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Background: Understanding and promoting healthy aging are increasingly important as China transitions into an aging society. Our study examines the challenges and opportunities faced by the older adults in urban areas regarding social engagement, potentially informing the development of effective, context-sensitive interventions and policies. Methods: The study is based on in-depth interviews with 30 participants from a Northern city in Mainland China regarding their daily lives, attitudes towards and subjective experiences of aging, and involvement in social activities. The participants were selected through purposive sampling, with the aim to maximize the diversity of perspectives and experiences. The data was subjected to thematic analysis. Results: The factors that facilitate social engagement among the older adults in urban China include financial security, available free time, heightened health awareness, access to organized recreational activities, community amenities, and well-developed urban infrastructure. Among the barriers to social engagement for urban Chinese older adults, the study identifies physical limitations, chronic illnesses, shrinking social networks, institutional ageism, and limited digital literacy. Conclusion: The social engagement of the older adults in urban China reflects and is influenced by the wider socio-economic transformation of the country in the recent decades. Financial security afforded by the pension system has lessened the older adults' need to engage in income-generating activities. Combined with an increase in leisure time, this represents a luxury previously unavailable to earlier generations. However, institutional ageism and low digital literacy are important constraints, particularly for the 'oldest old' and those with limited socio-economic status. [ABSTRACT FROM AUTHOR]

Occupations are everyday activities people do that bring meaning and purpose to life and is culturally shaped. This research aimed to explore the occupations of Chinese older adults living with a terminal illness and their caregivers in Singapore. Using a qualitative exploratory approach, 16 care recipient-family caregiver dyads were recruited from a local hospice provider. Semi-structured interviews were carried out and reflexive thematic analysis was employed. Three themes and seven subthemes described the challenges and changes to daily life faced by care recipients and caregivers as they adjusted to living with the terminal condition. Findings suggest that in a family-centric society, the occupations of care recipients are greatly impacted by their families. It is imperative to engage with family members in goal setting and intervention plans to facilitate therapy gains and carry-over into real life. These results may be applicable to other family-centric societies, but further research is required. [ABSTRACT FROM AUTHOR]

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

This review assesses interventions to reduce loneliness in Chinese older adults, analyzing 36 studies involving 3965 participants. Focusing on individuals aged 50 and over, the meta-analysis reveals a significant overall effect size (Hedges' g = 0.937, 95% CI [0.71,1.16], p<0.001), highlighting the effectiveness of psychological and mixed-method approaches. Despite promising results, methodological concerns suggest cautious interpretation. Future research should aim to refine intervention quality and examine the impact of technology-supported methods on loneliness. [ABSTRACT FROM AUTHOR]

Objectives: This study compared the psychological wellbeing, life satisfaction, and perceived social support in Chinese older immigrants living in Canada between the early (i.e., Wave 1: September–November 2020) and late (i.e., Wave 2: January–February 2023) stages of the COVID-19 pandemic. Additionally, it assessed perceived social support from family, friends, or others as predictors for psychological wellbeing and life satisfaction in this population. Methods: These questions were addressed with a cross-sectional survey design with two independent samples at Wave 1 (n = 171) and Wave 2 (n = 191), respectively. Results: The results revealed lower levels of psychological wellbeing, life satisfaction, and perceived social support in Wave 2 compared to Wave 1. The hierarchical regression models identified social support from friends (but not from family or others) as a significant predictor for psychological wellbeing and life satisfaction. Additionally, a higher level of income and being a male predicted better psychological wellbeing. A higher level of income and a lower level of education predicted greater life satisfaction. Conclusions: The findings suggest a deterioration in psychological wellbeing and life satisfaction from the early to late stages of the pandemic and highlight the protective effect of social support from friends among Chinese older immigrants. [ABSTRACT FROM AUTHOR]

Home- and community-based services (HCBS) may contribute to lowering mortality and enhancing quality of life among older adults. Limited research, however, has examined this relationship in the Chinese context. This study explored the longitudinal association between perceived availability of HCBS and all-cause mortality among Chinese older adults. This cohort study included 8,102 individuals aged 65 years and older from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. HCBS included daily life assistance, medical care services, emotional support and social services, and reconciliation and legal aid services. The association between perceived availability of HCBS and all-cause mortality was investigated using Cox proportional hazards models. Emotional support and social services were negatively associated with all-cause mortality (HR = 0.86, 95% CI: 0.78 ~ 0.95, P =.004). Daily life assistance, medical care services, and reconciliation and legal aid services were not significantly associated with all-cause mortality. Providing community-level emotional support and social services may reduce the risk of death. Focusing on the mental health and social well-being of older adults is just as important as caring for their physical health. [ABSTRACT FROM AUTHOR]

