Associations between living arrangements and health-related quality of life of urban elderly people: a study from China

Self-neglect as a mediator between family functioning and healthy aging in older adults living alone in rural China: A cross-sectional study

OBJECTIVE

This study aims to investigate the mediating role of self-neglect among older adults in the relationship between family functioning and healthy aging.

METHODS

A questionnaire survey was conducted between June and September 2023, involving 255 older adults living alone in rural China. The healthy ageing, self-neglect, and family functioning was assessed using the Healthy Aging Instrument;the Elderly Self-neglect Assessment (Rural);and Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) scale.

RESULTS

Positive correlations were found between family functioning and healthy aging (r = 0.363, p < 0.05). Moreover, self-neglect was identified as a significant mediator, explaining 40.84 % of the total effect.

CONCLUSION

Among older adults living alone in rural China, family functioning is significantly associated with healthy aging, with self-neglect mediating this relationship. These findings suggest that community-based interventions aimed at improving family functioning and addressing self-neglect behaviors might be beneficial for promoting healthy aging in this population.

The life experiences of living alone among Indonesia dwelling widowed women: A phenomenological study

In this study, the researchers aimed to understand the life experience of older widowed women living alone. Employing a phenomenological approach, we interviewed 15 older women (age 62 to 95) living alone at homes in two villages in Central Java. Through systematic text condensation procedure, we identified five themes: (1) negative feelings at times, (2) getting used to living alone, (3) needing help to support independent living, (4) coping toward negative feelings, (5) attachment to the original house. We depicted the struggles of older women living alone in their homes. Despite the coping strategies they have developed over time, older women needed help during hard times, especially when getting sick. Families and neighbors were the main resources to maintain their independent living. Improving the home environment to increase suitability for aging residents and providing a support system are the options that best fit the needs and values the older women believed.

Effects of Income on Subjective Well-Being in the Elderly: Complete Mediation Roles of Self-Rated Health and Psychological Capital

Although income and living conditions of residents have greatly improved in recent years, people's subjective well-being does not seem to increase daily. This study aimed to explore income, self-rated health, and psychological capital on subjective well-being, using data from the China General Social Survey conducted in 2017. A total of 1136 elderly as subsamples data were selected from 12 582 participants, involving general sociodemographic characteristics, income, self-rated health, psychological capital, and subjective well-being. SPSS v26.0 macro was used for descriptive statistics, ANOVA and correlation analysis. PROCESS v3.4 macro was performed to examine multiple mediating effects of self-rated health and psychological capital. The elderly residing in urban (P = .016) and having completed 9-year compulsory education (P = .016) reported higher subjective well-being scores. The findings revealed that subjective well-being was positively associated with income, health, and psychological capital among the aged adults (all P < .001). Self-rated health and psychological capital played complete mediation roles between income and subjective well-being (Effect indirect = 0.040, 95% bootstrap CI [0.022, 0.060]; Effect indirect = 0.027, 95% bootstrap CI [0.013, 0.044], respectively). Collectively, our findings indicate that residing in rural and having lower education levels serve as negative predictors of subjective well-being among the elderly. Although income still affects the elderly's subjective well-being, self-rated health and psychological capital may be the crucial mediating factors. Therefore, it is of utmost importance to improve health conditions and positive psychological capital for subjective well-being of the older people.

Integrating street view images and deep learning to explore the association between human perceptions of the built environment and cardiovascular disease in older adults

Understanding how built environment attributes affect health remains important. While many studies have explored the objective characteristics of built environments that affect health outcomes, few have examined the role of human perceptions of built environments on physical health. Baidu Street View images and computer vision technological advances have helped researchers overcome the constraints of traditional methods of measuring human perceptions (e.g., these methods are laborious, time-consuming, and costly), allowing for large-scale measurements of human perceptions. This study estimated human perceptions of the built environment (e.g., beauty, boredom, depression, safety, vitality, and wealth) by adopting Baidu Street View images and deep learning algorithms. Negative binomial regression models were employed to analyze the relationship between human perceptions and cardiovascular disease in older adults (e.g., ischemic heart disease and cerebrovascular disease). The results indicated that wealth perception is negatively related to the risk of cardiovascular disease. However, depression and vitality perceptions are positively associated with the risk of cardiovascular disease. Furthermore, we found no relationship between beauty, boredom, safety perceptions, and the risk of cardiovascular disease. Our findings highlight the importance of human perceptions in the development of healthy city planning and facilitate a comprehensive understanding of the relationship between built environment characteristics and health outcomes in older adults. They also demonstrate that street view images have the potential to provide insights into this complicated issue, assisting in the formulation of refined interventions and health policies.

Effects of safety and care services on psychological outcomes and housing satisfaction in Korean middle-aged and older adults living alone

BACKGROUND

Korean society has witnessed a rapid increase in the number of single-person households at risk for loneliness or solitary deaths. This study aims to evaluate the effectiveness of safety and care services (SCS) on the psychological outcomes and housing satisfaction of Korean middle-aged and older adults living alone.

METHODS

This study was a randomized controlled trial on residents of public rental housing. A total of 40 people underwent a 3-month intervention. For the experimental group, a caring service IoT solution was installed in participants' houses, and coordinators provided services using IoT information. The control group received only visits by coordinators.

RESULTS

The experimental group showed significant positive changes in depressive symptoms. An interaction effect of time and condition was observed, indicating that the loneliness scores of the experimental group were significantly reduced, whereas those of their counterparts were negligible. Both groups showed significant decreases in suicidal thoughts. Housing satisfaction in both groups significantly increased over time, but group differences were observed.

CONCLUSIONS

This study demonstrated the positive effects of SCS on depressive symptoms, suicidal thoughts and housing satisfaction for people living alone, suggesting that technology can be a useful tool for helping vulnerable people.

Living Arrangements and Subjective Well-Being of Elderly Chinese Tibetan People: The Mediating Role of Religion

While previous studies have found that living arrangements and religiosity can influence the subjective well-being (SWB) of older adults, they have tended to investigate each of these aspects separately. Engaging with this gap, the current study examines the relationship between living arrangements, religious attendance, and the SWB of older adults, as well as the mediating effect of religious attendance on the relationship between the other two factors. A total of 875 older adults from 40 villages or communities in a Tibetan area in China (Gannan) were surveyed. An ordinary least square regression was used to evaluate the relationship between SWB and living arrangements and/or religious attendance. A structural equation model was then used to test the mediating role played by religious attendance in the association between living arrangements and SWB. The results showed that older adults in the selected study areas who were co-residing with their children and/or spouse had a higher level of SWB compared to those living alone. While religious attendance was positively associated with older adults' SWB, the findings showed that living with their spouse or children decreased their frequency of attendance at religious activities. In contrast, it was found that living alone directly decreased older adults' SWB, but increased the frequency of their participation in religious events, thus indirectly promoting their SWB. A key implication of this study is its confirmation that religious attendance plays an important mediating role in the relationship between living arrangements and SWB.

