Social adaptation and adaptation pressure among the "drifting elderly" in China: A qualitative study in Shanghai

Applying Kumpfer's resilience framework to understand the social adaptation process of the trailing parents in China

BACKGROUND

Trailing parents, a distinct group emerging from China's rapid social change and urbanization, are experiencing migration in old age, posing challenges for their social adaptation. Existing research has mainly focused on the hardships faced by this group, but few studies have focused on how they cope with change and achieve some degree of successful social adaptation. This study aimed to understand the coping and social adaptation process of trailing parents in China.

METHODS

This study used a qualitative research approach. A total of 24 trailing parents were invited to participate in a semi-structured interview and share their experiences and efforts to cope with the many challenges. Kumpfer's resilience framework was used as the theoretical framework for the study design, data collection, and data analysis.

RESULTS

This study identified several intra-family and community stressors that trailing parents may face when moving to a new environment and uncovered five key resilience characteristics that may be triggered or fostered in the presence of these stressors, including physical fitness, psychological stability, open-mindedness, learning ability, and nurturing hobbies. Individuals with resilience traits have been observed to engage in positive cognitive processing and transform the new environment. Consistent with Kumpfer's resilience framework, this study revealed the dynamics of the stressors faced by trailing parents in the new environments, the role of resilience characteristics, and the critical influence of social support in shaping the interplay between the individual and the environment that enabled them to adapt positively.

CONCLUSIONS

This study highlights the importance of fostering resilience traits and leveraging positive coping mechanisms to facilitate a smoother adaptation process for trailing parents. Meanwhile, there is an urgent need to focus on creating opportunities that strengthen their social support networks.

Trajectories of psychological adaptation to Chinese older internal migrants: a latent transition model

OBJECTIVES

Little is known about the heterogeneity and transitions between psychological adaptation patterns in Chinese older internal migrants. This study addressed two questions: (a) Do distinct patterns of psychological adaptation exist among Chinese older internal migrants? (b) If so, what factors predict different trajectories?

METHOD

The study drew on two waves of data and involved 405 older internal migrants into Nanjing, China. First, a latent transition analysis was performed to visualize the different patterns of psychological adaptation. Second, an ecological model of resilience was used to identify the factors explaining the differences between adaptation patterns.

RESULTS

Three main trajectories of psychological adaptation among Chinese older internal migrants over time were: recovery, stability and deterioration. Adaptation trajectories were associated with age, gender, length of stay, psychological resilience, self-esteem, family support, social participation, and living with a spouse.

CONCLUSION

Chinese older internal migrants undertake heterogeneous psychological adaptation trajectories, and their positive adaptation is closely associated with coping resources. Our data may provide references for the identification of vulnerable older internal migrants, as well as the making of targeted interventions.

Elderly's Homesickness: Development of Elderly Homesickness Questionnaire

Introduction

Homesickness is a result of migration, and is related to adjustment difficulties and health problems, as well as clinical disorders. The aim of this study was to measure and explore the homesickness of Chinese elderly.

Methods

A total of 355 non-local Chinese elderly in Shenzhen were recruited to measure demographic information and homesickness. and tested for reliability and validity. Patterns and influences of homesickness among Chinese elderly were explored through latent profile analysis and One-way ANOVA on the basis of EHQ.

Results

A three-factor structure was verified in the 19-item elderly homesickness questionnaire (EHQ), namely "positive contact", "refusal to separate" and "homesickness behavior". The EHQ reports high validity and reliability. Chinese elderly had a high degree of homesickness, and homesickness among Chinese elderly varied significantly across variables such as age, occupation, and education level. Four homesickness patterns were found in Chinese elderly, named low homesick group, moderate homesick group, middle-high homesick group, and high homesick group. Coming from rural/urban areas and living with grandchildren are factors that affect classification.

