Sociodemographic Effects on the Dynamics of Task-specific ADL Functioning at the Oldest-old Ages: The Case of China

Exploring influential factors in the self-assessment of life satisfaction among Chinese elderly: a structural equation modeling analysis

The aging problem is becoming more and more prominent globally. Attention to the quality of life and related health improvement among the elderly has become an important issue in modern society. This study utilized a tracking survey conducted in 2017-2018, involving 9,327 Chinese older adults, to examine health influencing factors, and applied structural equation modeling to analyze the influencing factors on the self-assessment of life satisfaction among older adults in different regions (cities, counties, and villages) in China. This study revealed that economic status, psychological status, personal situation, life behaviors, and child care are important influences on older people's self- assessed life satisfaction. There is a positive correlation between economic status, psychological status, child care and the results of the self-assessment of life satisfaction of the elderly. Psychological status and child care have a greater impact on the self-assessment of life satisfaction among the elderly in urban areas compared to villages and towns. The influence of economic status on the self-assessment of life satisfaction of the elderly is lower in urban areas than in rural areas. There is a significant difference in the influence of personal situations on the self-assessment of life satisfaction among the elderly. Additionally, older individuals tend to report higher levels of self-assessment of life satisfaction. Furthermore, female elderly individuals tend to report higher levels of satisfaction compared to males. Findings from this study indicate that improving health self-assessment in older adults requires targeted efforts based on different geographic areas of life and the age stages of older adults, and more attention needs to be paid to men who are just entering old age.

Functional Disability Among Middle-Aged and Older Adults in China: The Intersecting Roles of Ethnicity, Social Class, and Urban/Rural Residency

This study explores how ethnicity, family income, and education level differentiate patterns of functional limitations among urban and rural Chinese (aged 45 ≥ years). Based on the 2018 China Family Panel Studies (CFPS) (n = 16,589), this nationwide study employed binary/multinomial logistic regression analyses, stratified by urban/rural residency, to estimate the likelihood of instrumental activities of daily living (IADLs) disability (0/1-2/≥3 limitations) by social determinants of health (SDoH). The estimated overall prevalence of IADLs disability was 14.3%. The multivariable analyses did not find significant ethnic disparity in IADLs disability in urban China, while in rural China, ethnic minorities were 44% more likely to have IADLs disability than Han Chinese. Among rural residents, Mongolians, Tibetans, and Yi minority more than tripled the odds of having ≥3 limitations than Han Chinese; and the intersections of ethnicity and social class were associated with functional limitations. Long-term care and anti-poverty programs should target minority aging populations in rural China.

Toileting Disability Among Older Adults in China and Role of Environmental Factors

Objectives: We investigated the risk factors associated with toileting disability among older adults in China, focusing on environmental factors (physical, social, and external supports). Methods: Data were drawn from the WHO's SAGE wave 1. We proposed a conceptual framework to guide the selection of risk factors, and implemented logistic regressions separately for urban and rural subpopulations. Results: In both subsamples, older adults who relied on assistive devices were about three times more likely to be toileting-disabled. Rural residents using non-flush toilets were 1.94 more likely to have difficulty toileting than those using flush system toilets. Sharing toilets and did not feel safe in homes were also positively associated with toileting disability. For urban residents, low neighborhood trust was weakly predictive of higher odds of toileting disability. Discussion: This study highlights the importance of environmental factors in explaining toileting disability, and the potential for related policy interventions in developing countries.

Bathing and toileting difficulties of older adults in rural China: the role of environment

BACKGROUND

For older adults, difficulties in bathing and toileting are often the most prevalent in the index of Activities of daily living (ADL). This study aims to examine how environmental factors are associated with difficulty of bathing and toileting among older adults in rural China.

METHOD

The data are from the 2014 Thousand-Village Survey (TVS), a national survey of Chinese rural residents of old age. The sample consists of 10,689 subjects, 55 years or older, from 536 villages across all provinces of China. Logistic regressions were applied to examine how difficulty of bathing and toileting was related to environmental factors such as geographic location, neighbourhood amenity, and related facilities of bathing and toileting.

RESULTS

Older adults living in the Southern regions of China had lesser difficulty in bathing and toileting than those living in Northern China, controlling for other confounders. Better neighbourhood conditions also reduced the likelihood of having such disabilities. Persons who bathed indoors without showering facilities, in public facilities, and outdoors were significantly more likely to have bathing disability than those who showered indoors with facility. Rural older adults who used pedestal pans and indoor buckets for toileting were more likely to have toileting disability than those who used indoor squatting facilities.

