Childlessness, psychological well-being, and life satisfaction among the elderly in China

Parity, socioeconomic status, and depression in women's mid-to-late life: Evidence from two prospective cohorts

Existing evidence on the relationship between parity and women's later-life depression was inconsistent. We aimed to examine the association of parity with depression in women's mid-late life, and to evaluate whether such association differs by socioeconomic status (SES). We used data of 9508 women from two nationally representative cohort studies: China Health and Retirement Longitudinal Study and US Health and Retirement Study. Participants were followed up from 2011 or 2012 (baseline) to 2018. Parity was the number of biological children; depression symptoms were measured using Center for Epidemiologic Studies Depression Scale. Logistic regression models were used to assess the association between parity status and depression. A total of 4291 women had depression at baseline, and 1804 women developed depression during follow-up. Compared to women with one child, those with no children had higher odds of baseline depression (odds ratio [OR] = 1.25, 95 % confidence interval [CI] = 1.00-1.56) and developing depression (OR = 1.98, 95 % CI = 1.41-2.79) during follow-up. For multiparous women, a higher parity was associated with higher prevalence and incidence of depression, with the odds of incident depression ranging from 1.49 (95 % CI = 1.22-1.82) to 1.86 (95 % CI = 1.47-2.34) for having two children to ≥4 children. Such associations were more evident among women with high and upper-middle SES, with the odds of incident depression increasing from 1.91 (95 % CI = 1.45-2.51) for women with two children to 2.65 (95 % CI = 1.87-3.78) for women with ≥4 children. However, these associations were not observed among women in low and lower-middle SES group. Our findings underscore that healthcare practice should consider reproductive histories and social context when addressing women's mental health issues.

The impact of a student-led intergenerational support program on life satisfaction, loneliness, and psychological well-being of institutionalized older adults

BACKGROUND

Institutionalized older adults often face significant challenges that affect their psychological status and experience a sense of loss and social isolation. One promising approach is the implementation of intergenerational support programs, which foster interactions between older adults and younger generations.

AIM

To evaluate the effect of the Intergenerational Support Program on life satisfaction, sense of loneliness, and psychological status among institutionalized older adults.

METHOD

A quasi-experimental research design was conducted on a convenience sample of volunteer students and older adults. A total of 74 older adults were recruited and divided equally into two matched groups: study and control groups, with each group consisting of 37 institutionalized older adults.

TOOLS

The Mini-Mental State Examination (MMSE), Socio-Demographic Data and presence of chronic diseases of older adults Structured Interview Schedule, Satisfaction with Life Scale (SWLS), De Jong Gierveld Loneliness Scale and Hospital Anxiety and Depression Scale (HADS). The study group received the proposed intergenerational support program, which included intergenerational sessions for each older adult occurring once a week for approximately one and a half to two hours over three months, totaling 12 sessions. The Chi test was used to test the association between two qualitative variables or to detect differences between two or more proportions.

RESULTS

The mean age of participants was 72.64 ± 7.52 years for the study group and 71.30 ± 8.41 years for the control group. Statistically significant differences were found between pre and post-intervention measurements in the study group regarding life satisfaction, sense of loneliness, depression, and anxiety (p = 0.000). In contrast, no statistically significant differences were found between pre and post-intervention measurements in the control group regarding life satisfaction (p = 0.212), sense of loneliness (p = 0.765), depression (p = 0.849) , and anxiety (p = 0.1068).

CONCLUSION

The proposed intergenerational support program significantly affects life satisfaction, feelings of loneliness, and psychological status.

IMPLICATIONS

Our findings foster strong relationships between students and older adults, emphasizing the importance of close and compatible interactions, which can build meaningful intergenerational bonds and offer emotional support and companionship to older adults.

Cognitive trajectories and their relationships with education and diets among older adults: a network-based 10-year cohort study

Objectives

Few studies have examined the underlying mechanisms of education, diets, and cognitive function in older adults. This study analyses the relationship between cognitive trajectories, education, and different dietary patterns in older adults from a network perspective, and further explores their longitudinal associations and mediation effects.

Methods

Data on cognitive trajectories were derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 2008 and 2018. Group-Based Trajectory Model (GBTM) was used to identify potential heterogeneity in the longitudinal changes in cognitive function. Multinomial logistic regression and network analysis were then applied to examine the relationships between different cognitive trajectories and years of education, food variety (FV), and plant-based dietary patterns. Cross-lagged panel model was used to examine the longitudinal associations between education, FV, and plant-based diet patterns. Furthermore, we constructed a mediation model based on categorical variables for cognitive trajectories to investigate the mediating effect of FV and plant-based diet index on education and cognitive.

Results

A total of 2,115 older adults were included in this study, revealing three distinct cognitive function trajectories. After controlling for potential confounders, education and dietary-related variables were associated with a cognitive stable decline trajectory (OR: 0.857/0.929/1.027) and a cognitive rapid decline trajectory (OR: 0.859/0.914, 95% CI: 0.775-0.882) compared to the cognitive stable trajectory. In the education, diet, and cognition network model, overall Plant-Based Diet Index (PDI) [expected influence (EI) = 1.82] and years of education (EI = 0.54) were the most central domains. There were longitudinal associations between education, FV, and plant-based dietary patterns, which were significant only in the slow decline group. FV acting as a mediator between education and cognitive trajectories.

Conclusion

Years of education are longitudinally associated with the diet of older adults in the slow cognitive decline group. Food diversity partially mediates the relationship between years of education and cognitive trajectories. Interventions targeting education and dietary behaviors may help alleviate cognitive decline in older adults.

Association of household chemicals use with cognitive function among Chinese older adults

Background

The paucity of empirical evidence supporting a correlation between the utilization of household chemicals and cognitive decline in Chinese older adults.

Methods

The data utilized for this study originated from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2018). Using regression models to investigate the relationship between exposure to household chemicals and cognitive decline, and evaluate the impact of different fields on cognitive function.

Results

The use of household chemicals was associated with a decline in cognitive function (anti-caries agent, OR = 1.68, P = 0.040; air freshener, OR = 2.48, P = 0.002; disinfectant, OR = 1.40, P = 0.033). The more frequent the use of household chemicals, the worse the cognitive function (Model1: OR = 2.54, P = 0.024; Model2: OR = 3.23, P = 0.006; Model3: OR = 3.59, P = 0.003).

Conclusion

The study has uncovered a correlation between the utilization of household chemicals and cognitive decline in individuals aged 65 years and over in China.

Predictors and consequences of visual trajectories in Chinese older population: A growth mixture model

Background

Given the relatively high prevalence of vision impairment and the heterogeneity of visual changes among the elderly population, we aimed to identify the visual trajectories and to examine the predictors and consequences associated with each trajectory class.

Methods

We analysed data from 2235 participants involved in the 5th, 6th, 7th, and 8th waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), where vision impairment was evaluated using an adapted Landolt-C chart during each wave. We employed a growth mixture model (GMM) to identify distinct visual trajectories and logistic regression analysis to examine the predictors associated with each trajectory class. Furthermore, we investigated the effect of visual trajectories on distal consequences, including cognitive function, activities of daily living (ADL), instrumental activities of daily living (IADL), depression, anxiety, and fall risk. Within the CLHLS study, cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (CMMSE), ADL via the Katz index, and IADL through a modified version of Lawton's scale. Lastly, depression was assessed using the 10-item version of the Centre for Epidemiologic Studies (CES-D-10), while anxiety was measured using the Generalized Anxiety Disorder scale (GAD-7). Fall risk was determined by asking the question: 'Have you experienced any falls within the past year?'

