Individual educational attainment, neighborhood-socioeconomic contexts, and self-rated health of middle-aged and elderly Chinese: Exploring the mediating role of social engagement

Patterns of physical and mental co-occurring developmental health among Chinese elderly: A multidimensional growth mixture model analysis

Background

This study focuses on the heterogeneity, interaction, and imbalance in the concurrent development of physical and mental health trajectories among Chinese elderly.

Methods

The data used in this study are from four waves of the China Health and Retirement Longitudinal Study (CHRLS) conducted between 2011 and 2018. A multidimensional growth mixture model (MGMM) was employed to analyze the patterns and characteristics of co-occurring physical and mental health development. Additionally, multinomial logistic regression analysis was conducted to systematically investigate the factors that predict the conjoint trajectories of physical and mental health.

Results

The study findings reveal the presence of four distinct latent classes of conjoint trajectories for physical and mental health. These classes are categorized as follows: 'physical and mental health deteriorating', 'physical disease increasing & low mental vulnerability maintaining', 'low physical & mental vulnerability maintaining', and 'high physical disease increased & mental health moderate-stable'. Furthermore, demographic characteristics, socioeconomic status, family-society relations, health behaviors, and institutional factors were found to significantly predict these latent classes.

Conclusion

The study emphasizes the diversity and complexity of physical and mental co-occurring developmental health issues in the elderly population in China. These findings have significant implications for the development of targeted intervention strategies that take into account the unique health changes experienced by older adults. Additionally, they can serve as evidence for the establishment of a comprehensive long-term care system.

Educational inequalities in self-rated health and their mediators in late adulthood: Comparison of China and Japan

Education has an impact on health, but the magnitude of the impact may vary across countries. This cross-sectional study compared educational inequalities in health and their mediators in late adulthood between China and Japan, which both face rapid population aging. We studied the same age cohort (63-72 years) based on two nationwide population-based surveys in 2018: the China Health and Retirement Longitudinal Study (N = 5,277) and Japan's Longitudinal Survey of Middle-Age and Elderly Persons (N = 20,001). The relative index of inequality (RII) in education was used to measure educational inequality in self-rated health (SRH). We then examined the extent to which income, smoking, leisure-time physical activity, and social participation mediated educational inequalities in SRH. In both countries, a lower educational level was associated with a higher risk of poor SRH; in China, however, the gradient was flatter. In China, the RII of education was 1.69 (95% confidence interval [CI]: 1.20-2.39) for men and 1.47 (95% CI: 1.06-2.05) for women. In Japan, meanwhile, RII was 2.70 (95% CI: 2.21-3.28) for men and 2.60 (95% CI: 2.13-3.18) for women. Our mediation analysis based on logistic regression models with bootstrapping also found that social participation was a key mediator of educational inequalities in health in both countries. In all, the results underscore that one's relative position in educational inequalities is a reliable predictor of subjective health in late adulthood in both China and Japan.

The impact of neighborhood mental health on the mental health of older adults

BACKGROUND

In this article, we use cross-sectional data obtained from the 2018 China Health and Aging Tracking Survey (CHARLS) to examine the impact of neighborhood mental health at the community level on the mental health of older adults aged 60 years and older.

METHODS

NMH is the average mental health of older adults in the same community, excluding the older adults themselves. The explained variable mental health in this paper was measured using the simple CES-D depression scale. The mediating variables were social connectedness, social participation and social inclusion, and the instrumental variables were physical exercise and amusement. regression analysis was conducted using OLS regression models, two-stage least squares (IV-2SLS) instrumental variables to address the two-way causality of NMH and MH, and KHB decomposition was used to investigate the effect mechanism.

RESULTS

Baseline regressions showed that the neighborhood mental health effect positively influenced the mental health of older adults (Coef. = 0.356, 95% CI 0.315,0.397). The neighborhood mental health effect estimated by IV-2SLS (Coef. = 0.251, 95% CI 0.096,0.405) was higher than the OLS regression, indicating endogeneity. The mediated effects of KHB showed total (Coef. = 0.356, 95% CI 0.314,0.398), direct (Coef. = 0.281, 95% CI 0.232,0.330), and indirect effects (Coef. = 0.075, 95% CI 0.049,0.101). While the total effect was 1.266 times higher than the direct effect, 21.03% of the total effect came from mediating variables.