Quality of life (QoL) has become an essential goal of contemporary healthcare and protective psychological resources. Individual life expectancy has increased with improved social progress, healthcare, nutrition and advanced health‐related technologies. However, research often overlooks the significant impact of social change and generational effects on the QoL of the ageing population. As people age, optimising opportunities for health, participation and safety to improve QoL has become crucial for society, policymakers and researchers. This study utilised a cross‐temporal meta‐analysis to investigate changes in the QoL among older adults from 1999 to 2017. Fifty two studies (N = 34,844) that used the Brief Health Status Survey Scale (SF‐36) were analysed. Direct and lagged correlation analyses were performed to examine the relationship between changes in the QoL of older adults and the macro social environment. The findings showed that QoL decreased by 7.94 points (d = −0.50) over the past 18 years. Economic status, social connectedness, and general threats were significant predictors of declining QoL among older adults. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

• Digital divide is a key influencing factor of health among Chinese older adults. • Internet access and usage of internet functions are important for older adults' health. • Social connection and adaptation are important pathways from internet use to older adults' health. In the digital era, increasingly more Chinese older adults have become Internet users, but the digital divide deeply affects their health. Based on the China Longitudinal Aging Social Survey, the influence of Internet use on older adults' physical and mental health are examined. It is found that digital access, online socializing and information/knowledge acquisition improve older adults' physical and mental health, while Internet skills can hardly influence their health. Social connection and adaptation are two important channels through which Internet use improves older adults' health. Younger and better-educated older adults gain more health benefits from Internet access, but online socializing and economic activities show stronger positive health effects in less-educated older adults. Narrowing the digital divide and promoting digital cohesion are important for the health of older population, so the health and pensions sector and geriatric nursing providers should help this group integrate into digital life to improve their health. [ABSTRACT FROM AUTHOR]

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.

To move beyond the focus on individual types of support, we examined the overall reciprocity of support between older adults and their adult children. Drawing on the theory of esteem enhancement, we hypothesized that the under benefited older adults, defined as older adults whose support provided is larger than support received in intergenerational relationships, may have better health conditions than those with a more or less balanced exchange of support. To test the hypothesis, we examined the relationship between the reciprocity of intergenerational support and self-rated health (SRH) among older adults in China. We also investigated the moderating role of gender in this relationship. Using data collected from 832 older adults in Wuhan, China, we found that compared to those with a balanced level of reciprocal support in the intergenerational relationship, older adults who were under benefited from the intergenerational support had better SRH. This finding is in line with the esteem enhancement theory. We also found that gender moderated the association between the reciprocity of intergenerational support and SRH. Specifically, older women who under benefit from the support had better SRH than older women with a balanced level of reciprocal support. In contrast, older men who under benefit from the support had worse SRH than older men with a balanced level of reciprocal support. This finding highlights the necessity of constructing social psychological frameworks that are attuned to gender variations for a more comprehensive comprehension of health and health-related behaviors among older adults in China. Plain language summary: We looked at how older adults and their adult children give and receive support from each other, instead of just focusing on one type of support. We thought that older adults who give more support than they receive might have better health. To test this, we asked 832 older adults in China about the support they gave and received, and how they rated their health. We found that older adults who gave more support than they received had better health than those with an equal exchange of support. Women who gave more support than they received also had better health, but men who gave more support than they received had worse health. This shows that we need to pay attention to differences between men and women when thinking about older adults' health. We should also consider how older adults and their grown children support each other when we plan programs to promote health in older adults. [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: High dietary diversity has been found to be associated with frailty. However, the trajectory of dietary diversity intake in relation to frailty is unclear. Methods: Using the latent class trajectory modeling approach, we identified distinctive dietary variety trajectory groups among 2017 participants based on the Chinese Longitudinal Healthy Longevity Survey acquired at four time points within a 10-year period. Frailty status was assessed using a frailty index comprising 37 health deficits. Dietary diversity was quantified using the dietary variety score (DVS), based on food category consumption frequency. Logistic regression analyses were employed to explore the association between DVS change trajectories and frailty. Results: This study identified two distinct DVS trajectories: "Moderate-Slow decline-Slow growth", encompassing 810 (40.16%) individuals, and "Moderate-Slow growth-Accelerated decline", including 1207 (59.84%) individuals. After adjusting for covariates, the odds ratio for DVS in the "Moderate-Slow decline-Slow growth" group was 1.326 (95% confidence interval: 1.075–1.636) compared to the "Moderate-Slow growth-Accelerated decline" group. The "Moderate-Slow decline-Slow growth" trajectory continued to decrease and was maintained at a low level in the early stages of aging. Conclusion: Sustaining a high dietary diversity trajectory over time, particularly in the early stages of aging, could potentially decrease the risk of frailty among older Chinese adults. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the relationship between sense of community and subjective well-being among older adults in China, and to further explore the potential mediating role of prosocial behavior and meaning in life in this association. Using a cross-sectional design, a cohort of 283 Chinese old adults aged between 60 and 85 years (Mage = 65.26, SDage = 5.73; 62.2% females) completed measures related to sense of community, prosocial behavior, meaning in life, and subjective well-being. To examine the mediating roles of prosocial behavior and meaning in life on the link between sense of community and subjective well-being, the PROCESS macro model4 and model6 were used to conduct single and serial mediation analysis, respectively. The results fully supported the proposed serial mediation model. The serial mediation model obtained in this study sheds light on the relationships between these factors and suggests that promoting sense of community independent of considering prosocial behavior and meaning in life may be insufficient to achieve good subjective well-being in Chinese older adults. These findings contribute to the refinement of interventions targeting the subjective well-being of older adults by emphasizing the importance of considering both the physical and social environments of the community. Highlights: Sense of community significantly and positively predicted Chinese older adults' subjective well-being. Prosocial behavior and meaning in life mediated the association between sense of community and subjective well-being separately. Prosocial behavior and meaning in life were identified as serial mediators in the relationship between sense of community and subjective well-being among Chinese older adults. [ABSTRACT FROM AUTHOR]

