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Background: Various measures of arterial stiffness have been linked to the risk of cardiovascular disease. However, the relationship between the estimated pulse wave velocity (ePWV), a novel indicator of arterial stiffness, and cardio-cerebrovascular disease risk remains unclear. This study investigated the relationship between the ePWV and the risk of cardio-cerebrovascular diseases. Methods: A total of 17,708 participants aged 45 years and older enrolled in the China Health and Retirement Longitudinal Study (CHARLS), conducted between 2011 and 2012, and participants with a 7-year follow-up were included. Ultimately, 8242 respondents were included in the study. The ePWV was calculated using age and mean blood pressure. Cardio-cerebrovascular diseases, including myocardial infarction, cerebral infarction, and intracerebral haemorrhage, were categorised as cardiovascular and cerebrovascular diseases. Clinical and demographic characteristics were collected. A Cox proportional hazards model was used to explore the relationship between ePWV and the risk of cardiovascular disease. Results: During the 7-year follow-up, 21.7% of the participants (1791/8242) developed cardio-cerebrovascular diseases. After adjusting for potential confounding factors, the ePWV was positively associated with the risk of cardio-cerebrovascular disease (adjusted hazard ratio: 1.16, 95% CI 1.11–1.22, P < 0.001). The ePWV was divided into quartiles, and regression analysis was performed. Participants in the highest ePWV quartile had a 128% higher risk of cardio-cerebrovascular disease than those in the lowest quartile. The subgroup analysis showed that the positive association between the ePWV and the risk of cardio-cerebrovascular disease remained consistent among middle-aged and older adults across different Chinese communities. Conclusions: In middle-aged and older Chinese adults, the ePWV was significantly and positively associated with the risk of cardio-cerebrovascular disease, making it a reliable and innovative predictor of these conditions. [ABSTRACT FROM AUTHOR]

Depressive symptoms is more prevalent in middle-aged and older populations, and the development of Internet technology has brought new challenges and opportunities for the mental health of this group. This study aims to explore the bidirectional relationship between Internet device diversity and levels of depressive symptoms through longitudinal data analysis, as well as investigate the mediating role of social participation. Data for the analysis was retrieved from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, 2018, and 2020, which included 9259 middle-aged and older adults. The sum of the number of devices mentioned by each participant was calculated to assess the diversity of internet device use, a weighted total score of how frequently and to what extent individuals had participated in various social activities in the past month was calculated to measure the social engagement, and the Center for Epidemiological Studies Depression Scale was used to calculate depressive symptoms. A cross-lagged mediation model and bivariate correlation analysis were employed to examine the longitudinal relationships among depressive symptoms, internet device diversity, and social participation. Age, gender, highest education level, marital status, drinking status, smoking history, self-rated health, sleep duration, and chronic health conditions were adjusted as covariates. The results from the three waves of longitudinal data revealed mutual predictive relationships among internet device diversity, social participation, and depressive symptoms. The mediating effect was significant (β = −0.612, 95 % CI −0.796 to −0.429), with significant gender differences observed. Furthermore, our findings indicated that social participation functioned as a protective factor against depressive symptoms, and the association between social participation and depressive symptoms was not a straightforward linear relationship. This suggests that participation in social activities (either high or low) is associated with a lower risk of depressive symptoms compared to no social participation, with no gender differences. This study suggests that there is a relationship between internet device diversity and lower levels of depressive symptoms among middle-aged and older adults in China. Social participation mediates the relationship between internet device diversity and depressive symptoms, and different levels of social engagement have different effects on depressive symptoms. It is recommended to increase support for social participation among middle-aged and older adults, strengthen structural social capital, and better leverage the use of the internet to reduce depressive symptoms levels and promote the physical and mental well-being of this population. • The diversity of internet use devices is associated with lower levels of depression symptoms. • Social participation plays a mediating role in the bidirectional relationship between internet device diversity and depression. • Different levels of social participation result in varying risks of depression symptoms. • Compared to middle-aged and older men, women's depression symptoms is more sensitive to the influence of internet usage. [ABSTRACT FROM AUTHOR]

Amid the COVID-19 pandemic, the mental health of middle-aged and older adults has become an increasing concern, and the role of the internet in addressing this public health crisis has drawn the attention of researchers. This study evaluated the impact of internet access during COVID-19 on depressive symptoms among middle-aged and older adults. Data were derived from China Health and Retirement Longitudinal Study (CHARLS) 2018 and 2020. Difference-in-differences analysis was performed to compare changes in depressive symptoms between the internet users during COVID-19 and those who didn't have access to the internet before and during the pandemic. We found that internet access during COVID-19 pandemic significantly reduced middle-aged and older adults' depressive symptoms. Further investigation identified the underlying mechanisms through which internet access helps in alleviating depressive symptoms by reducing the likelihood of experiencing negative emotions about COVID-19. Heterogeneity analyses showed that rural residents and middle-aged individuals benefited more from internet access during the pandemic. Since internet access can alleviate middle-aged and older adults' depressive symptoms amidst public health crisis, policy makers should focus on enhancing their access to the internet. • This paper investigated the impact of internet access on middle-aged older adults' depressive symptoms during the COVID-19. • We found that internet access during COVID-19 was beneficial to alleviate middle-aged and older adults' depressive symptoms. • Mechanism analysis showed that internet access can improve depressive symptoms by reducing negative emotions about COVID-19. • The effects were more salient among middle-aged adults and rural residents. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Purpose Methods Results Conclusion Trial Registration Physical inactivity in middle‐aged and older adults is a major health problem. Exercise snacks are an emerging form of physical activity characterized by shorter single bouts of high‐intensity exercise spread out repeatedly throughout the day which can provide more exercise opportunities for middle‐aged and older adults.To summarize perceptions and experiences of exercise snacks among middle‐aged and older adults, and explore the barriers and facilitators of promoting exercise snacks.We followed the PRISMA and systematically searched five databases from the earliest to May 2024. The Critical Appraisal Skills Program tool is used to quality assess and the Capability, Opportunity, and Motivation Model of Behavior (COM‐B model) is used to guide thematic synthesis.Fourteen categories from nine studies were summarized, and 277 findings were identified. Three synthesized findings were: capability of middle‐aged and older adults (including health‐related exercise disorders, learning and mastery skills, and health literacy), opportunities for exercise snacks (including flexible and free, easy and quick, integration into life, social and family support, and application of mobile health technology), and motivation of exercise snacks (including pleasurable experiences, gaining physical and mental benefits, effective reminders, incentives and feedback, personalized needs, and self‐efficacy).Exercise snacks are a promising approach， however, they need to be continuously optimized. Our results can provide evidence for designing and optimizing exercise snack programs. Medical workers should assist middle‐aged and older adults in developing appropriate exercise snack strategies.PROSPERO (CRD42024544089) [ABSTRACT FROM AUTHOR]

Objective To investigate the longitudinal relationship between physical function, impairment in activities of daily living, and depressive symptoms among middle-aged and older adults in China, as well as to explore the mediating role of self-rated health. Methods Data from the China Health and Retirement Longitudinal Study (CHARLS) national cohort from 2013 to 2020 were analyzed, including 7 899 participants aged 45 and older. The Cox proportional hazards regression model was employed to analyze the longitudinal association between impairment and depressive symptoms. The Process macro model 4 was used to construct the model, examining the mediating effect of self-rated health, with the Bootstrap method applied to test the significance of the mediation effect. Results After adjusting for confounding factors, the Cox proportional hazards regression results indicated that the risk of depressive symptoms for individuals with only physical function impairment, only activities of daily living impairment, and dual impairment was 1.408 times (95%CI: 1.284-1.543), 1.447 times (95%C/: 1.166-1.795), and 1.825 times (95%C7: 1.636-2.034) higher, respectively, compared to those without impairment (P<0.001). Self-rated health played a significant partial mediating role in the relationship between the two, with the effect size being the largest in the group with only physical function impairment at 24.29%, followed by the dual impairment group at 17.02%, and the group with only activities of daily living impairment at 12.15%. Conclusion There is a longitudinal relationship between physical function, activities of daily living impairment, and depressive symptoms among middle-aged and older adults. Additionally, self-rated health serves as a partial mediator in this relationship. Implementing targeted interventions to delay the aging of physical functions and improve self-rated health can effectively control the occurrence and progression of depression in this population, facilitating a shift towards preventive measures. [ABSTRACT FROM AUTHOR]