CONCLUSIONS

First, the neighborhood mental health effect has a positive impact on the mental health of older adults, but there are heterogeneous differences based on gender, age, and place of residence. Second, the results of the IV-2SLS estimation showed that the effect of the neighborhood mental health effect was underestimated if endogenous problems were not controlled for. Third, the effect of neighborhood mental health on older adults' mental health was tested to be stable. Moreover, social connectedness, social participation, and social interaction are important mediating mechanisms for the effect of neighborhood mental health on older adults' mental health. This study provides new perspectives and ideas for an in-depth understanding of the mental health of older adults in the context of social transformation in China.

Self-Rated Health of US Older Adults in the General Social Survey (GSS) 1972-2021: Complexity of the Associations of Education and Immigration

BACKGROUND

Multiple studies have shown a link between high education and better self-rated health (SRH). However, recent studies have suggested that immigrants may experience a weaker association between education and SRH than native-born individuals.

AIM

Using a national sample of US older adults, this investigation studied whether there is an inverse association between education and SRH and whether immigration status moderates this association.

METHODS

This study is based on marginalized diminished returns (MDRs) that argues socioeconomic status (SES) resources, such as education, may generate less favorable health outcomes for marginalized groups. Data were from the General Social Survey (GSS) 1972-2021, a cross-sectional survey in the US. A total of 7999 participants who were 65+ years old were included. The independent variable was education, measured as years of schooling and treated as a continuous variable. The dependent variable was poor/fair (poor) SRH. Immigration status was the moderator. Age, sex, and race were control variables. Logistic regressions were used for data analysis.

RESULTS

We found that higher levels of education were protective against poor SRH. However, this effect was weaker for immigrants than for US-born individuals.

CONCLUSIONS

This study found that native-born US older individuals are more likely to experience the protective effect of their education against poor SRH compared to their immigrants. Eliminating health inequality between immigrant and US-born individuals needs policies that go beyond socioeconomic status (SES) equality and address barriers that hinder highly-educated immigrants.

Neighborhood health effects on the physical health of the elderly: Evidence from the CHRLS 2018

Background

There are more than 26 million elderly people in China, and due to the Health China strategy proposed in 2020, “Elderly Health” has become an important topic of concern for all sectors of society. Neighborhoods provide important social relationships. However, Chinese researchers have not extensively explored the impact of these relationships on the physical health of the elderly.

Methods

Based on the data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), we constructed a comprehensive research framework integrating ordinary least square (OLS) regression, heterogeneity analysis, IV-2SLS, robustness testing, and Karlson–Holm–Breen (KHB) mediating effect analysis, which can be used to thoroughly examine neighborhood health effects (NHEs) in relation to the physical health of the elderly.

Results

The OLS results showed that the NHEs (B = 0.4689, p < 0.01) had a positive influence on the physical health of the elderly, and were lower than the NHEs estimated by IV-2SLS (B = 0.5018, p < 0.01). The mediating effects of social networks and social relationships were analyzed using KHB, and both the total (B = 0.6056, p < 0.01) and indirect (B = 0.0800, p < 0.01) effects on neighborhood health were significant, with the total effect being 10 times larger than the direct effect and 13.24% of the total effect coming from the mediating variable.

Conclusions

Firstly, the NHEs positively influence the physical health of elderly persons, but there are heterogeneous differences. Secondly, the IV-2SLS estimation results suggest that not controlling for endogeneity leads to underestimation of the role of the NHEs. Thirdly, using the county-level NHEs, self-rated health, and health changes to replace variables, and grouping by smokers (small sample) and never smoked (large sample), the influence of the NHEs on the physical health of the elderly is robust. Finally, social networks and social relationships are important transmission mechanisms of the NHEs when it comes to the physical health of the elderly.