Conclusion

The present study reveals the high validity and reliability of the EHQ among Chinese elderly. The Chinese elderly reported high levels of homesickness, which varied significantly across levels of demographic factors. Four patterns of homesickness were found among the Chinese elderly, coming from rural/urban areas and living with grandchildren are the factors that affect classification. There may be a masking of the male contribution to the main effect due to the larger female sample.

Can Post-Retirement Work Always Prevent Depression?

Given the rising popularity of post-retirement work and its potential benefits for older adults' mental health, this study examined older adults' adaptation ability as a conditional factor for the impact of post-retirement work on depression. Quantitative data from 1433 working older adults and 1433 non-working older adults were analyzed using the PROCESS macro in SPSS to test a moderated regression model with adaptation ability as the moderator. Results showed that older adults with lower adaptation ability demonstrated significantly lower depression if they worked (vs. did not work). Older adults with higher adaptation ability exhibited significantly higher depression if they worked (vs. did not work). These findings were subsequently verified with a robustness check. Overall, post-retirement work did not prevent depression for the entire sample; working only alleviated depression among older adults with limited adaptation ability. Older adults with stronger adaptation ability could better maintain their mental health by staying retired. This study fills a knowledge gap regarding the relationship between post-retirement work and mental health. Implications for aging societies are also discussed.

Cross-sectional study of factors affecting the receipt of mental health education in older migrants in China

BACKGROUND

Population migration in China has increasingly included middle-aged and older populations. Relatedly, the lack of mental health education among China's older migrants is still an important but neglected problem. This study aimed to understand the current situation of mental health education received by the older migrant population in China and to explore related influencing factors.

METHODS

This cross-sectional study included 5729 older migrants who participated in the 2017 China Migrants Dynamic Survey. The independent variables included four components: demographic and socioeconomic characteristics, migration factors, public health service utilization, and social integration factors. Data were analyzed using the chi-square test for single factors and a binary logistic regression model for multiple factors.

RESULTS

A total of 1749 older migrants received mental health education, for a receipt rate of 30.53%. Regression analysis showed that older migrant individuals who had an average monthly household income > 3000 CNY, self-rated their health as healthy, had chronic diseases, had heard of National Basic Public Health Services, had established health records, received ≥2 types of health education were willing to integrate into the local population, and were highly involved in the community were more likely to receive mental health education. Older migrants who were ≥ 70 years old, had an elementary school education or below, had difficulties in the local community, had migrated ≥11 years prior, moved for their offspring, and moved across provinces were less likely to receive mental health education.

CONCLUSIONS

The older migrant population does not receive sufficient mental health education. Mental health interventions should be tailored to the characteristics of older migrants to increase their mental health literacy and meet their psychological needs.

A Latent Class Analysis of Intergenerational Relationships Among the Elderly Migrants in Nanjing, China

Objective

This study aimed to identify (1) different types of intergenerational relationships among the elderly migrants, (2) factors influencing each type of relationship, and (3) the types significantly associated with psychological well-being of the elderly migrants.

Methods

Data were collected from 654 elderly migrants in Nanjing, China. Incorporating ten solidarity conflict indicators, the latent class analysis (LCA) was performed to classify intergenerational relationships. Logistic regression were used to analyze influencing factors, and ordinary least squares (OLS) regression was used to analyze the relationship of each type of intergenerational relationship with depression and life satisfaction.

Results

Three types of intergenerational relationships were classified: tight-knit (65%), conflicting (25%), distant intimate (10%). Gender, marital status, education level, annual income, subjective health, number of children and parentage were influencing factors for the three types. The tight-knit type predicted a healthy mental status.

Discussion

Three intergenerational relationships exist between elderly migrants and their children in Nanjing, China. A closer relationship predicts a better mental health in the elderly migrants.