The mental health of rural older adults: the role of the built environment in Jintang County

The mental health of older adults has become one of the major health challenges facing society today, which has attracted wide concerns from scholars in urban areas, but research in rural areas has been neglected. Therefore, this paper took rural older adult residents of 11 sample villages in Jintang County, Chengdu City, Sichuan Province, as the research object. After controlling the demographic characteristics of older adults in rural areas, this paper attempted to explore the effects of the rural built Environment on the mental health of older adults. Through field investigation in the sample villages, 515 valid questionnaires were obtained. The results from the Binary Logistic Regression Model show that good marital status, physical health, education level, well-constructed roads, and safe neighborhoods had significant positive effects on the mental health of rural older adults. Rural older adults who prefer to walk, cycle, and use public transport have better mental health, and accessibility to the periodic market, health station, bus station, village committee, supermarket, and the main road is positively correlated with the mental health of rural older adults, while the distance from home to the town center and coach terminal has a significant negative impact on the mental health of rural older adults. The research results provide a theoretical reference for further construction of rural aging environments.

Intergenerational Proximity to Aging Parents and Depression Among Married Persons in China

Using data from China Health and Retirement Longitudinal Study (N = 3864), we examined the relationship between proximity to aging parents and depression among middle-aged (45-64 years) married individuals in China. Our study depicted and explained the declining coresident rate and showed a majority of adult children live separately from their parents. Children living in different households had higher levels of depression than coresident children, including those living adjacently. Furthermore, having a coresident spouse increased the levels of depression of sons living in an adjacent dwelling and in the same city, and reduced the levels of depression of daughters living farther away. More intergenerational economic support increased the levels of depression of daughters living in an adjacent dwelling. These findings may offer a reference for married adult children to reconstruct intergenerational proximity and adjust intergenerational relations.

Analysis of the Impact of Environmental Perception on the Health Status of Middle-Aged and Older Adults: A Study Based on CFPS 2020 Data

Health risks and hazards caused by the environment have long been one of the most important public issues of concern to the state, society, and the public. At the same time, population aging is becoming a global issue, and residents' health is the most important component of people's livelihood, and residents can only pursue other rights and interests if they can protect their own health. Therefore, based on the micro data from the fifth round of the China Family Panel Studies (CFPS), this paper uses binary logistic regression with propensity score matching (PSM) to analyze the effect of environmental perception on the health status (including mental health and physical health) of middle-aged and older adults. It was found that environmental perceptions significantly affect the depressive state and sickness status of middle-aged and older adults. Among them, middle-aged and older adults who were female, of rural households, with low education and relatively low income were more affected by environmental shocks on their health. Therefore, we should pay attention to the mental and physical health of middle-aged and older adults and change the existing design concept of aging policy: the government should formulate effective policies and increase corresponding social support; and society and families should also give corresponding care and encourage middle-aged and older adults to exercise more and provide reasonable psychological guidance.

Depressive symptoms among older empty nesters in China: the moderating effects of social contact and contact with one's children

OBJECTIVES

Mental health for older people has become a major social concern. Literature has shown that older people, especially when they become empty nesters-when a parent lives alone or lives with his/her spouse after the youngest child leaves home-may start to develop various mental health problems due to reduced contacts with their children.

Using fixed-effects, multivariate regression with a difference-in-differences approach and propensity score matching, this paper examines the relationship between being an empty nester and mental health among older people in China, and the moderating effects of social contact and contact with one's children in terms of mental health. Our data come from the China Health and Retirement Longitudinal Study of 2011, 2013, 2015 and 2018.

RESULTS

We found that, in the short term, the mental health of older people may not be affected after they became empty nesters. But in the longer term, if they did not have regular contact with their children, their mental health would deteriorate with time. Social contact, especially cognitive activities, was beneficial to the mental health of the older empty nesters. We also found that for older empty nesters with disabilities, frequent social contact and contact with their children were more important.

CONCLUSION

We urge the government to promote community-based social activities for older people, especially for those with functional limitations.

Community social capital and the health-related quality of life among empty-nest elderly in western China: moderating effect of living arrangements

BACKGROUND

At present, the empty nest phenomenon is becoming more and more serious in the world, especially in China, and its health problems deserve attention. Therefore, the purpose of this study is to explore the impact of community social capital on the health-related quality of life of empty-nest elderly.

METHODS

The study used data collected from a survey study conducted between 2018 and 2019 in Sichuan province, China, with 638 empty-nest elderly meeting our criteria. SF-12 scale and self-made social capital scale were used to evaluate the health-related quality of life and community social capital of empty-nest elderly. Through descriptive statistical analysis, bivariate analysis and hierarchical multiple regression model, this study analyzes the relationship between community social capital and health-related quality of life of empty-nest elderly. Considering the role of living arrangements, this study further uses the simple effect analysis method to explore the moderating role of living arrangements.

RESULTS

After controlling the relevant variables, the cognitive social capital (CSC) of empty-nest elderly had a positive relationship with the physical health summary (PCS) (β = 0.188, p＜0.001) and mental health summary (MCS) (β = 0.205, p＜0.001). No effect of structural social capital on quality of life was found as a result. Living arrangements played a moderation effect on the relationship between CSC and MCS (β=-2.018, p＜0.05). The MCS score of high CSC group (55.516 ± 0.757) was significantly higher than that of low CSC group (49.383 ± 0.722).

CONCLUSION

The results suggest empty-nest elderly has poorer physical health and weaker structural social capital, while the cognitive social capital has a greater positive impact on their quality of life. Targeted interventions to enhance community social capital may be beneficial to improve health status of this vulnerable population.

The impact of socioeconomic status and sleep quality on the prevalence of multimorbidity in older adults

Introduction

Multimorbidity has become a global public health concern that can cause serious damage to the health status of older adults. This study aimed to investigate the impact of socioeconomic status (SES) and sleep quality on the prevalence of multimorbidity in older adults, thus providing a reference for reducing the risk of the prevalence of multimorbidity and improving the health of older adults.

Methods

A multi-stage random sampling method was used to conduct a questionnaire survey on 3,250 older adults aged 60 years and above in Shanxi Province, China. The chi-square test and multiple logistic regression models were used to analyze the association of SES and sleep quality with the prevalence of multimorbidity of older adults.

Results

The prevalence of multimorbidity was 30.31% in older adults aged 60 years and above in Shanxi Province, China. After adjusting for confounders, very low SES (OR = 1.440, 95% CI: 1.083-1.913) and poor sleep quality (OR = 2.445, 95% CI: 2.043-2.927) were associated with the prevalence of multimorbidity. Older adults with low SES and poor sleep quality had the highest risk of the prevalence of multimorbidity (OR = 3.139, 95% CI: 2.288-4.307).

