chinese older adults

Abstract Background Despite the existing literature highlights the central roles of sociodemographic factors, fruit & vegetable (F&V) intake, and physical activities for maintaining good health, less is known about the associations in the Chinese context. This study attempted to explore the associations of servings of F&V intake and levels of physical activities with poor self-rated health (SRH) among Chinese older adults. Methods Data were drawn from the Study on Global Ageing and Adult Health-China (SAGE-China) issued by the World Health Organization and included 7560 respondents aged ≥60 years in China. After screening out the potential confounding factors, multiple logistic regression models were adopted to explore the associations of sociodemographic factors, servings of F&V intake, and levels of physical activities with poor SRH. Results Among the sample, nearly a quarter reported poor health status. There were significant gender differences in the case of servings of F&V intake and levels of physical activities. Logistic regressions indicated that higher fruit intake was associated with lower likelihood of vigorous level of physical activity as compared to zero intake. Likewise, higher vegetable intake (≥10 servings) was associated with a higher likelihood of vigorous & moderate level of physical activity when compared to lower intake (≤ 4 servings). Higher fruit intake was associated with a lower likelihood of poor SRH. Similarly, vegetable intake (5 servings: AOR = 0.69, 95%CI: 0.58–0.83; 6–9 servings: AOR = 0.72, 95%CI: 0.59–0.87) was significantly associated with poor SRH. Additionally, vigorous level of physical activity (AOR = 0.79, 95%CI: 0.65–0.97) and vigorous fitness/leisure (AOR = 0.57, 95%CI: 0.39–0.84) were significantly associated with poor SRH. Conclusion This study suggested that older adults with high fruit intake had lower probability of performing vigorous & moderate level of physical activity, while those with high vegetable intake had higher probability of performing vigorous & moderate level of physical activity. Likewise, the older adults with high F&V intake and higher probability of performing vigorous level of physical activity, walk/bike activity, and vigorous/moderate fitness/leisure had less likelihood to face the risk for poor SRH outcomes. The appropriate servings of F&V intake and levels of physical activity should be highlighted.

Abstract Background Subjective cognitive decline (SCD) may be the first symptomatic manifestation of Alzheimer’s disease, but information on its health correlates is still sparse in Chinese older adults. This study aimed to estimate SCD symptoms and its association with socio-demographic characteristics, common chronic diseases among southern Chinese older adults. Methods Participants aged 60 years and older from 7 communities and 2 nursing homes in Guangzhou were recruited and interviewed with standardized assessment tools. Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire–9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to measure poor sleep quality, depression symptoms and anxiety symptoms. The SCD symptoms were measured by SCD questionnaire 9 (SCD-Q9) which ranged from 0 to 9 points, with a higher score indicating increased severity of the SCD. Participants were divided into low score group (SCD-Q9 score ≤ 3) and higher score group (SCD-Q9 score > 3). Chi-square tests and multivariate logistic regression analysis were used for exploring the influences of different characteristics of socio-demographic and lifestyle factors on SCD symptoms. Univariate and multivariate logistic regression analysis were applied to explore the association between SCD symptoms with common chronic diseases. Results A total of 688 participants were included in our analysis with a mean age of 73.79 (SD = 8.28, range: 60–101), while 62.4% of the participants were females. The mean score of the SCD-Q9 was 3.81 ± 2.42 in the whole sample. A total of 286 participants (41.6%) were defined as the low score group (≤3 points), while 402 participants (58.4%) were the high score group (> 3 points). Multivariate logistic regression analysis revealed that female (OR = 1.99, 95%CI: 1.35–2.93), primary or lower education level (OR = 2.58, 95%CI: 1.38–4.83), nursing home (OR = 1.90, 95%CI: 1.18–3.05), napping habits (OR = 1.59, 95%CI: 1.06–2.40), urolithiasis (OR = 2.72, 95%CI: 1.15–6.40), gout (OR = 2.12, 95%CI: 1.14–3.93), poor sleep quality (OR = 1.93, 95%CI: 1.38–2.71), depression symptoms (OR = 3.01, 95%CI: 1.70–5.34) and anxiety symptoms (OR = 3.11, 95%CI: 1.29–7.46) were independent positive related to high SCD-Q9 score. On the other hand, tea-drinking habits (OR = 0.64, 95%CI: 0.45–0.92), current smoking (OR = 0.46, 95%CI: 0.24–0.90) were independent negative related to high SCD-Q9 score. Conclusions Worse SCD symptoms were closely related to common chronic diseases and socio-demographic characteristics. Disease managers should pay more attention to those factors to early intervention and management for SCD symptoms among southern Chinese older adults.

