Prevalence and correlates of successful ageing: a comparative study between China and South Korea

Prevalence of successful aging in older adults: A systematic review and meta-analysis

BACKGROUND

Successful aging (SA) describes the multidimensional aspects of achieving optimal physical and mental health and social well-being combinations in old age. Recent years have seen increasing interest in understanding SA prevalence. This study systematically evaluates the current state of SA globally, defined as multidimensional outcomes.

OBJECTIVE

To systematically evaluate the global prevalence of SA in older adults.

METHODS

We searched PubMed, Embase, Web of Science, Cochrane Library, China Biomedical Database, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and Weipu Database from inception to February 14, 2024. Two researchers independently conducted literature screening, data extraction, and quality evaluation. Meta-analysis was performed using Stata 16.0.

RESULTS

Thirty studies comprising 250,460 older adults were included. Meta-analysis showed the overall global prevalence of SA was 24.0 % [95 % CI (20.7 %, 27.3 %)]. Prevalence rates were 25.1 % in Asia, 21.5 % in Europe, 20.6 % in the Americas; 16.8 % in developed and 27.1 % in developing countries. Subgroup analyses indicated higher SA rates among male older adults, married/cohabiting, living in urban areas, and having higher education levels.

CONCLUSIONS

The global prevalence of SA among older adults is low, with variations across age groups, regions, and education levels. Due to the limitations of the included studies, further high-quality research is needed to validate these findings.

Successful Aging Rates of Global Older Adults: A Systematic Review and Meta-analysis

OBJECTIVE

This meta-analysis aimed to qualitatively analyze the different aspects of the successful aging (SA) criteria and quantitatively assess the rate of SA and its different dimensions among people aged ≥60 years globally to provide a basis for constructing criteria for SA.

DESIGN

This is a systematic review and meta-analysis, which has been registered on PROSPERO (CRD42024585934).

SETTING AND PARTICIPANTS

Older adults (≥60 years).

METHODS

PubMed, Embase, CINAHL, Web of science, SCOPUS, and PsycINFO (inception to July 17, 2023) were used to search for relevant studies to evaluate the comprehensive level of SA. A random effects model was used to synthesize SA rates and 95% CIs. Quality assessment was conducted using the Agency for Healthcare Quality and Research criteria and the Newcastle-Ottawa Scale. Statistical analyses were conducted using Revman 5.3 and Stata 11.0.

RESULTS

A total of 546,228 older adults from 64 studies were incorporated into the meta-analysis. In the 64 studies, SA criteria mentioned 11 aspects: psychology, disease, cognitive function, physical function, social engagement, disability, independence, self-rated health, economy, memory impairment, and obesity. The meta-analysis indicated that the summary estimate of SA rate among people aged ≥60 years was 22.0% (95% CI 19.0%-25.0%) globally. A meta-analysis was conducted on the 6 aspects included more commonly in SA criteria, and the results showed that the rate of no disability was the highest (72.0%), followed by good psychological status (69%), active social engagement (65%), high cognitive function (64%), and high physical function (62%), with no major diseases being the lowest (50.0%).

CONCLUSIONS AND IMPLICATIONS

The overall estimated SA rate among people aged ≥60 years was 22% globally. The SA criteria mainly include 6 aspects: good psychological status, no major diseases, high cognitive function, high physical function, active social engagement, and no disability. Emphasizing the importance of psychological well-being and chronic disease management, the findings offer valuable insights for future research and policy making related to the welfare of aging populations.

Changes in successful aging and its related indicators among community-dwelling older adults: The Korean Frailty and Aging Cohort Study (KFACS)

This study aims to determine the prevalence of successful aging (SA) and examine the association of changes in the indicators of SA and variations in SA status between 2016 and 2020. The study included 548 participants recruited for the Korean Frailty and Aging Cohort Study (KFACS). Compared to participants who achieved SA in 2016 (N = 393, 71.7%), the number of older adults with SA decreased by 7.8% in 2020. Among older adults preserving SA (SA→SA group, 54%), there were relatively small numbers of older adults who successfully maintained indicators, including chronic diseases (no→no, 9.5%), employment (yes→yes, 12.2%), and volunteer activities (yes→yes, 2.9%). Our findings suggest that interventions to strengthen the physical and psychological function of older adults are needed, and social support needs to be guaranteed to improve social engagement for older adults.

Functional disability and receipt of informal care among Chinese adults living alone with cognitive impairment

BACKGROUND

Adults with cognitive impairment are prone to living alone in large numbers but receive relatively little attention. This study aimed to evaluate whether living alone with cognitive impairment was associated with a higher burden of functional disability but lack of informal care.

METHODS

982 observations of adults living alone with cognitive impairment and 50,695 observations of adults living with others and with normal cognition were identified from 4 waves (2011/2012, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS). A matched comparator was selected using propensity score matching (1:2). Functional disability included disability in Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and mobility. The time of receiving informal care was measured in monthly hours.

RESULTS

Adults living alone with cognitive impairment demonstrated significantly higher odds ratio of ADL disability (OR = 1.59, 95 % CI: 1.30, 1.95), IADL disability (OR = 1.19, 95 % CI: 1.00, 1.44), mobility disability (OR = 1.38, 95 % CI: 1.12, 1.70), but received fewer hours of informal care (β = -127.7 h per month, standard error = 25.83, P < 0.001), compared to the adults living with others and with normal cognition.

CONCLUSIONS

This study highlights the high burden of functional disability but low coverage of informal care among Chinese adults living alone with cognitive impairment and calls for more resources to be allocated to this vulnerable subpopulation to improve the functional health and to increase the provision of long-term care services.

Regional differences in the Association of Healthy Aging with the incidence of falls: an analysis based on the China Health and Retirement Longitudinal Study from 2011 to 2020

Background

Falls frequently occur among the older adult population. In this study, we examined the variations in fall incidence across different regions over time, focusing on the disparities between urban and rural areas among older adult Chinese individuals, Healthy aging is comprised of five dimensions: (1) absence of chronic diseases, (2) good physical functioning, (3) normal cognitive function, (4) active social participation, and (5) absence of depression. Additionally, we explored the relationship between healthy aging and the occurrence of falls in middle-aged and older adults. Falls are defined as events that occurred within the past two years.

Results

Among 9,918 participants, 33.8% lived in urban areas and 23.0% achieved healthy aging. In contrast, 66.2% resided in rural areas with 16.5% achieving healthy aging. In 2011, rural residents had a higher fall incidence rate (17% in rural vs. 13.5% in urban); by 2020, the fall rate remained higher in rural areas (19.5% in rural vs. 17.3% in urban). Unhealthy aging (HR = 1.08, 95%CI: 1.00-1.16) were risk factors for falls. Subgroup analysis revealed that in rural areas, unhealthy aging increased the risk of falls. In urban areas, the increased risk of falls associated with unhealthy aging was not significant (Rural HR = 1.11, 95%CI:1.01-1.22; Urban HR = 1.05, 95%CI: 0.93-1.18).

Conclusion

Healthy aging may be more strongly associated with a lower risk of falls in rural areas, while this association might be less pronounced in urban areas due to different environmental and social factors. This highlights the need for environment-specific fall prevention strategies and targeted measures for the older adult.

Trend analysis and influencing factors of healthy aging in middle-aged population in China: a longitudinal study based on the China Health and Retirement Longitudinal Study

OBJECTIVES

This study aimed to assess the trends of healthy aging and investigate its determinants in the middle-aged population.

STUDY DESIGN

This was a longitudinal study.

