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

Latent profile analysis of depression among empty nesters in China

OBJECTIVES

The study aimed to explore the depression profile of empty nesters and to identify heterogeneous subgroups in the elderly population. It explored the influencing factors of depression in elderly people with different depression profiles, with a view to provide a reference basis for improving the depression situation of empty-nesting elderly people.

METHODS

This study used the Chinese Longitudinal Healthy Lifespan Survey (CLHLS) survey data, with empty nesters over 60 as the research subjects. Latent profile analysis (LPA) was used to fit potential classes of depression in empty nesters; chi-square tests, Kruskal-Wallis, and multinomial logistic regression were used to explore the factors influencing different depression profiles in older adults.

RESULTS

A total of 4481 subjects were included in this study and were classified as low-level (11.6 %), moderate-level (51.6 %), and high-level (36.8 %). Compared to the low-level, the influencing factors for the high-level were IADL, anxiety, self-rated health, exercise, and education; and the influencing factors for the medium level group were anxiety, self-rated health, drink, and education. Factors influencing high-level relative to the mid-level group were IADL, anxiety, residence, self-rated health, exercise, and limited in activities.

LIMITATIONS

The CESD-10, as a screening tool, could not completely determine the presence of depression in high levels of empty nesters.

CONCLUSIONS

Psychological problems arising from depression among empty nesters seriously affected their overall health, and targeted intervention strategies should be developed for different categories of older adults to improve depression and enhance health-related quality of life.

Effectiveness of health-promoting lifestyle training on mental well-being, vitality, and quality of life of elderly with diabetes

This study aimed to investigate the effectiveness of health-promoting lifestyle (HPL) training on the mental well-being, vitality, and quality of life (QoL) of the elderly with diabetes. This was a quasi-experimental study based on a pre-test-post-test design with experimental and control groups. The statistical population consisted of all elderly with diabetes who were members of the Diabetes Association of Ahvaz in 2021, of whom 40 elderlies were selected as the sample through the convenience sampling method. The participants were randomly assigned to experimental and control groups. The participants in the experimental group attended eight 90-min sessions of HPL training. The data were statistically analyzed using the multivariate analysis of covariance in SPSS-17. The mean ± SD of the post-test scores of mental well-being, vitality, and QoL was 39.90 ± 4.80, 23.00 ± 3.31, and 35.00 ± 6.13 in the experimental group and 33.85 ± 4.81, 17.80 ± 3.15, and 29.15 ± 4.67 in the control group. The post-test results revealed a significant difference between the two groups in all of these three variables, as the HPL training significantly improved the mental well-being, vitality, and QoL of participants in the experimental group. Health professionals are recommended to apply HPL training, along with other training and therapeutic methods, to improve the health-related characteristics of such patients.

Effects of Health-Promoting Lifestyle on Late-Onset Depression in Older Adults: Mediating Effect of Meaning in Life and Interleukin-6 (IL-6)

Purpose

Late-onset depression (LOD) with poor treatment response has high incidence and mortality in the China's aged people, this study aims to explore the correlation between health-promoting lifestyle, meaning in life, interleukin-6 (IL-6) and LOD for providing scientific basis of LOD prevention and rehabilitation.

Patients and Methods

A total of 496 LOD patients (study group) and healthy older adults (control group) were enrolled and investigated by using the Health-promoting lifestyle Profile-II, revised (HPLP-IIR), Meaning in Life Questionnaire-Chinese Version (MLQ-C), and Hamilton Depression Scale (HAMD). The interleukin-6 (IL-6) in the circulating blood was detected by utilizing ELISA kit.

Results

The results showed that the scores of all factors in HPLP-IIR and MLQ were significantly lower and IL-6 level was higher in the study group than the control group. Scores of most factors in HPLP-IIR and MLQ negatively and IL-6 positively correlated with scores of subscales and total HAMD score. Meaning in life and IL-6 partially mediated the relationship between health-promoting lifestyles and depression severity in the study group, with the mediating effect explains 15.76% and 22.64% of the total effect, respectively.

Conclusion

Health-promoting lifestyles, meaning in life, and IL-6 are predictors of LOD, and an unhealthy lifestyle could induce LOD through the mediating effect of meaning in life and IL-6 in older adults.