• Elevating the SWB of older adults through healthy lifestyle choices constitutes a crucial pathway towards achieving successful aging. • SWB of the older adults can be augmented through habitual intake of vegetables and fruits, active involvement in physical exercise, and active participation in social activities. • Quitting smoking and drinking may not necessarily improve SWB, particularly in the context of China. There has been limited research on the relationship between health habits and subjective well-being (SWB) among Chinese oldest older adults. This study aims to explore lifestyle factors associated with SWB in this population. We analyzed data from three waves (2008–2014) of the CLHLS, including 28,683 older adults. Lifestyle factors analyzed included fruit and vegetable intake, smoking, alcohol consumption, physical exercise, and social participation. Results suggested that high frequency of fruit and vegetable intake, current and past physical exercise, and high levels of social participation were associated with increased SWB. SWB was lower in older adults who never smoked compared to persistent smokers and in those who never drank alcohol or ceased drinking compared to persistent drinkers. We encourage older adults to enhance SWB through increased fruit and vegetable intake, physical exercise, and social participation. However, quitting smoking and drinking may not necessarily improve SWB, particularly in the context of China. [ABSTRACT FROM AUTHOR]

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

Aim: To identify culturally related stressors that influence self‐care in Chinese older adults with multiple chronic conditions. Background: Effective self‐care can improve health outcomes for chronic conditions, but implementing self‐care is challenging. Individuals with multiple chronic conditions face even more self‐care complexity than those with single chronic conditions, generating additional stressors. Although stressors have been found to negatively influence self‐care in multiple chronic conditions, the role of culture in generating stressors has been neglected. Design: This paper reports on the qualitative component of a larger mixed‐methods study. Two free‐response items in a survey were used to identify culturally related stressors that influence self‐care. This report adhered to the SRQR guideline checklist. Methods: Data were collected between January and April 2022. One hundred and thirty‐eight free text responses asking participants to identify stressors that influenced their self‐care effectiveness were analysed sequentially using deductive content analysis and thematic analysis. Results: Findings from deductive content analysis largely confirmed published work in Western literature on stressors complicating self‐care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems. Conclusion: Chinese older adults with multiple chronic conditions identified a wide range of stressors that impacted their day‐to‐day self‐care. This study provided valuable insights into culturally related stressors in older adults with multiple chronic conditions. Findings deepened our knowledge of cultural influences on the success of self‐care in older adults with multiple chronic conditions, suggesting the potential for reaching populations across different cultures and regions. Implications for the profession and/or patient care: Stressors that might influence self‐care ability are important for nurses to assess in people with multiple chronic conditions. The design of self‐care interventions should take a culturally tailored intergenerational family‐centred approach to help mitigate the impact of stressors and ultimately improve patient outcomes. Impact: What problem did the study address?Stressors documented in older adults with MCCs have all been generated from research with Western populations. China is now home to the largest population of older people in the world. Understanding the influence of culturally relevant stressors on self‐care in Chinese older adults with MCCs is lacking.What were the main findings?Findings from deductive content analysis largely confirmed published work in Western literature on stressors that complicated self‐care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors in older adults with MCCs in China: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems.Where and on whom will the research have an impact?The research will have an impact on guiding nurses' assessment of culturally relevant stressors' impact on self‐care for older adults with MCCs. In addition, findings could inform research and policy development to aim at mitigating the impact of culturally based stressors on self‐care. Reporting Method: This study adhered to the Standards for Reporting Qualitative Research (SRQR) guideline checklist. Patient or Public Contribution: During the member‐checking process, the validation of findings for accuracy was carried out by 10 participants, who also found resonance between these findings and their own experiences. [ABSTRACT FROM AUTHOR]