METHODS

The sample comprised 3043 participants aged 45-59 years from the China Longitudinal Study of Health and Retirement 2011-2018. We plotted the prevalence across four waves and used ordered logistic models to investigate the determinants of cumulative times of healthy aging.

RESULTS

We enrolled 3043 middle-aged people in our study. The prevalence of healthy aging is 28.2% at baseline but subsequently decreased to 19.72% at wave 4. Active socializing consistently ranked the lowest among the five dimensions. Participants with older age (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.94-0.97), low monthly income (OR = 0.82, 95% CI: 0.69-0.97) or lived in urban (OR = 0.81, 95% CI: 0.70-0.94) were less likely to have per time increase in healthy aging. Participants with more than primary school degree (OR = 1.79, 95% CI: 1.31-2.46), high life satisfaction (OR = 2.38, 95% CI: 1.86-3.06), and good self-report health (OR = 1.97, 95% CI: 1.66-2.34) were more likely to have healthy aging.

CONCLUSION

The number of middle-aged individuals in China who achieved healthy aging is declining and eventually less than one in five, which was far from ideal. Particular attention should be paid to older, women, urban dwellers, individuals with low income, low life satisfaction or poor self-report health. It is urgent to develop public health policies to improve the health and well-being of the middle-aged population.

Geographical variation, demographic and socioeconomic disparities in Active Ageing: The situation in Thailand

Objectives

Being healthy and active is a goal to achieve a better quality of life as individuals age. This study aimed to explore and validate the Active Ageing (AA) model, and examine geographic variations, and demographic and socioeconomic disparities.

Study design

Utilising a cross-sectional secondary data analysis, the analytic unit is older adults aged 60-80 across all provinces in Thailand.

Methods

Exploratory Factor Analysis explored the AA structures, and the second-order Confirmatory Factor Analysis validated the model fit. Factor scores were used to identify geographic variation and sociodemographic disparities in AA. The association between geographic, and sociodemographic characteristics, and AA was examined through hierarchical regression analysis.

Results

The AA model, comprised of 14 indicators representing three latent factors-physical health, participation, and security-exhibited an optimal fit. Geographic inequality in AA emerged across the country, with specific areas linked to lower AA. An inverse relation between participation and security was observed. Rural residence, younger age, male, being married, and adequate income were associated with better AA. The association between AA and geographic, demographic, and socioeconomic emphasised the positive role of marital and economic status.

Conclusions

This study contributes to understanding the social determinants of health by constructing a comprehensive AA model. The findings highlight the geographic variations and demographic and socioeconomic disparities in AA across Thailand. While AA generally declines with age, a better economy may help alleviate these disparities. These findings underscore the need for tailored social and public health policies, avoiding a "one-size-fits-all" approach.

Regional differences in the effects of healthy aging on depressive symptoms: a Korean longitudinal study of aging (2006-2020)

Background

Depression is a widely prevalent, often recurrent condition. To analyze the regional differences in depressive symptoms over time, we investigated urban-rural differences in change in depression over time in South Korea and the association between healthy aging and depressive symptoms among middle-aged and older adults.

Methods

Data collected in the Korean Longitudinal Study of Aging, from 2006 to 2020, of adult participants aged ≥45 years without depressive symptoms were analyzed. Healthy aging was defined under five principal components: absence of chronic disease, good physical function, normal cognitive function, active social engagement, and good psychological adaptation. Depressive symptoms were measured using the short version of the Center for Epidemiologic Studies Depression Scale. Using the Andersen-Gill model for recurrent time-to-event, we examined the effect of healthy aging on depressive symptoms, with a subgroup analysis based on the residential area.

Results

Of the 7,708 participants, 78.2% lived in urban areas and 39.4% achieved healthy aging. In 2008, rural residents had a higher incidence of depressive symptoms (rural 11.8%; urban 8.9%); however, after 2016, the depressive symptoms of urban residents gradually increased (rural 6.4%; urban 12.1%). Unhealthy aging (adjusted hazard ratio = 3.04, 95% confidence interval: 2.72-3.39) and urban residence (adjusted hazard ratio = 1.15, 95% confidence interval: 1.06-1.24) were risk factors for depressive symptoms. The subgroup analysis revealed that individuals who did not achieve healthy aging had an increased risk of depressive symptoms, regardless of their residential area (hazard ratio [95% confidence interval]: urban, 3.13 [2.75-3.55]; rural 2.59 [2.05-3.28]).

Conclusion

As urbanization accelerates, urban residents have a higher risk of depressive symptoms than rural residents. Healthy aging is an essential factor in reducing depressive symptoms. To achieve healthy aging, appropriate interventions and policies that target the middle-aged adults and gradually extend to older adults are needed, considering individual and regional factors.

Healthy Aging and its Determinants Among Community-dwelling Older Persons in East Coast, Malaysia: A Multidimensional Assessment

Objectives

Exploring the possibility of healthy aging among older persons is crucial for achieving optimal health in the growing older population. This study aimed to determine the prevalence, pattern, and determinants of healthy aging among older persons in Terengganu, Malaysia.

Methods

We conducted a community-based cross-sectional study involving older persons aged % 60 years. An interviewer-guided questionnaire, anthropometric measurements, and physical assessments were administered to operationalize healthy aging based on a multidimensional concept.

Results

Among the 765 older persons surveyed, only 14.1% (95% CI: 11.64?"16.59) were classified as healthy agers. Multiple logistic regression analysis revealed that superior intrinsic religiosity (odds ratio (OR) = 3.42; 95% CI: 1.34?"8.73), higher social interaction (OR = 2.82; 95% CI: 1.32?"6.04), larger calf circumference (OR = 2.05; 95% CI: 1.24?"3.38), taking water intake % 5 cups per day (OR = 2.01; 95% CI: 1.23?"3.30), better gait speed (OR = 1.71; 95% CI: 1.04?"2.80), having savings (OR = 1.71; 95% CI: 1.10?"2.66), and normal waist circumference (OR = 1.63; 95% CI: 1.04?"2.55) were found positively associated with healthy aging.

Conclusions

Only one in 10 older persons in the state met all the criteria for healthy aging. Specific aspects of religious status, social interaction, socioeconomic, behavioral, physical, and nutritional factors were found to predict healthy ageing in this population. These important determinants should be considered in developing a well-defined and comprehensive public health policy to promote healthy aging in the nation.

Physiologically based pharmacokinetic (PBPK) modelling of oral drug absorption in older adults - an AGePOP review

The older population consisting of persons aged 65 years or older is the fastest-growing population group and also the major consumer of pharmaceutical products. Due to the heterogenous ageing process, this age group shows high interindividual variability in the dose-exposure-response relationship and, thus, a prediction of drug safety and efficacy is challenging. Although physiologically based pharmacokinetic (PBPK) modelling is a well-established tool to inform and confirm drug dosing strategies during drug development for special population groups, age-related changes in absorption are poorly accounted for in current PBPK models. The purpose of this review is to summarise the current state-of-knowledge in terms of physiological changes with increasing age that can influence the oral absorption of dosage forms. The capacity of common PBPK platforms to incorporate these changes and describe the older population is also discussed, as well as the implications of extrinsic factors such as drug-drug interactions associated with polypharmacy on the model development process. The future potential of this field will rely on addressing the gaps identified in this article, which can subsequently supplement in-vitro and in-vivo data for more robust decision-making on the adequacy of the formulation for use in older adults and inform pharmacotherapy.

Latent subgroups with distinct patterns of factors associated with self-rated successful aging among 1,510 community-dwelling Americans: potential role of wisdom as an implicit promoter

OBJECTIVES

To investigate whether latent subgroups with distinct patterns of factors associated with self-rated successful aging can be identified in community-dwelling adults, and how such patterns obtained from analysis of quantitative data are associated with lay perspectives on successful aging obtained from qualitative responses.