Conclusions

SES and sleep quality are associated with the prevalence of multimorbidity in older adults, and older adults with lower SES and poorer sleep quality are at higher risk for the prevalence of multimorbidity.

Cognitive, psychological and social factors associated with older adults' mobility: a scoping review of self-report and performance-based measures

Although many factors have been associated with mobility among older adults, there is paucity of research that explores the complexity of factors that influence mobility. This review aims to synthesise the available evidence for factors comprising the cognitive, psychological, and social mobility determinants and their associations with mobility self-reported and performance-based outcomes in older adults (60 years). We followed Arksey and O'Malley's five stages of a scoping review and searched PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature and Sociological Abstract databases. Reviewers in pairs independently conducted title, abstract, full-text screening and data extraction. We reported associations by analyses rather than articles because articles reported multiple associations for factors and several mobility outcomes. Associations were categorised as significantly positive, negative, or not significant. We included 183 peer-reviewed articles published in 27 countries, most of which were cross-sectional studies and conducted among community-dwelling older adults. The 183 articles reported 630 analyses, of which 381 (60.5%) were significantly associated with mobility outcomes in the expected direction. For example, older adults with higher cognitive functioning such as better executive functioning had better mobility outcomes (e.g., faster gait speed), and those with poor psychological outcomes, such as depressive symptoms, or social outcomes such as reduced social network, had poorer mobility outcomes (e.g., slower gait speed) compared to their counterparts. Studies exploring the association between cognitive factors, personality (a psychological factor) and self-reported mobility outcomes (e.g., walking for transportation or driving), and social factors and performance-based mobility outcomes in older adults are limited. Understanding the additive relationships between cognitive, psychological, and social factors highlights the complexity of older adults' mobility across different forms of mobility, including independence, use of assistive devices, transportation, and driving.

Factors of Functional Disability in the Social Participation of Older Adults Living Alone With Fall Experience

The fall experiences of older adults living alone lead to restrictions in their social participation. This study aimed to examine the factors that influence functional disability in social participation (FSP) among older adults who live alone and have experienced falls. This study used secondary data of 493 older adults living alone who experienced a fall, which were collected from the 2017 National Survey of Older Koreans. Multiple linear regression analyses were performed. Factors, such as old age, sex, economic status, frequency of drinking, and number of acquaintances, significantly related to functional disability in terms of social participation. In addition, poor muscle strength, depression, and cognitive decline comprised predictors of FSP. The findings of this study revealed that it is important to comprehensively evaluate the social participation of older adults who live alone and have experienced falls.

How to Improve the Cognitive Health of Middle-Aged and Elderly People: Evidence From China Family Panel Studies

In the context of the rapid development of the internet and the increasing severity of the aging problem, and in order to promote aged health and help construct a healthy society. We use micro survey data from the 2016 China Family Panel Studies (CFPS) to investigate the impact of the internet on the cognitive health of middle-aged and elderly people (those aged 40 and above). The robust results suggest that the internet plays a significant positive role in the cognitive health of middle-aged and elderly people in terms of internet use and internet involvement. This effect does not change significantly with differences in gender, household registration, location, or household composition, but there are heterogeneity effects due to differences in education. Further analysis indicates that the satisfaction of emotional attachment with children is the internal mechanism of the internet's influence on the cognitive health of people in this age group. Our paper both help scholars and the public to better understand the impact of the internet on the cognitive health of middle-aged and elderly people and clarifies different methods of defining the internet.

A Novel Predictor for Micro-Scale COVID-19 Risk Modeling: An Empirical Study from a Spatiotemporal Perspective

Risk assessments for COVID-19 are the basis for formulating prevention and control strategies, especially at the micro scale. In a previous risk assessment model, various "densities" were regarded as the decisive driving factors of COVID-19 in the spatial dimension (population density, facility density, trajectory density, etc.). However, this conclusion ignored the fact that the "densities" were actually an abstract reflection of the "contact" frequency, which is a more essential determinant of epidemic transmission and lacked any means of corresponding quantitative correction. In this study, based on the facility density (FD), which has often been used in traditional research, a novel micro-scale COVID-19 risk predictor, facility attractiveness (FA, which has a better ability to reflect "contact" frequency), was proposed for improving the gravity model in combination with the differences in regional population density and mobility levels of an age-hierarchical population. An empirical analysis based on spatiotemporal modeling was carried out using geographically and temporally weighted regression (GTWR) in the Qingdao metropolitan area during the first wave of the pandemic. The spatiotemporally nonstationary relationships between facility density (attractiveness) and micro-risk of COVID-19 were revealed in the modeling results. The new predictors showed that residential areas and health-care facilities had more reasonable impacts than traditional "densities". Compared with the model constructed using FDs (0.5159), the global prediction ability (adjusted R2) of the FA model (0.5694) was increased by 10.4%. The improvement in the local-scale prediction ability was more significant, especially in high-risk areas (rate: 107.2%) and densely populated areas (rate in Shinan District: 64.4%; rate in Shibei District: 57.8%) during the outset period. It was proven that the optimized predictors were more suitable for use in spatiotemporal infection risk modeling in the initial stage of regional epidemics than traditional predictors. These findings can provide methodological references and model-optimized ideas for future micro-scale spatiotemporal infection modeling.

Differences in Dietary Patterns among the Polish Elderly: A Challenge for Public Health

The aim of the study was to assess the diversity of dietary patterns within the elderly, in relation to the region of residence, household structure, and socioeconomic status. The questionnaire was conducted in a group of 427 Polish adults aged 60 and older from June to September 2019. The sample was selected by means of the snowball method in two regions. Principal component analysis (PCA) was used to extract and identify three dietary patterns (factors) from the frequency of eating 32 groups of foods. Logistic regression analysis was used to determine the relationship between the identified dietary patterns (DPs), region, household status, and socioeconomic index (SES). Adherence to the identified DPs, i.e., traditional, prudent, and adverse, was associated with socioeconomic status (SES) and living environment, i.e., living alone, with partner, or with family, while the region did not differentiate them. Less people living with their family were characterized by the frequent consumption of traditional food (the upper tertile of this DP), while more of them often consumed food that was typical for both prudent and adverse DPs (the upper tertiles of these DPs). The presence of a partner when living with family did not differentiate the adherence to DPs. A high SES decreased the chances of adhering to the upper tertiles of the “prudent” and “traditional” DPs, while living with family increased the chances of adhering to both the upper and middle tertiles of the “prudent” DP. Identifying the dietary patterns of the elderly contributes to a better understanding of the food intake of the senior citizens living in different social situations, in order to support public policies and nutritional counseling among this age group.