The role of pet attachment in alleviating the negative effects of loneliness on a health-promoting lifestyle: An empirical study based on threshold effects for pet owners

BACKGROUND

A health-promoting lifestyle is acknowledged as a 'positive ageing' strategy for older people. The inevitable decline in their social networks may lead to loneliness and subsequently damage their health-promoting lifestyle. Therefore, pet owning has become a popular way for them to alleviate loneliness. However, the attachment resulting from pet ownership may either facilitate or impede older people's ability to counteract the negative effect of loneliness on health-promoting lifestyles, and this effect may only be observed when pet owners have limited human confidants.

OBJECTIVES

To identify the role of pet attachment in alleviating the negative impact of loneliness on a health-promoting lifestyle and its supplementary role in the deficiency of social relationships by analysing the correlation mechanism between pet attachment, loneliness and a health-promoting lifestyle.

METHODS

Self-report questionnaires were sent to 879 older people (aged ≥60) with pets in China by using a multistage stratified random sampling method. Cross-sectional threshold regression models were established to analyse the nonlinear effects of loneliness on a health-promoting lifestyle and the different threshold effects among different social relationship levels.

RESULTS

A single threshold value (0.444) was drawn to determine the action mode of pet attachment on the negative relationship between loneliness and a health-promoting lifestyle. When the level of pet attachment exceeded 0.444, the inhibition of loneliness on a health-promoting lifestyle decreased significantly. Additionally, this threshold effect was evident among older people at different levels of social relationships.

CONCLUSIONS

The negative effect of loneliness on a health-promoting lifestyle is alleviated by the single threshold effect of pet attachment. Pet-owner relationships can compensate for a lack of social relationships to some extent and alleviate both an individual's loneliness and its negative effect on a health-promoting lifestyle.

IMPLICATIONS FOR PRACTICE

To alleviate loneliness and promote healthy ageing in older people who lack social relationships, the tailored pet intervention strategies that prioritize 'one health' at the animal-ecosystem interface that consider their different individual levels of social relationship should be developed.

Employment and Mental Health of the Chinese Elderly: Evidence from CHARLS 2018

Improving the mental health of the elderly has become an important strategic goal of healthy aging, among which employment is regarded as an essential factor for the mental health of the elderly. This study adopted ordinary least squares, ordered logit, propensity score matching (PSM), and KHB mediation analysis to examine the influence and mechanism of employment on mental health in older Chinese adults using data from the China Health and Retirement Longitudinal Survey of 2018. The study found that employment positively impacts older adults' mental health in China. This promotive effect of employment was significant for more senior people aged up to 80 years old with lower educational backgrounds and rural household registration. In addition, individual annual income, the financial support provided to children, and support received from children significantly mediate the realization of employment improving older people's mental health. Our findings are expected to provide valuable insight into delayed retirement and active aging in China. Therefore, the government must play the role of support and advocacy to promote employment and safeguard the well-being of older adults.

The association between internet use and depression among older adults in China: The mediating role of social networks

Objective

In the aging world, the depression of older adults has aroused great concern. It brings detrimental side effects to old adults and the sustainability of society. The information and communication technologies have reshaped how people live among which the Internet has gained much popularity in the senior community. This study aims to explore the association between Internet use and depression in older adults.

Methods

This study applied a representative national dataset (China Longitudinal Aging Social Survey, CLASS 2018) to examine by conducting regression analysis. Inspired by the social capital theory, we further examined the mediating role of general social networks (as a general concept) and specific networks (family and friend networks) in reducing depression. All calculations and analyses were conducted by STATA.

Results

(a) Internet use significantly reduces depressive symptoms among Chinese older adults; (b) internet use enhances social network support for Chinese older adults; and (c) social networks in general and family networks and friend networks in specific all play a mediating role between internet use and depression symptoms.

Conclusion

This work proved that internet use could reduce depression levels in older adults in China, and social networks, including family networks and friend networks, have a mediation role in the relationship between internet use and depression in older adults in China. Combined with the Chinese social context, we explained that the existence of an empty-nest elderly community in Chinese society and the emphasis on kinship in Chinese tradition may be the reasons. Based on the main findings, tailor-made suggestions for addressing depression issues among older adults were discussed.

Relationships between children-related factors, basic psychological need satisfaction, and multiple happiness among urban empty-nesters in China: a structural equation modeling

BACKGROUND

Aging and empty-nesting in China are becoming more and more serious. Empty-nesters refer to older adults who were not living with their children, were living alone, or were living independently with their spouses. The mental health of empty-nesters needs timely attention. Satisfying the needs of older adults is primarily dependent on their children. Therefore, this study aimed to explore relationships between children-related factors, basic psychological need satisfaction, and multiple happiness among urban empty-nesters in China.