METHODS

Cross-sectional data were collected from 1,510 community-dwelling Americans aged 21-99 years. Latent class regression was used to identify subgroups that explained the associations of self-rated successful aging with measures of physical, cognitive, and mental health as well as psychological measures related to resilience and wisdom. Natural language processing was used to extract important themes from qualitative responses to open-ended questions, including the participants' definitions of successful aging.

RESULTS

Two latent subgroups were identified, and their main difference was that the wisdom scale was positively associated with self-rated successful aging in only one subgroup. This subgroup had significantly lower self-rated successful aging and worse scores for all health and psychological measures. In the subgroup's qualitative responses, the theme of wisdom was only mentioned by 10.6%; this proportion was not statistically different from the other subgroup, for which the wisdom scale was not statistically associated with the self-rated successful aging.

CONCLUSION

Our results showed heterogeneous patterns in the factors underpinning successful aging even in community-dwelling adults. We found the existence of a latent subgroup with lower self-rated successful aging as well as worse health and psychological scores, and we suggest a potential role of wisdom in promoting successful aging for this subgroup, even though individuals may not explicitly recognize wisdom as important for successful aging.

Individual and environmental factors associated with successful aging among Korean older adults: Multilevel analysis of cross-sectional nationwide survey data

PURPOSE

The importance of environmental influences on successful aging has recently been emphasized. However, existing studies that investigated environmental factors related to successful aging in older adults did not apply multi-level analysis while simultaneously examining individual and environmental factors related to successful aging. Therefore, this study aimed to determine the level of successful aging in older adults and the individual and environmental factors related to successful aging.

MATERIALS AND METHODS

Data from a nationwide survey were used. The study comprised a cross-sectional sample of 73,942 community-dwelling adults aged ≥65 years with individual-level data drawn from the 2019 Korea Community Health Survey. Community-level data of 255 local administrative districts (cities or counties) were extracted from the Community Health Determinant Database from 2017 to 2019. These data were merged and used in multi-level logistic regression analyses.

RESULTS

Generally, 27.1% of the participants achieved successful aging. Individual factors including sex, age, marital status, education level, job, monthly household income, smoking, physical activity, and body mass index were significantly associated with successful aging. Four environmental factors, urban residential area, social network, satisfaction with living environment, and air quality, were positively associated with successful aging at the community level; among them, high satisfaction with living environment (OR = 6.06, 95% CI: 2.43-15.12) was the most strongly associated factor with successful aging.

CONCLUSIONS

The findings suggest that environmental factors are essential for successful aging among older adults in addition to individual factors. Therefore, multiple strategies considering individual and environmental factors are needed to improve successful aging.

Multivariate decomposition of gender differentials in successful aging among older adults in India

BACKGROUND

Rowe and Kahn define successful aging as a high physical, psychological, and social functioning in old age without major diseases. It is considered a viable solution to the burdens placed on healthcare systems and financial and social security in societies with aging population. The present study aimed to determine the prevalence of successful aging and explore the factors contributing to gender differentials in successful aging among older adults in India.

METHODS

This study utilized data from the nationally representative Longitudinal Ageing Study in India, conducted in 2017-18. The study is based on a sample of 15,098 older men and 16,366 older women aged 60 years and above. The outcome variable was a dichotomous measure of successful aging with six components including absence of chronic diseases, free from disability, high cognitive ability, free from depressive symptoms, active social engagement in life and free from obesity. Older adults satisfying all these conditions were considered aging successfully. Descriptive and bivariate analyses were carried out. Proportion test was used to evaluate the gender differentials and reflect the statistical significance in the associated factors. Multivariate decomposition analysis was conducted to identify covariates' contribution in explaining the gender differences in successful aging.

RESULTS

There was a significant gender difference in successful aging among older adults in India (Difference: 8.7%; p-value < 0.001] with 34.3% older men and 25.6% older women experiencing successful aging. A proportion of 88% of gender difference in successful aging was explained by the differences in the distribution of characteristics (Coef: 0.082; p-value < 0.05). Considerable gender gap in successful aging would be reduced if women had similar levels of work status (28% reduction) to their male counterparts. Bringing the level of frequent physical activity in women to the same levels observed in men would reduce the gender gap by 9%.

CONCLUSIONS

The findings suggest that women had a lower score in successful aging, which is attributed to several socioeconomic and behavioural factors including not working status and physical inactivity. More studies must be done to explore the reasons for such differences and what particular factors in low-income countries create differences among older men and women in achieving successful aging.

Preliminary Analysis of Volume-Based Resting-State Functional MRI Characteristics of Successful Aging in China

BACKGROUND

Resting-state function MRI (rs-fMRI) research on successful aging can provide insight into the mechanism of aging with a different perspective from aging-related disease.

OBJECTIVE

rs-fMRI research was used to analyze the brain function characteristics of successful aging.

METHODS

A total of 47 usual aging individuals and 26 successful aging (SA) individuals underwent rs-fMRI scans and neuropsychological tests. Volume-based rs-fMRI data analysis was performed with DPASF to obtain ALFF, ReHo, DC, and VMHC.

RESULTS

The SA group showed increased ALFF in right opercular part of inferior frontal gyrus (Frontal_Inf_Oper_R) and right supramarginal gyrus; increased ReHo in right middle temporal pole gyrus and decreased ReHo in left superior frontal gyrus and middle occipital gyrus; increased DC in right medial orbitofrontal gyrus and pulvinar part of thalamus; decreased DC in left fusiform gyrus and right medial frontal gyrus; increased VMHC in right medial orbitofrontal gyrus; and decreased VMHC in the right superior temporal gyrus, right and left middle temporal gyrus, right and left triangular part of inferior frontal gyrus. ALFF in Frontal_Inf_Oper_R were found to be significantly correlated with MMSE scores (r = 0.301, p = 0.014) and ages (r = -0.264, p = 0.032) in all subjects, which could be used to distinguish the SA (AUC = 0.733, 95% CI: 0.604-0.863) by ROC analysis.

CONCLUSION

The brain regions with altered fMRI characteristics in SA group were concentrated in frontal (6 brain regions) and temporal (4 brain regions) lobes. ALFF in Frontal_Inf_Oper_R was significantly correlated to cognitive function and ages, which might be used to distinguish the SA.

Gender Disparities in Healthy Aging: A Cross-National Comparative Study in the United States and South Korea from 2006 to 2016

Using the 2006-2016 wave of Health and Retirement Study and Korean Longitudinal Study of Aging, this study explores the gender disparities in the health of older adults in the United States and South Korea. A logit model is adopted to explore the differences in the likelihood of aging healthily by gender in two countries. Results indicate that older females in the United States have a significantly higher probability of healthy aging than their male counterparts. However, the opposite finding is demonstrated among the older population in South Korea. These results are verified using various robustness check methods. The heterogeneities in the gender disparities in healthy aging across age groups and income levels are further explored. The gender effect in each healthy aging domain is investigated to understand the underlying causes of gender disparities. These findings can provide cross-national insights for policymakers to establish targeted aging policies with a gender perspective.

The influence of environmental awareness and conditions on successful aging: Evidence of air and water pollution in China

This study examines three aspects of successful aging including subjective health, cognitive ability, and social participation and their relations with environmental conditions and environmental awareness. We used the seemingly uncorrelated regression and multilevel models to estimate the joint relationship by combining the Chinese General Social Survey (2013 and 2021) (N = 5404 and 1580 accordingly) and the Chinese Statistical Yearbook and used propensity score analysis to identify potential endogenous issues. The first finding is that older people who were men, married, lived in urban areas, or received social security had an edge in aging successfully. Secondly, the adverse effects of environmental pollution on older adults' cognitive ability and social participation can be reduced by the protective effects of environmental awareness. Additionally, air pollution had more apparent effects, and water pollution was more modest in social involvement. This study offers empirical results to enhance the well-being of the older population by lifting their environmental perception and improving environmental quality.