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NHEs are robust and significant in the Chinese social background.

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Community (county) level NHEs are positive for the positive health of the elderly.

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NHEs have a positive impact on self-rated health and health changes in older adults.

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Endogenous issues would underestimate the role of NHEs.

•Social networks and social relationships are transmission mechanisms of the NHEs.

The Wellbeing of Chinese Migrating Grandparents Supporting Adult Children: Negotiating in Home-Making Practices

Health geography provides a relational approach to understanding elders' wellbeing experience in relation to place. That the migrating grandparents move between their home and their adult children's home to support their children's life in the migrating city provides a particular pattern to supplement the place-based wellbeing literature. How they negotiate their wellbeing remains to be observed in the daily home-making practices related to their two homes. This study conducted in-depth interviews with 35 migrating grandparents and nine of their adult children and conducted extensive field notes in Shanghai from 2020 to 2022. Through thematic analysis, it finds that the migrating grandparents met a series of differences, challenges and tensions in the material, social and emotional home-making practices brought by the separation and rotation between their own and their children's homes. It weakens their physical, social and mental wellbeing. However, they take some initiatives to overcome and relieve these tensions. Therefore, accompanied by sacrifices and negotiations, they also obtain sustained material, social and spiritual-emotional values to negotiate a suboptimal experience of wellbeing. This study contributes to the intersection of elderly wellbeing and home-making studies by revealing the complex and ongoing inter-relationships between migrating grandparents and home in the rotating lifestyle.

Association of Neighborhood-Level Socioeconomic Measures With Cognition and Dementia Risk in Australian Adults

IMPORTANCE

Up to 40% of dementia cases are potentially preventable; therefore, it is important to identify high-risk groups to whom resources could be targeted for maximal impact in preventing late-life dementia. The association of neighborhood-level socioeconomic status (SES) with cognition and dementia risk is not well known, particularly in midlife when late-life dementia may still be preventable through established interventions, such as blood pressure management.

OBJECTIVE

To examine whether neighborhood-level SES is associated with differences in cognitive performance and dementia risk scores.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study analyzed data collected between November 17, 2016, and April 14, 2020, from 4656 participants in the longitudinal population-based Healthy Brain Project cohort. This large online cohort comprised community-dwelling individuals geographically dispersed across Australia. Participants were aged 40 to 70 years without dementia or other major neurological conditions.

EXPOSURES

Neighborhood-level SES was computed by matching participants' residential addresses to the Australian Bureau of Statistics Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). Postcodes provided by each participant were used to derive an IRSAD score that ranked participants according to deciles of neighborhood-level SES (range, 1-10, with higher deciles indicating greater socioeconomic advantage); neighborhoods in deciles 1 to 7 were considered to have low or intermediate SES, and neighborhoods in deciles 8 to 10 were considered to have high SES.

MAIN OUTCOMES AND MEASURES

Dementia risk estimated using the dementia risk score from the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) tool (n = 4656) and cognitive composite scores for memory and attention measured by the Cogstate Brief Battery (n = 2181).

RESULTS

Of 4656 participants (mean [SD] age, 56.1 [7.2] years; 3445 women [74.0%]), 2688 individuals (57.7%) lived in areas with high neighborhood-level SES (IRSAD decile ≥8), and 1968 (42.3%) lived in areas with low or intermediate neighborhood-level SES (IRSAD decile <8), with 1263 individuals (27.1%) residing in rural or regional areas. A total of 6 participants (0.1%) identified as African, 121 (2.6%) as Asian, 57 (1.2%) as Indigenous Australian, 24 (0.5%) as Latin American, 9 (0.2%) as Pacific Islander, 3671 (78.8%) as White or European, and 768 (16.5%) indicated other race (not specified). Each decile unit increase in neighborhood-level SES was associated with a lower CAIDE dementia risk score after adjustment for race and rurality (β [SE] = -0.070 [0.019]; P = .004). Each decile unit increase was also associated with better memory (β [SE] = 0.022 [0.006]; P = .006) but not with better attention (β [SE] = 0.009 [0.007]; P = .34), as measured by Cogstate Brief Battery composite z scores after adjustment for age, sex, race, years of education, and rurality. When comparing memory performance between individuals with IRSAD scores higher and lower than decile 8, neighborhood-level SES interacted with age (F1-2171 = 6.33; P = .02) and CAIDE dementia risk scores (F1-2173 = 4.02; P = .08). Differences in memory between neighborhood-level SES categories were larger among participants who were older and had a higher risk of dementia.