Results

We identified two distinct visual trajectories in our analysis. Most older adults (n = 1830, 81.9%) initially had a good vision level that diminished ('high-baseline decline' group). Conversely, the remaining participants (n = 405, 18.1%) initially had a lower vision level that improved over time ('low-baseline improvement' group). The 'high-baseline decline' group was more likely to include older adults with relatively higher body mass index (BMI) (odds ratio (OR) = 1.086; 95% confidence interval (CI) = 1.046, 1.127), individuals with higher formal educational qualifications (OR = 1.411; 95% CI = 1.068, 1.864), those current engaging in exercise (OR = 1.376; 95% CI = 1.046, 1.811), and individuals reporting more frequent consumption of fruit (OR = 1.357; 95% CI = 1.053, 1.749). Conversely, the 'low-baseline improvement' group had a higher likelihood of including older individuals (OR = 0.947; 95% CI = 0.934, 0.961), residents of nursing homes (OR = 0.340; 95% CI = 0.116, 0.993) and those self-reporting cataracts (OR = 0.268; 95% CI = 0.183, 0.391) and glaucoma (OR = 0.157; 95% CI = 0.079, 0.315). Furthermore, the 'high-baseline decline' group showed a positive impact on distal consequences, adjusting for sex, birthplace, residence, main occupation, education, economic status, and marital status. This impact included cognitive function (correlation coefficient (β) = 2.092; 95% CI = 1.272, 2.912), ADL (β  = -0.362; 95% CI = -0.615, -0.108), IADL (β  = -1.712; 95% CI = -2.304, -1.121), and reported lower levels of depression (β  = 0.649; 95% CI = 0.013, 1.285). We observed no significant influence on fall risk and anxiety within the identified visual trajectories in the adjusted model.

Conclusions

Vision in older adults with ocular disease could potentially be improved. Having formal education, maintaining an appropriate BMI, engaging in exercise, and consuming fruit more frequently appear to be beneficial for the visual health of the elderly. Considering the negative impact of visual impairment experience on distal cognition, self-care ability, and depression symptoms, stakeholder should prioritise long-term monitoring and management of vision impairment among older adults.

The Association Between Trajectories of Perceived Unmet Needs for Home and Community-Based Services and Life Satisfaction Among Chinese Older Adults: The Moderating Effect of Psychological Resilience

This study examined whether trajectories of perceived unmet needs for Home and Community-Based Services (HCBS) were associated with life satisfaction among Chinese older adults and whether the association was moderated by psychological resilience. Data came from five waves (2005-2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Latent class growth analysis revealed three distinct trajectories of perceived unmet HCBS needs: "increasing" (n = 977, 36.24%), "persistent" (n = 570, 21.14%), and "decreasing" (n = 1149, 42.62%). Multiple regression estimates showed that the increasing group was associated with lower life satisfaction, and the association was moderated by psychological resilience, especially for older adults who were male, living in rural, and oldest-old. Results indicate that inequalities in cumulative exposure to perceived unmet HCBS needs may further lead to increasing inequalities in life satisfaction. Interventions focused on minimizing the provision-need gap of HCBS and enhancing personal resilience should be considered to improve the life satisfaction of older adults.

Association of changes in waist circumference, waist-to-height ratio and weight-adjusted-waist index with multimorbidity among older Chinese adults: results from the Chinese longitudinal healthy longevity survey (CLHLS)

BACKGROUND

The association of changes in waist circumference (WC), waist-to-height ratio (WHtR) and weight-adjusted-waist index (WWI) with subsequent risk of multimorbidity remains unclear among older Chinese adults. Therefore, we aimed to assess this association by utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

METHODS

Our study was based on the 2011/2012 wave of the CLHLS whose follow-up surveys were conducted in 2014 and 2017/2018. A total of 2900 participants aged 65 and above at baseline were enrolled. WC, WHtR, and WWI were calculated from measured height, weight, and waist circumference. Multimorbidity refers to the coexistence of two or more of 18 chronic diseases. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs) to evaluate the effect of three-year changes in WC, WHtR, and WWI on the risk of multimorbidity.

RESULTS

During a mean follow-up time of 4.2 (2.0) years, 906 multimorbidity cases were identified. Compared to participants in the persistently low WC group, those in the WC gain group and the persistently high WC group had a higher multimorbidity risk with adjusted HRs (95%CI) of 1.23 (1.01-1.50) and 1.34(1.14-1.58), respectively. Participants in the WHtR gain group and the persistently high WHtR group also had higher risks of multimorbidity with HRs (95%CI) of 1.35 (1.08-1.67) and 1.27 (1.05-1.53), respectively, relative to the persistently low WHtR group. Compared to the persistently low WWI group, those in the WWI loss group had a lower risk of multimorbidity with HRs (95%CI) of 0.80 (0.66-0.98). For every standard deviation increase in WC, WHtR, and WWI over three years, the risk of multimorbidity was higher by 12% (95%CI: 1.05-1.19), 13% (95%CI: 1.06-1.20), and 12% (95%CI: 1.05-1.20), respectively.

CONCLUSIONS

Associations of changes in WC, WHtR and WWI with multimorbidity are significant among older Chinese adults. The findings highlight the importance of evaluating changes in WC, WHtR, and WWI in screening and prevention of multimorbidity in older adults.

Reciprocal Effects between Sleep Quality and Life Satisfaction in Older Adults: The Mediating Role of Health Status

OBJECTIVES

to examine the causal relationship between sleep quality and life satisfaction and explore the mediating role of health status on the relationship between sleep quality and life satisfaction.

METHODS

A total of 1856 older Chinese people participating in 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. A cross-lagged panel analysis (CLPA) combined with mediator analysis was utilized.

RESULTS

The average sleep quality levels for the years 2011, 2014, and 2018 were 3.70, 3.63, and 3.47 out of 5, respectively. The corresponding average levels of health status were 3.47, 3.44, and 3.39 out of 5, and the average levels of life satisfaction were 3.75, 3.86, and 3.87 out of 5, respectively. In addition, sleep quality at prior assessment points was significantly associated with life quality at subsequent assessments, and vice versa. Also, health status partially mediated this prospective reciprocal relationship.

CONCLUSIONS

There is a nonlinear decreased trend in sleep quality and health status, while there exists a nonlinear increased trend in life satisfaction for older adults from 2011 to 2018. Reciprocal positive effects between sleep quality and life satisfaction in older adults exist and are mediated by health status.

An assessment of self-rated life satisfaction and its correlates with physical, mental and social health status among older adults in India

Life satisfaction refers to the assessment of one's own life in terms of self-perceived favourable qualities. It is an integral part of healthy and successful course of ageing. It is widely associated with the health status and social well-being. The present study attempted to determine the constructing factors of self-rated life satisfaction, such as socio-demographic, physical, social, and mental well-being of older adults. We analysed information from the Longitudinal Ageing Study in India (LASI-1), the initial phase conducted during 2017-18 for the population of older adults in India. We applied descriptive statistics for prevalence assessment and association was checked using chi-square test. Further, to determine the adjusted outcome of predictor covariates on the likelihood of an individual being satisfied from life estimated by applying hierarchical multiple logistic regression models. Several noteworthy affirmations on the relationship between the socio-demographic variables and health risk behaviours with life satisfaction were observed. The results were consistent with studies showing change in life satisfaction subject to the state of physical and mental health, presence of chronic diseases, friends and family relations, dependency, and events of trauma or abuse. While comparing respondents, we found varying degrees of life satisfaction by gender, education, marital status, expenditure and other socio-economic features. We also found that besides physical and mental health, social support and well-being play a pivotal role in achieving higher life satisfaction among older adults. Overall, this work contributes to the study of the subjective well-being of older adults in India based on self-reported levels of life satisfaction and further narrows the gap in knowledge about associated behaviour. Hence, with on-going ageing scenario, there is need for multi-sectorial policy-oriented approaches at individual, family, and community level, which helps to take care of older-adults' physical, social, and mental health for the betterment of healthy ageing.

Rising trend of childlessness in China: analysis of social and regional disparities with 2010 and 2020 census data

INTRODUCTION

In recent decades, there has been a significant increase in childlessness. This paper analysed childlessness in China, specifically examining its socio and regional disparities.