The Expected Demand for Elderly Care Services and Anticipated Living Arrangements Among the Oldest Old in China Based on the Andersen Model

Objective: The first aim of this study was to explore expected demands of the oldest old and their determinants for different types of elderly care services. The second aim was to investigate preferred choices of living arrangements among the oldest old and the influencing factors.

Methods: Data of 4,738 participants aged ≥80 years were extracted from the Chinese Longitudinal Health Longevity Survey carried out in 2014. Using the Andersen model as the analysis framework, a multiple logistic regression analysis was performed to analyze the relationship between the expected elderly care services and living arrangements and other influencing factors. The odds ratios were calculated to indicate the relationship between the influencing factors and the dependent variables.

Results: From the descriptive analysis results, we found that the oldest old showed high anticipated needs for home visits (83.5%) and health education (76.4%). Further, there existed a huge imbalance between the supply and demand of care services for the aged. Living with children is still the most important way of providing for the oldest old. The regression results showed that the expected demands for elderly care services and anticipated living arrangements among the oldest old in China are influenced by age, residence, housing property rights, economic status, loneliness, and activities of daily living (ADLs). The oldest old who are older without housing property rights, childless, and have restricted ADLs were more frequently observed to live in long-term care institutions.

Conclusions: There is an inequality of the supply and expected demand for elderly care services, and living with children is still a preferred choice of the Chinese oldest old. Our findings indicate that when planning how to promote elderly care services among the oldest old, it is important to consider their expectations, especially for the subgroup that is relatively disadvantaged. Related policies should be developed to offer incentives to family caregivers when they live with the oldest old.

Effects of Living Alone and Sedentary Behavior on Quality of Life in Patients With Multimorbidities: A Secondary Analysis of Cross-Sectional Survey Data Obtained From the National Community Database

BACKGROUND

Having multimorbidities may increase health problems. Moreover, health-related quality of life correlates negatively with the number of chronic conditions a patient has. Living alone has been identified as a predictor of poorer quality of life, and a sedentary lifestyle is widely known to increase health problems and mortality.

PURPOSE

This study was designed to identify the effects of living alone and of sedentary behavior on health-related quality of life in patients with multimorbidities using nationally representative community data.

METHODS

A secondary data analysis of the Korea National Health and Nutrition Examination Survey was conducted. In this study, 1,725 adult patients aged 19 years and above with two or more chronic diseases were selected for the analysis. Health-related quality of life was measured using the European Quality of Life-5 Dimensions. Multiple logistic regression was performed to identify the effects of living alone and of sedentary behavior on health-related quality of life. The statistical analyses took into account the components of the complex sampling design such as the strata, clusters, weights, and adjustment procedures, and missing data were treated in a valid manner.

RESULTS

After adjusting for gender, age, employment status, and number of chronic diseases, it was found that the odds of having a high health-related quality of life were lower in single households than in multiperson households (odds ratio = 0.62, 95% confidence interval [0.46, 0.84]). In addition, after adjusting for gender, age, employment status, number of chronic diseases, and living arrangement, the odds of having a high health-related quality of life decreased as sedentary time increased (odds ratio = 0.93, 95% confidence interval [0.89, 0.96]).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

To improve quality of life in patients with multimorbidities, nursing interventions that support patients who live alone and have complicated disease-related issues and that reduce sedentary behavior should be developed.

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.

Do Living Arrangements and Social Network Influence the Mental Health Status of Older Adults in Malaysia?

Living arrangement has been reported to have a significant influence on several mental health statuses of older adults, but their social network may confound this association. This study is aimed at examining the interactive effect of living arrangements and social network on the mental health status among older adults in Malaysia. A total of 2,188 Malaysian older adults living nationwide were included in this cross-sectional study. Participants were classified into four groups according to their living arrangements (living alone or not living alone) and social network size (assessed using Lubben's Social Network Scale-6). Poor social network was defined as the lowest quartile (fourth quartile) of the score. Mental health statuses, which include flourishing in life, life satisfaction, cognitive functions, loneliness, depression, and perceived stress, were measured. Multiple linear regression models, adjusted for age, gender, education, and comorbidities, revealed that a good social network was significantly associated with an increase on the flourishing scale scores, regardless of living arrangements. Not living alone and having good social network was significantly associated with increased Montreal Cognitive Assessment scores and decreased loneliness scores. This study found that living arrangements are not always a risk factor for the mental health status of older adults. However, it may be confounded by the level of their social networks. The results suggested that the effects of social network may exceed the impact of living arrangements. It is recommended that health professionals pay more attention to the social networks of older Malaysians to harness its benefits in improving their mental health status.

Living alone, social cohesion, and quality of life among older adults in rural and urban China: a conditional process analysis

OBJECTIVES

To test the independent and combined impact of social cohesion and geographic locale (urban/rural) on quality of life (QoL) for older adults in China. Using conditional process analysis, we tested three hypotheses: (1) QoL will be lower for persons living alone than those who live with family; (2) social cohesion will mediate the association of living arrangement and QoL; and (3) geographic locale will moderate direct and indirect pathways in the mediation model.

DESIGN

Cross-sectional data from WHO Study on Global Aging and Adult Health (SAGE) (China, Wave 1, 2007-2010).

SETTING

National probability sample of 74 primary sampling units in China, 32 in urban, and 32 in rural areas.

PARTICIPANTS

A total of 9,663 adults aged 50 years and older.

MEASUREMENTS

We measured QOL with the 8-item version of the WHOQOL-Bref; living arrangement as alone versus with family; and social cohesion with an 9-item index of frequency of a range of social activities in the previous 12 months. We controlled for sociodemographic characteristics and health and mental health variables in multivariate analyses.

RESULTS

Data supported the first two hypotheses; however, the mediating effects of social cohesion held only in urban areas.

CONCLUSION

This study advances the large body of work on living arrangements and well-being of older adults in China. Social cohesion contributed to better QoL regardless of living arrangement, and cohesion mediated the association of living arrangement and QOL in urban but not rural areas. Programs and policies that strengthen social cohesion through older adults' community involvement, especially in urban areas, will help to enhance QoL.

Efficacy of the self-mutual-group model targeting quality of life improvement among empty-nest older adults in Taiyuan, China: an intervention study

Background

In China, more and more older people have encountered a situation called “empty nest.” Meanwhile, the health status of empty-nest older adults is an increasing public health concern. This research aims to examine the effectiveness of Self-Mutual-Group (SMG) model in improving quality of life of the empty-nest older adults to provide a scientific evidence for improving their health.

Methods

A prospective intervention study was conducted among empty-nest older adults in Taiyuan, Shanxi. Multi-stage stratified random cluster sampling was employed to selected participants. A total of 396 empty nesters were enrolled as participants, of which 204 and 192 were in the intervention and control group, respectively. The intervention group received a seven-month SMG-based intervention. A participant’s quality of life was measured at the baseline and seven months after using the Short Form 36-Item Health Survey (SF-36).