CONCLUSIONS AND RELEVANCE

In this study, higher neighborhood-level SES was associated with better memory and lower dementia risk scores. These results suggest that efforts to lower dementia risk factors in disadvantaged areas are needed to curtail the increasing burden of dementia and that inclusion of individuals living in areas with lower SES in research on dementia is warranted to improve understanding and potential interventions.

Examining Ethnic Variation in Life Expectancy Among Asians in the United States, 2012-2016

As the fastest growing racial group in the United States, understanding the health patterns of Asians is important to addressing health gaps in American society. Most studies have not considered the unique experiences of the ethnic groups contained in the Asian racial group, implying that Asians have a shared story. However, we should expect differences between the ethnic groups given the differences in their timing and place of migration, socioeconomic status, and racialized experiences in the United States. We estimate the life expectancy of the six largest Asian ethnic groups-Chinese, Asian Indians, Filipinos, Vietnamese, Koreans, and Japanese-analyzing data from the Multiple Cause of Death File (2012-2016) and the American Community Survey (2012-2016) in the United States at the national and regional levels. Nationally, Chinese had the highest life expectancy (males e0 = 86.8; females e0 = 91.3), followed by Asian Indians, Koreans, Japanese, Filipinos, and Vietnamese, generally reflecting the pattern expected given their educational attainment, our primary indicator of socioeconomic status. We also found regional differences in life expectancy, where life expectancy for Asians in the West was significantly lower than all other regions. These findings suggest the presence of underlying selection effects associated with settlement patterns among new and traditional destinations. Our results underline the necessity of studying the experiences of the different Asian ethnic groups in the United States, permitting a better assessment of the varying health needs within this diverse racial group.

Does social capital interact with economic hardships in influencing older adults' health? A study from China

BACKGROUND

The importance of social and economic capital as predictors of health is widely documented, yet the complexity of interactions between them and effects on older people's health is still unclear. Combining the material and psychosocial explanations of health, this study explores the potential interactions between social and economic capital in influencing older adults' health in urban and rural China.

METHODS

Using data from the China Family Panel Survey, physical and mental health in 2018 were regressed on social and economic capital indicators in 2016, controlling for sociodemographic characteristics of 3535 respondents aged 65 and older. Rothman's synergy index was calculated to investigate potential interaction effects.

RESULTS

Economic hardships were significantly related to both self-reported health and mental health. Neighborhood cohesion and social participation were significantly associated with mental health for all, bonding trust was significantly associated with mental health for urban older people. We found no significant associations between social capital components and self-reported health. There was an interaction effect between low neighborhood cohesion and economic hardships, and between low social participation and economic hardships, creating an increased burden of poor mental health. The interaction effect between low bonding trust and economic hardships on mental health was apparent only among urban older people.

CONCLUSIONS

Geographical settings are important factors in the complexity between social and economic capital in affecting older health. Intervention efforts directed towards reducing simultaneously multiple dimensions of deprivation, such as poverty, social exclusion, social isolation, could be helpful in improving older people's health. In materially deprived places, policies to promote health equity by improving social capital but without eliminating poverty may be less effective.

Effect of social participation on the development of physical frailty: Do type, frequency and diversity matter?

BACKGROUND

Little is known about the longitudinal association between social participation and incident frailty in community-dwelling older adults in general and particularly in China. This study examined the impact of type, frequency and diversity of social participation on incident physical frailty at two-year follow-up.