CONCLUSION

Environmental barriers were associated with functional disability among older adults in rural China, but the disabled individuals may change their environments to adapt to their functional capabilities. Our findings suggest that it is imperative to promote the use of showering facilities and pedestal pans for toileting in rural China.

Stronger Increases in Cognitive Functions among Socio-Economically Disadvantaged Older Adults in China: A Longitudinal Analysis with Multiple Birth Cohorts

Highly variable changes in cognitive functions occur as people get older, and socio-economically disadvantaged older adults are more likely to suffer from cognitive decline. This study aims to identify the longitudinal trend in cognitive functions among different socio-economic groups of older adults. The Chinese Longitudinal Healthy Longevity Survey (CLHLS) followed up 32,323 individuals aged 65 years and older over a 12-year period. A series of mixed-effects models was used to explicitly assess cohort trend and its socio-economic disparity in the cognitive functions of older adults. Scores for significant increase in cognitive functions by birth cohort were smaller by 0.49, 0.28, and 0.64 among older adults with more educational experience, a lower household income, or economic dependence relative to their counterparts. Scores for differences in cognitive function between older adults with higher and lower incomes were smaller by 0.46 among those living in urban areas than among those living in rural areas. Although there were larger cohort growth trends in cognitive functions among older adults with lower educational attainment, lower household income, and who were economically dependent, effective public intervention targeting these socio-economically disadvantaged populations is still necessary.

Socioeconomic disparities in leisure activities over the life course of the oldest-old in China

OBJECTIVE

To identify the socioeconomic factors leading to disparities in participation in leisure activities over the life course among Chinese oldest-old people.

METHODS

Data are from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a sample of adults aged 80 years or older in the period 1998-2012, featuring 38 312 individuals (58 945 observations).

RESULTS

The younger birth cohorts were found to have significantly higher levels of participation in leisure activities, with a non-linear decrease in age observed for oldest-old men and women. Higher participation levels were significantly related to higher education levels, economic independence and non-manual occupations before retirement among the Chinese oldest-old.

CONCLUSIONS

Leisure activity participation has increased substantially in recent cohorts of Chinese oldest-olds. Those with lower socioeconomic status may represent a disadvantaged population in terms of participation in leisure activities over their life course.

Effect of sociodemographic and physical activity on cognitive function in older adults: A nationwide cross-sectional survey

OBJECTIVE

We aimed to assess the effect of socioeconomic status and physical activity on cognitive function using a large population-based survey data in China.

METHODS

We took advantage of the Chinese Longitudinal Healthy Longevity Survey conducted in 2014 to examine the relationship between sociodemographic, physical activity, and cognitive function in older adults (OAs) for persons aged above 65 (N = 2848). Socioeconomic status was assessed by sex, age, co-residence situation, category of residence, years of schooling, and marital status. Multiple linear regression for predictors was utilized. Physical activity was assessed using activities of daily living (ADL) and instrumental activities of daily living (IADL) measures. Cognitive function was assessed by the Modified Mini-Mental State Examination.

RESULTS

The mean age of the OAs was 80.65 years (SD = 8.55). Their mean Mini-Mental State Examination score was 21.55 (SD = 2.38), mean ADL Total score was 6.24 (SD = 0.95), and mean IADL Total score was 10.21 (SD = 3.84). OAs' age at testing, co-residence and category of residence significantly predicted both ADL Total score and IADL Total score (P < 0.05), sex significantly predicted IADL Total score (R²  = 0.02, β = 0.13, P = 0.000) but not ADL Total score (R²  = 0.00, β = 0.02, P = 0.211). OAs' sex, age, co-residence, and years of schooling significantly predicted cognitive function (P < 0.05), IADL total score significantly predicted cognitive function (P < 0.01), while the relationship between ADL total score and cognitive function was not significant (P = 0.94).

CONCLUSION

OAs' sex, age, co-residence, years of schooling, and IADL were significantly associated with cognitive function. Improving OAs' IADL, especially in lower social classes, may help to improve the overall cognitive function of the OAs.

Socioeconomic Status and Physical Functioning: A Longitudinal Study of Older Chinese People

Objectives

We aimed to assess the longitudinal associations of socioeconomic status and physical functioning using a large population-based survey data in China.