Rapidly changing digital technologies are reconfiguring the way human society lives, indicating that more and more middle-aged and older adults will lead a digital life in the future. Whether digital technology for today can effectively improve the quality of digital life of this cohort is the focus of this study. This study proposed a "cognitive–emotional–behavioral" model and situated the use of the Extreme Edition App as a cross-sectional research object. The study also explored the relationship between middle-aged and older adults' perceptions of the benefits of cash subsidies, the pleasure and worry generated by the use of the app, and their continued use of the app. It has become a fact that human beings are walking side by side with digital technology; digital technology still moves forward and upward. Thus, it is forward-looking to pay attention to the digital life adaptation of the current middle-aged and older groups. A total of 1200 valid questionnaires were obtained, and regression analysis showed that (1) the more comprehensive and in-depth the cohort's knowledge of the benefits of cash subsidies is, and the more sustainable their continuous use of the Extreme Edition App is, the more pleasure they experience, and the less worry they feel during its use. (2) The more pleasure middle-aged and older adults feel while using the Extreme Edition App, the more likely they are to continue using it. Conversely, the more worry they feel, the less likely they are to maintain its use. (3) Emotions generated during the use of the Extreme Edition App mediate the relationship between this cohort's perceptions of cash subsidy benefits and their continued-use behavior. [ABSTRACT FROM AUTHOR]

Objective: The use of cobalt alloys in medical implants poses a high risk of cobalt exposure, yet there is a lack of evidence regarding the association between blood cobalt levels and anemia. This study aimed to explore the link between blood cobalt levels and the onset of anemia and to identify potential threshold levels of blood cobalt that could affect anemia. Methods: The US National Health and Nutrition Examination Survey data from 2017 to 2020 were analyzed for this cross-sectional study. This study primarily employed multivariate logistic regression, stratified interaction analysis, restricted cubic splines (RCS), and threshold effect analysis to explore the relationship between blood cobalt concentration and anemia. Results: The study included 5510 participants and among them 12.2% were diagnosed with anemia. Logistic regression model indicates a positive correlation between blood cobalt levels and the risk of anemia. RCS shows that the relationship between ln cobalt concentration and anemia was non-linear (J-shaped). The ln cobalt inflection point was approximately 0.81. The odds ratio of anemia with ln cobalt ≥ 0.81 was 4.00 (95% CI: 2.95–5.43, p < 0.001), the odds ratio of anemia with ln cobalt < 0.81 was 0.73 (95% CI: 0.45–1.18, p = 0.201). Conclusions: The analysis unveiled a non-linear relationship, indicating that elevated blood cobalt levels were linked to a heightened likelihood of developing anemia in middle-aged and older adults; the cut-off value of ln cobalt was approximately 0.81. The findings of this study warrant further investigation. [ABSTRACT FROM AUTHOR]

Background: Sexual health is an essential component of health and well-being across the life course. However, sexual health research often focuses on young adults and excludes those aged 45 years and older. We organized a national crowdsourcing open call and co-creation events to identify recommendations to improve sexual health service provision for middle-aged and older adults in the United Kingdom (UK). Methods: We conducted a crowdsourcing open call and seven co-creation events consisting of workshop-style meetings and one-to-one in-depth interviews. Open call submissions and qualitative data from the co-creation events were analyzed using a thematic approach. A social-ecological framework was used to code deductively, but new codes were allowed to emerge. Thematic categories were organized to describe factors influencing the accessibility and inclusivity of sexual health services for middle-aged and older adults. Results: We received 22 submissions in total; of those, 35% of participants reported a disability, 40% of individuals were aged 45–65 years, and 6% of submissions came from individuals that identified as gay/lesbian. Five key themes highlighted that improving sexual health services for adults aged 45 years and over requires a multi-leveled approach: increase sexual health education, enhance patient and provider relationships, utilize community-led sexual health promotion efforts and delivery of reliable sexual health information, improve inclusive sexual health services, and break down sexual health taboos against adults aged 45+ years. Conclusions: Our data suggest that middle-aged and older adults can co-create compelling strategies to enhance sexual health services for middle-aged and older adults in the UK. Further implementation research is needed to pilot these strategies. Sexual health research and community engagement projects often focus on youth and neglect middle-aged and older adults. This research demonstrates that crowdsourcing open calls and co-creation activities focused on sexual health are feasible among middle-aged and older adults, including those with disabilities. Key findings from this study suggest that improving sexual health services for middle-aged and older adults must be addressed at various levels of healthcare service delivery. This article belongs to the collection: Sexual health among older adults: A multi-disciplinary collection. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodResultsConclusionAmbivalent feelings in a partner relationship, characterized by simultaneous positive and negative emotional experiences, can significantly influence individuals’ mental health. Traditionally measured indirectly, this study introduces the Partner Ambivalence Scale (PAS), developed for directly capturing the complexity of ambivalent emotions. This study aimed to analyze the psychometric properties of the PAS, and assess the effects of ambivalent feelings on partner relationship quality and depressive symptomatology.390 individuals (60% women), 40 years or older (M = 60.88, SD = 10.7), and in a partner relationship, participated. Data collected included ambivalent feelings in couples, marital satisfaction, frequency of arguments, and depressive symptoms.The exploratory factor analysis of the PAS yielded a one factor structure explaining 59% of the variance of ambivalent feelings. Higher ambivalent feelings were associated with lower marital satisfaction, higher frequency of disagreements, and higher depressive symptoms. Even when controlling for covariates, ambivalent feelings contributed significantly to the explanation of depress on.The PAS demonstrates good psychometric properties, making it suitable for use with middle-aged and older adults. Ambivalent feelings toward the partner are significant for understanding partner relationship quality and mental health and may increase vulnerability to depressive symptoms during middle and older age. [ABSTRACT FROM AUTHOR]

Introduction: Mental health is the cornerstone of public health, especially where middle-aged and older adults during the COVID-19 pandemic were concerned. The impact of Internet usage on mental health in the time of the crisis still presents a mixed picture. Methods: This study employs the PSM-DID method according to longitudinal data (CFPS) to explore whether Internet usage reduced the impact of COVID-19 on the mental health of middle-aged and older adults. Results: The results reveal that Internet use improves the mental health of middle-aged and older adults during the pandemic in China, but that the impact varies between urban and rural residents. Furthermore, the moderator effects model shows that people's perceptions of the Internet have an impact upon the length of time spent online and its consequent effect on mental health. Discussion: These findings suggested that Internet use had a significant effect on alleviating the levels of depression in middle-aged and older adults. Greater marginal gains may be realized by enhancing the digital capacity of and narrowing the digital divide that exists among rural residents. The enhancement of digital capacity and proper guidance in digital education should be taken into consideration where the mental health of middle-aged and older adults is at issue. [ABSTRACT FROM AUTHOR]

Aim: This study aims to explore the association between declining lung function and depression in middle‐aged and older adults, with a special focus on the mediating role of cognitive function. Methods: This study utilizes self‐reported and physical examination data from 5345 individuals participating in the 2015 cycle of the China Health and Retirement Longitudinal Study (CHARLS) to explore the role of cognitive function changes in mediating the effects of diminished lung function on depression among middle‐aged and older adults. Results: Multivariate linear regression analysis revealed a positive correlation between pulmonary and cognitive functions (β = 0.003, 95% CI: 0.002∼0.003, P < 0.01) and a negative correlation between cognitive function and depression (β = −0.279, 95% CI: −0.330–0.228, P < 0.01). Cognitive function plays a mediating role in linking pulmonary function with depression, exhibiting a mediation effect of −0.0007 and a total effect of −0.0046, wherein the mediation effect contributes to 15.22% of the total effect. For females, the mediating effect of cognitive function was stronger (β = −0.0013, 95% CI: −0.0018∼–0.0008, P < 0.01) than it was for males (β = −0.0006, 95% CI: −0.0009∼–0.0003, P < 0.01). Conclusions: The study underscores the importance of monitoring lung and cognitive functions as interconnected factors contributing to the mental health of middle‐aged and older adults. It suggests that interventions aimed at improving pulmonary health and cognitive function may help mitigate depressive symptoms among middle‐aged and older adults. Further research is warranted to validate these findings across diverse cultural and demographic settings. Geriatr Gerontol Int 2024; 24: 1210–1217. [ABSTRACT FROM AUTHOR]