METHOD

Longitudinal data from three waves of the China Health and Retirement Longitudinal Study were used. Older adults who were non-frail and aged 60 years or more at baseline and had information on physical frailty at follow-up were included. Frailty was measured using the modified frailty phenotype criteria. Social participation was measured as the type, frequency and diversity of engagement in social activities, including interacting with friends, playing group games, participating in sports clubs, community-related organizations, and voluntary activities.

RESULTS

A total of 6959 eligible respondents were included. Playing group games (OR=0.73, 95%CI=0.55-0.96) or participating in the activities of sports clubs (OR=0.54, 95%CI=0.34-0.85) once or more times per week led to a decreased risk of developing frailty in two years whereas participating in voluntary activities occasionally (OR=0.50, 95%CI=0.30-0.84) had a protective effect on the development of frailty. More diverse social participation was significantly associated with lower risk of incident frailty at two-year follow-up.

CONCLUSIONS

The association between social participation and onset of physical frailty differed by the specific type and frequency of the activities that older adults engaged in. Promoting social participation of various types and at an appropriate frequency may be a promising way to mitigate the burden associated with physical frailty among older adults.

Investigating Factors of Active Aging among Chinese Older Adults: A Machine Learning Approach

BACKGROUND AND OBJECTIVES

With the extension of healthy life expectancy, promoting active aging has become a policy response to rapid population aging in China. Yet, it has been inconclusive about the relative importance of the determinants of active aging. By applying a machine learning approach, this study aims to identify the most important determinants of active aging in three domains, i.e., paid/unpaid work, caregiving, and social activities, among Chinese older adults.

RESEARCH DESIGN AND METHOD

Data were drawn from the first wave of the China Health and Retirement Longitudinal Study (CHARLS), which surveys a nationally representative sample of adults aged 60-year-old and above (N=7,503). We estimated Random Forest and the least absolute shrinkage and selection operator (LASSO) regression models to determine the most important factors related to active aging.

RESULTS

Health has a generic effect on all outcomes of active aging. Our findings also identified the domain-specific determinants of active aging. Urban/rural residency is among the most important factors determining the likelihood of engaging in paid/unpaid work. Living in a multi-generational household is especially important in predicting caregiving activities. Neighborhood infrastructure and facilities have the strongest influence on older adults' participation in social activities.

DISCUSSION AND IMPLICATIONS

The application of feature selection models provides a fruitful first step in identifying the most important determinants of active aging among Chinese older adults. These results provide evidence-based recommendations for policies and practices promoting active aging.

From Traditional and Socialist Work-Unit Communities to Commercial Housing: The Association between Neighborhood Types and Adult Health in Urban China

The urban structure in China has been transformed profoundly through rounds of economic reforms. Over the past 60 years, various types of neighborhoods have emerged at different stages of economic and social transition. Formed and organized in different ways, these neighborhoods provide distinct economic, social, and physical environments to residents. However, little is known about the link between neighborhood types and the health of residents in urban China. Using longitudinal data from the China Labor-Force Dynamics Survey (2012-2014), we estimate multilevel regression models to predict self-rated health (SRH) while controlling for a lagged measure of SRH. Results show that living in traditional communities in old districts and work-unit compounds for state-owned enterprises is associated with better SRH among older adults (≥50 years old) compared with living in other types of neighborhoods, such as commercial-housing communities and migrant enclaves. Neighborhood types do not matter for the health of younger adults (< 50 years old). Neighborhood water quality and distance to facilities are associated with SRH for older adults but do not account for the relationships between neighborhood types and SRH.

Pain management and cognitive function among older adults: an exploratory study of the China Health and Retirement Longitudinal Study

BACKGROUND

Chronic pain and cognitive decline are common age-related conditions affecting a large segment of older populations. Little is known about the pathway of cognitive functioning during the course of pain management in older adults.

AIMS

The study aimed to examine the association between chronic body pain management and cognitive function over time among Chinese older adults.

METHODS

A total of 792 respondents aged 60 and above from urban and rural households in 28 provinces, 150 counties/districts, and 450 communities were selected from the China Health and Retirement Longitudinal Study (2013-2015). Cognitive function was measured in three domains: episodic memory, mental status, and global cognitive function. Difference-in-differences approach and mixed-effects linear regression models were employed to assess the association between chronic body pain management and cognitive function over time.