METHODS

This study employs the Children-related Factors Questionnaire (CFQ), the Chinese Version of the Basic Psychological Need Satisfaction (BPNS) Scale, and the Multiple Happiness Questionnaire (MHQ) to explore children-related factors, basic psychological need satisfaction and multiple happiness of urban empty-nesters in Fuzhou, China. A total of 507 samples were recruited by cluster sampling.

RESULTS

Factors that affect BPNS include physical condition, the number of children, satisfaction with children's marriage, employment and income, retirement, gender, monthly personal income, and self-care have statistical differences (P < 0.05). Factors that affect MHQ include physical condition, the number of children, satisfaction with children's marriage, employment and income, gender, monthly personal income, living status, and self-care have statistical significances (P < 0.05). Structural equation model results showed that BPNS directly impacted MHQ, and factors about children indirectly affect MHQ through BPNS. The mediating role of BPNS in the relationship between children-related factors and MHQ.

CONCLUSION

We should encourage our children to spend more time with the empty-nesters and communicate with them, which could help them relieve their negative emotions, satisfy their psychological needs, and improve their well-being.

TRIAL REGISTRATION

Reg date: 20/08/2021; No. ChiCTR2100050175.

The causal association between empty nest and depressive symptoms with cognitive impairments in China

BACKGROUND

In the context of rapid aging, "empty nest syndrome" is becoming a major public health concern. The causal effects of empty nest on depressive symptoms have been studied in developed countries, but the mediating mechanism of depressive symptoms in the association between empty nest and cognitive impairments has not been studied. This study estimated the causal association of empty nest with depressive symptoms and cognitive impairments in China, and then estimated how depression mediates the association between empty nest and cognitive impairments.

METHODS

Using data of 23,614 urban older adults (65+) obtained from the Shandong Province Aging and Mental Health Survey in 2020, a weighted linear regression model combined with instrumental variable was applied to explore the causal effects of empty nest, and a four-step mediation model was run to test the mediator of depressive symptoms. The Ascertain Dementia 8-item Questionnaire and Patient Health Questionnaire-9 were used to measure cognitive impairments and depressive symptoms.

RESULTS

Empty nest was associated with 0.13 (95%CI: 0.04-0.23) and 0.23 (95%CI: 0.14-0.33) increases in the Ascertain Dementia 8-item Questionnaire and the Patient Health Questionnaire-9 scores, respectively. The association between empty nest and the Ascertain Dementia 8-item Questionnaire scores was mediated by the Patient Health Questionnaire-9 scores.

CONCLUSIONS

Empty nest affected depression in adulthood with cognitive impairments. A focus on integrative intervention for empty nesters is recommended, taking depression and cognition into account.

LIMITATIONS

It is a cross-sectional study and the data is not nationally representative.

The impact of chronic diseases on psychological distress among the older adults: the mediating and moderating role of activities of daily living and perceived social support

OBJECTIVES

Previous literature has shown that chronic diseases and psychological distress are correlated. However, the mediating and moderating mechanisms underlying this relationship have not been sufficiently studied. The purpose of this study was to explore the role played by activities of daily living (ADL) and perceived social support.

METHOD

Face-to-face questionnaire-based surveys were conducted with 3250 valid participants (age ≥60 years). Participants were assessed using the Barthel Index, Perceived Social Support Scale, and Depression Anxiety Stress Scale-21.

RESULTS

1) Chronic diseases had a significant direct effect on psychological distress in older adults; 2) the relationship between chronic diseases and psychological distress was partially mediated by ADL; and 3) the impact of chronic diseases on psychological distress was significantly moderated by perceived social support. More importantly, perceived social support was a protective factor that could effectively alleviate the adverse effects of chronic diseases on psychological distress.

CONCLUSION

The results add to the existing literature by uncovering the underlying mechanisms between chronic diseases and mental health. These findings have implications for early intervention and prevention of mental health problems in older adults.

The association between health-promoting-lifestyles, and socioeconomic, family relationships, social support, health-related quality of life among older adults in china: a cross sectional study

Objectives

Lifestyles, accounting for 53% in determining death, play a vital role in improving the health of older adults. Thus, this study aimed to explore the influencing factors of the health-promoting-lifestyles and interaction mechanisms among older adults.