Results

No significant difference was found between the intervention and control groups in terms of participant characteristics at baseline (P > 0.05). After the intervention, participants’ scores on Mental Component Summary (MCS), Physical Component Summary (PCS), role emotional (RE), vitality (VT), social function (SF), mental health (MH) and general health (GH) increased significantly in the intervention group. Additionally, these scores differed significantly from those in the control group (P < 0.05).

Conclusion

This study showed that the SMG-based health management is effective in improving quality of life among empty-nest older adults after seven months.

Trial registration

Study on the ‘SMG’ Health Management Model Based on Community Organization Theory among empty-nest older adults (ChiCTR1800015884). Registration date: 26-04-2018. Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02155-4.

Quality of Life of Older People Receiving Home Health Care Services: An Example From Turkey

Advanced age, restrictions on daily life activities, increased disability, and chronic diseases negatively affect the quality of life of older individuals. The aim of the present study was to investigate the quality of life of older patients receiving home health care services (HHCS) in Samsun province, Turkey. The population of this cross-sectional study comprised 489 individuals aged 65 years and older. Patient selection was performed using the stratified randomized sampling method. A total of 183 patients were included in the study. Data were collected using a questionnaire and face-to-face interviews. The Mann-Whitney U and Kruskal–Wallis tests were used in the statistical evaluation of data, and significance was regarded as p < .05 for all tests. Some 75.4% of the patients were women, and the average age was 82 years. Eighty-three percent of the participants were semi-dependent or completely dependent in the activities of daily living (ADL); however, in the instrumental activities of daily living (IADL), 96.0% were semi-dependent or completely dependent. The quality of life of the older people receiving HHCS was identified as low both in the physical and mental health components. However, physical quality of life was statistically higher in men, in graduates of primary school or above, and in patients with no decubitus ulcers compared with the others. We found that the older individuals receiving HHCS had a lower quality of life due to their chronic diseases and high dependency compared with the general population and their contemporaries.

Association between living arrangement and quality of life for older adults in the community

Objective:

to compare the sociodemographic and economic characteristics of the older adults in the community according to the living arrangement and to verify the association between the type of living arrangement and the quality of life scores.

Method:

a cross-sectional epidemiological study conducted with 796 older adults in the community. To assess quality of life (dependent variable), network and social support (adjustment variable), validated and applied chi-square tests, descriptive statistical analysis, multiple comparison analysis (ANOVA) and multiple linear regression model (p<0.05) were used.

Results:

the older adults who lived only with their spouses had better quality of life scores in all domains and facets, except in the death and dying domain, which did not show any significant difference. The lowest scores for quality of life were identified in the groups with the presence of children and, exceptionally, in the domain of social relationships and, in the facets death and dying and intimacy, those who lived alone had worse assessments. In the adjusted model, there was an association between the type of living arrangement and the different domains and facets of quality of life.

Conclusion:

living arrangement was associated with quality of life scores for older adults in the community, even after adjusting for the gender, age, number of morbidities, and social support variables.

Health-related quality of life among elderly individuals living alone in an urban area of Shaanxi Province, China: a cross-sectional study

Objectives

To describe health-related quality of life (HRQoL), sex differences in HRQoL, and factors affecting the HRQoL of elderly people living alone in urban areas of Shaanxi Province, China.

Methods

A cohort was obtained using multistage stratified cluster random sampling. We collected cross-sectional data using surveys. HRQoL was measured using the 36-item Short Form Health Survey. Multivariable multilevel linear regression analysis was used to examine factors associated with mental and physical health component summary scores.

Results

Overall, 442 elderly Chinese individuals who lived alone completed the survey (mean age 73 years, women: 59%). Women were more likely to report better mental health than men. Factors significantly associated with reduced mental health scores were older age, having never been married or being divorced, and having a history of cancer, urinary tract disease, fractures or gastrointestinal disorders. Factors associated with physical health were having never been married or being divorced and having hypertension.

Conclusions

To our knowledge, this is the first study to describe HRQoL in a representative sample of elderly people living alone in urban areas of Shaanxi, China. Poor physical and mental HRQoL in this elderly Chinese population was mainly associated with chronic diseases and demographic factors.

Living arrangements and quality of life among older adults in China: does social cohesion matter?

Objectives: This study investigated how living arrangements are related to the well-being of Chinese older adults and the role of social cohesion in this relationship. Methods: This study used the China data from the WHO's Study on Global AGEing and Adult Health. The analytic sample featured 5,600 Chinese adults aged 60 or older. The study conceptualized two sets of models: social cohesion as mediators and as moderators in the relationship of living arrangements and quality of life. Results: Results from structural equation modelling analyses show that Chinese older adults who lived with adult children had lower quality of life scores compared with those who did not live with adult children; the negative relationship was partially mediated through decreased social cohesion. The study also found social cohesion may buffer the negative influence of not living with a spouse compared with those who did. Conclusion: This study sheds light on the mediating and moderating effects of social cohesion on the relationship between living arrangement and quality of life among older adults in China. The findings indicate the necessity of promoting social connectedness and neighborhood cohesion for older Chinese, especially those who live with their adult children.

The influence of co-residential and non-co-residential living arrangements on sufficient fruit and vegetable consumption in the aging population in Thailand

Background

Living arrangements have an impact on a family’s health-related behaviors, especially its eating behaviors. However, studies that have examined the association between living arrangements and food intake, especially fruit and vegetable (FV) consumption of older adults, are rare. This study aimed to investigate the association between living arrangements and FV consumption in a population of older adults in Thailand from a national sample of households.

Methods

This study extracted data on 2048 persons age 60 years or older from a study of a nationally-representative sample of Thai households. The survey asked respondents about FV intake, living arrangements, household size, and socio-demographic characteristics. Binary logistic regression analysis was used to investigate the association between the variables and FV intake.

Results

The mean age of the respondents was 68.2 ± 6.5 years. Of the total sample, only 31.9% had sufficient FV intake. The group with the lowest possibility of sufficient FV intake was persons who lived alone. Those who lived with at least one child or lived in a skipped-generation household were 2.7 and 2.2 times as likely to have sufficient FV intake as those who lived alone (p < 0.001 and p < 0.01, respectively). Older adults living only with their spouse were 2.1 times as likely to have sufficient FV intake as those who lived alone. FV intake also differed significantly by socio-demographic characteristics (sex, place of residence, educational attainment, occupation and income), self-rated health, FV knowledge, and exposure to a FV promotion campaign in the community.

Conclusions

The findings from this study suggest that a different approach is required to improve FV consumption in the older population by taking into account their living arrangements, community context, level of FV knowledge, and socio-demographic characteristics. The older adults who live alone, as well as those living in a large household, are at particular risk of inadequate FV intake, and require special attention.

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.