RESULTS

Scores of mental status were found to decline slower by 0.49 unit (SE = 0.22, p < 0.05) in respondents who received pain management using analgesics, complementary and alternative medicine, or both from 2013 to 2015 after controlling for basic demographic and health confounders.

CONCLUSION

Chronic pain management was associated with slower decline in domain-specific cognitive function, mental status over time. Findings of the study may contribute to understanding the mechanism of change in diverse cognitive abilities attributable to pain symptoms. More research is needed to elucidate the mediating effect of pain on cognitive decline, which could lead to testing of the impact of pain management on cognitive function among older population in both clinical and community settings.

The longitudinal relationship between income and social participation among Chinese older people

The vital role of active social participation in older people's lives is widely acknowledged. The maintenance of adequate levels of social participation is an essential element of successful aging. Low income may inhibit older people from engaging in social activities. Given its recent rapid economic growth, China provides a unique setting for the study of changes in income and social participation among older people over time. In this study, the longitudinal relationship between income and social participation among Chinese older people was investigated using a nationally representative dataset from three waves of the China Health and Retirement Longitudinal Study (CHARLS). At baseline, a total of 3863 participants with a mean age of 60.4 years (range: 50-89) were included in our study; 49.9% of the participants were female, and 64.4% lived in rural areas. Generalized estimating equations were used to analyze the longitudinal relationship between income and social participation, with and without adjustment for background variables (age, gender, marital status, educational level, empty-nest status, area of residence, and multimorbidity). The results of unadjusted and adjusted analyses clearly showed a longitudinal association between income and social participation. People from the highest income group were almost two times more likely to participate in social activities than were those from the lowest income group. People with a higher educational level are also more likely to participate in social activities compared to people with a lower educational level. Being married and living with children decreased the odds of social participation. Social participation is also less likely among older aged and those living in rural areas. Our findings indicate that higher income levels are associated positively with social participation over time among older people in China.

Trajectories of rural-urban disparities in biological risks for cardiovascular disease among Chinese middle-aged and older adults

This study examined rural-urban differences in age trajectories of biological risks for cardiovascular disease (CVD) among Chinese middle-aged and older adults. Data were from the 2011 wave of China Health and Retirement Longitudinal Study, including 11,528 respondents (M_age = 59.15) from 440 communities. CVD risk factors included C-reactive protein (CRP), high-density lipoprotein (HDL), body mass index (BMI), and waist circumference (WC). Multilevel models revealed that rural adults had higher levels of HDL and lower levels of CRP and BMI on average, compared to urban adults. We also found significant rural-urban differences in the age trajectories of CVD risks. Rural-urban disparities in CVD risks increased from middle to later life, and converged at later old age. Findings suggest that rural-urban differences in cardiovascular health are not static, but rather vary throughout adulthood.

The power of weak ties in preserving cognitive function: a longitudinal study of older Chinese adults

Objectives: Characterized by infrequent contact, low emotional intensity, and limited intimacy, weak ties are found to be associated with better subjective well-being and other health outcomes. Drawing on the theory of weak ties and the convoy model of social relations, this paper aims to examine the association between weak ties and cognitive function among older adults in China.Methods: We used multilevel growth modeling to analyze panel data for adults aged 60 years and over (N = 2,650) selected from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015). Weak ties were measured based on the frequency of social activity participation and the number of social activities.Results: Weekly or irregular social activity participation in at least one social activity was significantly associated with better mental status and memory. The number of participated social activities was also significantly and positively associated with mental status and memory. After controlling for age, gender, marital status, educational attainment, geographic residence, household expenditures, and health conditions (i.e., depressive symptoms and self-reported health), we found that participation in a greater number of social activities protected memory from declining by 4% for every 2 years (p < 0.001).Conclusion: These findings suggest that social interactions with peripheral members of a diverse social network may help prevent cognitive decline for older Chinese adults. Greater attention on weak ties might yield practical implications for non-pharmacological dementia prevention and health promotion for the general older population.