Chronic diseases have become one of the most important factors threatening human health. Subjective life expectancy (SLE) describes an individual's expectation or subjective perception of lifespan. This article aims to explore the relationship between chronic diseases and SLE, as well as the differences among different age groups and different types of chronic diseases in this relationship. China Health and Retirement Longitudinal Study (CHARLS) is a nationwide longitudinal study that evaluates the social, economic, and health conditions of middle‐aged and older adult families and individuals aged 45 and above in China. In this study, CHARLS used probability proportional to size sampling (PPS sampling) to ensure the breadth and representativeness of the sample. This study selected cross‐sectional data from CHARLS 2018, removed missing values, and obtained a valid sample of 10,658 middle‐aged and older individuals, of whom 8564 had chronic diseases. After controlling demographic, health behavior, socioeconomic, psychological, and social security factors, an ordered logistic regression was performed to explore the relationship between chronic disease and SLE in middle‐aged and older adults. The results show that chronic diseases negatively correlate with SLE in middle‐aged and older adults. Middle‐aged and older adults with chronic diseases are 36.2% less likely to have high life expectancy than those without chronic diseases. Many different types of chronic diseases are negatively correlated with SLE. Cancer is most negatively correlated with SLE, far exceeding other chronic diseases. Chronic disease and SLE of middle‐aged and older adults have age‐heterogeneous differences. For middle‐aged people aged 45–59 and young older adults aged 60–79, there is a significant correlation between chronic diseases and SLE. However, there is no correlation between chronic diseases and subjective life expectancy in the older population aged 80 and above. The government and society should pay close attention to the prevention and treatment of chronic diseases among middle‐aged and older adults and adjust policies and measures according to the population's age structure. In addition, the government and society should pay attention to the spiritual needs of middle‐aged and older adults. The government and society should pay more attention to cancer patients. Finally, the scientific research team should also strengthen research on chronic diseases, research and development of specific drugs and vaccines, improve the cure rate of chronic diseases, promote people's health, and make people no longer afraid of diseases. [ABSTRACT FROM AUTHOR]

Purpose: Identifying factors that influence Chinese herbal medicine (CHM) use in chronic lung disease (CLD) patients can inform targeted strategies to boost CHM use. However, the prevalence and factors affecting CHM use for treating CLD in middle-aged and older Chinese patients remain understudied. This study aims to examine the prevalence and influencing factors of CHM use among middle-aged Chinese patients with CLD. Patients and Methods: The data analyzed in this study were extracted from the China Health and Retirement Longitudinal Study in 2018. A cross-sectional analysis of 2784 participants aged 45 years and older taking CHM for CLD was included, and influencing factors (demographic characteristics, health status, and healthcare service use) predicting the use of CHM for CLD were identified through multivariate logistic regression model. Results: The prevalence of using CHM to treat CLD was 22.4% (624/2784). Compared to participants with CLD who did not use CHM, those with CLD who used CHM were more likely to be female, and non-smoking, non-drinking, purchased insurance (OR=2.35; 95% CI=1.09, 5.04), went to a traditional Chinese medicine hospital (OR=3.5; 95% CI=1.96, 6.25) and self-treatment (OR=1.67; 95% CI=1.33, 2.10), the health status being poor (OR =1.74; 95% Cl=1.18, 2.56), asthma (OR=1.55; 95% Cl=1.16, 2.09) and depression (OR =1.42; 95% Cl=1.14, 1.75). In the additive interaction analysis, patients who tend to self-medicate and with depression were most likely to use CHM (OR=2.52; 95% Cl=1.85, 3.42). Conclusion: A considerable middle-aged and older Chinese patient with CLD uses CHM for treatment. Multiple factors can influence CHM use, particularly self-treatment and depression. [ABSTRACT FROM AUTHOR]

Abstract Background Various measures of arterial stiffness have been linked to the risk of cardiovascular disease. However, the relationship between the estimated pulse wave velocity (ePWV), a novel indicator of arterial stiffness, and cardio-cerebrovascular disease risk remains unclear. This study investigated the relationship between the ePWV and the risk of cardio-cerebrovascular diseases. Methods A total of 17,708 participants aged 45 years and older enrolled in the China Health and Retirement Longitudinal Study (CHARLS), conducted between 2011 and 2012, and participants with a 7-year follow-up were included. Ultimately, 8242 respondents were included in the study. The ePWV was calculated using age and mean blood pressure. Cardio-cerebrovascular diseases, including myocardial infarction, cerebral infarction, and intracerebral haemorrhage, were categorised as cardiovascular and cerebrovascular diseases. Clinical and demographic characteristics were collected. A Cox proportional hazards model was used to explore the relationship between ePWV and the risk of cardiovascular disease. Results During the 7-year follow-up, 21.7% of the participants (1791/8242) developed cardio-cerebrovascular diseases. After adjusting for potential confounding factors, the ePWV was positively associated with the risk of cardio-cerebrovascular disease (adjusted hazard ratio: 1.16, 95% CI 1.11–1.22, P

Growing evidence has linked extreme temperature with neuropsychiatric disorders under climate warming with frequent extreme heat events over the past decades, while cognitive performance in relation to heat exposure remains largely unstudied, particularly in populations at high vulnerability to climate risks (e.g., China). Based on five survey waves of a nationwide dynamic cohort (2011–2020), we analyzed 47,825 cognitive test records from 14,729 respondents aged 45+ years across 126 Chinese cities. Global cognitive performance and its two dimensions (episodic memory and mental status) was measured using standardized questionnaires. Temperature exposure prior to cognitive tests was assessed using both average temperatures and heat days exceeding predefined temperature thresholds. Linear mixed-effects models were utilized to examine the relationship between high temperature exposure and cognitive function. This study revealed consistent evidence for heat-related declines in global cognitive performance and episodic memory across multiple exposure-window analyses, while robust associations were observed solely during prolonged exposure periods (more than 90 d) for mental status. For each 1-°C rise in annual mean temperature within 1 year prior to investigation, cognitive scores declined by 0.058 (95% CI: −0.079, −0.037) points for global performance, 0.033 (95% CI: −0.048, −0.018) points for episodic memory, and 0.025 (95% CI: −0.038, −0.013) points for mental status, respectively. Similar findings were seen in analyses using heat exposure days defined by multiple temperature percentiles, linking per 10-d increase in heat duration to reduced global cognitive scores ranging from −0.142 (95% CI: −0.214, −0.070) to −0.168 (95% CI: −0.254, −0.082). Despite varied evidence by heat exposure metrics and cognitive dimensions, stratified analyses suggested possibly higher susceptibility among females, less-educated, and urban-dwelling residents to heat-related cognitive impairment. These results provided suggestive evidence for the role of exposure to heat in triggering cognitive impairment in middle-aged and older individuals. This finding may be crucial in developing public health strategies for managing climate change risks of neurobehavioral disorders in a healthy aging society.