Livable environment and ways, as the necessary conditions for the elderly to enjoy their old age, have a significant impact on their mental health and happiness. It's crucial to understand how living arrangements affect depressive symptoms in China. Studies on how various leisure activities modify this association are yet limited. This study relies on panel data derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), collected during waves spanning 2008/2009, 2011/2012, 2014, and 2018. The primary objective is to examine the relationship between living arrangements, leisure activities, and depressive symptoms of elderly individuals. Linear mixed-effects models were used to analyze the data. A total of 26,342 observations aged 65 and over were included in this paper. Older adults living alone (β = 0.66, 95 % CI: 0.55, 0.76) or living in institutions (β = 0.69, 95 % CI: 0.40, 0.98) had more depressive symptoms than those living with family. Leisure activities were negatively associated with depressive symptoms (β = −0.16, 95 % CI: −0.18, −0.15). Moreover, there was significant interactions between living arrangements and leisure activities. No matter which kind of living arrangements, participating in physical, productive or social activity was associated with a lower risk of depressive symptoms. Study design might introduce bias, and it cannot establish causality between the tested variables. Older adults living alone or in institutions have more possibility to develop depressive symptoms than those living with family, and such a relationship among Chinese older adults can be moderated by participating in leisure activities. • Older adults living alone or in institutions had more depressive symptoms than those living with family. • Participation in leisure activities showed a negative association with depressive symptoms. • There were significant interactions between living arrangements and leisure activities. • Whatever the life arrangements, participating in leisure activities was related to a lower risk of depressive symptoms. [ABSTRACT FROM AUTHOR]

The association between body mass index (BMI) and cognitive impairment (CI) has been the subject of extensive research, yet the precise dose-response effects remain undefined. Older adults were selected from the 2011/2012 survey at baseline and the new recruits from the 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression models were used to evaluate the association between BMI categories and CI, and Restricted Cubic Spline (RCS) was used to explore the nonlinear relationship between BMI and CI. The study included 29,380 older adults aged from 65 to 117 years, with an average age of 82 years. Of these, 13,465 were men, and 5359 exhibited cognitive impairment. The logistic model indicated that in female participants, being underweight was positively correlated with CI (OR:1.32; 95%CI 1.20–1.46), whereas being overweight was inversely correlated with CI (OR:0.86; 95%CI 0.75–0.99), and we didn't find any association between BMI category and CI in male participants. RCS modeling revealed a U-shaped relationship between BMI and CI. When stratified by sex, men exhibited a similar trend, with the lowest risk at a BMI of 22.774 kg/ m2, while women had the lowest risk of CI at a BMI of 24.817 kg/ m2. This was a cross-sectional study, it cannot provide information on causal relationships. A U-shaped relationship was observed between BMI and CI in older adults, more pronounced in the male population, suggesting that male older adults may need to manage their BMI more rigorously. • U-shaped correlation between Body Mass Index (BMI) and cognitive impairment was discovered. • Male older adults may need to manage their BMI more rigorously. • We recommend that Chinese male older adults should keep their BMI around 22.774 kg/m2 and female older adults keep it above 24.817 kg/m2. • Transforming cognition into a categorical variable for analysis may obscure the true relationship between overweight/obesity and cognitive impairment. [ABSTRACT FROM AUTHOR]