METHODS

With data from China's 2020 population census, supplemented with data from China's 2010 population census and 2015 inter-censual 1% population sample survey, we used a basic indicator of age-specific childlessness proportion, a decomposition method, and probability distribution models to analyse, fit and project childlessness.

RESULTS

We presented age-specific childlessness proportions for women as a whole and by socioeconomic features, decomposition and projection results. The childlessness proportion increased markedly from 2010 to 2020, reaching 5.16% for women aged 49. The proportion is highest for city women, followed by township women, and is lowest among village women, at 6.29%, 5.50% and 3.72 % for women aged 49, respectively. The proportion for women aged 49 with high college education or above was 7.98%, and only 4.42% for women with junior high school education. The proportion also exhibits marked provincial discrepancies, and the total fertility rate is negatively correlated with childlessness at the province level. The decomposition results distinguished the different contribution of change in educational structure and change in childlessness proportion for subgroups to the total childlessness proportion change. It is projected that city women, women with high education will have higher childlessness proportion, and the proportion will further increase with the rapid increase in education level and urbanisation.

CONCLUSIONS

Childlessness has risen to a relatively high level, and varies among women with different characteristics. This should be taken into consideration in China's countermeasures to reduce childlessness and curtail further fertility decline accordingly.

Coping strategies for happy childless ageing: an explorative study in Poland

Childless older people face many challenges resulting from their lack of children that may have an impact on their subjective well-being, especially in a country where family ties are strong, and children are the main source of support. In this paper, we examine the coping strategies that childless seniors in Poland employ in order to mitigate various risks related to having no offspring. We use a qualitative approach, drawing upon in-depth interviews with 42 childless men and women aged 65 or older. We frame our analyses within the life course approach, stressing the biographical development of coping strategies over the life course. Our results corroborate previous findings, and show that the major challenges older childless people in Poland face are related to feeling lonely, and to having insufficient (practical) support and care in case of dependency. We describe the actions the respondents consciously took in response to these challenges, and examine how these actions changed over the life course. The strategies aimed at promoting healthy ageing or helping older people expand their social networks are strongly in line with the respondents’ personal predispositions and earlier lifestyles and experiences.

The path to healthy ageing in China: a Peking University-Lancet Commission

Around the world, populations are ageing at a faster pace than in the past and this demographic transition will have impacts on all aspects of societies. In May 2020, the UN General Assembly declared 2021–2030 the Decade of Healthy Ageing, highlighting the importance for policymakers across the world to focus policy on improving the lives of older people, both today and in the future. While rapid population ageing poses challenges, China’s rapid economic growth over the last forty years has created space for policy to assist older persons and families in their efforts to improve health and well-being at older ages. As China is home to 1/5 of the world’s older people, China is often held up as an example for other middle-income countries. This Commission Report aims to help readers to understand the process of healthy ageing in China as a means of drawing lessons from the China experience. In addition, with the purpose of informing the ongoing policy dialogue within China, the Commission Report highlights the policy challenges on the horizon and draws lessons from international experience.

Co-Reasoning With the Significant Other(s): How Childless Older Adults in Rural China Make Residential Decisions

Applying the concept of residential co-reasoning, this research explored the role of the next of kin in the residential decision-making of childless older adults in rural China. We examined research questions regarding who, if anyone, had been the significant other(s) during the residential decision-making, and how they conducted the co-reasoning process. A constructivist grounded theory approach was applied, with 27 childless older adults being interviewed. We found that participants tended to choose to age in place if they had a continuous, reliable, and trustworthy relationship with certain members of next of kin, which they referred to as "I have someone at home." Acquiring care from kin was an ongoing negotiation process. Participants applied three types of negotiations: exchanging properties for care from kin; maintaining relational intimacy with kin; and counting on the filial obligation of kin. Otherwise, if care from kin was unavailable, participants tended to relocate to rural institutions.

The Impact of Social Pension Schemes on the Mental Health of the Chinese Elderly: A Mediating Effect Perspective of Two-Way Intergenerational Support

With the rapid decline in China’s fertility rate, the acceleration of aging, the continuous miniaturization and nucleation of China’s family structure, and the deterioration of the elderly’s living conditions and mental states, the elderly’s mental health has emerged as a major public health issue and a major social problem. Pensions are the elderly’s primary source of income, and they can help them meet their basic needs while also promoting family harmony and improving their mental health. Based on the data of the 2012, 2016, and 2018 Chinese Family Panel Studies (CFPS), we empirically examined the impact of pensions on the elderly’s mental health by using the fixed effects model, mediating effect model, and so on. The results show that receiving pension benefits can significantly reduce the level of depression and improve the mental health of the elderly. Receiving pension benefits causes reverse intergenerational economic transfer, which reduces the effect of pensions on the elderly’s mental health to some extent, but the life care and mental comfort provided by children increases when the elderly share pensions with their children. Overall, receiving pension benefits improves the mental health of the elderly. In addition, the effect of pensions on the elderly with different characteristics is heterogeneous. The older elderly, women, the elderly living with their children, and the elderly in rural areas all benefit more from receiving pension benefits. Moreover, the worse the mental health of the elderly is, the stronger the influence of pensions on their mental health is. Our discussion has important policy implications.

Late-Life Working Participation and Mental Health Risk of Retirement-Aged Workers: How Much Impact Will There Be From Social Security System?

PURPOSE

Increasing retirement-aged workers are encouraged to stay in the labor market, as delayed retirement initiative is proposed. This study investigates the interplay of late-life working participation and social security on the mental health risk of retirement-aged workers.

METHOD

We applied data from the China Health and Retirement Longitudinal Study (CHARLS-2018), and the instrumental variables regression was conducted.

RESULTS

Late-life working could alleviate depression, as did the beneficiary status of employment-based social health insurance and the pensionable phase of social pension participation. Besides, the role of late-life working in alleviating depression became more salient when late retirees were not insured by the employment-based social health insurance and still in the pension contribution phase.

CONCLUSIONS

It is suggested that the current social security system in China has not been sufficiently well designed to protect the mental health of retirement-aged workers.

The Relationships among Mindfulness, Self-Compassion, and Subjective Well-Being: The Case of Employees in an International Business

This study aimed to investigate the relationships among mindfulness, self-compassion, and subjective well-being among employees. The questionnaire research method was used to collect data in this study, and the subjects included employees of Carrefour, an international business in Taiwan. A total of 629 valid questionnaires were used to evaluate the overall structure and analyze the mediating effect with the SPSS 21.0 statistical software. The results showed that mindfulness was positively related to subjective well-being, mindfulness was positively related to self-compassion, and self-compassion was positively related to subjective well-being. It was also found that self-compassion partially mediated the relationship between mindfulness and subjective well-being.

Childlessness, personal social networks and wellbeing at advanced ages: a cross-sectional study in a Southern European familistic welfare state

During the past decades, childless old age has attracted a considerable amount of scholarly interest. However, few studies address this phenomenon in Southern European familistic welfare states, where there is a pervading expectation that family members, especially spouses and children, care for their older relatives. The present cross-sectional study aims to analyse the relationship between childlessness, social networks and wellbeing in a sample of 612 Portuguese individuals aged 65 and over, comprising two sub-samples: parents (N = 540) and childless (N = 72). Data were collected through a research protocol that included a sociodemographic questionnaire, a personal social network assessment inventory, and several validated psychometric measures of psychological wellbeing focusing on mental health, loneliness, depression and satisfaction with life. Childless older adults' social networks are smaller but more diverse, including a more significant proportion of friends and neighbours. No differences were found in perceived support from significant others, but network reciprocity was lower among non-parents. The childless subsample also reported more feelings of loneliness and less life satisfaction, but regression analysis showed that parenthood status, per se, is not significantly related to any outcome measures. Besides the central role of sociodemographic characteristics and personal functioning measures in explaining psychological wellbeing variance, several network factors were also identified as influential predictors. Implications for micro-level network intervention and macro-level social policy making are discussed.