Abstract The objective of this study is to assess the impact of dietary intake and supplementation of total magnesium, iron, zinc and selenium on pulmonary function in middle-aged to elderly individuals diagnosed with chronic obstructive pulmonary disease (COPD). This study utilized publicly available data from NHANES, focusing on the 2007–2012 cycles to include participants aged 50 and above with COPD. The definition of COPD followed the 2024 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Dietary mineral intake was assessed through two 24-h dietary recall surveys. Pulmonary function assessments included parameters such as forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), forced mid-expiratory flow (FEF 25–75%), and peak expiratory flow (PEF). Sex-specific associations of total magnesium, iron, zinc, and selenium intakes with pulmonary function parameters were assessed using multivariable regression models adjusted by potential covariates. The study sample had a mean age of 64.56 ± 8.26 years, with 35% being female. The median intakes of total magnesium, iron, zinc, and selenium for males were 312.8 mg, 15.6 mg, 14.4 mg, and 127.9 mcg, respectively, while for females, they were 257.5 mg, 12.8 mg, 11.4 mg, and 96.2 mcg. In males, higher total magnesium and iron intake were significantly associated with increased FEV1, FVC, and PEF (P

Abstract Background Adverse Childhood Experiences (ACEs) have been implicated in the development of body pain, yet research on their impact on body pain and its progression remains scarce. This study aimed to examine the associations between ACEs and the presence and areas of body pain, as well as their developmental trajectories among middle-aged and older Chinese adults. Methods We included participants aged 45 years and above from the China Health and Retirement Longitudinal Study (CHARLS) conducted between 2011 and 2018. Retrospective data on ACEs and pain sites were collected with questionnaires. The presence of pain at different body sites was categorized into three areas: head & neck, trunk, and limbs. ACEs consisted of ten types of adverse experiences and were cumulatively scored. For the cross-sectional analysis (2011), logistic regressions were performed to estimate the associations between ACEs and pain presence in specific areas. In the longitudinal analysis (2011–2018), we further applied group-based trajectory modelling (GBTM) to determine the developmental trajectories of body pain. Multinomial logistic regressions were then conducted to estimate the associations between ACEs and pain trajectories. Results In the cross-sectional analysis (n = 8157), ACEs were positively associated with the presence of pain in the head & neck (odds ratio [OR] = 3.55, 95% confidence intervals [CI] = 2.37–4.74), trunk (OR = 3.28, 95% CI = 2.47–4.34), and limbs areas (OR = 2.30, 95% CI = 1.77-3.00) compared to no ACEs. These associations varied by sex and residence. In the longitudinal analysis (n = 5188), GBTM identified three developmental trajectories of body pain (n = 9521): high-increasing (7.44%), low-moderate (33.67%) and maintained-low trajectories (58.89%) trajectories. Compared to participants without ACEs, individuals had three ACEs and 4 or more ACEs were consistently associated with low-moderate (three ACEs: OR = 2.26, 95% CI = 1.81–2.83, four or more ACEs: OR = 3.11, 95% CI = 2.51–3.87) and high-increasing (three ACEs: OR = 3.28, 95% CI = 2.03–5.30, four or more ACEs: OR = 6.78, 95% CI = 4.30-10.68) body pain trajectories across sexes and residence. Conclusion This study highlighted the significant association between ACEs and body pain among middle-aged and older Chinese, emphasizing the importance of preventing or mitigating ACEs as a strategy for the prevention and management of body pain.

The relationship between depression and cognition in middle-aged adults is a topic of interest. Whether poor cognitive function exacerbates depression remains controversial. We clarified the association between cognitive decline and depression based on six nationwide cohorts. 89,056 participants were retrieved from six cohorts in Europe, North America, Asia and Africa. Each two consecutive interviews were collected as a sample set with a total of twenty-eight sample sets to assess changes in depression and cognitive function. Multiple linear regression was conducted within each sample set to evaluate the association between cognitive decline and depression. A two-stage meta-analysis was performed to obtain the average effect within each cohort and the overall effect excluding population and regional heterogeneity. Meta-regression and subgroup analysis were used to explore heterogeneity and potential effect modifiers. Almost all sample sets indicated negative association between changes in cognitive function and depression scores. The average effects varied across regions: Korea (−0.150 [−0.175, −0.126]), Europe (−0.130 [−0.149, −0.112]), South Africa (−0.090 [−0.129, −0.060]), China (−0.083 [−0.137, −0.030]), Mexico (−0.063 [−0.084, −0.042]), and North America (−0.048 [−0.056, −0.040]). The overall effect excluding population and regional heterogeneity was −0.094 [−0.129, −0.060], and was robust across populations of different age, sex, alcohol consumption, daily living activities and marital status. The cross-sectional design limited our ability to determine causal relationships. Cognitive decline was associated with the exacerbation of depression status in middle-aged and older adults worldwide. Country-level factors, rather than individual-level factors, are more likely to modify this effect. • It is the first global study to examine the association between cognition and depression in middle-aged and older adults worldwide. • Declines in cognitive function are associated with the exacerbation of depression status. • This relationship is more likely to be modified by macro-level factors than by individual-level factors. • Cognitive training or cognitive therapy may be helpful to control or prevent depression. [ABSTRACT FROM AUTHOR]

Abstract Background Long-term care insurance (LTCI) is essential to alleviate the challenges of rapid aging. Research on LTCI in developing countries is limited and conclusions remain controversial. This study aims to empirically evaluate how the LTCI pilot in selected cities influences healthcare utilization and expenditures among middle-aged and older Chinese adults. Methods Data was from 2013, 2015, and 2018 China Health and Retirement Longitudinal Study. 167 LTCI and 8225 non-LTCI group participants were identified. Propensity score matching difference-in-difference method was used to evaluate the net effect of LTCI. The robustness of the findings was tested using a placebo test. Results In the pilot cities, around 17.8% of the population had LTCI coverage, with approximately 59.9% participating in urban employee medical insurance and 81.4% being urban residents. LTCI significantly reduced the monthly out-of-pocket outpatient expenditure by 313.764 yuan (P

Abstract Background The association between weight-adjusted waist index (WWI) and disability is unclear. This study aimed to assess the relationship between WWI and disability in middle-aged and elderly Chinese individuals and provide more predictive indicators for disability prevention. Methods In this study, 13,015 middle-aged and older adults aged 45 years and above who were surveyed in 2011 by the China Health and Aging Tracking Survey (CHARLS) database were selected, and 8344 respondents with complete data were included for cohort analysis after seven years of follow-up. Information on clinical demographic characteristics, anthropometric indices, assessment of disability, and related covariates were collected, and the presence or absence of disability was assessed by the disability scale. WWI was calculated by dividing the waist circumference (cm) by the square root of the body weight (kg). Cox proportional hazards model was used to analyze the association between WWI and disability after follow-up. Results Our study found that 2912 of 8344 participants had disability after seven years of follow-up, and disability incidence was approximately 34.9%. Age, sex, place of residence, chronic disease, depression, waist circumference, and WWI were significantly associated with disability in univariate analysis. Among them, there was a positive association between WWI as a continuous variable and incidence of disability (hazard ratio (HR) = 1.26, 95% CI: 1.22–1.31, p

Abstract Background Patient satisfaction is a powerful predictor of an individual's mental health, according to previous research. However, there has not been a thorough study on the relationship between depression and overall medical service satisfaction (OMSS) in middle-aged and older adults. Moreover, little is known about how different Internet-using patterns affect this relationship. Methods We selected 4,523 participants from the China Family Panel Studies (CFPS) 2020 dataset who were aged 45 and older. The relationship between OMSS and depression was examined using logistic regression analysis, distinct Internet-using patterns were investigated using latent class analysis, and the moderating effects of these patterns were examined using SPSS PROCESS macro analysis. Results The results showed OMSS was negatively related to depression in middle-aged and older adults (β = -0.181, p

Abstract Background According to the United Nations classification of aging societies, China is rapidly transitioning into a moderately aging society, facing significant challenges related to population aging. Concurrently, China is actively implementing the Internet Power Strategy and the Internet Plus action plan, which are profoundly transforming the daily lives of individuals, including their health status. However, research on the impact of internet use on the health of middle-aged and older adults has not reached a consensus. This study aims to investigate the effects of internet use on the health of middle-aged and older adults, as well as the mechanisms and heterogeneity of these effects. Methods This study utilized data from the China General Social Survey conducted in 2018, which includes a sample of 6470 individuals. Self-rated health, mental health, and objective health were used as key health indicators, with internet use identified as the primary independent variable. The study aims to analyze the impact of internet use on the health status of middle-aged and older adults through the application of an ordered probit model and instrumental variable methods. Results The results indicate that internet use has a significant positive impact on the health of middle-aged and older adults, with significance at the 1% level. This finding has passed a series of robustness tests. Mechanism analysis reveals that information acquisition is a crucial mediating mechanism between internet use and the health of middle-aged and older adults. This suggests that increased internet use enhances information access, thereby improving health outcomes. Furthermore, heterogeneity analysis shows that the impact of internet use on health is more pronounced among individuals living in rural areas, western regions, low-income groups, and those aged under 60, compared to their counterparts in urban areas, eastern regions, higher-income brackets, and those aged 60 and above. Conclusion Internet use can improve the health of middle-aged and older adults. Therefore, government departments, senior universities, communities, and families should collaborate to actively conduct digital skills training for older adults. Additionally, efforts should be accelerated to adapt electronic products to be more elder-friendly, helping older adults overcome the digital divide and thereby reducing health inequalities among middle-aged and older groups.

