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ObjectivesThis study compares patterns of gender difference in the receipt of informal care among community-dwelling older adults across the United States, Korea, and China where family-oriented systems for providing care to older adults are emphasized.MethodData came from the 2014 Health and Retirement Study, the 2014 Korea Longitudinal Study of Aging, and the 2015 China Health and Retirement Longitudinal Study. Logistic regression models were used to predict the receipt of informal care by gender. We also examined how the effects of health and living arrangement on the receipt of informal care differ depending on gender.ResultsIn the United States and China, older women were more likely to receive informal care than men. However, older Korean women were less likely to receive informal care than men. The effects of health and living arrangement on the use of informal care were moderated by gender in different ways across countries.DiscussionThis study provides evidence that patterns of gender differences in the receipt of informal care vary across the three countries. More attention needs to be paid to the design and implementation of long-term supports and services to address the unique patterns of gender difference in care arrangement in each country.

Objectives: We examined the associations of aspects of the immigrant experience—acculturation, neighborhood belonging, and perceived discrimination—with healthy aging in older Chinese Americans and explored whether the associations vary by age and gender. Method: The sample included 3,056 older Chinese Americans. Healthy aging was defined as no disability, no cognitive impairment, and high physical functioning, coded dichotomously (1 = meets all criteria, 0 = otherwise). Acculturation, neighborhood belonging, and perceived discrimination were measured using standardized scales. Results: About 31% of the sample experienced healthy aging. Acculturation was positively associated with healthy aging, with stronger associations in older age and women. A greater sense of neighborhood belonging was associated with higher odds of healthy aging; experiences of discrimination were associated with lower odds. Discussion: Interventions to promote healthy aging in Chinese Americans are needed. Programs that support immigrants with low acculturation levels, strengthen immigrants’ connectedness to their neighbors, and promote inclusiveness may improve population health.

Objectives This study aims to examine the relationship between psychological well-being (PWB) and cognitive function in older adults in China. Methods: Data are from the Chinese Longitudinal Healthy Longevity Survey. Analyses were restricted to 9,487 older persons (age ≥ 60) without cognitive impairment at baseline. Respondents were followed over a 12-year period. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (C-MMSE). PWB was assessed using a composite index capturing optimism, conscientiousness, neuroticism, loneliness, personal control, self-esteem, and happiness. Results: Multilevel mixed effects generalized linear models showed that respondents with greater PWB had a slower rate of cognitive decline over time, adjusting for sociodemographic and health characteristics. In addition, multilevel multinomial logistic regression models showed that greater PWB was associated with lower odds of developing cognitive impairment. Conclusions: Findings suggest that fostering PWB may prevent or delay adverse cognitive changes.

The objectives of this investigation were to identify a valid and practical benchmark for the assessment of healthy aging in the Chinese population and examine its socio-structural correlates. Using data from the 2011 China Health and Retirement Longitudinal Study, we investigated the validity of a continuum of healthy aging definitions. We found that definitions of healthy aging that emphasize disease of “significance” and functional health offer a valid and practical approach to the assessment of healthy aging. Results of multilevel logistic regression analyses indicate that socio-structural characteristics of individuals (age, gender, education, and pension status), their households (structure and wealth), and communities (infrastructure and geographic region) are significantly associated with the odds of healthy aging. Policy-level interventions are needed to enable individuals, regardless of their gender, socioeconomic status, and place of residence to experience a healthy old age.

Previous research has shown the beneficial effects of positive psychological assets on health, but more research is needed to confirm the prospective effects on cognitive function. The purpose of this study is to examine the relationship between psychological well-being and the earliest onset of cognitive impairment among Chinese older adults. Data came from 2000 to 2014 waves of the Chinese Longitudinal Healthy Longevity Survey. Study sample consisted of 6,225 older adults who were free from cognitive impairment in 2000. Psychological well-being was measured based on seven items that assessed optimism, conscientiousness, self-determination, happiness, self-esteem, pessimism, and loneliness, with responses ranging from “always (1)” to never (5)”. Negative feelings items were reverse coded. Higher score indicated more positive psychological well-being. Cognitive impairment was measured by a Chinese version of the Mini-Mental State Examination. Respondents scored at or above 24 were regarded as having no cognitive impairment. A multi-category time-varying variable was used to capture four potential outcomes: (1) persistently free of cognitive impairment between waves, (2) onset of cognitive impairment, (3) death between waves, and (4) attrition. Socio-demographics, chronical diseases conditions, functional health status were served as controls. Multilevel multinomial logistic regression models that account for clustering of observations within a subject over time were employed for the study. Results show that more positive psychological well-being is significantly associated with reduced risk of cognitive impairment onset and death over time. Results suggest that developing more psychological resilience-based intervention programs among older adults may help them delay the onset of cognitive impairment.