Effects of Health Service Utilization and Informal Social Support on Depression, Anxiety, and Stress among the Internal Migrant Elderly following Children in Weifang, China

This study explored the relationship between health service utilization, informal social support and depression, anxiety and stress among the internal migrant elderly following children (IMEFC) in Weifang, China. A total of 613 IMEFC were selected using multistage cluster random sampling. The Depression Anxiety and Stress Scale 21 (DASS-21) was used to assess the depression, anxiety and stress of the IMEFC. Descriptive analysis and univariate and binary logistic regression analyses were used to clarify the correlation between health service utilization and social support and depression, anxiety and stress of the IMEFC. The prevalence of depression, anxiety and stress of the IMEFC was 6.9%, 7.7% and 3.4%, respectively. Logistic regression analysis showed that the IMEFC who having financial stress on medical costs were more likely to feel depressed than those haven't financial stress on medical costs (OR = 6.557), while those unemployed and having no income were less likely to feel depressed than those employed (OR = 0.262), having children support were less likely to feel depressed than those haven't children support (OR = 0.257) and having comfort support were less likely to feel depressed than haven't comfort support (OR = 0.018). Trans-city migration were more likely to feel anxious than trans-county migration (OR = 3.198), having outpatient service were more likely to feel anxious than haven't experienced inpatient service (OR = 3.818), having financial stress on medical costs were more likely to feel anxious than haven't financial stress on medical costs (OR = 3.726), while having children support were less likely to feel anxious than haven't children support (OR = 0.198). Those who migrate to cure disease or rehabilitation were more likely to feel stressed than those migrated to taking care of grandchildren (OR = 12.702) and having financial stress on medical costs were more likely to feel stressed than haven't financial stress on medical costs (OR = 32.155), while having children support were less likely to feel stressed than haven't children support (OR = 0.055) and having economic support in troubles were less likely to feel stressed than haven't economic support in troubles (OR = 0.012). More effective measures should be taken to improve the accessibility and efficiency of cross-regional health insurance reimbursement, and family members should spend more time with the IMEFC to lower their psychological tension in a new environment.

Childcare burden and psychological distress among elderly people involved in grandparenting: A study on local and migrant grandparents in Hangzhou, China

Grandparenting is known to impact psychological health in older people. However, the extent to which the effect is altered by migration-related and sociodemographic determinants is less clear. Therefore, we conducted this cross-sectional study to investigate whether the association between grandparenting and psychological distress differs between rural-urban migrants and local older adults from May to September 2019. A total of 373 rural-urban migrants and 602 local older adults involved in grandparenting in Hangzhou completed measurements assessing sociodemographic characteristics, childcare burden and psychological distress. In total, 22.2% of the grandparents reported psychological distress. Rural-urban migrant grandparents had a lower socioeconomic status (SES), a higher childcare burden (23.6 ± 9.2 vs. 20.7 ± 9.5, p < 0.001) and higher levels of psychological distress (29.8% vs. 17.4%, p < 0.001) than local grandparents. Childcare burden and pressure from adult children were the most significant predictors for psychological distress in both groups (ps < 0.05). Psychological distress was also significantly associated with self-rated health status (β = -0.276, p = 0.033) and willingness to participate in grandparenting (β = -0.659, p = 0.024) in migrant grandparents but associated with female gender (β = 0.346, p = 0.022), caring for children at night (β = 0.424, p = 0.011), conflict with adult children (β = 0.432, p < 0.001) and annual income (β = -0.237, p < 0.001) in local grandparents. Migrant status showed a statistically significant moderating effect between childcare burden and psychological distress. These results may be of assistance in comprehensively understanding the social determinants of mental health of grandparents involved in grandparenting.

The positive association between internal migration and hospitalization among the older adults in China: Regional heterogeneity and chronic disease management

Background

Post-retirement migrants are rapidly increasing in China, but the impact of internal migration on hospitalization among older adults remains under-researched. Understanding this impact is essential for health policies development and improvement. This study aims to identify the most vulnerable population, evaluate the association between migration and hospitalization, and discuss potential causes of the association.

Methods

14,478 older adults were extracted from the 2018 to 2019 Chinese Longitudinal Healthy Longevity Survey (CLHLS) database and divided into four groups according to migration experience and age at migration: non-migrants, pre-adulthood migrants, pre-retirement migrants, and post-retirement migrants. Post-retirement migrants were key research subjects. We employed Pearson's chi-square test to compare group differences in outcome and covariates, and multivariate logistic regression analysis to examine the association between migration and hospitalization by regions and chronic conditions.