Abstract Background Musculoskeletal disease (MSD) is a major cause of disability among older adults, and understanding the role of physical activity (PA) in preventing these conditions is crucial. This study aimed to explore the association between PA levels and MSD risk among adults aged 45 and above, clarify the dose‒response relationship, and provide tailored guidelines. Methods Using data from the China Health and Retirement Longitudinal Study (CHARLS), a cross-sectional analysis was conducted on 15,909 adults aged 45 and over. The study population was divided into MSD (n = 7014) and nMSD (n = 8895) groups based on musculoskeletal health status. PA levels were assessed using the International Physical Activity Questionnaire and categorized into low intensity physical activity (LIPA), moderate vigorous physical activity (MVPA), and vigorous physical activity (VPA). Multivariable logistic regression models and restricted cubic spline regression were used to examine the relationship between PA levels and MSD risk in middle-aged and older adults. Sensitivity analyses and stratified analyses were also performed. Results The main outcome measures were musculoskeletal diseases prevalence and PA levels. MVPA and VPA reduced MSD risk by 19% [OR = 0.81, 95% CI (0.72, 0.90), P

Abstract Background Socioeconomic status (SES) is associated with both depression and activities of daily living (ADL and IADL). However, the role of ADL as a biological mechanism in the relationship between SES and late-life depression, examined through longitudinal data, remains understudied. This study explored the longitudinal mediation effects of basic ADL or IADL on the SES-depression link in older adults. Methods Data from the China Health and Retirement Longitudinal Study (N = 4104) were utilized. Mediation analysis was performed using parallel process latent growth curve modeling. Results The average age of participants was 57.76 years, and 55.7% being females. Significant linear growth over time was observed in ADL, IADL, and depression. Adjusting for covariates, SES was positively linked to the initial levels (intercepts) of ADL (β iADL=-0.100[-0.143, -0.057]), IADL (β iIADL=-0.140[-0.185, -0.095]), and depression (β iDEP=-0.103[-0.158, -0.048]). However, SES showed no significant correlation with the rate of change (slopes) in ADL, IADL, or depression (P > 0.05). The intercepts of ADL (β iDEP = 0.566[0.503, 0.629]) and IADL (β iDEP = 0.607[0.544, 0.670]) were positively correlated with the depression intercept but negatively with the depression slope. Conversely, the slopes of ADL and IADL were positively associated with the depression slope. These results suggest a negative indirect relationship between SES and the initial level of depression, but a positive indirect relationship with the rate of increase in depression through ADL (or IADL) intercept. Conclusions Higher SES is associated with a lower initial risk of depression and ADL difficulties. However, this same higher SES may relate to a faster increase in ADL difficulties and depression among middle-aged and older adults. The findings underscore the need for increased governmental healthcare funding and improved healthcare accessibility. Additionally, maintaining adequate sleep and physical activity can help prevent disability and reduce depression risk later in life, particularly among older adults with lower SES.

Abstract Objectives Middle-aged and older adults smoking for years are afflicted by smoking-related diseases and functional limitations; however, little is known about the effect of smoking on nonfatal conditions in middle and later life. This study aims to investigate the impact of smoking on both total life expectancy (TLE) and disability-free life expectancy (DFLE) and the variations in such effects by educational level in China. Methods Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), 2011–2018, with a total sample of 16,859 individuals aged 45 years or older involved in the final analysis. The Activities of Daily Living (ADL) scale was used to measure disability, and the population-based multistate life table method was used to estimate the differences in TLE and DFLE by smoking status and educational attainment. Results At baseline, 28.9% of participants were current smokers, 8.5% were former smokers, and 62.6% never smoked. Approximately 5.6% were identified with ADL disability. Both current smokers and former smokers experienced lower TLE and DFLE than never smokers, and such differences were particularly prominent among men. Intriguingly, former smokers manifested a lower DFLE for both sexes and a lower TLE among women, though a longer TLE among men, compared with current smokers. Similar differences in TLE and DFLE by smoking status were observed for groups with different levels of education. Conclusion Never smokers live longer and healthier than current smokers and persons who quit smoking. Smoking was associated with greater reductions in TLE and DFLE among men. However, educational attainment might not moderate the adverse effect of smoking on both fatal and nonfatal conditions in the context of China. These findings have implications for disability prevention, aged care provision and informing policies of healthy aging for China and elsewhere.

Abstract Background To investigate the cross-sectional and longitudinal associations between depressive symptoms and the prevalence of frailty and its components in a nationally representative sample of middle-aged and older Chinese adults. Method The China Health and Retirement Longitudinal Study (CHARLS) provided data on 2581 (after inclusion and exclusion criteria) adults aged ≥ 45 years. Every two years, face-to-face, computer-aided personal interviews (CAPI), and structured questionnaires were used to follow up with the respondents. The Chinese version of the Center for Epidemiologic Studies-Depression Scale (CES-D) was used to evaluate depressive symptoms, and the Fried criteria were used to measure frailty. The odds ratio (OR) and 95% confidence interval (CI) for the association of exposure (depressive symptoms at baseline) with the onset of the outcome (frailty and its components) in the individuals at baseline were analyzed by binary logistic regression. Results At baseline, 11.62% of participants had frailty, and 57.92% had depressive symptoms. In the cross-sectional analysis, depressive symptoms (OR = 5.222, 95%CI 3.665–7.442) were associated with frailty. In the longitudinal analysis, after adjusting for the full set of covariates among participants free of baseline frailty, depressive symptoms were significantly associated with incident frailty during the short term (OR = 2.193, 95%CI 1.324–3.631) and the long term (OR = 1.926, 95%CI 1.021–3.632). Meanwhile, depressive symptoms were associated with an increased risk of weakness (OR = 1.990, 95%CI 1.250–3.166), slowness (OR = 1.395, 95%CI 1.044–1.865), and exhaustion (OR = 2.827, 95%CI 2.150–3.719) onset during the short-term. Depressive symptoms were associated with an increased risk of exhaustion (OR = 2.869, 95%CI 2.004–4.109) onset during the long-term. Conclusion Among middle-aged and older adults, depressive symptoms could predict frailty during 2 years of follow-up and 4 years of follow-up. When considering potential confounding factors, depressive symptoms were considered a predictor of weakness, slowness, and exhaustion. Interventions aimed at preventing depressive symptoms may be beneficial in reducing frailty and its components.

Abstract Background The incidence of chronic diseases is on the rise worldwide, with a high mortality rate in China, posing a serious threat to the health-related quality of life (HRQoL) of middle-aged and older adults. This study explores the association between chronic diseases and the HRQoL of middle-aged and older adults, as well as the role of physical activity (PA) and degree of digitization in this relationship. Methods The data used in this study was obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which included 13,620 middle-aged and older Chinese adults (≥ 45 years). The study utilized correlation analysis, and bootstrapping to investigate the mediating role of PA and the moderating influence of the degree of digitization. Data analysis was conducted using SPSS 26.0. Results The study findings indicate that the severity of chronic disease has a significant negative predictive effect on HRQoL (PCS, physical component summary; MCS, mental component summary) (PCS: β = -2.515, p