Methods

A total of 8526 elders were selected by a three-stage stratified random cluster sampling method. Socioeconomic status, family relationships, social support, health-related quality of life (QOL), and health-promoting-lifestyles (HPLP) of older adults were assessed with the Social Support Rating Scale, the short form 36 health survey (SF-36) and Health-Promoting Lifestyle Profile. A structural equation model (SEM) was conducted to test the direct and indirect association between influencing factors with HPLP.

Results

In this study, there were 4901 older adults who were empty nesters, and 3625 were non-empty nesters. Of all respondents, the average QOL score of older adults was 62.28 ± 16.51, average social support score was 78.06 ± 7.50. The HPLP score of older adults was 105.9 ± 19.6, and the average score of subscales was 2.5 ± 0.5, which was at the medium level. Social support had a positive and direct effect on HPLP of older adults (total effect, 0.34). Meanwhile, social support mediated the relationship between socioeconomic (total effect, 0.17), QOL (total effect, 0.33) and HPLP. Family relationships had a small indirect effect on HPLP via social support (0.01).

Conclusions

Social support is the strongest influencing factor in the health-promoting-lifestyles among older adults, followed by socioeconomic, health-related quality of life and family support. Thus, maintaining higher social support was important to improve the HPLP of older adults.

The Impact of Sleep Quality on Subjective Wellbeing Among Older Adults With Multimorbidity: A Moderated Mediation Model

Background

Studies have found that poor sleep quality is negatively associated with subjective wellbeing in older adults, but the mechanisms underlying are unclear. In this study, we aimed to examine the mediating role of negative emotions and the moderating role of perceived social support in the relationship between sleep quality and subjective wellbeing in older adults with multimorbidity.

Methods

A multi-stage random sampling method was used to select a sample of 3,266 older adults aged 60 years and older. The Memorial University of Newfoundland Scale of Happiness (MUNSH), Pittsburgh Sleep Quality Index (PSQI), Depression Anxiety Stress Scales-21 (DASS-21), and Perceived Social Support Scale (PSSS) were used to assess subjective wellbeing, sleep quality, negative emotional states, and perceived social support, respectively. The moderated mediation models were examined using SPSS PROCESS Version 3.3 software.

Results

Sleep quality had a significant direct effect on subjective wellbeing in older adults (β = −0.997, t = −11.783, p < 0.001). Negative emotions partially mediated the effect of sleep quality on subjective wellbeing (ab = −0.608, 95%CI: −0.728, −0.497). The indirect effect was moderated by perceived social support (β = −0.038, 95%CI: −0.062, −0.014, p < 0.001; β = −0.002, 95%CI: −0.004, −0.01, p = 0.008).

Conclusion

Negative emotions increased the negative association between sleep quality and the subjective wellbeing of older adults with multimorbidity, and perceived social support played a moderating role. Psychological and behavioral interventions should be implemented as early as possible to promote mental health and enhance social support level of older adults with multimorbidity, and ultimately improve the subjective wellbeing of older adults.

Left-Behind Status and Bullying in Chinese Rural Children: The Roles of Parental Supervision and Support and Friends in Puppy Love

Bullying behaviors, as exhibited by left-behind children (LBC) in China, occur commonly. Parental supervision and support, as well as friendship networks, have previously been verified as crucial aspects in determining the bullying behaviors of LBC. However, evidence of the interactive effect of these vital factors is sparse, and puppy love, which is inevitable among school-age children, is seldom investigated. The current study aimed to examine the roles of parental supervision and support as well as peers in puppy love in LBC bullying behaviors by means of a moderated mediation model. The data were derived from 28 counties/districts across China. We used data from the China Education Panel Survey (CEPS) of 3,252 junior high school students. A moderated mediation model was conducted by PROCESS procedure in Statistical Product and Service Solutions (SPSS) and the bootstrapping method was performed for inference test. The moderated mediation analysis showed that left-behind status was associated with bullying behaviors displayed by school-age students. Parental supervision and support mediated this association; furthermore, the mediation effects were dependent on the number of friends in puppy love. In particular, as the number of friends in puppy love increased, the mediating effect of parental supervision weakened, whereas the mediating effect of parental support became stronger. These results revealed the importance of parental support and supervision and peers in puppy love in shaping bullying behaviors among LBC. Future bullying prevention and intervention should promote parental supervision and support among LBC in rural China, especially those with many friends in puppy love.