Social isolation undermines quality of life in older adults

OBJECTIVE

Several studies have documented associations between social isolation and poor physical health or well-being. However, little is known of the importance of social support among older adults on specific topics about their quality of life. The purpose of the present study was to determine the relationship between social isolation and quality of life among older adults.

DESIGN

A cross-sectional study.

SETTING

Mexico City.

PARTICIPANTS

1,252 subjects aged ≥ 60 years living at home.

MEASUREMENTS

We used the Abbreviated Version of the Lubben Social Network Scale (LSNS-6) to assess social isolation and the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-Old) to assess quality of life. Socio-demographic and health factors were collected through face-to-face interviews. A series of linear regression analyses were used to investigate relationship between social isolation and quality of life. The statistical models were controlled for socio-demographic and health factors.

RESULTS

A total of 750 women (60%) and 502 men (40%) participated in the study. According to their LSNS-6 scores, 426 participants (34.0%) were classified into the highest group of isolation (range 0-10 points). Older adults with higher scores of social isolation exhibited lower quality of life. Regression analyses indicated that social isolation correlated with lower levels of global quality of life, autonomy, intimacy, and past, present, and future activities.

CONCLUSIONS

Coping with life from a socially isolated situation entails serious difficulties concerning quality of life. Interventions that foster environments where older adults can forge social bonds might improve their quality of life.

Living alone, loneliness, and depressive symptoms among Indonesian older women

In this study, the researchers aimed to investigate the factors associated with loneliness and depressive symptoms among Indonesian older women. A secondary data analysis of the Indonesian Family Life Survey-5 was conducted. Data from 1233 women aged 60 years or above were analyzed using logistic regression. Results indicated fewer than one in five older women lived alone, half reported loneliness, and 16% reported depressive symptoms. Living alone was significantly associated with loneliness and depressive symptoms. Different factors were associated with loneliness and depressive symptoms. Loneliness and depression were found to be independent constructs of older women living alone in Indonesia.

Effects of different living conditions on the risk of osteoporosis in Chinese community-dwelling elderly: a 3-year cohort study

Objective

Osteoporosis can lead to bone fragility and an increased risk of bone fracture with resultant high morbidity and mortality. Living alone has been associated with various mental and physical health problems. However, the risk of osteoporosis among individuals with different living conditions and changing living conditions is unclear. We examined the risk of osteoporosis in different living conditions over a 3-year period in community-dwelling suburban elderly Chinese.

Methods

This study involved 288 elderly Chinese suburb-dwelling participants with no documented history of osteoporosis. All were aged ≥60 years (mean, 65.6±3.75 years; 157 men). A quantitative ultrasound scan of the calcaneus with a T score of <−2.5 was used to identify a high risk of osteoporosis.

Results

In total, 54.2% of participants were determined to have a high risk of osteoporosis (male, 51.6%; female, 57.3%). People who had always lived alone had a significantly higher risk of osteoporosis, even after adjusting for potential confounders. A change from living alone to living with others had no significant impact on the risk of osteoporosis.

Conclusion

Our results indicate that living alone is associated with a high risk of osteoporosis. Thus, people who live alone may need regular bone tests to avoid adverse events.

Variety, frequency, and type of Internet use and its association with risk of depression in middle- and older-aged Chinese: A cross-sectional study

BACKGROUND

Internet use is beneficial to mental health has been acknowledged, but its specific patterns await further investigation in China's context of urban-rural disparity. Therefore, we aimed to understand the patterns of Internet use and measure their associations with risk of depression in China from three dimensions: variety, frequency and type.

METHODS

We selected 18,492 urban and rural Chinses respondents aged 45 years and older from China Health and Retirement Longitudinal Study (CHARLS) 2015 dataset. Risk of depression was measured by 10-item Centre for Epidemiologic Studies (CES-D 10). Internet use was measured from three dimensions: variety, frequency and type, whereas its relationship with risk of depression was examined by multivariate logistic regression model.

RESULTS

In the whole sample, 67.2% of respondents had no risk of depression, and approximately 7% used Internet, which was inversely associated with risk of depression (AOR=0.617, 95% CI=0.444, 0.858). Rural respondents had higher risk of depression (37.1% VS 26.2%) and lower prevalence of Internet use (2.6% VS 13%). Among rural respondents, using Internet occasionally (AOR=0.338; 95% CI=0.130, 0.881), using one type of device (AOR=0.293; 95% CI=0.113, 0.760), especially mobile phone (AOR=0.427; 95% CI=0.187, 0.978) were associated with lower odds of depression. No significant associations were observed in urban respondents.

LIMITATIONS

The causal relationship between variables awaits further investigation with a longitudinal design.

CONCLUSION

Internet use was negatively associated with risks of depression, especially in rural but not in urban participants. Rural-urban disparities should be considered when designing strategies to encourage moderate Internet use.

Improvement of social support in empty-nest elderly: results from an intervention study based on the Self-Mutual-Group model

BACKGROUND

China has the world's largest elderly population and an increasing number of empty-nest elderly. The purpose of this study is to evaluate the effectiveness of the Self-Mutual-Group model on social support of the empty-nest elderly, thus providing reference for improving their quality of life.

METHODS

A intervention study was conducted between October 2016 and May 2017 at six communities in Taiyuan, Shanxi Province, China. A total of 350 empty-nest elderly aged 60-88 years were randomly assigned in the intervention group (n = 167) with a 7-month SMG-based intervention or to a control group (n = 183) with no intervention. The social support of the participating elderly (n = 350) was assessed by the Social Support Rating Scale (SSRS) at the baseline and 7 months later, respectively.

RESULTS

A 7-month follow-up showed an increasing mean scores of SSRS, objective support, subjective support and support utilization of the intervention group, and reached statistical significance (P < 0.05).

CONCLUSIONS

The Self-Mutual-Group model was considered to be a positive intervention and was effective in increasing social support among the empty-nest elderly. Furthermore, future research should extend the intervention period and introduce multi-point measurement to better evaluate the intervention process and outcomes.

TRIAL REGISTRATION

Study on the 'SMG' Health Management Model Based on Community Organization Theory among empty-nest elderly (ChiCTR1800015884).

The role of social engagement in the association of self-reported hearing loss and health-related quality of life

BACKGROUND

Hearing loss is highly prevalent and associated with reduced well-being in older adults. But little is known about the role of social factors in the association of hearing difficulty and its health consequences. This study aims to examine the association between self-reported hearing loss and health-related quality of life (HRQoL, consisted of physical and mental component summary, PCS and MCS), and to investigate whether social engagement mediates this association.

METHOD

Data on 4035 older adults aged 60 years or above from a cross-sectional nationally representative database in China were obtained to address this study. HRQoL was measured by the Short Form 12 Health Survey (SF-12). Hearing loss was defined by a dichotomized measure of self-reported hearing difficulty, which has been proved to be sensitive and displayed moderate associations with audiometric assessment in elderly population. Social engagement was measured by the Index of Social Engagement Scale. Bootstrap test was applied to test for the significance of the mediating role of social engagement.