Due to labor migration and social changes, the Chinese elderly are facing significant social isolation, along with changes in aging attitudes. However, whether social isolation affects loneliness among the Chinese elderly and whether this relationship is moderated and mediated by aging attitudes is unclear. This empirical study aimed to respond to the above questions in the Chinese context, Based on the data from the 2014 China Longitudinal Aging Social Survey (N = 6,645), the results showed that social isolation is a positive predictor of loneliness; aging attitudes mediate the relationship between social isolation and loneliness. Social isolation affects the loneliness of the elderly partially by weakening positive aging attitudes and strengthening negative aging attitudes; aging attitudes moderate the effect of social isolation on loneliness. For those older adults with higher positive aging attitudes, social isolation has a much smaller effect on loneliness. While for those older adults with higher negative aging attitudes, social isolation has a more substantial effect on their feelings of loneliness. Our results indicate that less social isolation is an effective way to relieve loneliness, and maintaining higher positive aging attitudes and lower negative aging attitudes, is important for the Chinese elderly to prevent loneliness when facing social isolation.

The growing number of aging populations has become a major problem worldwide. Nursing homes play an essential role in the later life of older adults. Previous research indicated potential associations between external factors and older adults' intention to live in nursing homes. However, intrinsic motivation has yet to be fully understood. This article addresses an academic void that integrated the Basic Psychological Needs Theory (BPNT) and the Theory of Planned Behavior (TPB) to explore older adults' intentions to live in nursing homes. More specifically, it tested the effects of autonomy, competence, and relatedness needs satisfaction as defined in the BPNT on attitudes, subjective norms, perceived behavioral control, and live-in intentions toward nursing homes in the TPB. An online survey provided quantitative data from 425 aging people. The results indicated that the higher the satisfaction of the basic psychological needs (i.e., autonomy needs, competence needs, and relatedness needs) of the older adults, the lower their intention to live in nursing homes. Furthermore, social pressure partially mediates this relationship. That is, the higher the satisfaction of the basic psychological needs of older adults, the lower the pressure from society. Thus, they should be admitted to the nursing home, and the lower their intention to live in nursing homes. The results contribute to a better understanding of the deep psychological motivation of the older adults' intention to live in nursing homes and support further development of the BPNT-TPB model in older adults' health research.

PurposeThis study aimed to investigate the association between physical performance and subjective wellbeing among Chinese older adults.MethodsData on the Chinese population were gathered from the Study on Global Aging and Adult Health Survey (SAGE). This survey used a stratified multistage cluster sample design based on geographical location and economic status. Chinese older adults aged 65 years old or above from eight provinces (Guangdong, Hubei, Jilin, Shaanxi, Shandong, Shanghai, Yunnan, and Zhejiang) were included in this cross-sectional study. Physical performance was measured using relative handgrip strength and normal gait speed. Subjective wellbeing was measured using quality-of-life (QOL), happiness, and mood through interviews with participants. Logistic regressions were used to examine the associations between physical performance and each of the three wellbeing variables (QOL, happiness, and mood).ResultsData of 5,421 Chinese older adults (mean age: 72.93 ± 5.89 years old, 47.1% men) were analyzed. In this sample, individuals with a higher level of relative handgrip strength (rHGS) had better mood compared to those with a lower level of rHGS (p < 0.05), and persons with lower gait speed had poorer QOL, happiness, and mood compared to those with faster gait speed (p < 0.05).ConclusionOur findings suggest that a higher level of relative handgrip strength predicted better mood and lower gait speed predicted poor QOL, happiness, and mood in Chinese older adults.