Method

We used four waves of the Chinese Longitudinal Healthy Longevity Survey (2002-2011). Physical functioning was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL) measures. Socioeconomic status was assessed using educational attainment, occupational status, household income, financial resources, and access to health services. Latent growth curve model combined with selection model was utilized.

Results

High education was not associated with the baseline level or the rate of change in ADL score but predicted better baseline IADL functioning. High income was related to better IADL functioning but had no effect on the rate of change in IADL. Inadequate financial resources and unavailability of health services were mainly associated with poorer ADL and IADL functioning at baseline. White-collar occupation was unrelated to the trajectory of physical functioning.

Discussion

This study provides no support either for the cumulative disadvantage or age-as-leveler theory. Improving financial status and accessibility of health care services, especially in lower social classes, may help to improve the overall level of physical functioning of the older adults.

The debilitating effects of chronic diseases among the oldest old in China

OBJECTIVES

The aims of this study were to assess the current sharp rise in chronic diseases and disabilities with advancing age, and to examine the debilitating effects of chronic diseases among the oldest old in China.

STUDY DESIGN AND OUTCOME VARIABLES

This study used data from four waves of the Chinese Longitudinal Health and Longevity Survey (CLHLS) conducted in 2002, 2005, 2008 and 2011. The sample comprised 2137 older adults who were interviewed in 2002 and re-interviewed in the following waves. Cross-tabulations were run to show the rise in chronic disease and disability with age. Ordinal logistic regression was run to examine the debilitating effects of these diseases in terms of the ability of the oldest old to perform activities of daily living.

RESULTS

The prevalence of chronic diseases rose sharply with age. The prevalence rate of six major diseases increased between 38% (respiratory diseases) and 533% (neurological disorder) among respondents who were re-interviewed nine years later. Cardiovascular diseases were the most common. Neurological disorder and cancer were less common, but had the most debilitating effects on patients. Overall, 10.0%, 3.1% and 3.1% of the respondents were disabled by cardiovascular, musculoskeletal and sensorial diseases, respectively. Ordinal logistic regression showed that neurological disorder had the strongest debilitating effects, followed by musculoskeletal and cardiovascular diseases among 2137 older persons who had survived and were followed up from the base year (2002) through 2011.

CONCLUSION

The rapid rise in chronic diseases has resulted in an increased burden of disability among the oldest old in China. There is a need to improve health care systems for the prevention and management of chronic diseases.

Conceptual and operational considerations in identifying socioenvironmental factors associated with disability among community-dwelling adults

Disability is conceived as a person–context interaction. Physical and social environments are identified as intervention targets for improving social participation and independence. In comparison to the body of research on place and health, relatively few reports have been published on residential environments and disability in the health sciences literature. We reviewed studies evaluating the socioenvironmental correlates of disability. Searches were conducted in Medline, Embase and CINAHL databases for peer-reviewed articles published between 1997 and 2014. We found many environmental factors to be associated with disability, particularly area-level socioeconomic status and rurality. However, diversity in conceptual and methodological approaches to such research yields a limited basis for comparing studies. Conceptual inconsistencies in operational measures of disability and conceptual disagreement between studies potentially affect understanding of socioenvironmental influences. Similarly, greater precision in socioenvironmental measures and in study designs are likely to improve inference. Consistent and generalisable support for socioenvironmental influences on disability in the general adult population is scarce.

An exploratory discrete-time multilevel analysis of the effect of social support on the survival of elderly people in China

This study undertakes a survival analysis of elderly persons in China using Chinese Longitudinal Healthy Longevity Survey 2002-2008. Employing discrete-time multilevel models, we explored the effect of social support on the survival of elderly people in China. This study focuses on objective (living arrangements and received support) and subjective activities (perceived support) of social support, finding that the effect of different activities of social support on the survival of elderly people varies according to the availability of different support resources. Specifically, living with a spouse, financial independence, perceiving care support from any resource is associated with higher survival rates for elderly people. Separate analysis focusing on urban elderly and rural elderly revealed broadly similar results. There is a larger difference between those perceiving care support from family or social service and not perceiving care support in urban areas comparing to those in rural areas. Those who cannot pay medical expenses are the least likely to survive. The higher level of economic development in province has no significant effect on the survival of elderly people for the whole sample model and the elderly people in urban areas; however, there is a negative influence on the survival of the rural elderly people.