Aims: This study investigated the relationships between specific types of social participation and well‐being variables (i.e., life satisfaction, positive affect, negative affect, symptoms of depression and anxiety) in Chinese older adults in Hong Kong. Methods: This study was a cross‐sectional study. A convenience sample of 341 participants aged 55–95 years (mean, 70.92; SD, 9.03) was recruited to complete a survey questionnaire during the COVID‐19 pandemic (between April and June 2022). Five hierarchical multiple regression analyses were conducted to examine the relationships between different types of social participation (physical, cultural, recreational, religious, and voluntary work) and outcome variables. Results: After controlling for covariates, it was revealed that only physical activities were associated with all outcome variables. Religious and cultural activities were positively related to positive affect, while an inverse relationship was found between recreational activities and anxiety. Conclusions: With the restrictions on social participation arising from the COVID‐19 pandemic, these findings suggest that promoting different types of social interactions might foster various aspects of well‐being in Chinese older adults. To achieve successful aging, the role of physical activities might be of paramount importance even under adverse situations. Geriatr Gerontol Int 2024; 24: 364–369. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to investigate the independent associations of dietary factors with cognitive impairment (CI) and physical frailty (PF) among Chinese older adults. Methods: This study included 10,734 participants (mean age = 78.7 years) free of CI and PF at baseline from the Chinese Longitudinal Health Longevity Survey. Dietary intake was collected using a simplified food frequency questionnaire every 3–4 years. The Chinese version Mini-Mental State Examination was used to assess cognition function, participants with a score below 18 were defined as CI. PF was defined using the activities of daily living, instrumental activities of daily living, and functional limitation-related questions. The outcome was defined as the first onset of either CI or PF. Competing risk models were used to estimate the corresponding hazard ratios (HRs) and the 95% confidence intervals (95% CIs). Results: During the study follow-up (mean = 8.1 years), a total of 1220 CI cases and 1451 PF cases were newly identified. Higher frequency of fruits intake was associated with a lower hazard of CI (HR = 0.75, 95% CI 0.58–0.97), whereas higher intake of preserved vegetables demonstrated an opposite association (HR = 1.23, 95% CI 1.07–1.42). In terms of PF, we observed a lower risk associated with higher meat and poultry intake (HR = 0.72, 95% CI 0.61–0.88). In particular, a significant protective association of fish and aquatic products intake with PF was observed among participants with ≥ 28 natural teeth (HR = 0.52, 95% CI 0.27–0.99). Conclusion: Our findings suggest divergent roles of major dietary factors in the development of CI and PF among Chinese older adults. [ABSTRACT FROM AUTHOR]

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.

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 (< 277 pg/mL), medium (277–375 pg/mL) and high (> 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 < 0.001) in older adults with a low DDS, whereas no significant association between vitamin B12 levels and anemia was found in older adults with a high DDS in a full-model after adjustment for various confounding factors (multi-adjusted OR, 0.88, [95% CI, 0.65 ~ 1.19], P = 0.41). Conclusion: The relationship between vitamin B12 levels and the prevalence of anemia was significant only when the level of dietary diversity in the older adults was relatively low. The dietary structure of the population should be taken into consideration in combination in order to effectively improve anemia status by supplementing vitamin B12. [ABSTRACT FROM AUTHOR]

We examined the relationship among living arrangements, activity participation and depression and the mediating effects of activity participation on the relationship between living arrangements and depression. This was a cross-sectional study based on nationally representative data. 9647 older adults aged 60 years and over were recruited from the 2018 Chinese Longitudinal Healthy Longevity Survey. Three-step regression and mediation analysis methods were used. Compared with older adults living with family members, those living in institutions attended fewer activities and experienced higher depression rates, and those living alone attended more activities and experienced higher depression rates. In the group living with family members, living with a spouse was an important way to increase activity participation and reduce depression. Mediation analysis suggested that activity participation mediated the impact of living arrangements on depression. Attending more activities could alleviate depression for older adults who are living alone, living in institutions and living without a spouse. Our findings suggest an emphasis on the role of spouses and activity participation during depression interventions among older adults. [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