Objectives: Studies have shown that the frequent participation of the elderly in cognitive stimulation activities is associated with a reduced risk of dementia, but the prospective evidence of this association is limited.Methods: We used data from a prospective cohort study of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), and included 11,821 community-living Chinese individuals aged 65 years or older at 2008 baseline who were free of dementia, and were followed up every 2–3 years until 2018. Cox proportional hazards models were applied to generate the hazard ratios (HRs) and 95% confidence intervals (CIs) for analyzing the associations between the frequency of playing cards/mahjong and the incidence of dementia.Results: A total of 821 participants were diagnosed with dementia during the 10-year follow-up. The average age of patients with dementia and non dementia were 89 and 90 years old, respectively. Compared with participants who rarely or never played cards/mahjong, participants who played cards/mahjong almost every day had a significantly lower risk of dementia (HR = 0.63; 95%CI, 0.42–0.95) after the multivariable-adjusted model. Similar results were observed in subgroup analyses based on sex (male: HR = 0.52, 0.28–0.96; female: HR = 0.62, 0.36–0.98), age (

Abstract Background The hypertriglyceridemic waist (HTGW) phenotype has been proposed to be related to the occurrence and progression of chronic kidney disease (CKD). The ageing trend of the Chinese population continues to intensify, and elderly individuals are at high risk of CKD. The purpose of this study was to investigate the cross-sectional and longitudinal associations between the HTGW phenotype and the risk of CKD by following community-dwelling adults aged 60 years and older in Tianjin, China, for 7 years. Methods This study was an observational cohort study conducted between 2013 and 2019. Of 2050 participants aged 60 years and older who underwent an annual health examination in 2013, 1605 individuals with complete data were enrolled in the cross-sectional analysis. Among them, 1271 individuals were observed until 2019. Detailed follow-up records were available for 816 participants, of whom 600 participants without CKD at baseline were eligible for inclusion in the retrospective analysis. The HTGW phenotype was defined as a waist circumference of 90 cm or more and triglyceride concentrations of 2.0 mmol/L or more in males or a waist circumference of 85 cm or more and triglyceride concentrations of 1.5 mmol/L or more in females. CKD was defined as an estimated glomerular filtration rate (eGFR)

Xiaojun Liu,1 Shuoni Chen,2 Anran Tan,2 Jiayi Zhou,2 Wenbin Liu1 1Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, Fujian, 350122, People’s Republic of China; 2Department of Global Health, Wuhan University, Wuhan, Hubei, 430072, People’s Republic of ChinaCorrespondence: Wenbin LiuDepartment of Health Management, School of Public Health, Fujian Medical University, Room 108 in the Building for School of Public Health, No. 1 Xuefubei Road, Minhou District, Fuzhou, 350122, People’s Republic of ChinaTel/Fax +86- 591-2286-2572Email wenbinliu126@126.comPurpose: The association between body mass index (BMI) and health-related quality of life (HRQOL) has not been verified neither in China nor in any other Asian country. This study aimed to examine the association between BMI and HRQOL in the Chinese older adults population.Methods: A total of 5018 older adults from the China’s Health-Related Quality of Life Survey for Older Adults 2018 was included in this study. The HRQOL was measured by the Chinese version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD). Multiple linear regression analysis was used to explore the associations between BMI and HRQOL among the older adults in rural, urban, and total samples.Results: After adjusting all the confounders, compared with normal weight group, underweight was negatively correlated with the total scores of HRQOL among the older adults in rural (B= − 2.310, p < 0.01), urban (B= − 1.019, p < 0.001), and total samples (B= − 2.351, p < 0.001), whereas overweight was positively associated with the total scores of HRQOL among the older adults in rural samples (B= 0.888, p < 0.05). The results showed that obesity was not associated with the total scores of HRQOL among the older adults in rural (B= − 1.214, p > 0.05), urban (B= − 0.074, p > 0.05), and total samples (B= − 1.461, p > 0.05).Conclusion: This study suggests that obese Chinese older adults did not show a better quality of life than those of normal weight. But this result does not deny the “jolly fat” hypothesis entirely, as the overweight older adults from rural areas showed better HRQOL. Moreover, underweight older people show a poorer HRQOL. The relationship between BMI and HRQOL in the older adults needs to be differentiated according to different characteristics of the population.Keywords: body mass index, BMI, health-related quality of life, HRQOL, “jolly fat” hypothesis, Chinese older adults