Results

Significant intergroup differences were observed in demographic characteristics, socioeconomic factors, health habits, and health-related factors. Post-retirement migrants displayed following characteristics: female predominance (61.6%; 1,472/2,391), tending toward urban areas (80.9%; 1,935/2,391), and the highest prevalence rate of chronic disease (46.7%; 1,116/2,391). Urban migrants in eastern China were more likely to be hospitalized (OR = 1.65; 95% CI: 1.27-2.15), especially those who were diagnosed with chronic disease (OR = 1.51; 95% CI: 1.04-2.19) or with unconfirmed chronic conditions (OR = 1.98; 95% CI: 1.36-2.89).

Conclusions

Internal migration is associated with the hospitalization of post-retirement migrants moving to eastern China. Improved chronic disease management and early interventions might lower the hospitalization. Effective policies should be formulated to reduce the disparity in primary care services across China, thereby facilitating the access of migrants to these services.

Health-Related Perceptions of Older Adults/Patients with Degenerative Lumbar Diseases (ODLs) are associated with their Quality of Life: a Mixed-Methods Study

PURPOSE

This study aimed to elucidate the quality of life of older adults/patients with degenerative lumbar diseases (ODLs) and analyse its association with some of their health-related perceptions.

MATERIALS AND METHODS

This mixed-methods study consisted of a questionnaire survey and an in-depth interview, which was designed within this study. ODLs were recruited from January 12, 2017 to June 27, 2018. The independent sample t-test and grounded theory coding method were employed for data analysis.

RESULTS

Of the 125 participants who returned valid questionnaires, 18 were included in the in-depth interviews. ODLs' quality of life was associated with the following health-related perceptions: "life barriers", "subjective health status", and "treatment outcomes" across the domains of physiology, psychology, social relations, and environment.

CONCLUSION

Our findings indicate that ODLs' quality of life is associated with their health-related perceptions. Thus, to improve older adults' quality of life, more attention should be paid to enhancing non-medical factors such as their health-related perceptions.

Association of Chinese drifting elderly's intergenerational support satisfaction with expectation: A mixed method study in Shanghai

OBJECTIVE

In China's drifting elderly explosive growth context, in spite the importance of intergenerational support for drifting elderly is well recognised, but the association of related satisfaction with expectation is neglected. So current study was designed to explore this.

METHODS

A mixed study with two-stage survey was undertaken involving 136 drifting elderly in Shanghai from June to September in 2019, among which 17 patriciates were involved in the in-depth interviews in stage 2. The intergenerational support in two directions, which were support drifting elderly provided and received, and in three dimensions, which were material, service and emotional, were analysed.

RESULTS

The intergenerational support relationship of drifting elderly and their adult children were strengthened by the unsatisfied social support context. A stronger satisfaction with service support and material support was associated with weaker related expectation, and weaker satisfaction with emotional support was associated with a stronger related expectation.

CONCLUSION

A stronger satisfaction of drifting elderly with intergenerational material and service support can result in a weaker related expectation. While a weaker satisfaction intergenerational emotional support can result in a stronger related expectation. Thus, strengthen drifting elderly's emotional support as they expected is necessary for satisfying their old-ageing pension in urban.

Association between rural-to-urban migration and the cognitive aging trajectories of older Chinese adults: results from a prospective cohort analysis

BACKGROUND

Increasingly, older Chinese adults from rural areas are moving to urban areas to live with their children who have already migrated to these areas. However, few studies have examined this pattern of migration and its effects on cognitive function. We aimed to investigate the association between domestic rural-to-urban migration and the trajectories of cognitive function in older Chinese adults, as well as the factors contributing to these association.