This study examines whether participation in home-based productive activities impedes or encourages formal volunteering among Chinese older adults. We analyzed data newly collected from a random sample of adults aged 55 and older living in Shanghai in 2018. Respondents were sampled through a stratified multistage probability sampling design. A total of 1,200 older adults were sampled and 882 completed the survey, yielding an overall response rate of 73.5%. Home-based productive activities were defined as engaging in caring for grandchildren or homemaking. Volunteering was dichotomized as either participating in any type of community-based volunteer work. Considering that participation in home-based productive activities is likely to be endogenous–correlated with unobservable variates that are also correlated with volunteering, we used two-stage least squares (TSLS) models for the study. Perception of children’s filial piety (1=not filial to 4=very filial) was served as the instrumental variable. Socio-demographic characteristics and health conditions were included as control variables. Results indicated that older adults who were engaged in home-based productive activities were less likely to volunteer. Unlike evidence found in the Western studies, this study provides support for the competing hypothesis that persons who engage in time-consuming activities such as caregiving likely reduce their commitments to other social activities outside the home. Practitioners or policymakers might use this evidence to identify and develop more culturally acceptable, indigenous forms of volunteering for Chinese older adults.

The onset of disability among older adults is an important risk factor of nursing home admissions. Better understanding antecedents of disability incidence enables researchers and practitioners to design possible interventions to delay the onset of disability. The purpose of this study is to examine the relationship between productive activity participation and the incidence of ADL disability over time. Data came from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2002–2011). The at-risk sample consisted of 10,632 participants aged 60 or older who were free of ADL disability in 2002. A multi-category time-varying variable was used to capture three potential health outcomes: (1) persistently free of any ADL disability between waves, (2) onset of any ADL disability, and (3) death between waves. Attrition (i.e. lost to follow-up) was also included as a competing outcome. Productive activities were defined as engaging in paid work or providing assistance to family. Multilevel multinomial logistic regression models that account for clustering of observations within a subject over time were employed for the study. The results show that providing assistance to family is significantly associated with reduced risk of ADL onset and death over time, controlling for individual socio-demographic characteristics, chronic diseases conditions, and cognitive health status. Results suggest that encouraging participation in productive activities, especially providing assistance to family, may help older Chinese adults delay the onset of disability. Practitioners or policy makers could use this evidence to develop more family-oriented productive activities for Chinese older adults.

Objective: We used three operational definitions of healthy aging to estimate the prevalence of healthy aging among older adults in China. Methods: Data were from the China Health and Retirement Longitudinal Study (CHARLS). Participants aged 65+ were included (N=4350). The three healthy aging definitions represent a conceptual continuum and all encompass disease, physical and cognitive functioning dimensions. Logistic regression was used to examine the association of age, gender, education, pension, and Hukou (Chinese identification system) on each definition. Results: The prevalence of healthy aging increases when the operational definitions are loosened, ranging from 3.9% (most restrictive definition) to 15.2% (least restrictive). Across definitions, the odds of healthy aging were lower for people of advanced age, low education, female gender, and without pension when compared to their counterparts. Discussion: Our findings regarding prevalence of healthy aging helps to set a benchmark to plan and evaluate initiatives to promote healthy aging in China. Our preliminary findings showed that disability prevalence was higher than that reported in a prior U.S. study. A reason for the difference is that our sample was less likely to have major diseases but more likely to be disabled compared to the U.S. sample. This suggests that the reporting of disease and the path from disease to disability may be different between older adults in China and the U.S. However, socioeconomic disadvantages associated with healthy aging are similarly supported in our and the U.S. study.