Individual and province inequalities in health among older people in China: evidence and policy implications

This paper uses multi-level modelling to analyse data from the nationally-representative Chinese Health and Retirement Longitudinal Study (CHARLS) in order to investigate the characteristics associated with poor health among older people, including individual and household characteristics as well as the characteristics of the provinces in which the older person lives (contextual effects). The results show that older Chinese women, rural residents, those with an education level lower than high school, without individual income sources, who are ex-smokers, and those from poor economic status households are more likely to report disability and poor self-rated health. Differentials in the health outcomes remain substantial between provinces even after controlling for a number of individual and household characteristics.

A new classification of function and disability in China: subtypes based on performance-based and self-reported measures

OBJECTIVES

To develop a new classification method to describe incidence and prevalence of function and disability and their predictors in Chinese older adults.

METHODS

Data were obtained from 16,020 older adults in the 2002 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). The subtypes of function and disability were defined by combining physical performance (PP) tests and self-reported assessments of activities of daily living (ADL).

RESULTS

The most prevalent subtype involved PP limitations without ADL dependency. Rural living made it more likely that an individual with physical performance limitations would be independent in ADL, whereas city residence made dependence in ADL more likely, regardless of whether performance limitations were present.

DISCUSSION

Self-reported and performance-based tools can be used in combination to estimate conceptually different subtypes of function and disability, with different epidemiological rates of incidence and different social, medical, and environmental predictors.

Out-migration of Young Adults and Gender Division of Intergenerational Support in Rural China

Using data from the baseline and follow-up surveys of "Well-being of Elderly in Anhui Province, China" conducted in 2001, in 2003 and in 2006, respectively, by the Institute for Population and Development Studies of Xi'an Jiaotong University, this paper employs random effects models to explore the gender division of intergenerational support in the elderly rural families. Analyses by parents' and children's gender suggest that there are gender differences in intergenerational support because of gender roles and division in family. Our analysis shows that older mothers receive more returns, which reciprocates their support, while older fathers benefit more from the out-migration of adult children. While sons take more responsibility for family support, daughters reciprocate support from their elderly parents more. Enhancement of the role and function of daughters in families has accompanied out-migration of young adults and suggests that gender differences in intergenerational supports between sons and daughters have decreased.

Effects of walking speed and results of timed get-up-and-go tests on quality of life and social participation in elderly individuals with a history of osteoporosis-related fractures

OBJECTIVE

To investigate the relationships between physical performance, quality of life (QoL), and social participation among elderly men and women with a history of osteoporosis-related fractures.

METHOD

The study was a population-based cross-sectional study including 155 participants aged 60 to 93 years from the Swedish longitudinal investigation, "Good Aging in Skåne." The participants had suffered fracture of the vertebrae, hip, pelvis, or ankle. Physical performance was expressed as walking speed (WS) and timed get-up-and-go (TUG). QoL was measured as using the Health Related Quality of Life (HRQoL) and Life Satisfaction (LS) scales. Social participation was defined as taking part in social, cultural, and leisure activities.

RESULTS

Lower WS and/or TUG were associated with lower HRQoL, lower LS, and a reduction in social participation, after adjustment for confounding factors.

DISCUSSION

Measurements of WS and TUG could be used to determine QoL and social participation in elderly people having sustained fractures.

Preventing disability through exercise: investigating older adults' influences and motivations to engage in physical activity

In this qualitative study focus groups were used to gain an in-depth understanding of personal and social influences on physical activity in 48 52-87-year-old participants. A model produced using a Grounded Theory analysis showed that preventing health decline was particularly important in determining physical activity participation. Other influences included enjoyment of exercise, others as motivators to exercise and perceived limited appreciation for older people's needs. The results are discussed in relation to health and exercise interventions designed to motivate exercise behaviour in older adults.

Intergenerational support and subjective health of older people in rural China: a gender-based longitudinal study

AIM

To examine gender differences in the effect of intergenerational exchanges on subjective health of Chinese rural elderly.

METHODS

Using the data from three waves of the survey 'Well-being of Elderly in Anhui Province, China' conducted in 2001, 2003 and 2006, respectively, this study uses random effect logit models for men and women separately.

RESULTS

While an increase in instrumental support from children to older people is associated with deterioration in the subjective health of older men, financial support from older people to children is associated with improvement in the formers' subjective health. Although an increase in instrumental support from older people to children, and mutual emotional support is associated with improved subjective health of older women, financial support from children to older women has a negative effect on the latter's subjective health.

CONCLUSIONS

Reciprocal intergenerational transfers contribute to improvement in subjective health of older people, while increased support through demand-based transfers appears to result in deterioration of their health.