RESULTS

Self-reported hearing loss was found negatively associated with HRQoL in older adults, and hearing loss was much more related to reduced mental well-being. Social engagement played a partial mediating role in the association of hearing loss and HRQoL. Social engagement account for 4.14% of the variance in the change of PCS scores and 13.72% for MCS, respectively.

CONCLUSION

The study lends support to the hypothesis that hearing loss is associated with aging well beings, and the use of hearing aid or proper social engagement intervention may improve the quality of life among the elderly.

Mediators and Moderators of the Influences of Living Alone on Psychological Distress Among Japanese Older Adults

This study explored gender differences in mediators and moderators of the association between living alone and psychological distress among 2556 Japanese older adults aged 65 years and older. Putative mediators and moderators were physical health, income, informal networks, and social support. Living alone was significantly related to psychological distress only in men. Significant mediators were income in both genders and social support only in men. Living alone in women was related to having more informal networks, which reduced psychological distress. This contributed to mitigating the effect of living alone on psychological distress among women. Effective moderators were not discovered.

Prevalence and Factors Associated with Psychological Distress among Older Adults Admitted to Hospitals After Fall Injuries in Vietnam

Although psychological distress is one of the major health issues among aging populations, little is known about how this challenge affects older patients after falls. A cross-sectional study was conducted in Thai Binh province, Vietnam, to explore the prevalence of psychological distress and associated factors among 405 older patients after falls. The 6-item Kessler Psychological Distress Scale (K6) was used to measure psychological distress. Socio-demographic and clinical characteristics were collected using a structured questionnaire. Multivariate Tobit and Logistic regressions were used to determine factors associated with psychological distress. The prevalence of psychological distress among participants was 26.2%. Patients who were alone or older had a higher likelihood of psychological distress. Patients with a history of falls in the past 12 months were more likely to suffer from psychological distress (OR = 2.87, 95%CI = 1.74; 4.72). Having two and three comorbidities was significantly associated with greater K6 scores and a higher risk of psychological distress. This study underlined a significantly high prevalence of psychological distress among older patients after falls. Providing frequent mental health monitoring, screening, treatment, and facilitating social engagements are important implications to improve the mental health of this population.

Risk Factors for Depression in Empty Nesters: A Cross-Sectional Study in a Coastal City of Zhejiang Province and China

The elderly are susceptible to depression, especially empty nesters. This study investigated the risk factors associated with depression in empty nesters. The participants were selected via multi-stage random cluster sampling. Depression symptoms were assessed using the Geriatric Depression Scale. The questionnaire surveyed demographic characteristics, underlying diseases, behaviors and lifestyles, negative life experiences, social support, self-care ability, etc. Chronic health conditions, such as being overweight/obese, smoking cessation, cancer, and chronic pain, as well as negative life experiences, such as the death of a loved one and financial loss, increased the risk of depression in empty nesters. In addition, the incapability of performing self-care also increased the risk of depression in empty nesters. The prevalence of depression in empty nesters was high. Being overweight/obese, cancer, chronic pain, smoking cessation, the death of a loved one, financial loss, and the incapability to deliver self-care were risk factors for depression in empty nesters. It is recommended that comprehensive measures be taken to enhance health interventions for this population, including encouraging a proper diet and physical activity for weight control, providing psychological counseling after negative life experiences, and teaching correct methods of smoking cessation.

Moderating effect of social support on depression and health promoting lifestyle for Chinese empty nesters: A cross-sectional study

BACKGROUND

Health promoting lifestyle (HPL) may be a facilitator for empty nesters' active aging against depression. Social support (SS) may improve their HPL. This study aimed to examine moderating effect of SS and its three sources of SS on relationship between depression and HPL among empty nesters. The compensating role of socioeconomic status (SES) for lack of SS was examined, too.

METHODS

A cross-sectional survey of empty nesters (n = 1593) was conducted in six districts of Taiyuan, China, using a stratified random cluster sampling method. Hierarchical multiple linear regression analyses were performed to assess moderation models by SS and its three sources.

RESULTS

The findings indicated that low depression (p < 0.001) and sufficient perceived SS (p < 0.001) could directly predict better HPL among empty nesters. The effect of SS on HPL declined with the raise of educational level (p < 0.001). Family support (β = 0.083, p < 0.001), friends support (β = 0.085, p < 0.001) and others support (β = 0.098, p < 0.001) expressed significant negative buffer effects on depression and HPL individually.

LIMITATIONS

There was a cross-sectional study that limited the moderating effect of SS on depression and HPL just for empty nesters in Taiyuan, China. The results cannot explain the causal relationships among the study variables.

CONCLUSIONS

SS might be a protective factor of empty nesters' health in China. Three sources of SS all showed moderating effect on the relationship between depression and HPL among empty nesters, and should be integrated to achieve maximum utility. Friends support/ others support could play complement role for lack of family support. SES expressed partial compensatory for lack of SS.

Association of living arrangements with depressive symptoms among older adults in China: a cross-sectional study

Background

Depression is regarded as a major public health concern in our society. While living arrangements as a structural factor of social support may contribute to older adults’ depression. Our study aims to investigate the association between living arrangements and depressive symptoms among older adults in the whole China, and to explore whether such influences differ by genders.

Methods

Data were obtained from the 2015 China Health and Retirement Longitudinal Study. The sample was comprised of 6001 individuals aged ≥60 years. Depressive symptoms were measured by the 10-item Short-Form Center for Epidemiological Studies Depression. Independent variables were divided into 4 groups, considering living with/without a spouse and living with/without a child. The multivariate logistic regression was used to estimate the relationship between living arrangements and depressive symptoms in four models.

Results

Compared with living only with a spouse, people living with a spouse and child, or living alone were more likely to have depressive symptoms (odds ratio = 1.23 95% CI 1.06–1.42 and 1.40 95% CI 1.03–1.92, respectively). Women were more associated with depressive symptoms (odds ratio = 2.13), but there were no significant associations between living arrangements and depressive symptoms among women. Men living with a spouse and a child had stronger positively depressive symptoms (odds ratio = 1.37).

Conclusions

Older adults living alone, or living with both a child and spouse were more likely to have depressive symptoms. It is important to provide more social services for those older adult, particularly for men living with a spouse and child.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7350-8) contains supplementary material, which is available to authorized users.

Factor analysis of the influence of neighborhood satisfaction of the elderly: Evidence from Xuzhou, China

According to a recent survey of the elderly in Xuzhou, China, neighborhood relationships (NP) have a significant impact on neighborhood satisfaction (0.420), followed by shopping and travel (ST) (0.262). At the same time, public facilities (PF) have a significant impact on neighborhood relationships (NP) (0.323), followed by environmental sanitation (ES) (0.295). This means that Chinese older people pay more attention to neighborhood relationships, while community public facilities and environmental sanitation have a significant impact on neighborhood relationships. Some of the environmental aspects have an impact on neighborhood satisfaction through the social environment.