Abstract Background Middle-aged and elderly individuals are the most susceptible groups for metabolic diseases, with their dietary behaviors being significant influencing factors. Exploring the association between overall dietary behaviors and obesity metabolic phenotypes is crucial for early prevention and control of chronic diseases, precision treatment and personalized interventions. Methods We conducted a cross-sectional study of 15,160 middle-aged and older adults between June 2019 and August 2021 to collect information on their body mass index (BMI), biochemical indices and disease history. The population was classified into four categories by the criteria of obesity metabolic phenotypes: metabolically healthy non-obesity (MHNO), metabolically unhealthy non-obesity (MUNO), metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). Scores were calculated based on compliance with healthy eating behavior patterns (appropriate or light dietary taste, moderately soft and hard food, slightly hot food temperature, medium or slow eating speed, daily intake of dietary supplements and eating with others), and the population was categorized into subgroups 0–2 (did not meet and met only 1 or 2), 3–4 (met 3 or 4), 5–6 (met 5 or 6). The relationship between dietary behavior patterns and different obesity metabolic phenotypes in middle-aged and elderly people were analyzed by multi-categorical logistic regression model. Results Compared with the 5–6 subgroup, the dietary behavior patterns of 0–2 and 3–4 scores were risk factors for MUNO, MHO and MUO (P

Background: Previous studies have consistently documented positive associations between depressive symptoms and altitude; however, a longitudinal study of these relationships among middle-aged and older adult community populations in China has not been previously reported. Methods: We screened 17,705 subjects who met the inclusion criteria from the China Health and Retirement Longitudinal Study database 2011. The altitude is the altitude at which the participants lived in our study area. We estimated the prospective associations between altitude and depressive symptoms among middle-aged and older adults. The 10-item Center for Epidemiological Studies Depression Scale short form was used to measure depressive symptoms. A total of 6,594 participants without depressive symptoms were recruited from the same cohort in 2011 and were followed up in 2018. Multivariate logistic regression was used to assess the associations between altitude and depressive symptoms among middle-aged and older adults. Results: The prevalence of depressive symptoms was 27.3% in our study. The prevalence of depressive symptoms increased with increasing altitude, and the prevalence of depressive symptoms in women was greater than that in men. Multivariate logistic regression adjusted for all other relevant variables showed that sex, altitude, education level, professional status and marital status were associated with depressive symptoms. Conclusions: This finding provides evidence of the relationship between altitude and depressive symptoms among middle-aged and older adult community populations in China and shows that depressive symptoms are significantly positively correlated with altitude and other factors, including sex, education level, professional status, and marital status. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal disease (MSD) is a major cause of disability among older adults, and understanding the role of physical activity (PA) in preventing these conditions is crucial. This study aimed to explore the association between PA levels and MSD risk among adults aged 45 and above, clarify the dose‒response relationship, and provide tailored guidelines. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), a cross-sectional analysis was conducted on 15,909 adults aged 45 and over. The study population was divided into MSD (n = 7014) and nMSD (n = 8895) groups based on musculoskeletal health status. PA levels were assessed using the International Physical Activity Questionnaire and categorized into low intensity physical activity (LIPA), moderate vigorous physical activity (MVPA), and vigorous physical activity (VPA). Multivariable logistic regression models and restricted cubic spline regression were used to examine the relationship between PA levels and MSD risk in middle-aged and older adults. Sensitivity analyses and stratified analyses were also performed. Results: The main outcome measures were musculoskeletal diseases prevalence and PA levels. MVPA and VPA reduced MSD risk by 19% [OR = 0.81, 95% CI (0.72, 0.90), P < 0.001] and 12% [OR = 0.88, 95% CI (0.79, 0.98), P < 0.05], respectively. What's more, after adjusting for confounding factors, VPA increased risk by 32% [OR = 1.32, 95% CI (1.04, 1.66), P < 0.05]. The relationship was nonlinear, showing a U-shaped pattern with age and hypertension status as significant moderators. The optimal PA energy expenditure was identified as approximately 1500 metabolic equivalents of tasks (METs) per week for adults aged 45–74, 1400 METs per week for those aged 75 and above, and 1600 METs per week for hypertensive adults aged 45 and older. Conclusions: For adults aged 45 years and older, VPA significantly increases the risk of MSD. Adults aged 45 years and older should adjust their weekly METs based on their age. Additionally, those with hypertension should moderately increase their weekly METs to promote optimal musculoskeletal health. [ABSTRACT FROM AUTHOR]

Introduction: The world population is rapidly aging, and depression mainly affects middle-aged and older adults with chronic diseases and cognitive impairments. The sample for this study was obtained from the China Health and Retirement Longitudinal Study (CHARLS) public database. The sample size for inclusion was 12,767. There were 6,773 females and 5,994 males, with an overall low level of education. This study aims to provide a theoretical and practical reference basis for the clinical non-pharmacological treatment of depression in middle-aged and older adults (age = 50 years) with chronic diseases. Additionally, the study seeks to promote the development of mental health interventions for middle-aged and older adults (age = 50 years) with chronic diseases, ultimately enhancing the sense of well-being and quality of life for this demographic. Methods: Cognitive functioning and depressive symptoms of the study participants were assessed using the Mini-Mental State Examination Scale (MMSE) and the short version of the Center for Epidemiological Studies Depression Scale (CESD-10). Results and discussion: Binary logistic regression results showed that among middle-aged and older adults (age = 50 years) with chronic diseases, participation in physical activity [OR = 1.397; 95% CI (1.181-1.651); p < 0.05] was more effective than participation in social activities [OR = 0.997; 95% CI (0.924-1.076); p < 0.05] for preventing depression. Those with cognitive impairment [OR = 1.206; 95% CI (1.089-1.335); p < 0.05] were more likely to experience depression than those without cognitive impairment. Activity participation (physical activity and social activity) had a more significant effect on mild and moderate depression compared to no depression, and cognitive level had a more pronounced effect on moderate depression [OR = 1.491; 95% CI (1.278-1.740); p < 0.05] and major depression [OR = 2.231; 95% CI (1.282-3.884); p < 0.05]. Within the specific cohort of middle-aged and older adults (age = 50 years) with chronic diseases, both activity participation and cognitive level exert a significant influence on the prevention and intervention of depression. Engagement in physical activity, participation in social activities, and enhanced cognitive functioning emerged as protective factors against depression. Therefore, the policy-maker should strengthen the prevention and treatment of depression in a comprehensive manner through the promotion of physical and social activities and the enhancement of cognitive level, so as to safeguard the mental health of middle-aged and older adults with chronic diseases. [ABSTRACT FROM AUTHOR]

Background: The association between negative wealth shocks and depression among middle-aged and older individuals remains unclear. Our study aimed to assess the association between negative wealth shocks and depression and its trajectories, and to explore cross-national differences in these associations Methods: Our sample included 21 999 participants, of which 9519 were from the Health and Retirement Study (2012–2020), 4936 from the English Longitudinal Study of Ageing (2012–2020), 2520 from the China Health and Retirement Longitudinal Study (2011–2020), and 5024 from the Mexican Health and Aging Study (2012–2021). We used latent class trajectory models to identify depressive trajectories, alongside mixed-model logistic regression and multinomial logistic regression to evaluate associations. Results: In the USA (OR 1.73, 95% CI 1.40–2.16), England (OR 1.71, 95% CI 1.09–2.70), and China (OR 1.38, 95% CI 1.09–1.75), negative wealth shocks were associated with subsequent depressive symptoms, but not in Mexico (OR 1.06, 95% CI 0.86–1.29). Additionally, negative wealth shocks were associated with several depressive trajectories in the USA and China. This association occurred only in increasing–decreasing trajectory in England, while no significant association was found across any trajectory in Mexico. Conclusions: Negative wealth shocks were associated with subsequent depressive symptoms, with significant associations observed in some specific depressive trajectories. These associations exhibited cross-national differences, underscoring the importance of considering country-specific contexts when addressing the mental health impacts of wealth shocks. [ABSTRACT FROM AUTHOR]

Background: Patient satisfaction is a powerful predictor of an individual's mental health, according to previous research. However, there has not been a thorough study on the relationship between depression and overall medical service satisfaction (OMSS) in middle-aged and older adults. Moreover, little is known about how different Internet-using patterns affect this relationship. Methods: We selected 4,523 participants from the China Family Panel Studies (CFPS) 2020 dataset who were aged 45 and older. The relationship between OMSS and depression was examined using logistic regression analysis, distinct Internet-using patterns were investigated using latent class analysis, and the moderating effects of these patterns were examined using SPSS PROCESS macro analysis. Results: The results showed OMSS was negatively related to depression in middle-aged and older adults (β = -0.181, p < 0.001). For skilled Internet users, there was a significant positive moderating effect (β = -0.272, SE = 0.096, p < 0.01), for unskilled users, there was a significant negative moderating effect (β = 0.497, SE = 0.156, p < 0.01). Yet, there is no moderating effect of a controlled Internet-using pattern on the correlation between OMSS and depression. Conclusions: This study highlights the potential value of improving medical service satisfaction in reducing depressive symptoms in middle-aged and older adults. Additionally, in order to maximize the benefits of healthcare for mental health, the study suggests that Internet-using patterns could be a significant area for intervention. [ABSTRACT FROM AUTHOR]