Introduction: Valid assessments of quality of life (QoL) and cognition are important in caring for individuals with severe dementia; there is an urgent need for validated assessment tools for specific populations. This study aimed to develop and validate Chinese versions of the Quality of Life in Late-Stage Dementia (QUALID-C) scale and the Cognitive Test for Severe Dementia (CTSD-C) for Chinese older adults. Methods: This was a cross-sectional validation study comprised of 93 Chinese older adults with severe dementia recruited from 6 residential homes. The content and cultural validity of the QUALID-C and CTSD-C were evaluated by a 7-member expert panel, and interrater reliability, test-retest reliability, internal consistency, concurrent validity, and factorial structure were examined. Results: The QUALID-C showed acceptable internal consistency (Cronbach α = 0.65), good interrater reliability (intraclass correlation coefficient [ICC] = 0.99), and good test-retest reliability (ICC = 0.96). Principal component analysis yielded 3 factors; the items loaded on the factors were comparable to those in previous studies and suggested the scale’s multidimensionality to measure QoL. The CTSD-C showed satisfactory internal consistency (Cronbach α = 0.862), good interrater reliability (ICC = 0.99), and good test-retest reliability (ICC = 0.958). Principal component analysis yielded 3 factors; the items loaded on factors 1 and 2 resembled the items of the automatic response and attentional control factors of the original study. Conclusion: The QUALID-C and the CTSD-C are reliable and valid scales to measure the QoL and cognitive functions of Chinese older adults with severe dementia. These assessments can be utilized to evaluate the effectiveness of treatment and future research work.

ObjectivesSocial function is an important indicator for physical and psychological health of older adults. However, there is a lack of a standardized questionnaire for measuring social function of older adults. This study developed a questionnaire to assess Chinese older adults’ social function.MethodsWe used three samples (N = 2,257 aged ≥60 years) to test the reliability and validity of the questionnaire.ResultsBased on exploratory and confirmatory factor analyses with two samples, the final version of Social Function Questionnaire for Chinese Older Adults (SFQCOA) contained three dimensions with 12 items: social support, social adaptation, and social engagement. Criterion validity test with the third sample showed that SFQCOA was positively related to the healthy indices and negatively related to the unhealthy indices.ConclusionThe validity and reliability of the questionnaire reach the requirements of psychometric standards, suggesting it is an effective tool for measuring social function of older adults.

Abstract Background The substitute or complementary effect of formal care on informal care service used by the elderly has been tested in Western countries. However, this effect is excluded from the discussion in the Chinese context. The identification of the relationship between informal care and formal care may imply different directions in policy-making. Thus, this study contributes to understanding the relationship between informal care and formal care among Chinese older adults. Methods Using the dataset from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2014, this study uses regression models and instrumental variable (IV) method to examine the impact of formal care on informal care. Results The results primarily show that formal care does not substitute informal care among Chinese older adults. In fact, formal care is a supplement to informal care in China. Conclusion It is expected that informal care will become less available in the future in China. Thus, policymakers should be concerned about the underdevelopment of formal care for the elderly in China.

Introduction: The interactions between apolipoprotein E (APOE) genotype and diet pattern changes were found significant in several trials, implying that APOE gene may modify the effect of animal protein-rich food on health outcomes. We aim to study the interaction of APOE genotype with the effect of meat, fish and egg intake on mortality.Methods: This population-based study enrolled 8,506 older adults (mean age: 81.7 years, 52.3% female) from the Chinese Longitudinal Healthy Longevity Study. The intake frequency of meat, fish and egg was assessed by 3-point questions at baseline. Cox regression was conducted to calculate the hazard ratios for all-cause mortality of intake levels of meat, fish and egg. The analyses were stratified by APOE genotype and sex. The analyses were performed in 2020.Results: In the multivariable-adjusted models, meat and fish intake was associated with all-cause mortality (high vs. low intake: meat: HR: 1.14, 95% CI: 1.01, 1.28; fish: HR: 0.83, 95% CI: 0.73, 0.95). APOE genotype have significant interactions with meat and fish intake (Ps < 0.05). Compared with low fish intake, high fish intake was associated with lower risk of mortality (HR: 0.74, 95% CI: 0.56–0.98) only among the APOE ε4 carriers. High meat intake was significantly associated with higher risks of mortality (HR: 1.13, 95% CI: 1.04–1.25) only among the APOE ε4 non-carriers. The interactive relationship was restricted among the male. No significant findings were observed between egg and mortality among carriers or non-carriers.Conclusions: Among Chinese older adults, the significance of associations of mortality with reported meat or fish intake depended on APOE-E4 carriage status. If validated by other studies, our findings provide evidence for gene-based “precision” lifestyle recommendations.