Obesity-related measures and successful ageing among community-dwelling older adults in India: a cross-sectional study

Obesity is a chief lifestyle disease globally and causes a significant increase in morbidities. Overweight/ obesity prevalence has been rising faster in India compared to the world average. Therefore, the study examined the association between overweight/ obesity and successful ageing among older population in India. We also explored the gender difference in risks posed by obesity on successful ageing and the different socio-economic correlates associated with successful ageing. This study utilized data from India's first nationally representative longitudinal ageing survey (LASI-2017-18). The effective sample size for the present study was 31,464 older adults with a mean age of 69.2 years (SD: 7.53). Overweight/ obesity was defined as having a body mass index of 25 or above. The study carried out a bivariate analysis to observe the association between dependent and independent variables. Further, multivariable analysis was conducted to examine the associations after controlling for individual socio-demographic, lifestyle and household/community-related factors. The study included 47.5% men and 52.5% women. It was found that the prevalence of obesity/overweight was higher among older women compared to older men (23.2% vs 15.5%). Similarly, high-risk waist circumference (32.7% vs 7.9%) and high-risk waist-hip ratio (69.2% vs 66.5%) were more prevalent among older women than older men. The study found significant gender differences (men-women: 8.7%) in the prevalence rate of successful ageing (p < 0.001). The chances of successful ageing were significantly higher among older adults who were not obese/overweight [AOR: 1.31; CI 1.31-1.55], had no high-risk waist circumference [AOR: 1.41; CI 1.29-1.54], and those who had no high-risk waist-hip ratio [AOR: 1.16; CI 1.09-1.24] compared to their respective counterparts. Interaction results revealed that older women who were not obese/overweight had a lower likelihood of successful ageing compared to the older men who was not obese/overweight [AOR: 0.86; CI 0.80-0.93]. Similarly, older womens who had no high-risk waist circumference [AOR: 0.86; CI 0.80-0.96] and no high risk-hip ratio [AOR: 0.81; CI 0.73-0.89] were less likely to have successful ageing compared to their counterparts, respectively. Being overweight/ obese and having high-risk waist circumference and waist-hip ratio were found to be significant factors associated with less successful ageing among older adults, especially women in this study. The current findings highlight the importance of understanding the modifiable factors, including nutritional awareness and developing targeted strategies for promoting successful ageing.

Longitudinal Association Between Depressive Symptoms and Cognitive Function Among Older Adults: A Latent Growth Curve Modeling Approach

Objectives: Although the evidence from numerous longitudinal studies has indicated a remarkable change in cognitive function (CF) and depressive symptoms (DS) over time, the parallel latent growth curve model (LGCM) has seldom been used to simultaneously investigate the relationship between their change trajectories. This study aimed to examine whether a change in DS was associated with CF over time using an LGCM. Methods: Data were collected from the Chinese Longitudinal Healthy Longevity Survey's 2011, 2014, and 2018 waves. A parallel LGCM examined the association between CF and DS. Results: The multivariate conditioned model's goodness of fit supported the validity of the longitudinal model (Tucker-Lewis index [TLI] = 0.90, comparative fit index [CFI] = 0.96, root mean square error of approximation [RMSEA] = 0.04). The results showed that the CF intercept was positively to the DS slope (β = 0.42, p = 0.004). The CF and DS slopes were significantly linked (β = -0.65, p = 0.002). Conclusion: The findings expand the knowledge about CF's effect on DS in older adults.

Prevalence and Associated Factors of Successful Ageing among People 50 Years and Older in a National Community Sample in Thailand

The aim of the study was to assess the prevalence and associated factors of successful ageing (SA) among people 50 years and older in Thailand. We analyzed national cross-sectional data (5092 men and women 50 years or older) from the Health, Aging and Retirement in Thailand (HART) study in 2015. The SA measures included (1) life satisfaction, (2) social engagement, (3) no major illness, (4) no probable depression, and (5) absence of functional disability. The sample included 5092 participants (median age 67 years, interquartile range 60 to 78 years). The prevalence of SA was 60.0% in adults 50 years and older, ranging from 43.8% in Krabi province to 80.2% in Pathum Thani province, 58.1% (≥60 years), and 56.3% (≥65 years), and the prevalence of the components of SA was 92.3% without major illness, 96.1% without functional disability, 87.5% without probable depression, 91.3% social engagement, and 82.3% high life satisfaction. In multivariable Poisson regression analysis, Buddhist religion (adjusted Prevalence Ratio (aPR): 1.50, 95% Confidence Interval (CI): 1.25 to 1.79), high subjective economic status (aPR: 1.29, 95% CI: 1.11 to 1.49), and physical activity (≥150 min/week) (aPR: 1.11, 95% CI: 1.01 to 1.24) were positively associated and increasing age (aPR: 0.993, 95% CI: 0.989 to 0.997) was negatively associated with SA. Almost two in three older adults in Thailand were successfully ageing. Factors associated with SA included being Buddhist, younger age, higher subjective economic status, and higher engagement in physical activity. These identified factors should be incorporated into health promotion intervention programs in Thailand.

Developing a Cross-National Disability Measure for Older Adult Populations across Korea, China, and Japan

This study aims to develop a universal scale for comparing cognitive and physical functions among countries using health survey data from China, Korea, and Japan. This study used the data of 934 participants from the Korean Longitude Study of Aging, 2506 participants from the China Health and Retirement Longitude Study, and 178 participants from the Japanese Study of Aging and Retirement. Each physical and cognitive function item in the three countries has five key items. The anchoring method used the key items to link each cognitive and physical function of the three countries. We investigated the psychometric characteristics of the final item using the Rasch analysis. We extracted 13 items of 19 cognitive function items and 20 items out of 29 physical function items using the anchoring method and the Rasch analysis. The Rasch analysis showed good fit statistics for 13 cognitive function items and 20 physical function items. The measurement scale developed in this study will enable valid comparisons of older adults' cognitive and physical functions across these three countries.

Classifying and characterizing the development of self-reported overall quality of life among the Chinese elderly: a twelve-year longitudinal study

Background

To promote healthy aging, the information about the development of quality of life (QoL) is of great importance. However, the explorations of the heterogeneity in the change of QoL under the Chinese context were limited. This study aimed to identify potential different development patterns of QoL and the influential factors using a longitudinal, nationally representative sample of the Chinese elderly.

Methods

We adopted a five-wave longitudinal dataset from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), and a total of 1645 elderly were obtained. The sample had a mean age of 72.7 years (SD = 6.64) and was 47.2% male. Overall QoL was measured through self-report during the longitudinal process. We utilized the conditional growth mixture model (GMM) with time-invariant covariates (TICs) to explore various development patterns and associated factors.

Results

Three distinct trajectories of self-reported overall QoL were identified: the High-level Steady Group (17.08%), the Mid-level Steady Group (63.10%), and the Low-level Growth Group (19.82%). Results also indicated that several factors predicted distinct trajectories of self-reported overall QoL. Those elderly who received enough financial resources, had adequate nutrition, did not exhibit any disability, engaged in leisure activities, and did less physical labor or housework at the baseline were more likely to report a higher level of overall QoL over time.