Background: The association between weight-adjusted waist index (WWI) and disability is unclear. This study aimed to assess the relationship between WWI and disability in middle-aged and elderly Chinese individuals and provide more predictive indicators for disability prevention. Methods: In this study, 13,015 middle-aged and older adults aged 45 years and above who were surveyed in 2011 by the China Health and Aging Tracking Survey (CHARLS) database were selected, and 8344 respondents with complete data were included for cohort analysis after seven years of follow-up. Information on clinical demographic characteristics, anthropometric indices, assessment of disability, and related covariates were collected, and the presence or absence of disability was assessed by the disability scale. WWI was calculated by dividing the waist circumference (cm) by the square root of the body weight (kg). Cox proportional hazards model was used to analyze the association between WWI and disability after follow-up. Results: Our study found that 2912 of 8344 participants had disability after seven years of follow-up, and disability incidence was approximately 34.9%. Age, sex, place of residence, chronic disease, depression, waist circumference, and WWI were significantly associated with disability in univariate analysis. Among them, there was a positive association between WWI as a continuous variable and incidence of disability (hazard ratio (HR) = 1.26, 95% CI: 1.22–1.31, p < 0.001). WWI was transformed into categorical variables using quartiles as cutoffs for disability regression analysis. After adjusting covariates, HR values in the 2nd, 3rd and 4th quantile showed an increasing trend compared with the 1st quantile, and the risk of disability among WWI subjects in the 4th quantile increased by 43% (95% CI: 1.24–1.64). P values for the trend test in the model were all < 0.001. In subgroup analyses, the positive association between WWI and risk of disability remained robust for sex, age, alcohol consumption, smoking status, education level, marital status, and place of residence after adjusting for all covariates considered in this study. Conclusions: WWI is a new and reliable obesity-related indicator that can be used for disability prevention. WWI can be detected and controlled for reducing the risk of disability. [ABSTRACT FROM AUTHOR]

Handgrip strength (HGS) weakness and asymmetry were recently reported to be associated with age-related health conditions. However, little is known about their combined effects on depression. We aimed to explore the joint association of HGS asymmetry and weakness with depressive symptoms in Chinese middle and older aged population. 8700 participants aged ≥45 years were enrolled from China Health and Retirement Longitudinal Study (2015–2018). HGS weakness was determined as maximal HGS < 28 kg in males and <18 kg in females. HGS asymmetry was measured by HGS ratio and was defined using two different rules. Specifically, HGS ratio < 0.90 or >1.10 (10 % rule) and <0.80 or >1.20 (20 % rule) were considered as asymmetry. Participants were classified into four groups: normal and symmetric HGS, asymmetry only, weakness only, and both weakness and asymmetry. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale, with scores ≥12 defined as depression. The logistic regression and multiple linear regression models were conducted to estimate the associations between HGS status and depressive symptoms. The three-year incidence of depression was 19.2 %. After adjusting for covariates, compared to normal and symmetric HGS, participants with both HGS asymmetry and weakness showed the greatest risk of incident depression (10 % rule: OR 1.55, 95 % CI 1.19–2.02; 20 % rule: OR 1.71, 95 % CI 1.16–2.50). The coexistence of asymmetry and weakness was related to a significant increase in depression score (10 % rule: β 0.96, 95 % CI 0.38–1.54; 20 % rule: β 0.94, 95 % CI 0.08–1.81). The complete case analysis supported the results, and the associations were not modified by age, sex, and hand dominance. Depressive assessment was based on self-reported screening instrument. The presence of both HGS asymmetry and weakness was associated with a higher risk of depression. Examining HGS asymmetry along with weakness may aid in identifying individuals at risk of depression to enable early interventions. • The presence of both HGS asymmetry and weakness was strongly associated with incident depression. • HGS asymmetry combined with weakness was related to a significant increase in depression score. • Early recognition and intervention of HGS asymmetry and weakness may help reduce depression risk. [ABSTRACT FROM AUTHOR]

Background: Long-term care insurance (LTCI) is essential to alleviate the challenges of rapid aging. Research on LTCI in developing countries is limited and conclusions remain controversial. This study aims to empirically evaluate how the LTCI pilot in selected cities influences healthcare utilization and expenditures among middle-aged and older Chinese adults. Methods: Data was from 2013, 2015, and 2018 China Health and Retirement Longitudinal Study. 167 LTCI and 8225 non-LTCI group participants were identified. Propensity score matching difference-in-difference method was used to evaluate the net effect of LTCI. The robustness of the findings was tested using a placebo test. Results: In the pilot cities, around 17.8% of the population had LTCI coverage, with approximately 59.9% participating in urban employee medical insurance and 81.4% being urban residents. LTCI significantly reduced the monthly out-of-pocket outpatient expenditure by 313.764 yuan (P < 0.05), but had no significant effects on the inpatient utilization and expenditure. Further analysis of vulnerable subgroup revealed that LTCI decreased monthly outpatient visits frequency, total outpatient expenditure, and out-of-pocket outpatient expenditure by 0.523 times, 643.500 yuan, and 302.367 yuan, respectively (P < 0.05). Robustness tests confirmed the stability of these results. Conclusions: The LTCI coverage rate has remained low. While LTCI has contributed to reducing outpatient utilization and expenditure, its impact on controlling inpatient-related outcomes is limited. It is recommended to broaden LTCI coverage beyond existing participants to encompass more vulnerable populations, and improve awareness and quality of LTCI services to achieve a significant effect on inpatient care. [ABSTRACT FROM AUTHOR]

A better understanding of the causal relationship between spousal cognitive functioning and depression levels among middle-aged and older adults is vital for effective health policymaking under the globally severe aging challenge. However, the related evidence is often limited by potential omitted-variable bias and reverse causation. This study uses an instrumental variables approach, namely the two-stage least squares (2SLS) method, to examine the impact of spousal cognitive functioning on depression levels among middle-aged and older adults in China. The data were sourced from the China Health and Retirement Longitudinal Study (CHARLS) of 2020, including a total of 3,710 couples aged 45 years and above. Depression levels were measured using the Center for Epidemiologic Studies Depression Scale (CES-D-10), while cognitive functioning was assessed using the Mini-Mental State Examination (MMSE). Spousal social participation was employed as the instrumental variable to address omitted-variable bias and reverse causation. Additionally, an interaction effect test between gender and spousal cognitive functioning was conducted. The results show that for each one-point increase in the spouse's MMSE score, the CES-D-10 score of middleaged and older adults decreased by 17.1% to 68.2%. The OLS results indicated that women, rural residents, and middle-aged individuals were more sensitive to these changes. The interaction effect test results confirmed that women were more affected by changes in spousal cognitive functioning. However, after a more reliable 2SLS analysis, the results for age groups shifted, showing that middle-aged individuals were more sensitive to these changes, with a decrease in depression levels reaching 70.0%, compared to 60.2% for the elderly group. Nonetheless, given the prevalence of depression among the elderly, the impact of spousal cognitive decline on depression in this group should not be overlooked. Our findings highlight the importance of spousal cognitive health in managing depression among both middle-aged and older adults, with particular attention to women and rural populations. [ABSTRACT FROM AUTHOR]