Abstract Background Existing studies in developed countries show that social participation has beneficial effects on the functional ability of older adults, but research on Chinese older people is limited. This study examined the effects of participating in different types of social activities on the onset of functional disability and the underlying behavioral and psychosocial mechanisms among older adults aged 65 and older in China. Methods The 2005, 2008, and 2011 waves of the Chinese Longitudinal Health Longevity Study were used. Life table analysis and discrete time hazard models were adopted to examine the relationship between social participation and functional disability. Social participation was defined as the frequencies of engaging in group leisure-time activities (i.e., playing cards/mahjong) and organized social activities, involving in informal social interactions (i.e., number of siblings frequently visited), and participating in paid jobs. Extensive social participation was measured by a composite index by adding up the four types of social activities that an older person was engaged in. Results After controlling for the effect of socio-demographic characteristics, health status, and health behavioral factors, extensive social participation is associated with a significant reduced risk for the onset of functional disability (hazard ratio [HR] = 0.92, p

This study aimed to examine the prevalence and correlates of gambling participation and problems among community-dwelling Chinese older adults in the U.S. Based on a community-based participatory research approach, the study enrolled 3,159 Chinese older adults aged 60 years and above in the greater Chicago area. Among the participants, 58.9% were women and the average age was 72.8 years. Overall, 467 older adults had engaged in gambling in the past twelve months and 65 older adults had experienced any risk of problem gambling. Visiting a casino was the most commonly reported type of gambling, whereas betting on Mahjong had the highest frequency. Being male, lower educational levels, higher income levels, having more children, living in the U.S. for a longer period of time, living in the community for a longer period of time, better health status, lower quality of life, and improved health over the past year were significantly correlated with any gambling in the past year. Younger age, being male, and living with more people were significantly correlated with experiencing any risk of problem gambling in the past year. Future studies should be conducted to better examine the health effects of gambling and problem gambling among Chinese older adults.

This study examined the socio-demographic and health related characteristics of elder mistreatment (EM) in a community-dwelling older Chinese population. Methods: Guided by a community-based participatory research approach, the PINE study conducted in-person interviews with 3,159 U.S. Chinese older adults aged 60 years and older in the Greater Chicago area from 2011–2013. Participants answered questions regarding psychological, physical and sexual mistreatment, caregiver neglect, and financial exploitation. Definitional approaches for EM subtypes were constructed from least restrictive to most restrictive. Results: The sociodemographic and health-related characteristics associated with EM differed by type of mistreatment and by the operational definition used. Living with fewer people, having been born in countries other than China, poorer health status, and lower quality of life were significantly correlated with physical mistreatment. Only higher education was positively and significantly associated with sexual mistreatment and only poorer health status was consistently correlated with psychological mistreatment among all definitions. Male gender, higher educational levels, higher income, fewer children, and having been in the U.S. for fewer years were significantly correlated with financial exploitation. As for caregiver neglect, older age, having more children, having been in the U.S. for more years, poorer health status, lower quality of life, and worsening health over the past year were consistently correlated with caregiver neglect with different definitions. Conclusions: Prevention and intervention programs on EM should be geared towards specific types of mistreatment. Studies on EM should conduct a thorough analysis to justify the operational definition used.

Aims: To examine the association between marital status and cognitive impairment among community-dwelling Chinese older adults. Methods: We analyzed data from 2,498 Chinese aged 55 and older from the Singapore Longitudinal Aging Study cohort. Cognitive impairment was defined as a Mini-Mental State Examination total score of 23 or below. Odds ratios of associations were reported and adjusted for potential confounders in logistic regression models. Results: The prevalence of cognitive impairment was 12.2% (n = 306). Being single was associated with about 2.5 times increased odds of cognitive impairment compared to being married (adjusted OR = 2.53, 95% CI: 1.41-4.55). The association between marital status and cognitive impairment was much stronger in men compared to that in women, and was indeed statistically significant only for men. Among the single and widowed persons social engagement was associated with a lower risk of cognitive impairment. Compared with subjects in the lowest tertile of social engagement scores, the odds of having cognitive impairment was lowered by 50% for subjects in the second and the third tertile. Conclusion: Being single or widowed was associated with higher odds of cognitive impairment compared to being married in a cohort of older Chinese men but not women.