METHODS

Data for this study were drawn from three waves of the China Health and Retirement Longitudinal Study. Migrants were defined as participants who had rural hukou status (under China's household registration system) but resided in an urban area. Cognitive functions were measured using an adapted Chinese version of the Mini-Mental State Examination. We used multilevel linear regression models to examine the association between internal migration and cognitive function trajectories.

RESULTS

The study included 3876 Chinese adults aged ≥60 years at baseline. Compared with their rural non-migrant counterparts, migrants (n = 850) had higher levels of education and reported more interactions with family. Additionally, female migrants were more likely to participate in leisure activities. All cognitive function scores declined over time, but no significant differences were observed in rates of cognitive decline between migrants and non-migrants, regardless of sex. Female migrants exhibited significantly better performance in terms of total cognition (β = 0.77, P < .001) and mental status (β = 0.68, P < .001) than female non-migrants, whereas no inter-group difference was observed regarding memory (β = 0.09, P > .05). Among the male subjects, no significant differences in cognitive function levels were observed between migrants and non-migrants. A series of adjusted models revealed that psychosocial factors such as residing with children, caring for grandchildren, depression and participation in leisure activities partly explained the association between migration and cognition in women.

CONCLUSIONS

Rural-to-urban migration was positively associated with cognitive functions only in women. However, this pattern did not affect the rate of cognitive decline in either sex. Our findings provide directions for tailored interventions improving cognitive functions of older adults and rural non-migrating older adults, especially female non-migrants.

How Can Smart Mobility Innovations Alleviate Transportation Disadvantage? Assembling a Conceptual Framework through a Systematic Review

Transportation disadvantage is about the difficulty accessing mobility services required to complete activities associated with employment, shopping, business, essential needs, and recreation. Technological innovations in the field of smart mobility have been identified as a potential solution to help individuals overcome issues associated with transportation disadvantage. This paper aims to provide a consolidated understanding on how smart mobility innovations can contribute to alleviate transportation disadvantage. A systematic literature review is completed, and a conceptual framework is developed to provide the required information to address transportation disadvantage. The results are categorized under the physical, economic, spatial, temporal, psychological, information, and institutional dimensions of transportation disadvantage. The study findings reveal that: (a) Primary smart mobility innovations identified in the literature are demand responsive transportation, shared transportation, intelligent transportation systems, electric mobility, autonomous vehicles, and Mobility-as-a-Services. (b) Smart mobility innovations could benefit urban areas by improving accessibility, efficiency, coverage, flexibility, safety, and the overall integration of the transportation system. (c) Smart mobility innovations have the potential to contribute to the alleviation of transportation disadvantage. (d) Mobility-as-a-Service has high potential to alleviate transportation disadvantage primarily due to its ability to integrate a wide-range of services.

Evaluation Indexes and Correlation Analysis of Origination–Destination Travel Time of Nanjing Metro Based on Complex Network Method

The information level of the urban public transport system is constantly improving, which promotes the use of smart cards by passengers. The OD (origination–destination) travel time of passengers reflects the temporal and spatial distribution of passenger flow. It is helpful to improve the flow efficiency of passengers and the sustainable development of the city. It is an urgent problem to select appropriate indexes to evaluate OD travel time and analyze the correlation of these indexes. More than one million OD records are generated by the AFC (Auto Fare Collection) system of Nanjing metro every day. A complex network method is proposed to evaluate and analyze OD travel time. Five working days swiping data of Nanjing metro are selected. Firstly, inappropriate data are filtered through data preprocessing. Then, the OD travel time indexes can be divided into three categories: time index, complex network index, and composite index. Time index includes use time probability, passenger flow between stations, average time between stations, and time variance between stations. The complex network index is based on two models: Space P and ride time, including the minimum number of rides, and the shortest ride time. Composite indicators include inter site flow efficiency and network flow efficiency. Based on the complex network model, this research quantitatively analyzes the Pearson correlation of the indexes of OD travel time. This research can be applied to other public transport modes in combination with big data of public smart cards. This will improve the flow efficiency of passengers and optimize the layout of the subway network and urban space.