Conclusions

There existed three development patterns of self-reported overall QoL in elders, and the findings provided valuable implications for the maintenance and improvement of QoL among the Chinese elderly. Future studies could examine the influence of other confounding factors.

Decomposing rural-urban differences in successful aging among older Indian adults

The modernization and shift towards urbanized lifestyles have triggered several diseases, and the context of aging varies in urban and rural settings in India. The study aimed to investigate the urban-rural differences in successful ageing among older adults in India and the contributing factors in those differences. The study utilizes data from nationally representative Longitudinal Ageing Study in India (LASI, 2017-18). The analytical sample size for the study was 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis were carried out to present the initial results. Multivariable logistic regression and decomposition analysis was used to find the associations between explanatory variables and successful aging and to identify the contributions of covariates that explain the rural-urban differences in successful ageing. A proportion of 32% and 24% of older adults from rural and urban areas were successful agers with an urban disadvantage. Urban-dwelling older adults had 0.67 times [95% confidence interval (CI): (0.64, 0.71)] lower unadjusted odds of successful ageing than rural older adults. Again, after adjusting for the effect of other explanatory variables, urban older adults had 0.92 times [CI: (0.87, 0.98)] lower odds of being successful agers than their rural counterparts. The major contributors to the rural-urban inequality in successful aging were differences in regional distribution (17% contribution), waist circumference (16%), working status (16%), body mass index (13%) and physical activity (8%) among rural and urban older adults. The urban disadvantage in aging successfully may reflect the higher prevalence of adverse lifestyle behaviours in urban dwellers and under-diagnosis and under-reporting of many diseases in rural areas, particularly non-communicable diseases, suggesting the need for further investigation.

Sleep Quality Partially Mediate the Relationship Between Depressive Symptoms and Cognitive Function in Older Chinese: A Longitudinal Study Across 10 Years

Objective

This study aimed to examine the relationship between cognitive function and depressive symptoms and to explore the mediating role of sleep quality in the cognition-depression relationship in Chinese older adults (OAs).

Methods

Data came from a nationally representative sample of 16,209 Chinese OAs (aged 65+) from 2008, 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A random intercept cross-lagged panel model (RI-CLPM) combined with mediation analysis was adopted to determine the relationship between cognitive function and depressive symptoms and the mediating effect of sleep quality on the ascertained cognition-depression relationship.

Results

Poorer cognitive function at prior assessment points were significantly associated with severe depressive symptoms at subsequent assessments, and vice versa. Sleep quality partially mediated the prospective relationship of cognition on depressive symptoms, which accounted for 3.92% of the total effect of cognition on depression.

Discussion

Cognitive decline may predict subsequent depressive symptoms, and vice versa. The impact of cognition on depression is partially explained by its influence on sleep quality. Multidisciplinary interventions aimed at reducing depression and cognitive decline per se as well as improving sleep quality would be beneficial for emotional well-being and cognitive health in OAs.

Development and Validation of a Multimorbidity Index Predicting Mortality Among Older Chinese Adults

Objective

This study aimed to develop and validate a multimorbidity index using self-reported chronic conditions for predicting 5-year mortality risk.

Methods

We analyzed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and included 11,853 community-dwelling older adults aged 65–84 years. Restrictive association rule mining (ARM) was used to identify disease combinations associated with mortality based on 13 chronic conditions. Data were randomly split into the training (N = 8,298) and validation (N = 3,555) sets. Two multimorbidity indices with individual diseases only (MI) and disease combinations (MIDC) were developed using hazard ratios (HRs) for 5-year morality in the training set. We compared the predictive performance in the validation set between the models using condition count, MI, and MIDC by the concordance (C) statistic, the Integrated Discrimination Improvement (IDI), and the Net Reclassification Index (NRI).

Results

A total of 13 disease combinations were identified. Compared with condition count (C-statistic: 0.710), MIDC (C-statistic: 0.713) showed significantly better discriminative ability (C-statistic: p = 0.016; IDI: 0.005, p < 0.001; NRI: 0.038, p = 0.478). Compared with MI (C-statistic: 0.711), the C-statistic of the model using MIDC was significantly higher (p = 0.031), while the IDI was more than 0 but not statistically significant (IDI: 0.003, p = 0.090).

Conclusion

Although current multimorbidity status is commonly defined by individual chronic conditions, this study found that the multimorbidity index incorporating disease combinations showed supreme performance in predicting mortality among community-dwelling older adults. These findings suggest a need to consider significant disease combinations when measuring multimorbidity in medical research and clinical practice.

The Relationship Between Successful Aging and All-Cause Mortality Risk in Older Adults: A Systematic Review and Meta-Analysis of Cohort Studies

Background

This meta-analysis aimed to explore the effect of successful aging (SA) on all-cause mortality risk in older people to provide a theoretical basis for promoting SA.

Methods

PubMed, Embase, CINAHL, CNKI, and WanFang databases (inception to March 4, 2021) were searched for cohort studies to evaluate the relationship between SA and mortality in older people. A random-effects model was used to synthesis hazard ratio and 95% confidence intervals. Quality assessment was performed using the Newcastle–Ottawa scale. All statistical analyses were conducted in STATA 16.0.

Results

In total, 21,158 older adults from 10 studies were included in the current systematic review and meta-analysis. The SA group tended to have 50% lower risk of all-cause mortality than the non-SA group (pooled hazard ratio = 0.50, 95% confidence intervals: 0.35–0.65, P < 0.001; I² = 58.3%). The risk of all-cause mortality in older people increased by 17% for each unit increment in the healthy aging index (HAI) (I² = 0%, P = 0.964). Compared with the reference group (HAI 0-2), older people with HAI 3-4, HAI 5-6, and HAI 7-10 had 1.31-fold, 1.73-fold, and 2.58-fold greater risk of all-cause mortality, respectively. Subgroup analysis did not reveal possible sources of heterogeneity.

Conclusions

This meta-analysis suggests that older adults with SA reduced the risk of all-cause mortality by 50%. However, few interventional studies have been conducted. Therefore, healthcare providers must be aware of the relationship between SA and mortality risk and actively develop intervention methods for helping old people achieve SA.

Childhood adversity and healthy ageing: a study of the Chinese older population

This study examines the relationship between childhood adversities and healthy ageing in the Chinese older population. The data come from the China Health and Retirement Longitudinal Survey (CHARLS), a national survey that collected life history and ageing-related information on 9248 older people aged over 60 in 2014 and 2015. The analysis of healthy ageing focuses on seven indicators: IADL limitations, ADL limitations, cognitive functioning, depressive symptoms, life satisfaction, self-reported health, and chronic illness. Using k-means clustering, an unsupervised learning technique, we identified four qualitatively different groups according to their achievement in healthy ageing. We studied 17 types of childhood adversities and found that experiencing multiple childhood adversities is associated with a lower probability of achieving healthy ageing. This relationship is moderated by age and gender. Women are more vulnerable than men to the negative impacts of childhood adversities. The threat of childhood adversities to healthy ageing is greatly attenuated among people aged over 80. We argue that the policy response to healthy ageing should not be confined to those services and programmes that directly target older people. Instead, healthy ageing can be better addressed by concerted efforts in different areas of social policy.

