Search

The objective of this study was to estimate the joint effects of cognitive impairment and depressive symptoms on health‐related quality of life (HRQoL) and to explore the mediating role of disability among Chinese community‐dwelling older adults. A cross‐sectional study was conducted with 2525 community‐dwelling older adults aged ≥60 years and living in Shanghai, China in 2019. Participants were divided into four groups: (1) non‐depressed without dementia, (2) non‐depressed with probable MCI, (3) depressed without dementia and (4) depressed with probable mild cognitive impairment (MCI). HRQoL was assessed using the 36‐Item Short‐Form Health Survey. Cognitive impairment and depressive symptoms were evaluated with the AD8 and the Geriatric Depression Scale respectively. Activities of daily living (ADL) and instrumental activities of daily living (IADL) disability and other sociodemographic variables were also assessed. The results of this study showed that controlling for sociodemographic characteristics, significant differences in a physical component score (PCS) and a mental component score (MCS) of HRQoL were found across the four groups. Compared to those who were non‐depressed without dementia, older adults who were depressed with probable MCI reported the lowest level of PCS and MCS, followed by older adults who were depressed without dementia. Both ADL and IADL disabilities played mediating roles in the relationship between cognitive impairment and depressive symptoms and PCS. Based on this study, we suggest that the early detection and adequate management of depressive symptoms and cognitive status—as well as efforts to improve individuals' ability to manage their ADLs and IADLs—may help to maintain or improve their HRQoL. [ABSTRACT FROM AUTHOR]

BACKGROUND: Older migrants in China without local resident registration (hukou) are a vulnerable population and face barriers to receiving local healthcare. OBJECTIVES: We aimed to quantify the disparities in healthcare utilization between older migrants and local residents in Shanghai, China. DESIGN: This was a cross‐sectional study. SETTING: The study was conducted in Shanghai, China, in 2016. PARTICIPANTS: Older adults (aged ≥60 years) were recruited based on a three‐stage stratified cluster sampling method (2571 older locals and 1920 older migrants). MEASUREMENTS: We compared utilization of outpatient care, inpatient care, preventive care, emergency room (ER) admission, and dental care, as well as medication use between older migrants and local residents. The local‐migrant gap was parsed into observed and unobserved components using the Blinder‐Oaxaca decomposition method. RESULTS: Older migrants were less likely to utilize outpatient (odds ratio [OR] = 0.757; 95% confidence interval [CI] = 0.617‐0.928), inpatient (OR = 0.642; 95% CI = 0.443‐0.931), and preventive care (OR = 0.743; 95% CI = 0.643‐0.858) and were more likely to use medication (OR = 1.254; 95% CI = 1.089‐1.445) than local residents. Differences in ER admissions and dental care utilization were not significant in the regression analysis. The decomposition results indicated that 55% and 71% of the local‐migrant gap in outpatient and preventive care utilization were attributable to individual characteristics, like health insurance. Unobserved components, including hukou‐related factors and personal heterogeneous preferences, contributed 59% and 63% to utilization of inpatient care and medication use, respectively. CONCLUSION: We identified local‐migrant gaps in healthcare utilization among older adults in China. Further research is needed into integration of the health insurance system, accessibility of public health welfare benefits, and reconstruction of social networks among older migrants. J Am Geriatr Soc 68:1560‐1567, 2020. [ABSTRACT FROM AUTHOR]