Predicting the long-term cognitive trajectories using machine learning approaches: A Chinese nationwide longitudinal database

OBJECTIVES

This study aimed to explore the long-term cognitive trajectories and its' determinants, and construct prediction models for identifying high-risk populations with unfavorable cognitive trajectories.

METHODS

This study included 3502 older adults aged 65-105 years at their first observations in a 16-year longitudinal cohort study. Cognitive function was measured by the Chinese version Mini Mental State Examination. The heterogeneity of cognitive function was identified through mixed growth model. Machine learning algorithms, namely regularized logistic regression (r-LR), support vector machine (SVM), random forest (RF), and super learner (SL) were used to predict cognitive trajectories. Discrimination and calibration metrics were used for performance evaluation.

RESULTS

Two distinct trajectories were identified according to the changes of MMSE scores: intact cognitive functioning (93.6%), and dementia (6.4%). Older age, female gender, Han ethnicity, having no schooling, rural residents, low-frequency leisure activities, and low baseline BADL score were associated with a rapid decline in cognitive function. r-LR, SVM, and SL performed well in predicting cognitive trajectories (Sensitivity: 0.73, G-mean: 0.65). Age and psychological well-being were key predictors.

CONCLUSION

Two cognitive trajectories were identified among older Chinese, and the identified key factors could be targeted for constructing early risk prediction models.

The impact of unmet needs for assistance with activities of daily living on the self-rated health and life satisfaction of Chinese community-dwelling older adults

OBJECTIVES

This study examined the associations of change in unmet needs for assistance with Activities of Daily Living (ADLs) with the self-rated health and life satisfaction of community-dwelling Chinese older adults.

METHODS

Using national longitudinal data from the Chinese Longitudinal Healthy Longevity Study, we examined the associations of change in unmet ADL needs with self-rated health and life satisfaction from baseline (T1) to a 3-year follow-up (T2) among 1,914 ADL-limited older adults. Change in unmet ADL needs was categorized into 'Persistently Unmet,' 'Unmet at T1 Only,' 'Unmet at T2 Only,' and 'Never Unmet.' Self-rated health and life satisfaction were rated by 5-point Likert scales. Linear mixed models were performed to examine the associations, controlling for sociodemographics, health conditions, and social support.

RESULTS

Older adults whose ADL needs were 'Persistently Unmet,' 'Unmet at T2 Only,' or 'Never Unmet,' showed a significant decline in self-rated health, but those whose ADL needs were 'Unmet at T1 Only' exhibited a significant rise at follow-up. While life satisfaction was stable among older adults with 'Persistently Unmet' or 'Never Unmet' ADL needs, it significantly decreased among those with 'Unmet at T2 Only' ADL needs and increased among those with 'Unmet at T1 Only' ADL needs.

CONCLUSION

Unmet needs may play an even more significant role in negatively impacting life satisfaction than the ADL limitation itself. Unmet ADL needs' effects on self-rated health and life satisfaction appeared to be short-term rather than long-term. Thus, it is never too late to adequately meet older adults' ADL needs.

Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2045563.

The relationship between living arrangements and depression among older adults in Shandong, China: The mediating role of social support

BACKGROUND

Living arrangements and social support have an impact on depression among older adults. However, the underlying mechanism between those variables remains unknown. This study aims to investigate the mediating role of social support in the relationship between living arrangements and depression among older adults.

MATERIALS AND METHODS

Multi-stage stratified sampling method was used to select 3,859 older adults from Taian City, Shandong Province, China, for cross-sectional investigation. Living arrangements were measured by a question. Social support and depression were measured using the Multidimensional Scale of Perceived Social Support and Patient Health Questionnaire-9. Multiple linear regression models were used to assess the relationship between living arrangements and depression and the possible influence of social support on the relationship between living arrangements and depression.

RESULTS

Statistics showed that 15.08% of older adults lived alone. After controlling for covariates, living arrangements (ß = 0.45, t = 2.87, P < 0.01) and social support (ß =-0.08, t =-16.93, P < 0.001) were significantly associated with depression. The linear regression model showed that social support mediated the relationship between living arrangements and depression, and the mediating effect accounted for 18.20% of the total effect.

CONCLUSION

This study revealed that living arrangements played an essential role in indirectly predicting depression in older adults through social support. This provided evidence for how to reduce depression in older adults.

Communication About Chronic Pain in Older Persons' Social Networks: Study Protocol of a Qualitative Approach

A lack of social relations appears to impact on health and life expectancy among the older persons. The quality and diversity of social relations are correlated with good health and well-being in later life. Chronic pain is a crucial issue in aging population. Effective communication between the older persons with chronic pain, their relatives and the actors of the healthcare system facilitates the management of this condition. Studies on communication in later life generally do not consider the older persons' social network as a whole, focusing only a specific segment (e.g., family or medical staff). This lack of scientific data prevents the actors of the healthcare system from offering solutions to bridge clinically relevant communication gaps. As a consequence, our study has three objectives: (1) to identify how the older persons perceive communication about chronic pain with their social network; (2) to identify their unmet communication needs; (3) to develop recommendations that improve communication about chronic pain in later life. The study will be divided into two phases. The first phase will meet objectives 1 and 2. It will involve individual interviews with about 50 people over 75 years old suffering from chronic pain and without major cognitive or auditory troubles. In this phase, we will apply a multi-layered analysis. We will map the older persons' personal network and identify their communication practices and needs, by combining content and discourse analysis with social network theories. The second phase of the study will aim at recommendations based on the results of the first phase (objective 3). It will require focus groups with different sets of stakeholders (older persons, relative caregivers, health professionals, decision-makers). In the second phase, we will use content analysis to pinpoint the concerns and suggestions for action. The results will be disseminated on three levels: (1) to the scientific world (specialists in the field of health and aging and health communication); (2) to health practitioners working with older persons; (3) to society at large, with a focus on institutions and groups directly concerned by the issue.

Unpacking the Mental Health of Nurses during COVID-19: Evidence from Pakistan

The prime objective of the present study is to test the effect of COVID-19 fear on the mental condition of nurses in the public health sector of Pakistan. This study seeks to measure the psychological distress, anxiety, and psychological well-being of nurses due to fear of COVID-19 and exposure to COVID-19. This research further reveals the moderating role of “social support” in the link between COVID-19 fear, exposure and mental health. Through a convenient sampling technique, 250 sample contributors were chosen from 12 public hospitals. The results were obtained by applying multiple regression and moderation analysis by SPSS and the Hayes process. The outcomes indicated that fear of exposure to COVID-19 affects the mental health of nurses. The findings also discovered that social support is not very constructive in the pandemic. However, we suggested that social support is the best weapon to encourage nurses to relieve their fear and minimize negative emotions.

Attitude towards ageing and perceived health status of community-dwelling older persons in a low resource setting: a rural-urban comparison

BACKGROUND

Older person's attitude to ageing is critical for their adjustment, acceptance of health-related behaviour, survival and choices. Their attitude influences how they cope with the challenges experienced while ageing, which affects their quality of life and health-related outcomes. Despite the increasing number of older persons in sub-Saharan Africa, there is limited information about their experience. This study examines the experience and attitude of older persons in Nigeria regarding the ageing process.

METHODS

A descriptive cross-sectional study among older persons aged 60 years and above was carried out in a selected rural and an urban community in Oyo State, south-western Nigeria. The study participants were selected using a multi-stage sampling technique. Trained research assistants collected data with the aid of an interviewer-administered, semi-structured questionnaire. The Attitude to Ageing Questionnaire (AAQ) was used to measure participants' perception of ageing in three domains (psychosocial loss, physical changes and psychological growth). Data were analysed using Stata version 14 at a level of significance p < 0.05.

RESULTS

A total of 1,180 participants (588 rural vs. 592 urban) were recruited for the study. The mean age was 73.2 ± 9.3 years. The majority (69.7 %) were females and still working (50.5 %). Overall, urban-dwelling participants had a better attitude to the ageing process in all the domains compared with rural-dwelling participants (psychological growth 32.5 ± 3.4 vs. 32.4 ± 3.3, p = 0.30; physical change 27.5 ± 5.1 vs. 26.9 ± 5.0, p = 0.03; and psychosocial loss 25.3 ± 5.7 vs. 25.0 ± 5.3, p = 0.60). Among the rural and urban-dwelling participants, good self-rated health was significantly associated with a positive attitude to ageing across the domains.