Examining the Multi-Scalar Unevenness of High-Quality Healthcare Resources Distribution in China

Healthcare disparity is, to a large extent, ascribable to the uneven distribution of high-quality healthcare resources, which remains insufficiently examined, largely due to data unavailability. To overcome this barrier, we synthesized multiple sources of data, employed integrated methods and made a comprehensive analysis of government administrative structures and the socio-economic environment to build probably the most inclusive dataset of Chinese 3-A hospitals thus far. Calibrated on a sample of 379 hospitals rated by a reputable organization, we developed a realistic and viable evaluation framework for assessing hospital quality in China. We then calculated performance scores for 1246 3-A hospitals, which were aggregated and further analyzed at multiple scales (cities, provinces, regions, and economic zones) using general entropy indexes. This research shows that the fragmented governance and incoordination of "kuai" and "tiao" is rooted deeply in China's legacy of centrally-planned systems, and has had a far-reaching yet partially contradictory influence over the contemporary distribution and performance of healthcare resources. Additionally, the unevenness in the distribution of healthcare resources is related closely to a city's administrative rank and power. This study thus suggests that the policy design of healthcare systems should be coordinated with external socio-economic transformation in a sustainable manner.

Emergency Department Utilization among Underserved African American Older Adults in South Los Angeles

Objectives: Using the Andersen’s Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South Los Angeles, California. Methods: This cross-sectional study recruited a convenience sample of 609 non-institutionalized AA older adults (age ≥ 65 years) from South Los Angeles, California. Participants were interviewed for demographic factors, self-rated health, chronic medication conditions (CMCs), pain, depressive symptoms, access to care, and continuity of care. Outcomes included 1 or 2+ ED visits in the last 12 months. Polynomial regression was used for data analysis. Results: Almost 41% of participants were treated at an ED during the last 12 months. In all, 27% of participants attended an ED once and 14% two or more times. Half of those with 6+ chronic conditions reported being treated at an ED once; one quarter at least twice. Factors that predicted no ED visit were male gender (OR = 0.50, 95% CI = 0.29–0.85), higher continuity of medical care (OR = 1.55, 95% CI = 1.04–2.31), individuals with two CMCs or less (OR = 2.61 (1.03–6.59), second tertile of pain severity (OR = 2.80, 95% CI = 1.36–5.73). Factors that predicted only one ED visit were male gender (OR = 0.45, 95% CI = 0.25–0.82), higher continuity of medical care (OR = 1.39, 95% CI = 1.01–2.15) and second tertile of pain severity (OR = 2.42, 95% CI = 1.13–5.19). Conclusions: This study documented that a lack of continuity of care for individuals with multiple chronic conditions leads to a higher rate of ED presentations. The results are significant given that ED visits may contribute to health disparities among AA older adults. Future research should examine whether case management decreases ED utilization among underserved AA older adults with multiple chronic conditions and/or severe pain. To explore the generalizability of these findings, the study should be repeated in other settings.

Seasonal mobility and well-being of older people: The case of 'Snowbirds' to Sanya, China

Seasonal retired migrants have increased rapidly in developing countries in recent years. This article adopts a relational perspective to understand the relationships between older people's seasonal mobility and well-being. It shows that the complex spatiotemporal dynamics of seasonal mobility and the non-western sociocultural context influence older people's relations with their places of origin and destination, which in turn shape their well-being experiences during seasonal mobility. Narrative analysis of interview data from five pairs of 'snowbirds' to Sanya, China, reveals that seasonal mobility and well-being of older people are evolving processes, interwoven with risks and opportunities. Older people construct routinized daily activities, stable social relations, and peer-supporting and active-aging environments in their place of destination to maintain short-term well-being. However, they encounter difficulties in integrating the corporeal and social dimensions of their bodily experiences and constructing long-term well-being due to their separations from their lifelong relations in their places of origin. But overall, seasonal mobility creates alternative options for aging across multiple places and promotes leisure-oriented aging life.