Successful ageing among a national community-dwelling sample of older adults in India in 2017-2018

This study aimed to determine the prevalence and correlates of successful ageing in older community-dwelling adults in India. The cross-sectional sample included 21,343 individuals (≥ 65 years) from the Longitudinal Ageing Study in India (LASI) Wave 1 in 2017-2018. Successful ageing was assessed utilizing a multidimensional concept, including five components: (1) absence of major illness, (2) free of disability, (3) no major depressive disorder, (4) social engagement and (5) life satisfaction. Overall, 27.2% had successful ageing, including 83.3% had no major diseases, 51.0% free from disability, 91.8% had no major depressive disorder, 73.6% were socially engaged and 74.6% had high life satisfaction. In the adjusted logistic regression analysis, male sex (Adjusted Odds Ratio-AOR 1.40, 95% Confidence Interval-CI 1.21-1.26), married (AOR 1.48, 95% CI 1.22-1.79), having formal education (AOR 1.47, 95% CI 1.23-1.74), high subjective socioeconomic status (AOR 1.61, 95% CI 1.29-2.01), urban residence (AOR 1.42, 95% CI 1.19-1.70), Sikhs (AOR 1.76, 95% CI 1.38-2.24), high physical activity (AOR 1.65, 95% CI 1.38-1.97), and daily Yoga practice (AOR 1.34, 95% CI 1.11-1.61) increased the odds of successful ageing, while increasing age (AOR 0.96, 95% CI 0.94-0.79), poor childhood health (AOR: 0.47, 95% CI 0.29-0.75), and underweight (AOR 0.70, 95% CI 0.61-0.81) decreased the odds of successful ageing. Almost one in three older adults in India were successfully ageing. Factors associated with successful ageing included, male sex, married, having formal education, high subjective socioeconomic status, urban residence, Sikhs, physical activity, Yoga practice, younger age, good childhood health, and not having underweight.

Successful Aging in East Asia: Comparison Among China, Korea, and Japan

OBJECTIVES

Heterogeneity in successful aging has been found across countries. Yet, comparable evidence is sparse except in North America and Europe. Extending prior research, this study examined the prevalence and correlates of successful aging in East Asia: China, Korea, and Japan.

METHOD

We used harmonized data sets from national surveys. A total of 6,479 participants (aged between 65 and 75) were analyzed. Using Rowe and Kahn's (1987, 1997) model, successful aging was defined as having no major diseases, no difficulty performing activities of daily living, obtaining a median or higher score on tests of cognitive function, and being actively engaged.

RESULTS

The average prevalence of successful agers was 17.6%. There were variations in the global and specific measures of successful aging within and across countries, even after controlling for individual sociodemographic factors (age, gender, and education). The odds of aging successfully were highest in Japan and lowest in China, especially in the rural areas. Being younger and males were associated with a higher likelihood of successful agers in both global and specific measures.

DISCUSSION

This study observed heterogeneity in successful aging in East Asia. To identify policy implications, future research should explore potential societal factors influencing individuals' opportunities for successful aging.

Successful Aging Among Community-Dwelling Older Adults in Urban Areas of Liaoning Province: The Crucial Effect of Visual Ability

Purpose

Successful aging is an effective approach to coping with population aging; however, the definition and associated factors vary due to culture and demographic distribution differences. This study was designed to assess successful aging of the older adults in China and explore the associated factors.

Methods

A community-based cross-sectional study was performed in Liaoning, China. After double-cognitive function screening, 3558 older adults (1656 males and 1902 females) ≥65 years of age served as our subjects. Successful aging was assessed based on the following: physical disability; cognitive function; activities of daily living; and self-rated psychological/mood status.

Results

The rate of successful aging was 31.7% in males and 29.4% in females. After adjustment for age, multivariate logistic regression showed that successful aging was significantly associated with, in odds ratio sequence, visual ability, self-rated chronic disease, marital status, and filial piety in males, and with visual ability, self-rated chronic disease, watching television, and ethnicity in females.

Conclusion

The level of successful aging in China is lower than in other countries. Demographic characteristics, health status, individual behavior, and social-psychological factors are all associated with successful aging. Overall, visual ability had the most crucial role in successful aging for the older adults, whether males or females.

Ethnic and Gender Disparities in Healthy Ageing among People 50 Years and Older in South Africa

OBJECTIVE

this study aimed to determine the prevalence and correlates of healthy ageing in older adults living in the community in South Africa.

METHODS

the cross-sectional sample consisted of 3734 individuals (≥50 years) from the cross-sectional South African National Health and Nutrition Survey (SANHANES-1) in 2011-2012. Healthy ageing was assessed using a multidimensional concept, which includes five components: (1) absence of major illness, (2) absence of disability, (3) good mental health, (4) social engagement and (5) well-being or good health.

RESULTS

in general, 36.6% had a healthy ageing, including 73.3% had no major diseases, 87.1% were free of disability, 62.3% had good mental health, 73.0% were socially engaged and 64.0% had a high well-being. In the adjusted logistic regression analysis, male sex (Adjusted Odds Ratio-AOR: 1.33, 95% confidence interval-CI: 1.03-1.72), white population group (AOR: 3.46, 95% CI: 2.29-5.22) and coloured population group (AOR: 1.82, 95% CI: 1.34-2.47), were positively associated with healthy ageing, while increasing age (AOR: 0.96, 95% CI: 0.94-0.97), daily tobacco use (AOR: 0.56, 95% CI: 0.42-0.74), perceived underweight (AOR: 0.48, 95% CI: 0.34-0.66) and perceived overweight (AOR: 0.53, 95% CI: 0.34-0.81) were negatively associated with associated with healthy ageing.

CONCLUSION

almost two in five older adults in South Africa were successfully ageing. Factors associated with healthy ageing included, younger age, male sex, population group (Whites, Coloureds), not daily tobacco users, not having underweight and overweight.

Successful aging among community-dwelling palestinian older adults: Prevalence and association with sociodemographic characteristics, health, and nutritional status

Background

Aging population and life expectancy are increasing globally, to cope with this trend, successful aging (SA) attracted the attention of gerontology research to determine its prevalence, risk factors, and its correlates. However, the published research about SA and older adult's health are sparse in Palestine.

Objectives

This study aimed to determine the prevalence and correlates of SA, normal aging, and mild cognitive impairment (MCI) among Palestinian older adults in Hebron governorates.

Methods

A cross-sectional study was conducted during March 2018-May 2018 among a total of 185 participants selected by stratified random sampling from five different areas in Hebron governance. SA was defined based on the multidimentional model; absence of chronic diseases, normal functional status with complete independency, maintains normal cognitive and psychological function and social engagement. Sociodemographic data, nutrition, and health status were also collected and analyzed.

Results

The prevalence of SA among older Palestinians (22.2%), usual aging (58.9%), and the MCI (18.9%), with no significant difference in the prevalence between men and women P <0.05. The most prevalent subdomain is independent living skill (77.8%) and the lowest is the absence of chronic diseases (30.8%). SA was associated with younger older age (60-70 years), still working, and well-nourished participants.

Conclusion

The results of this study revealed, successful aging is associated with younger age, still working and good nutritional status. Further research with appropriate methodology different parts of Palestine is required.

Socioeconomic position and healthy ageing: A systematic review of cross-sectional and longitudinal studies

BACKGROUND

The association between socioeconomic position (SEP) and health is well-established. However, the association between SEP and healthy ageing as a multidimensional construct is unclear.

METHODS

We conducted a systematic review of peer-reviewed cross-sectional and longitudinal studies on the associations between SEP and multidimensional healthy ageing measures. Studies were identified from a systematic search across major electronic databases from inception to February 2021.

RESULTS

Fourthy-five articles met inclusion criteria (26 cross-sectional and 19 longitudinal studies). There was no consistency in method of operationalizing healthy ageing across studies, domains included in the healthy ageing measures, or in the definition and number of levels of SEP indicators. Overall, regardless of heterogeneity between studies, a positive association between educational level (85.0 % of studies) and income/wealth (81.4 % of studies) and healthy ageing was evident. Regarding occupational position, evidence from 11 studies was inconclusive. The number of studies including home ownership, parenteral SEP, or composite SEP scores was insufficient to be able to draw a conclusion.