CONCLUSIONS

Older persons residing in urban communities had higher positivity to ageing than their rural older counterparts. The common factor significantly associated with a positive attitude to ageing in both groups was good self-rated health. This information can be used for the planning of targeted interventions and informing policy formation for improved provisions for community-dwelling older persons in Nigeria and other sub-Saharan African countries.

Do Social Pension Schemes Promote the Mental Health of Rural Middle-Aged and Old Residents? Evidence From China

As China experiences rapid aging, the mental health of older rural adults has become a major public health concern. Among other social insurance programs, the New Rural Social Pension (NRSP) scheme was established to replace part of the income for old-age rural residents in China. This article employs survey data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018 to investigate the impact of a pension on depression in middle-aged and old residents. Our results show that the pension scheme not only reduces the depressive symptoms of the rural residents but keeps down the prevalence rate of depression. Among the subscribers of the pension scheme, the pensioners benefit more from enrolling in the pension scheme than the contributors in terms of depression alleviation. The impact of pension on depression displays heterogeneity; female residents, residents in central China, and/or those from lower income households are found to be positively affected. It is also confirmed that a pension scheme contributes to easing depression via reduced labor supply, better family support, and more consumption expenditure.

JEL Classification: H55, I18, I38.

Feeling about living arrangements and associated health outcomes among older adults in India: a cross-sectional study

INTRODUCTION

Advancement in the field of gerontology has been concerned with the well-being of older adults in a family setup that is associated with caregiving and support. While family life and well-being are defined by emotion, caregiving, and support activities, dissatisfaction/discontent with living arrangements is a public health concern, which is increasing with a rise in the proportion of the older population in the country. The study examines the association of dissatisfaction with living arrangements with health outcomes among older men and women in India.

METHODS

The present research used data from the 'Building a Knowledge Base on Population Aging in India'. The effective sample size for the analysis was 9181 older adults. Descriptive statistics and bivariate analysis were performed to present the preliminary estimates. For finding the association between various health outcomes over explanatory variables, binary logistic regression model was used separately for men and women.

RESULTS

About 22.8% of men and 30.8% of women who were living alone were dissatisfied with their present living arrangement. It was revealed that both men and women who were dissatisfied with their present living arrangements had significantly higher odds of experiencing poor self-rated health [OR:4.45, 3.25 ~ 6.09 and OR:3.32, 2.54 ~ 4.34], low psychological health [OR: 2.15, 1.61 ~ 2.86 and OR: 1.99, 1.57 ~ 2.53], low subjective well-being [OR: 3.37, 2.54 ~ 4.45 and OR: 3.03, 2.36 ~ 3.38], low ADL [OR: 1.77, 1.2 ~ 2.62 and OR: 1.59, 1.17 ~ 2.18, low IADL] [OR: 1.32, 1.03 ~ 1.69 and OR: 1.57, 1.24 ~ 1.98] and low cognitive ability [OR: 1.26, 0.98 ~ 1.61 and OR:1.44, 1.13 ~ 1.82] in comparison to their counterpart from men and women respectively.

CONCLUSION

It is found that dissatisfaction with the living arrangement of older men and women is negatively associated with major health outcomes. Hence, appropriate policies and programs must be developed to promote increased family care and support and an improved residential environment that would create a feeling of comfort and happiness among older individuals.

Residential reasoning: how childless older adults choose between ageing in place (AIP) and institutionalisation in rural China

The decision of whether to grow old in one's home (also referred to as ageing in place (AIP)) or relocating to an institution is an ongoing negotiation process, which involves residential decisions and adaptation. This research aims to explore how childless older adults in rural China choose between AIP and institutionalisation. Through a qualitative study conducted in rural China among childless older adults, we explored the reasons why they make certain residential choices and how they adapted during the decision process. Twenty-five childless participants (aged 60–83) were interviewed. Findings suggested that they referred to the term ku (literally meaning ‘bitterness’; and a metaphor referring to ‘conducting farming and farm-related activities’) to explain their residential decisions. If a person could endure ku – sustain food and basic living through farming and farm-related activities, they tended to choose to age in place; otherwise, they chose to relocate to institutions. Ku represents a sense of mastery, encompassing the stressfulness and suffering aspect that requires adaptation. Three adaptive strategies were identified: (a) positive reappraising of the negative aspect of ku, (b) routinising ku, and (c) transcending the narrative of ku into a toughness identity. Our findings suggest that childless older adults struggled to achieve residential mastery while making residential decisions, even though a sense of mastery was shaped by the individual and structural constrictions.

Childlessness and Social Support in Old Age in China

Although previous studies showed that children are the primary source of old-age support in China, much less is known about the availability and sources of social support among childless elders. Also, little research has explored how older adults' social support transitions over time by childless status. Using the 2005 and 2011 Chinese Longitudinal Healthy Longevity Survey (N = 14,575), this study examined the transition of living arrangement and sources of social support by childless status among adults aged 65 and older. A series of multinomial logistic and linear regression models were used to analyze the data. Results show that compared to elders with children, childless elders were more likely to live alone or in an institution at baseline, but their probability of living alone decreased substantially while that of living in an institution increased modestly in the 6-year follow-up. Moreover, childless elders generally had fewer support sources, but this disadvantage became smaller over time. Although childless elders were significantly more likely to depend on nobody, the spouse, grandchildren (or other relatives), or nonrelatives for support at baseline, this pattern disappeared in the follow-up likely due to mortality selection. Findings imply that although the risk of social isolation among childless elders becomes lower as age progresses, garnering more social resources at younger ages may help reduce their premature mortality.

Association between mental health and community support in lockdown communities during the COVID-19 pandemic: Evidence from rural China

Governments worldwide have taken unprecedented social distancing and community lockdown measures to halt the COVID-19 epidemic, leaving millions of people restrained in locked-down communities and their mental well-being at risk. This study examines Chinese rural residents' mental health risk under emergency lockdown during the COVID-19 pandemic. It investigates how the environmental, socioeconomic, and behavioral dimensions of community support affect mental health in this emergency context. We also explore whether community support's effectiveness depends on the strictness of lockdown measures implemented and the level of individual perceived COVID-19 infection risk. We collect self-reported mental health risk, community support, and demographics information through a cross-sectional survey of 3892 Chinese rural residents living in small towns and villages. Ordinary least square regressions are employed to estimate the psychological effects of community support. The results suggest that the COVID-19 epidemic and lockdown policies negatively affect psychological well-being, especially for rural females. The capacity for community production has the largest impact on reducing mental health risks, followed by the stability of basic medical services, community cohesion, housing condition, the stability of communications and transportation supply, and the eco-environment. The effectiveness of different community support dimensions depends on the level of lockdown policy implemented and the levels of one's perceived risk of COVID-19 infection. Our study stresses the psychological significance of a healthy living environment, resilient infrastructure and public service system, and community production capacity during the lockdown in rural towns and villages.

Childlessness and Health Among Older Adults: Variation Across Five Outcomes and 20 Countries

OBJECTIVES

No previous study to the best of our knowledge has examined the association between childlessness and health using a wide range of countries and health outcomes. This study improves previous literature by examining the relationship between "childlessness" (1 = childless for any reason, 0 = parent of biological, step, or adopted child) and health across 20 countries and five health outcomes.

METHODS

Drawing on cross-sectional harmonized data from the family of Health and Retirement Surveys across the United States (HRS, Wave 11), Europe (SHARE, Waves 4 and 5), Mexico (MHAS, Wave 3), and China (CHARLS, Wave 2), we use logistic regression models to estimate the association between childlessness and poor health (poor self-rated health, 1 or more ADL limitations, 1 or more IADL limitations, 1 or more chronic conditions, and depression) in a sample of adults aged 50 and older across 20 countries (N = 109,648).