Introduction: The effects of exposure to particulate matter and frailty, as well as its exposure-response relationship, have not been effectively explored. This study aimed to explore the association between long-term exposure to particulate matter and frailty state and each dimension in Chinese middle-aged and older adults, in addition to the exposure-response relationship. Methods: The data were obtained from the National Urban Air Quality Real-Time Dissemination Platform and China Health and Retirement Longitudinal Study (CHARLS). Frailty was measured by a frailty index containing 39 indicators. Annual averages of seven pollutants were calculated from hourly monitoring data. We used multilevel regression modeling to explore the association between long-term exposure to particulate matter and frailty. Meanwhile, we explored the exposure-response relationship based on a multilevel generalized summation model. We performed a sensitivity analysis using a multi-pollution model and a quantile-based g-computation (QGC) model. Results: A total of 15,611 participants were included in the analysis. We find that long-term exposure to PM2.5 was associated with an increased risk of pre-frailty and frailty (all p < 0.05). PMc and PM10 exhibited similar associations. The exposure-response relationship between PM2.5 showed a linear relationship, whereas the exposure-response relationship between PM10, PMc showed a nonlinear relationship. Elevated PM2.5 concentrations showed significant positive associations with the number of chronic disease score, IADL score, and functional limitation status score (all p < 0.05). PM10 and PMc showed similar positive correlations. These results remained robust after sensitivity analyses using a multi-pollution model and QGC model. Conclusion: Chronic exposure to particulate matter was significantly associated with increased risk of frailty. The exposure-response relationship between PM2.5 concentration and frailty showed a linear relationship, and the exposure-response relationship between PM10 and PMc showed a nonlinear relationship. Exposure to a mixture of pollutants carried a higher risk of frailty than exposure to a single pollutant. [ABSTRACT FROM AUTHOR]

The study explored the effects of gamifying learning materials on the health care knowledge and emotions of middle-aged and older adults. A quasi-experimental research study was conducted to examine the effects of different learning approaches on the health care knowledge and emotional experiences of middle-aged and older adults. A total of 84 people voluntarily participated in this study and were assigned to three treatment groups: board games, digital games, and traditional instruction. The findings revealed that participants who engaged with board games demonstrated better health care knowledge than those who used digital games. Additionally, they reported positive emotions, such as pride and relaxation. In contrast, participants who accessed digital games were more likely to experience negative emotions, such as shame, sadness, and hopelessness. For middle-aged and older adults using digital games, it is important to consider their levels of technology acceptance, as this significantly influences their intention to use these tools. The results of this study suggest that it is necessary to strengthen the digital literacy and abilities of middle-aged and older adults to reduce learning-related anxiety. In conclusion, board games serve as a beneficial learning channel for middle-aged and older adults. [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? To what extent do activity limitation and emotional distress serially mediate the association between pain characteristics and sleep quality among older adults? • What is the main finding of this study? Pain characteristics (i.e., pain intensity and pain interference) were significantly associated with increased sleep problems among older adults in the sub-Saharan African context, where research on this topic is largely neglected. Most importantly, the association was significantly and serially mediated by activity limitation and emotional distress. • What is the meaning of the finding? Older adults with pains may be at greater risk of sleep problems, underscoring the need for conscious policy and public health interventions to manage pain-induced sleep problems in later life effectively. Indeed, before intervening in pain-induced sleep problems in old age, clinicians should screen for functional status and emotional distress. Pain is increasingly becoming common among middle-aged and older adults. While research on the association between pain characteristics and sleep problems (SP) is limited in low- and middle-income countries, the underlying mechanisms of the association are poorly understood. This study examines the association of bodily pain intensity and pain interference with SP and investigates the mediating role of activity limitation and emotional distress in this association. We analyzed population-based data, including 1,201 individuals aged ≥50 (mean [SD] age 66.14 [11.85] years) from the 2016–2018 AgeHeaPsyWel-HeaSeeB study in Ghana. Multiple OLS regressions and serial multiple mediation modeling using bootstrapping analyses examined direct and indirect effects from pain to SP through activity limitation and emotional distress. Regressions demonstrated that pain intensity and interference were significantly associated with higher levels of activity limitation, emotional distress, and SP (range: β = 0.049–0.658). Bootstrapping analysis showed that activity limitation and emotional distress serially mediated the relationship between pain intensity and SP (total effect: β = 0.264, Bootstrap 95% confidence interval [CI] = 0.165–0.362; direct effect: (β = 0.107, Bootstrap 95% CI = 0.005–0.210; total indirect effect: β = 0.156, Bootstrap 95% CI = 0.005–0.210) accounting for ∼59%. Activity limitation and emotional distress mediated pain interference and SP association (total effect: β = 0.404, Bootstrap 95% CI = 0.318–0.490; direct effect: β = 0.292, Bootstrap 95% CI = 0.201–0.384; and total indirect effect: β = 0.112, Bootstrap 95% CI = 0.069–0.156) yielding ∼28%. Our data suggest that activity limitation and emotional distress may convey stress-related risks of pain on SP. Future research should evaluate if activity limitation and emotional distress could be effective targets to reduce the effect of pain on sleep in later-life. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic status (SES) is associated with both depression and activities of daily living (ADL and IADL). However, the role of ADL as a biological mechanism in the relationship between SES and late-life depression, examined through longitudinal data, remains understudied. This study explored the longitudinal mediation effects of basic ADL or IADL on the SES-depression link in older adults. Methods: Data from the China Health and Retirement Longitudinal Study (N = 4104) were utilized. Mediation analysis was performed using parallel process latent growth curve modeling. Results: The average age of participants was 57.76 years, and 55.7% being females. Significant linear growth over time was observed in ADL, IADL, and depression. Adjusting for covariates, SES was positively linked to the initial levels (intercepts) of ADL (βiADL=-0.100[-0.143, -0.057]), IADL (βiIADL=-0.140[-0.185, -0.095]), and depression (βiDEP=-0.103[-0.158, -0.048]). However, SES showed no significant correlation with the rate of change (slopes) in ADL, IADL, or depression (P > 0.05). The intercepts of ADL (βiDEP = 0.566[0.503, 0.629]) and IADL (βiDEP = 0.607[0.544, 0.670]) were positively correlated with the depression intercept but negatively with the depression slope. Conversely, the slopes of ADL and IADL were positively associated with the depression slope. These results suggest a negative indirect relationship between SES and the initial level of depression, but a positive indirect relationship with the rate of increase in depression through ADL (or IADL) intercept. Conclusions: Higher SES is associated with a lower initial risk of depression and ADL difficulties. However, this same higher SES may relate to a faster increase in ADL difficulties and depression among middle-aged and older adults. The findings underscore the need for increased governmental healthcare funding and improved healthcare accessibility. Additionally, maintaining adequate sleep and physical activity can help prevent disability and reduce depression risk later in life, particularly among older adults with lower SES. [ABSTRACT FROM AUTHOR]

Studies of lifestyle through comprehensive objective and subjective measurements of health outcomes are lacking. An examination of lifestyle factors in middle-aged and older adults in terms of age, gender, and the interaction effect of age and gender from physiological and psychological perspectives are imperative. Recent advances in technology such as actigraphy have facilitated objective measurements. This exploratory study contributes to research on age and gender interactions on circadian rhythm, physical activity, sleep, and psychological variables by employing wrist accelerometers to measure behavioral circadian rhythm objectively and by using questionnaires to assess psychological status subjectively. The data were drawn from 218 participants aged 50 and older from the "Middle-aged and older adults Chinese Health and Actigraphy in Taiwan (MOCHA-T)". The results: (1) older adult group is associated with declined physical activity (MVPA time 79.9 min VS. 107.9 min, p =.002), worse sleep efficiency (78.1% VS. 81.9%, p =.008), and earlier lifestyle (Acrophase 14.19 h VS. 14.69 h, p =.01) comparing to middle-aged group. (2) Women have a more regular lifestyle (Interdaily stability 0.6 VS. 051, p < 0.001), higher physical activity (MVPA time 105.7 min VS. 79.3 min, p =.004), and better sleep efficiency (81.6% VS. 77.8%, p =.011) than men. (3) Significant age-by-gender interactions existed in life satisfaction (p =.025), relative amplitude (p =.016), and total wake time (p =.038). Furthermore, aging was associated with significant increases in life satisfaction among men as well as significant decreases in relative amplitude and reductions in the total wake time among women. In conclusion, aging exerted differential effects on life satisfaction in men as well as relative amplitude and the total wake time in women. This result highlights disparities in lifestyle arising from interconnected social and biological challenges. [ABSTRACT FROM AUTHOR]