CONCLUSIONS

There is evidence that socioeconomic inequalities, as assessed by educational level and income/wealth, are associated with healthy ageing. These findings, and the broader evidence base on SEP and healthy ageing, highlight the importance of addressing inequality through integrated health and social policies and strategies.

What intensity of exercise is most suitable for the elderly in China? A propensity score matching analysis

BACKGROUND

The strategy of successful ageing is an important means to deal with the challenges of the current ageing society. This paper aims to explore the effects of different intensities of physical activity on the successful ageing of the elderly.

METHODS

Our data were from wave 4 of the China Health and Retirement Longitudinal Survey (CHARLS), involving 9026 residents aged 60 years and older. The intensity of physical activity was divided into three levels: vigorous, moderate and mild. The concept of successful ageing adopted a four-dimensional model of life satisfaction added to the theoretical model of Rowe and Kahn's. Propensity score matching (PSM) with controlling nine confounding factors were used to analyse the effects of different intensities of physical activity.

RESULTS

The percentage of successful ageing was 1.88% among all subjects. Among them, 30.26, 29.57 and 29.40% of the elderly often participated in vigorous, moderate and mild physical activity, respectively. The results of PSM showed that participation in moderate activity increased the probability of successful ageing of the elderly by 0.76-0.78% (P < 0.001), while participation in vigorous and mild physical activity had no significant effect on successful ageing (P > 0.05). Moderate physical activity had statistically significant effects on four components of successful aging, including major disease, physical function, life satisfaction, and social participation (P < 0.05).

CONCLUSION

Moderate-intensity physical activity was most beneficial to the successful ageing of the elderly and should be promoted in the elderly population.

Cognitive decline trajectories and influencing factors in China: A non-normal growth mixture model analysis

BACKGROUND

With the increase in the aging population worldwide, cognitive decline has become an important research topic. The purpose of this study is to examine the cognitive development trajectories and influencing factors of different latent classes of Chinese elderly people. This will provide us with effective guidance for prevention and intervention.

METHODS

Four waves of data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were collected and included 2440 Chinese elderly individuals. The cognitive function of elderly individuals was measured using the Mini Mental State Examination (MMSE). A nonnormal Growth Mixture model (GMM) with five time-invariant covariates was used to identify the different trajectories of cognitive decline in elderly individuals.

RESULTS

Three latent decline trajectory groups were identified: stable cognitive group (SCG), high initial level - cognitive decline group (HIL-CDG), and high initial level - cognitive decline group (LIL-CDG). Elderly women were more likely to be assigned to a lower level subgroup than men. People who smoked and played cards or mahjong were more likely to be assigned to a cognitively stable group.

CONCLUSION

Education may help raise the upper limit of cognition. Smoking may impair cognitive upper limit. A small amount of alcohol intake and participation in cognitive and physical activities may help the elderly to delay cognitive decline in their later years.

Effects of subjective successful aging on emotional and coping responses to the COVID-19 pandemic

BACKGROUND

Middle-aged and older adults are more vulnerable to hospitalization and mortality if they are infected with the COVID-19 virus. The present study investigates the longitudinal effects of subjective successful aging on middle-aged and older adults' emotional and coping responses to the COVID-19 pandemic, and explores an underlying mechanism through perceived time limitation during the pandemic.

METHODS

A sample of 311 Hong Kong Chinese middle-aged and older adults (M_age = 64.58, SD = 10.14, Range = 45-90 years) were recruited from an Adult Development and Aging Project and participated in a questionnaire study via an online platform or phone interview. Their levels of subjective successful aging, perceived time limitation, and emotional and coping responses to the pandemic were measured.

RESULTS

The respondents who perceived themselves as more successful in aging process reported more positive and fewer negative emotions compared with their counterparts with lower levels of subjective successful aging. The mediation analysis showed that perceived time limitation could partially account for the effects of subjective successful aging on emotional and coping responses.

CONCLUSIONS

Findings of this study unveil the beneficial effects of subjective views of successful aging on emotional and coping responses to the pandemic through alleviating their perception of time limitation.

The spatiality and driving forces of population ageing in China

Studying the spatial characteristics of China’s ageing and its influencing factors is of great practical significance because China has the largest elderly population in the world. Using 2000 and 2010 census data, this study explores the degree, pace, and pattern of population ageing and its driving mechanism using exploratory spatial data analysis and the geographically weighed regression model. Between 2000 and 2010, population ageing increased rapidly countrywide; yet, spatial differences between eastern and western China narrowed. The degree of provincial population ageing and its spatiality were determined by natural population growth, migration, and local economic development. Life expectancy and mortality were the primary long-term factors, and GDP per capita was the prime contributor in the early days of economic development; the migration rate was the dominant influence after 2010. China’s overall spatial differentiation of population ageing shifted from a north–south to an east–west division.

Cross-National Comparisons of Cognitive and Physical Health in Older Adults Across China, Japan, and Korea: A Systematic Review

Background

Cross-national studies are an emerging research area in public health. Specifically, cross-national health comparisons are important for understanding the factors driving the success or failure of public health policies. Therefore, this study systematically analyzed studies that compared health status (physical health and cognition) of the older adults using national panel data for three East Asian countries—China, Japan, and Korea.

Methods

Google Scholar and PubMed were used for the literature search. The search strategy targeted papers published between 2005 and 2020, yielding a total of 2690 papers, of which seven were selected for the review. The Center for Evidence-Based Medicine (CEBM) criteria was used to assess study design quality. The risk of bias for non-randomized studies (RoBANS) tool, a quality assessment tool developed in Korea to evaluate non-randomized interventional studies, measured risk of bias.

Results

Of the seven included papers, two studies performed cognitive comparisons, four studies performed physical health comparisons, and one study compared both cognition and physical health. The studies selected for this study by CEBM criteria included four prospective cohort studies (Level 2B) and three expert opinions without explicit critical appraisal (Level 5). Risk of bias using the RoBANS tool found a risk of confounding variables in four out of seven papers. Finally, measurement items of cognitive and physical health differed across all three countries’ panel surveys.

Conclusion

These results suggest that in order to compare East Asian health policies according to the aging society, it is necessary to develop consistent cognitive and physical health evaluation tools in the future.

Data Analysis Model Design of Health Service Monitoring System for China's Elderly Population: The Proposal of the F-W Model Based on the Collaborative Governance Theory of Healthy Aging

In the era of artificial intelligence, big data and 5G, health care for elderly people is facing an important digital transformation. The objective of this study is to design the data analysis module of the elderly health service monitoring system (HSMS) and attempt to put forward a new healthy aging (HA) model that is applicable not only to the individual HA, but also to the regional HA system. Based on the HA theory of collaborative governance, we divided the elderly HSMS into four modules, including physical health, mental health, ability of daily activity, and social participation. Then, factors that influence HA were assessed by stepwise logistic regression to build the analysis model, using the public micro-panel data of the China Health and Retirement Longitudinal Survey (CHARLS). Age (odds ratio (OR) = 1.55 (95% confidence interval (CI): 1.06–2.27)), living in urban areas (OR = 1.57 (95% CI: 1.03–2.39)), being literate (OR = 1.51 (95% CI: 1.01–2.23)), expecting to get long-term health care in the future from their grown children (OR = 1.69 (95% CI: 1.10–2.61)) and having literate grown children (OR = 2.01 (95% CI: 0.26–0.97)) had a significant positive impact on HA of elderly people. Therefore, the F-W (factors and weighs, also family and welfare) model is proposed in this paper. The outcomes can contribute with designing HSMS for different provinces and several different regions in China and leave a door open to improve the model and algorithm application for HSMS in the future studies.