RESULTS

Our results point to an absence of associations between childlessness and health, and suggest that childlessness may be associated with better (e.g., Mexico, Hungary) or worse health (e.g., Austria, Estonia, Netherlands, Poland) in certain contexts and for certain measures.

DISCUSSION

We discuss these findings in light of the meaning of childlessness, as well as cross-national economic, social, and cultural contexts to provide suggestions for aging policy and future research.

Life satisfaction among older adults in urban China: does gender interact with pensions, social support and self-care ability?

In urban China, the social welfare system and the family structure have changed dramatically, while gender norms are still deep-rooted, particularly among older adults. Under this social, demographic and cultural context, this study aims to take a gender-specific perspective to investigate whether and how gender moderates the roles of pensions, social support and self-care ability on older adults’ life satisfaction. Based on the survey data collected from 2,047 older adults aged 65 years and over in urban China in 2018, multiple linear regressions were applied to explore the moderation effects. The results show that the pension is important to older adults’ life satisfaction regardless of gender. For social support, the association between family support and life satisfaction is stronger for older men than for older women; interdependent social support, especially being a confidant, matters more to women than to men. The interaction between self-care ability and gender reveals some interesting patterns: self-care ability is found to have a positive association with women's life satisfaction but a negative association with men's. This study contributes to the existing literature by demonstrating how gender intertwines with the most important factors of older adult's life satisfaction in China – a society with strong gender norms and a patriarchal culture. These findings could be relevant to other Asian societies.

The Role of Self-Esteem in the Relationship Between Loneliness and Life Satisfaction in Late Adulthood: Evidence from Poland

Background

The life satisfaction of elderly persons has been extensively investigated and discussed. However, a literature review shows that relatively few studies have focused on the effect of loneliness on the life satisfaction of older adults. Some researchers have acknowledged that the character of the relationship between loneliness and life satisfaction is still unclear, and this association is much more complex that it appears to be. Therefore, the main purpose of the current study was to understand how loneliness is associated with satisfaction, and whether self-esteem and educational involvement in the University of the Third Age (U3A) courses can affect this relationship among elderly people.

Methods

The research was conducted on a group of 179 elderly adults (65% women). We measured loneliness, satisfaction, and self-esteem. The data were collected via the paper-and-pencil format through convenience sampling, just before the COVID-19 pandemic began.

Results

The results obtained show that loneliness correlated negatively with self-esteem and life satisfaction. Self-esteem was associated positively with life satisfaction. Self-esteem acted as a suppressor between loneliness and life satisfaction. The participation of older adults in U3A moderated the strength of the relationship between loneliness and life satisfaction (direct effect) and between loneliness and life satisfaction mediated by self-esteem (indirect effect).

Conclusion

The mediatory role of self-esteem and the moderating role of educational activities in the relationship between loneliness and life satisfaction in late adulthood have important developmental and social implications. It appears that although feelings of loneliness and social isolation have a negative association on the life satisfaction of older adults, this relationship may be altered by empowering seniors’ self-esteem through their involvement in lifelong learning. Such a solution supports the functioning of older people also at the social level.

Preferences, Partners, and Parenthood: Linking Early Fertility Desires, Marriage Timing, and Achieved Fertility

In the United States, underachieving fertility desires is more common among women with higher levels of education and those who delay first marriage beyond their mid-20s. However, the relationship between these patterns, and particularly the degree to which marriage postponement explains lower fertility among the highly educated, is not well understood. We use data from the National Longitudinal Survey of Youth 1979 cohort to analyze differences in parenthood and achieved parity for men and women, focusing on the role of marriage timing in achieving fertility goals over the life course. We expand on previous research by distinguishing between entry into parenthood and average parity among parents as pathways to underachieving, by considering variation in the impact of marriage timing by education and by stage of the life course, and by comparing results for men and women. We find that women with a bachelor's degree who desired three or more children are less likely to become mothers relative to women with the same desired family size who did not attend college. Conditional on becoming mothers, however, women with at least a bachelor's degree do not have lower completed family size. No comparable fatherhood difference by desired family size is present. Postponing marriage beyond age 30 is associated with lower proportions of parenthood but not with lower parity among parents. Age patterns are similar for women and men, pointing at social rather than biological factors driving the underachievement of fertility goals.

Identification, Trend Analysis and Influencing Factors of Mental Health Status of the Chinese Older Adults

This study aimed to analyse the classification, development trends and the influencing factors of the Chinese older adults’ mental health state. Based on longitudinal data of Chinese older adults from 2005 to 2014, 2077 older adults aged 64 to 105 were included and the Latent Class Model, Latent Growth Mixture Model and Multinomial Logit models were employed in this study. We find that there are three types of mental health state of the Chinese older adults: negative, positive and contradictory; and the contradictory type could easily turn into negative or positive mental health state. There are four types of dynamic trends of mental health state: persistently negative, persistently positive, pro-negative, and pro-positive. About 40% of the older adults could maintain positive mental health state, and the pro-negative accounts for larger proportion than the pro-positive. Better economic status, good living habits, cohabitation with family members and pension coverage are beneficial for positive mental health state of the Chinese older adults. There is significant heterogeneity in the state as well as development trends of mental health of the older adults. The older adults with contradictory and negative types of mental health state should get timely psychological help to avoid turning into negative state. A series of polices are needed to promote mental health for the older adults in China.

Grandparenthood in China and Western Europe: An analysis of CHARLS and SHARE

Grandparenthood is a fascinating research area that not only brings together three generations and multiple roles in different life domains, but also echoes social contexts across historical times and places. Comparative research on grandparenthood, however, rarely includes non-western countries. This article seeks to answer the question of how grandparenthood differs between Western Europe and China by using comparable representative surveys of older adults. We extend the literature in two ways by showing that: 1) compared to Western Europe, becoming a grandparent occurs earlier and is virtually universal in both Urban and Rural China - the probability of being a grandparent is over 80% for Chinese by the time they are 55, while the same cannot be said for Western Europeans until they are aged between 70 and 80; and 2) the role-overlaps with grandparenthood are different for older Chinese and Western Europeans. The probability of being a working grandparent in Rural China is about twice that in Western Europe, while the rate is similar to Western Europeans for Urban Chinese. Chinese grandparents are also more likely to live with their children than Western Europeans. Conversely, as all family transitions come earlier for Chinese but life expectancy is shorter, the probabilities that grandparenthood overlaps with widowhood and filial roles are similar to that in Western Europe. Taken together, this study provides an overarching picture of the characteristics of grandparenthood in different societies that are fundamental to the meaning, performance, and impact of grandparental roles and relevant to a better understanding of grandparenthood worldwide.

Hypothetical Interventions on Risk Factors for Cognitive Impairment among Chinese Older Adults: An Application of the Parametric G-Formula

The effects of psychosocial and dietary interventions on risk of cognitive impairment is not known. The aim of this study was to estimate the 10-year risks of cognitive impairment under hypothetical interventions of psychosocial factors and dietary intake among Chinese older adults. A sample of 7377 respondents aged 65 and over was drawn from the last four waves of the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2011/2012. The parametric g-formula was used to estimate the risk of cognitive impairment under independent hypothetical interventions of social engagement, psychological well-being (PWB), dietary intake, and the joint interventions of their different combination. The observed risk of cognitive impairment was 20.08% (95% confidence interval (CI): 18.81, 21.07). The risk ratios (RR) of cognitive impairment under the hypothetical interventions on higher social engagement, eating fruits at least sometimes, eating vegetables at least sometimes, positive PWB were 0.72 (95% CI: 0.65, 0.82), 0.93 (95% CI: 0.89, 0.95), 0.98 (95% CI: 0.89, 1.00) and 0.99 (95% CI: 0.98, 0.99), respectively. The RR of joint intervention was 0.64 (95% CI: 0.58, 0.73). Hypothetical interventions on psychosocial factors such as social engagement and PWB, as well as fruits and vegetable intake, were beneficial to protect older adults from cognitive impairment.