Changes in health-related quality of life of Chinese populations measured by the EQ-5D-3 L: a comparison of the 2008 and 2013 National Health Services Surveys

BACKGROUNDS

The EuroQol Group Five-Dimensional (EQ-5D) instruments have been validated in China for measuring health-related quality of life (HRQoL) and are increasingly being used in health economic studies. However, there is paucity in the literature documenting long-term changes in the EQ-5D results in the Chinese populations. This study aims to identify such changes and their determinants using the EQ-5D-3 L instrument.

METHODS

Data were obtained from the National Health Services Surveys in China, which included the EQ-5D-3 L since 2008. We compared the differences between the 2008 and 2013 surveys in the percentage of reported problems, visual analogue scale (VAS) scores, and the EQ-5D-3 L utility index derived from the national value sets. Factors associated with population changes in these EQ-5D results were identified using logistic, linear and Tobit regression models, respectively.

RESULTS

Compared with 2008, reported problems in self-care (3.3% vs 3.1%), usual activities (4.8% vs 4.6%) and anxiety/depression (6.4% vs 5.3%) decreased, whereas reported problems in mobility (5.1% vs 5.9%) and pain/discomfort (9.3% vs 12.6%) increased significantly (p < 0.05) in 2013. The regression models revealed a rise (β = 1.61, p < 0.001) in VAS scores, but a slight drop (β = - 0.01, p < 0.001) in utility index in 2013 compared with 2008 after controlling for variations in demographic, behavioral, socioeconomic and residential variables. But the effect sizes of the changes over time (estimated by "average change divided by baseline standard deviation") did not reach the threshold of clinical importance after adjustment for variations in other factors. Higher socioeconomic status (in terms of education, income and residential location) was associated with better EQ-5D-3 L results.

CONCLUSION

The changing trend (decrease) of the utility index is contradictory to that (increase) of the VAS scores, although neither is deemed clinically important. It is evident that socioeconomic and regional disparities in HRQoL exist in China.

Prevalence and related influencing factors of depressive symptoms among empty-nest elderly in Shanxi, China

BACKGROUND

In China, aging has become a serious social problem, and the number of empty-nest elderly is on the rise. The aim of this study is to clarify the prevalence of depressive symptoms among empty-nest elderly in Shanxi province and evaluate the effects of sociodemographic factors and health-promoting lifestyles so as to provide a scientific reference for preventing and intervening their depression.

METHODS

A cross-sectional study, which used a multi-stage random cluster sampling way, was conducted among 4901 empty-nest elderly in Shanxi. An independent t-test and a chi square test were used to compare the sociodemographic factors, depression scores, and health-promoting lifestyle scores of the empty-nest elderly. Multinomial logistic regression was used to analyze the potential influencing factors for depression.

RESULTS

The prevalence of depressive symptoms in the population was 64.2%. Among all participants 1,776 (36.2%) had mild depression, 1,236 (25.2%) had moderate depression, and 135 (2.8%) had severe depression. The health-promoting lifestyle of the empty nesters in this study was at the medium level (2.51 ± 0.47). Gender, education level, old-age provision model, exercise frequency, chronic disease, relationships with children, self-care ability, and health-promoting lifestyles were found to be influencing factors of depression and all variables had different effects on different degrees of depression.

LIMITATIONS

This was a cross-sectional study, so the results cannot establish causal relationships among the study variables.

CONCLUSIONS

Depression was prevalent among the empty-nest elderly in Shanxi. Maintaining good interpersonal relationships, developing extensive interests, and maintaining healthy lifestyles including good nutrition habits and regular exercises can reduce the incidence of depression among empty nesters.

Risk factors of mental disorders among empty and non-empty nesters in Shanxi, China: a cross-sectional study

Background

China has the world’s largest size of elderly population. Mental disorders of the elders deserve keen attention. This study aims to comparatively explore mental disorders and risk factors among empty and non-empty nesters.

Methods

Using the stratified random cluster sampling method, we recruited 8526 elders aged 60 years and above from 11 cities in Shanxi Province in central China, comprising 4901 empty and 3625 non-empty nesters. The mental disorders were assessed with the 12-item Chinese Health Questionnaire (CHQ-12). The binary logistic regression was performed to analyze the risk factors in the two groups.

Results

The prevalence of mental disorders in empty nesters was significantly higher than that in non-empty ones (26.9% vs 23.5%). Binary logistic regression showed that the empty nesters who lived alone or lived in an institution were more likely to suffer from mental disorders compared with the non-empty ones, empty nesters living with spouse showed no significant deviation. And single status, hardly or part self-care ability, having chronic diseases, having lower income, and paying less attention to daily healthy diet had positive associations with mental disorders for empty nesters, and no or partial self-care ability and having chronic diseases for non-empty nesters.

Conclusions

The study indicated that empty nesters had a higher prevalence of mental disorders than non-empty ones. Empty nesters living alone, with no or partial self-care ability, chronic disease, lower income and less attention to daily healthy diet were more vulnerable to mental disorders. And the lack of self-care ability and having chronic diseases were risk factors of mental disorders for non-empty nesters.

Migration of adult children and mental health of older parents 'left behind': An integrative review

Background

Although a number of studies have examined the effect of the out-migration of children on the mental health of ‘left behind’ elderly parents, research on the consequences of children’s migration on the mental health and well-being of elderly parents left behind is inconclusive and a systematic review is warranted.

Objectives

To identify the association between the left behind or empty nest status and the mental health of older parents, and to identify common risk factors for poor mental health among those left behind.

Methods

Online databases CINAHL, PsycINFO, PubMed, Scopus and ProQuest were searched for research (2000-September 2017) that focused on the relationship between the migration of adult children and the mental health of the older parents (≥50 years) left behind. The JBI Checklist for Analytical Cross Sectional Studies was used to assess the methodological quality of the articles.

Results

25 articles met the inclusion criteria. The studies identified that left behind older parents had higher levels of mental health problems compared to non-left behind. Left behind parents had higher depressive symptoms, higher levels of loneliness, lower life satisfaction, lower cognitive ability and poorer psychological health. A number of risk factors were identified for mental health disorders among the left behind parents, which included living arrangements, gender, education, income, physical health status, physical activity, family and social support, age, rural residence and frequency of children’s visit.

Conclusions

This review synthesised the various studies related to the mental health of left behind parents, advancing the theoretical and empirical understanding of the implications of out-migration of adult children on the psychological health and well-being of older parents. More responsive preventive measures and effective management approaches are required for this vulnerable cohort.