Psychometric Evaluation of the Persian Version of the Successful Aging Inventory

BACKGROUND

The first step to successful aging planning is to assess the current status using valid instruments. This study aimed to evaluate the psychometric properties of the Persian version of the Successful Aging Inventory (SAI).

MATERIALS AND METHODS

In the first step, SAI. was translated through forward-backward translation, and its face and content validity were qualitatively and quantitatively assessed. For construct validity assessment, 300 elderly were recruited through multi-stage random sampling. Exploratory factor analysis and known-group comparison were used. SAI reliability through internal consistency and stability was assessed using the Cronbach's alpha values of the inventory and intraclass correlation coefficient (ICC), respectively. The standard error of measurement, smallest detectable change, and floor and ceiling effects were calculated.

RESULTS

The impact scores, content validity ratios, and content validity indices of all items were more than 1.5, 0.62, and 0.8, respectively. The scale-level content validity index was 0.94. Factor analysis identified four factors for the inventory, which explained 58.17% of the total variance of the SAI score. SAI mean score among mentally healthy participants was significantly higher (P<0.001). The relative frequencies with the lowest and highest possible scores of SAI were 0 and 3.7%, respectively. The Cronbach's alpha, ICC, standard error of measurement, and the smallest detectable change of SAI were 0.835, 0.999, ±0.47, and 1.9, respectively.

CONCLUSION

As a valid and reliable instrument, the Persian version of SAI could be used for a successful aging assessment.

Aging Well on the Autism Spectrum: An Examination of the Dominant Model of Successful Aging

There is a gap in our knowledge of aging with autism. The present study examined the applicability of the popular gerontology concept of "aging well" to autistic adults. Using survey data, a model of "aging well" was operationalised and applied to 92 autistic adults and 60 controls. A very small proportion (3.3%) of autistic adults were found to be aging well. Significantly less autistic adults were "maintaining physical and cognitive functioning" and "actively engaging with life" in comparison to controls. Whilst important differences in health and functioning status were found, the current dominant model of "aging well" is limited for examining autistic individuals. Suggested adjustments include development of a broader, more flexible and strengths -based model.

Designing Urban Green Spaces for Older Adults in Asian Cities

Elderly populations in Asian countries are expected to increase rapidly in the next few decades. Older adults, particularly in high-density cities, spend a considerable amount of time in urban green spaces (UGSs). The World Health Organization noted that UGSs are key to improving the age-friendliness of neighborhoods. Thus, it is necessary to design UGSs for the promotion of healthy ageing to enhance preventive healthcare and relieve medical burdens. This study conducted interviews using a questionnaire with a sample size of 326 participants in the cities of Hong Kong (China) and Tainan (Taiwan region). The inter-relationships among the design of UGSs (e.g., spatial distribution and accessibility, characteristics of plants and UGSs), older adults' perceptions on safety and aesthetics quality of UGSs, and their self-reported health conditions (assessed by the self-reported SF-12v2 Health Survey) were investigated with bivariate Spearman rank correlation tests. The results indicate that the duration of visits to UGSs was positively associated with mental health and social functioning, two subscales evaluating health-related quality of life in SF 12v2. The statistical model (moderation analysis) showed that such a correlation was especially significant in women and those with low social support and social capital. A positive relationship was found between the physical health subscale and perceived safety in UGSs. This relationship was stronger among older adults living alone (moderation analysis). Furthermore, the color of plants and maintenance condition of UGSs were significant aspects affecting the subjective assessment of aesthetic quality. This study provides useful information regarding how to plan and design urban green spaces with certain characteristics that could improve the accessibility and aesthetic quality, which are preferred by older adults.

Healthy Aging in China: Benchmarks and Socio-Structural Correlates

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

Disability Prior to Death Among the Oldest-Old in China

Background

To estimate the prevalence of disability during the last 3 years prior to death among the oldest-old (≥80 years) in China.

Methods

We used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationally representative study of the oldest-old in China. The analytic sample included 23,934 decedents who died between 1998 and 2014 and had at least one interview within the last 3 years of life. Disability was defined as being incontinent or needing assistance in performing one or more of five other essential activities (bathing, transferring, dressing, eating, and toileting).

Results

About 57.8% (weighted) of the study decedents were female. The prevalence of disability increased modestly from 36 months to 24 months prior to death (20% to 23%), more rapidly from 24-months to 12-months before death (23% to 31%), and substantially from 12 months before death to the last month of life (31% to 48%). The disability rates were lowest for participants who died between 80 and 89 years, intermediate for those who died between 90 and 99 years, and highest for those who died at age 100 or older, although the patterns over the 3-year period were comparable for the three age groups. At each time point prior to death, a higher percentage of women was disabled than men.

Conclusions

In this large nationally representative sample of the oldest-old in China, the prevalence of disability during the 3 years prior to death is high and is greater in women than men and those who die at the oldest ages.

Association between tea consumption and depressive symptom among Chinese older adults

Background

Despite accumulating evidence on the protective effect of tea consumption against depression, studies specifically focusing on the elderly population are yet limited. This paper examined the association between the frequency and duration of tea drinking and depressive symptoms of older adults by gender and age groups, based on a nationally representative sample in China.

Method

The study employed the panel data from 2005, 2008/2009, 2011/2012 and 2014 waves of Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used the frequency and consistency of tea drinking behaviors to identify four types of tea consumption amongst Chinese seniors. Depressive symptoms were assessed by a five-item scale. Linear mixed effects models were applied.

Results

We found that consistent and frequent tea-drinking was associated with significantly less depressive symptoms, and such impact was partially mediated by socioeconomic status, health behavior, physical health, cognitive function, and social engagement. However, the association was only significant for males and the oldest-old, rather than females and younger elders.

Conclusions

Consistent and frequent tea-drinking may effectively reduce the risk of depressive symptoms for the Chinese elderly. The promotion of the traditional lifestyle of tea drinking could be a cost-effective way towards healthy aging for China.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1259-z) contains supplementary material, which is available to authorized users.

Successful Aging and Mortality Risk: The Korean Longitudinal Study of Aging (2006-2014)

OBJECTIVES

The aim of this study is to examine the association of successful aging with mortality and further find gender differences in the effect of components of successful aging on mortality risks.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

A total of 3848 adults aged 65 and older from the Korean Longitudinal Study of Aging (2006-2014) data.

MEASURES

Successful aging was defined as success in the following 7 components: absence of major disease, no depression, no freedom from disability, high cognitive and physical function, active social engagement, and satisfaction with life. All-cause mortality was measured by death certificate and family interview.

RESULTS

In both genders, the mortality rate was higher in the older adults who did not achieve successful aging than in their counterparts (men: hazard ratio [HR] = 1.69, 95% confidence interval [CI] 1.18-2.43; and women: HR = 2.37, 95% CI 1.21-4.63). All components of no successful aging were associated with an increased risk of mortality except for no satisfaction with life in females. Mortality rates were predominant in major disease (HR = 1.86, 95% CI 1.54-2.25) and depressive symptoms (HR = 1.62, 95% CI 1.26-2.10) in males, and disability (HR = 2.08, 95% CI 1.68-2.57) and low physical functioning (HR = 2.31, 95% CI 1.79-2.98) were predominant in females.

CONCLUSION/IMPLICATION

We found that older Koreans who did not achieve successful aging had a higher risk of all-cause mortality than successful agers. There were gender differences in mortality risks across all components of successful aging.