A longitudinal analysis of the association between the living arrangements and psychological well-being of older Chinese adults: the role of income sources

Background

Understanding how living arrangements may affect psychological well-being (PWB) is critical in China, a society with the largest older population in the world. However, few studies have examined the moderating effect of income sources on the relationship between living arrangements and PWB. Our aim was to examine whether living arrangements are associated with PWB and whether income sources moderate this association.

Methods

The data were drawn from the third (2002) to sixth (2011/2012) waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Six questions reflecting older adults’ well-being were used to measure PWB. Living arrangements were classified as follows: living alone, living with family and living in an institution. Income sources were categorized into financially independent, supported by children, and governmental support. We performed random-effects ordinal probit models to examine the association of living arrangements with PWB and the moderating effect of income sources on this relationship.

Results

We included a total sample of 30,899 observations for 16,020 respondents aged 65 and over during 9-year follow-up. Older adults living with family (β = .29, p < .001) and those living in an institution (β = .34, p < .001) had stronger PWB than those living alone; moreover, support from children (β= −.24, p < .001) or from the government (β= −.08, p < .05) has a negative effect on PWB compared to the effect of financial self-support. Living in an institution with support from children (β= −.22, p < .05) led to lower PWB than living alone with financial self-support. The opposite result was observed for older adults living with their family and supported by the government (β = .16, p < .05).

Conclusions

Our analysis provides a significant contribution to the existing literature on the relationship between living arrangements and PWB in China. We recognize that living with family or in an institution leads to better PWB than does living alone. In addition, financial support from the government can moderate this association.

Factors associated with elevated consumption of alcohol in older adults-comparison between China and Norway: the CLHLS and the HUNT Study

OBJECTIVES

The primary objective was to investigate the prevalence and factors associated with elevated alcohol consumption among older adults 65 years and above in China and Norway. The secondary objective was to compare the prevalence and factors in the two countries.

DESIGN

A secondary data analysis was conducted using two large cross-sectional studies (Chinese Longitudinal Healthy Longevity Survey data in 2008-2009 and Nord-Trøndelag Health Study data in 2006-2008).

PARTICIPANTS

A total of 3223 (weighted) Chinese older adults and 6210 Norwegian older adults who responded drinking alcohol were included in the analysis.

OUTCOME MEASURES

The dependent variable was elevated alcohol consumption, which was calculated as a ratio of those with elevated drinking among current drinkers. Multivariable logistic regression was used to test the dependent variable.

RESULTS

The prevalence of elevated alcohol consumption among current drinkers for the Chinese and Norwegian samples were 78.3% (weighted) and 5.1%, respectively. Being male was related to a higher likelihood of elevated alcohol consumption in both Chinese and Norwegian samples (OR=2.729, 95% CI 2.124 to 3.506, OR=2.638, 95% CI 1.942 to 3.585). Being older, with higher levels of education and a living spouse or partner were less likely to have elevated drinking in the Chinese sample (OR=0.497, 95% CI 0.312 to 0.794, OR=0.411, 95% CI 0.260 to 0.649, OR=0.533, 95% CI 0.417 to 0.682, respectively). Among Norwegian older adults, a higher level of education was related to higher likelihood of elevated drinking (OR=1.503, 95% CI 1.092 to 2.069, OR=3.020, 95% CI 2.185 to 4.175). Living in rural areas and higher life satisfaction were related to lower likelihood of elevated drinking in the Norwegian sample (OR=0.739, 95% CI 0.554 to 0.984, OR=0.844, 95% CI 0.729 to 0.977, respectively).

CONCLUSIONS

The elevated alcohol consumption patterns were strikingly different between China and Norway in regards to prevalence and socioeconomic distribution. To develop and implement culturally appropriate public health policies regarding alcohol in the future, public health policy makers and professionals need to be aware of the cultural differences and consider the demographic, social and economic characteristics of their intended population.

"It is not simply the loss of a child": The challenges facing parents who have lost their only child in post-reproductive age in China

The death of one's only child in post-reproductive age (in Chinese, shidu) is a traumatic event that has specific cultural implications in China. This study investigates the experience of a changed life and emerging challenges amongst Chinese shidu parents. Thematic analysis of 36 interviews revealed four main life consequences following shidu: impairment of psychological and physical health, weakening of social networks and interactions, loss of meaning in life, and lack of care and security. We suggest that health monitoring and mental health intervention, adequate social and community support, and improved social security are the critical needs in this vulnerable group.

Disability, Psychological Well-Being, and Social Interaction in Later Life in China

Many studies show that disability predicts lower social participation and poorer psychological well-being. However, few have examined how disability, social interaction, and psychological well-being interrelate with one another. We use diary data from World Health Organization's Study on Global AGEing and Adult Health, 2007-2010 ( N = 8,771) and mediation analysis to examine the links between disability, daily social interaction, and the momentary and global well-being of older adults in China. We find suggestive support for the hypothesis that psychological well-being predicts social interaction in the context of disablement, but little evidence for the converse. Specifically, in a cross-sectional analysis, disability predicts lower levels of momentary affect, happiness, and life satisfaction, which are linked to spending more time alone and participating in fewer activities with grandchildren, friends, and coworkers. These findings are consistent with the hypothesis that a less active social life is explained by poor functional performance and compromised psychological vibrancy.

Cell Phone Use and Happiness Among Chinese Older Adults: Does Rural/Urban Residence Status Matter?

This study explores the relationship between cell phone use and self-reported happiness among older adults in Mainland China and whether rural/urban residence status moderates this relationship. The analysis is based on a sample of 6,952 respondents over the age of 60, from the 2010 wave of China Family Panel Studies. Findings show that using own cell phone is positively associated with self-reported happiness among Chinese older adults (odds ratio [ OR] = 1.283, p < .001). This relationship remains for respondents residing in rural areas ( OR = 1.616, p < .01) but not for their urban counterparts. Findings reflect on how the happiness of Chinese older adults has been affected by a growing shift in the traditional family values due to the unprecedented economic growth. Results also highlight the disparities between state support for older adults in rural and urban areas as well as the necessity to develop relevant policies to improve the subjective well-being of China's rapidly growing population of older adults.

Family status and later-life depression among older adults in urban Latin America and the Caribbean

Rapid fertility declines in Latin American and Caribbean countries since the 1960s have contributed to smaller family sizes among the current cohorts of older adults. This may have mental health implications in these societies as the family unit is highly valued as a source of social support. Utilising data from the 2000 Survey of Health, Well-being and Aging in Latin America and the Caribbean (SABE), this study examines the association between parental status, marital status and the likelihood of experiencing depressive symptoms among adults 60 years and older in seven cities within Latin America and the Caribbean (N = 9,756): Buenos Aires, Bridgetown, São Paulo, Santiago, Havana, Mexico City and Montevideo. Results from multivariate logistic regressions indicate that parental status is not significantly associated with depressive symptoms. Nonetheless, unmarried older adults, both those living alone and those living with others, are more vulnerable to experiencing depressive symptoms than their married counterparts. Marriage is especially protective for older adults in Havana and Montevideo. Older adults’ perceived income adequacy significantly moderates the relationship between marital status and depressive symptoms. Other significant covariates, such as experiencing disability and comorbidity, showed positive associations with depressive symptoms. While families may still represent a critical component for the mental health of older adults, broader investments in health across the lifespan are needed to improve individual psychological wellbeing.