Cognitive disorders have emerged as an important public health problem among older adults in China. Cohort studies investigating the relationship between tea consumption, various cognitive functions, and mental health have exhibited limited evidence and inconsistent findings. The present study aimed to explore the associations between these variables among community-dwelling Chinese older adults. Analysis of covariance (ANCOVA) was used to compare scores on cognitive functions among green tea-consumers (GTC), other types of tea consumers (OTC), and non-tea-consumers (NTC), after adjusting for gender, education, residence, drinking, smoking, and hobbies. Thereafter, binary logistic regression analysis was applied to evaluate the role of tea consumption in differentiating between patients with mild cognitive impairments (MCI) and the controls without impairment. Among 972 participants, green tea consumption was significantly associated with improved performance on global cognitive function except for mental health assessments. In contrast to NTC, reduced risk of cognitive impairment was observed for both GTC and OTC after adjusting for demographic, lifestyle, and body health indicators. Furthermore, a significant correlation was found between tea consumption and improved cognitive performance. Thus, tea consumption played an important role in distinguishing older adults with mild cognitive impairment from older adults without cognitive impairment. [ABSTRACT FROM AUTHOR]

Understanding individuals' long-term care preferences is essential to the provision of person-centered care. This study aims to describe the preferences for long-term care settings and investigates sociocultural factors associated with long-term care preferences among older Chinese adults. Responses from 22,112 older adults aged 60 years or above were analyzed using multinomial logistic regression. Four ideal long-term care settings were identified: in-home care, community day care, institutional care, and undecided long-term care arrangements. The study found that the majority of participants desired to age in place at home, regardless of their health status and social support conditions. Therefore, research and advocacy efforts are needed to inform policymakers to strategically develop home-based long-term care supports in China. Besides needs, social means and values are crucial to long-term care preferences among older Chinese adults. Among different long-term care options, the vast majority of the participants (82%) preferred aging in place in a home setting. China's long-term care policy should prioritize the support for developing home-based services. [ABSTRACT FROM AUTHOR]

(1) Objectives: This study aims to investigate the bidirectional relationship between depressive symptoms and cognitive function among older adults in China, addressing a research gap in the context of developing nations. (2) Methods: A total of 3813 adults aged 60 and older participating in 2013, 2015, and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS) were included. A fixed-effects model and cross-lagged panel model (CLPM) was utilized. (3) Results: First, the results indicated that a significant negative correlation existed between depressive symptoms and cognitive function in older adults during the study period (β = −0.084, p < 0.001). Second, after controlling for unobserved confounding factors, the deterioration and improvement of depressive symptoms still significantly affected cognitive function (β = −0.055, p < 0.001). Third, using the cross-lagged panel model, we observed a reciprocal relationship between depressive symptoms (Dep) and cognitive function (Cog) among Chinese older adults (Dep2013 → Cog2015, β = −0.025, p < 0.01; Dep2015 → Cog2018, β = −0.028, p < 0.001; Cog2013 → Dep2015, β = −0.079, p < 0.01; Cog2015 → Dep2018, β = −0.085, p < 0.01). (4) Discussion: The reciprocal relationship between depressive symptoms and cognitive functioning in older adults emphasizes the need for integrated public health policies and clinical interventions, to develop comprehensive intervention strategies that simultaneously address depressive symptoms and cognitive decline. [ABSTRACT FROM AUTHOR]

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.

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 < 0.001). The OR of frailty for severe tooth loss was only slightly decreased to 1.74 (p < 0.001) when dietary diversity was added to the model and to 1.64 (p < 0.001) when socioeconomic status, family support, and healthy lifestyles were further adjusted. In the cross-lag or longitudinal models, the ORs were mildly or moderately reduced to 1.29, 1.27, and 1.23, respectively, yet remained statistically significant (p < 0.001 or p < 0.01). The mediation analyses showed that dietary diversity had some small yet significant effects on the relationship between tooth loss and frailty in both concurrent and longitudinal settings. Conclusions: This study improves current knowledge regarding the impact of tooth loss on frailty among Chinese older adults. Future intervention strategies designed to improve healthy diets may have preventive effects against the risk of frailty among Chinese older adults with severe tooth loss. [ABSTRACT FROM AUTHOR]