Exploring predictors of life satisfaction and happiness among Siberian older adults living in Tomsk Region

Despite the growing interest in studying factors affecting subjective well-being of older adults, little research has been conducted on vast territory of Siberia (Russia) with large population. To address this lack of evidence, we explored the relationship between subjective well-being and social aspects (social and emotional support, social network, and social activities), living conditions (standards of living and residence area), self-reported health, and demographic characteristics in older adults living in Tomsk Region, Siberia. Subjective well-being was measured by life satisfaction and happiness (each measured with one 11-point question). Sample included 489 community-dwelling respondents, aged 65 or older. We found that mean life satisfaction and happiness reported by our respondents were lower than those of European countries. Higher quality of social interaction, better standards of living, and being satisfied with own health were associated with higher life satisfaction and happiness. This study provides original data on a region barely investigated and suggests that Siberian older adults receive strong benefits from social support and from social network and that similar factors are related to subjective well-being both in Siberian and Eastern European older adults. Future studies should further explore the relationship between different kinds of social support (e.g., psychological vs. material support) and subjective well-being in different Siberian ethnic groups or regions.

"Ikigai", Subjective Wellbeing, as a Modifier of the Parity-Cardiovascular Mortality Association - The Japan Collaborative Cohort Study

BACKGROUND

Nulliparity is associated with an excess risk of cardiovascular disease (CVD). "Ikigai", subjective wellbeing in Japan, is associated with reduced risk of CVD. The impact of ikigai on the association between parity and the risk of CVD, however, has not been reported.

METHODS AND RESULTS

A total of 39,870 Japanese women aged 40-79 years without a history of CVD, cancer or insufficient information at baseline in 1988-1990, were enrolled and followed until the end of 2009. They were categorized into 7 groups according to parity number 0-≥6. Using Cox regression hazard modeling, the associations between parity and mortality from stroke, coronary artery disease, and total CVD were investigated. During the follow-up period, 2,121 total CVD deaths were documented. No association was observed between parity and stroke and CVD mortality in women with ikigai, but there was an association in those without ikigai. The multivariable hazard ratios of stroke and total CVD mortality for nulliparous women without ikigai vs. those with 1 child were 1.87 (95% CI: 1.15-3.05) and 1.46 (95% CI: 1.07-2.01), respectively, and that for stroke mortality in high parity women without ikigai was 1.56 (95% CI: 1.00-2.45).

CONCLUSIONS

Nulliparous or high parity women without ikigai had higher mortality from stroke and/or total CVD, suggesting that ikigai attenuated the association between parity and CVD mortality in Japanese women.

Childlessness and vulnerability of older people in China

Background

the number of childless older people is increasing in China, but relatively little is known about the role of childlessness in health outcomes. This study investigates the relationship between childlessness and three health outcomes: difficulty with Instrumental Activities of Daily Living (IADLs), self-rated health and depression.

Methods

this study includes 13,171 individuals aged 50 and above from national survey data of the second wave of the China Family Panel Study (2012). Binary/multinomial logistic and ordinary least squares regression models are presented.

Results

childless individuals whose children have all died exhibit worse health outcomes than individuals with children, but this effect is influenced by demographic characteristics, socio-economic status and social security. On the other hand, individuals who are childless due to other reasons (involuntary or voluntary) are less likely to report difficulty with IADLs and to report depression than older people with all children alive after controlling for demographic and socio-economic and social security factors.

Conclusions

the death of a child has an adverse effect on people's health for both childless people whose children have all died and those who have lost a child but have other children alive. These two groups are in the most vulnerable position, which could also suggest that their children have died because they grew up in a vulnerable family. The government needs to improve the social security for these two groups and provide social services (particularly mental health services) to older people who have lost a child; these could contribute to alleviating some of the adverse effects of the death of a child.

Factors Affecting Life Satisfaction of Older Adults in Turkey

This study aimed to examine the determinants of life satisfaction of older adults in Turkey. The sample consisted of 2,959 older adults over 65 years. The effects of psychological, daily life and instrumental activity, physical health and health status, and other important variables on life satisfaction were analyzed. The variables lessening life satisfaction for older adults included poverty, a lower self-reported health status, a decline in physical health, ability to chew, ability to do household activities, and an increase in feelings of depression and feeling social withdrawn. In contrast, being married, having a higher education level, and having an income-generating work increased life satisfaction among older adults. This study suggests the necessity of developing local and national policies that enable older adults to become more active in their communities. These policies should be coordinated under the framework of national aging policies that bridge health, social, and economic issues.

Factors associated with consumption of alcohol in older adults - a comparison between two cultures, China and Norway: the CLHLS and the HUNT-study

Background

There is little knowledge about the consumption of alcohol among Chinese and Norwegian older adults aged 65 years and over. The aim of this study was to investigate the prevalence and factors related to alcohol consumption among older adults in China and Norway.

Methods

The Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2008–2009 conducted in China and The Nord-Trøndelag Health Study data in 2006–2008 (HUNT3) conducted in Norway were used. Mulitvariable logistic regression was used to test the factors related to alcohol consumption.

Results

The prevalence of participants who drink alcohol in the Chinese and Norwegian sample were 19.88% and 46.2%, respectively. The weighted prevalence of participants with consumption of alcohol in the Chinese sample of women and men were 7.20% and 34.14%, respectively. In the Norwegian sample, the prevalence of consumption of alcohol were 43.31% and 65.35% for women and men, respectively. Factors such as younger age, higher level of education, living in urban areas, living with spouse or partner, and better health status were related to higher likelihood of alcohol consumption among Norwegian older women and men; while reported better health status and poorer life satisfaction were related to higher likelihood of alcohol consumption among Chinese. In addition, rural males and older females with higher level of education were more likely to consume alcohol.

Conclusion

The alcohol consumption patterns were quite different between China and Norway. Besides economic development levels and cultures in the two different countries, demographic characteristics, socioeconomic status, overall health status, and life satisfaction were associated with alcohol consumption as well.

Parenthood and depression: is childlessness similar to sonlessness among Chinese seniors?

We investigate how the mental health of older adults (60–85) is associated with childlessness and sonlessness in China, where gender-biased filial expectations and strong son preference exist. The China Family Panel Study (2012, N = 6,021) and ordinary least squares regression models are used to investigate the relationship between depression (Center for Epidemiologic Studies – Depression scale) and parental status, distinguishing between childless, parents of both sons and daughters, parents of only sons and parents of only daughters. Arguing that modernisation shapes gender preferences for children as well as formal care and pension provisions for older adults, we find a sharp rural–urban divide in the relationship between parental status and depression. Just having a son is not what matters as the best faring groups are parents who have both sons and daughters, regardless of the number of children. Rural childless and sonless are similar, whereas in urban areas parental status is not so salient, supporting modernisation theory.

Trajectories of Life Satisfaction and their Predictors among Korean Older Adults

BACKGROUND

Among older adults, life satisfaction (LS) correlates with health, mortality, and successful ageing. As various potential threats to LS tend to increase with advancing years, patterns of age-related changes in LS among older adults remain inconsistent. This study aimed to identify LS trajectories in older adults and the characteristics of individuals who experience them.

METHODS

Large-scale, nationally representative, longitudinal data collected from 2005 to 2013 were analyzed for this study. The outcome measure was a summary of multidimensional domains influencing LS: health, finance, housing, neighbor relationships, and family relationships. Latent class growth models and logistic regression models were used to identify trajectory groups and their predictors, respectively.

RESULTS

Within 3517 individuals aged 65 or older, five trajectories were identified across eight follow-up years: "low-stable" (TG1; n = 282; 8%), "middle-stable" (TG2; n = 1146; 32.6%), "improving" (TG3; n = 75; 2.1%), "upper middle-stable" (TG4; n = 1653; 47%), and "high" (TG5; n = 361; 10.3%). High trajectory individuals more frequently had higher education, financial security, good physical health, and good mental health than those in the stable, but less satisfied, groups. Similarly, compared to the largest group (upper middle-stable trajectory), individuals in the low-stable or middle-stable trajectory group not only had poorer physical and mental health but were more likely to be living alone, financially stressed, and residing in urban locations. Individuals with improving trajectory were younger and in poorer mental health at baseline compared to the upper middle-stable trajectory group.

CONCLUSION

Life satisfaction in the older follows distinct trajectories. For older adults, trajectories are stable over time and predictable, in part, from individual characteristics. Knowledge of these patterns is important for effective policy and program development.