Social support and subsequent cognitive frailty during a 1-year follow-up of older people: the mediating role of psychological distress

Background

Frailty and cognitive impairment are two common geriatric symptoms linking adverse health-related outcomes. However, cognitive frailty, a new definition defined by an international consensus group, has been shown to be a better predictor of increased disability, mortality, and other adverse health outcomes among older people than just frailty or cognitive impairment. This study estimated the prospective association between social support and subsequent cognitive frailty over 1 year follow-up, and whether psychological distress mediated the association.

Methods

The data was drawn from a prospective repeated-measures cohort study on a sample of participants aged 60 and over. A total of 2785 older people who participated in both of the baseline and 1-year follow-up survey were included for the analysis. Cognitive frailty was measured by the coexistence of physical frailty and cognitive impairment without dementia. Control variables included sex, age, education, marital status, economic status, smoking status, alcohol drinking status, chronic conditions, and functional disability. Path analyses with logistic function were performed to examine the direct effects of social support (predictors) on subsequent cognitive frailty (outcome) at 1-year follow-up and the mediating role of psychological distress (mediator) in this link.

Results

After adjusting for covariates and prior cognitive frailty status, social support was negatively associated with psychological distress (β = − 0.098, 95% CI = − 0.137 to − 0.066, P < 0.001) and was negatively associated with the log-odds of cognitive frailty (β = − 0.040, 95% CI = − 0.064 to − 0.016, P < 0.001). The magnitude of mediation effects from social support to cognitive frailty via psychological distress was a*b = − 0.009, and the ratio of a*b/(a*b + c’) was 24.32%.

Conclusions

Lower social support is associated with increased rates of subsequent cognitive frailty over 1-year follow-up, and this link is partially mediated through psychological distress, suggesting that assessing and intervening psychological distress and social support may have important implications for preventing cognitive frailty among older people.

The association between sleep quality and psychological distress among older Chinese adults: a moderated mediation model

BACKGROUND

Previous research has found a link between sleep quality and psychological distress. However, the underlying mechanisms of this connection have still not been well explored. The aim of this study was to examine the roles of activities of daily living (ADL), physical activity, and perceived social support in the link between sleep quality and psychological distress among older adults.

METHODS

Three thousand two hundred fifty valid individuals (aged 60 years or above) participated in face-to-face questionnaire-based surveys. Older individuals were assessed using the Pittsburgh Sleep Quality Index, Barthel Index, International Physical Activity Questionnaire, Perceived Social Support Scale, and Depression Anxiety Stress Scale-21. The PROCESS macro developed by Hayes was used to conduct moderated mediation analysis.

RESULTS

In older adults, sleep quality had a substantial direct influence on psychological distress. ADL mediated the association between sleep quality and psychological distress. Physical activity significantly reduced ADL's mediating influence on the relationship between sleep quality and psychological distress. Furthermore, perceived social support moderated the direct relationship between sleep quality and psychological distress, as well as the second half of the mediating effect of the ADL. Moreover, physical activity and perceived social support were preventive factors that might successfully mitigate the detrimental effects of poor sleep quality on ADL and psychological distress.

CONCLUSIONS

The findings contribute to existing understanding by clarifying the fundamental mechanisms that link sleep quality and psychological distress. These results may provide a valuable reference to the Chinese government for improving mental health in older individuals.

The influencing factors of health-related quality of life among rural hypertensive individuals: a cross-sectional study

Background

Previous reports regarding health-related quality of life (HRQoL) of hypertensive individuals commonly concentrated on urban population. This study focused on rural population and aimed to explore the influencing factors of HRQoL.

Methods

Date were derived from Henan Rural Cohort study. The HRQoL of participants were assessed via European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) instrument. Tobit regression model and generalized linear model were employed to explore the influencing factors of HRQoL. Another binary logistic regression was utilized to examine the robustness of our results.

Results

Among 23,485 rural population, 8128 participants were identified with hypertension. The mean (SD) utility index and VAS score of non-hypertension group were 0.96 (0.09) and 79.66 (14.20), respectively, while in hypertension group were 0.94 (0.14) and 75.88 (15.50), respectively. Pain/discomfort was the most common self-reported problem (23.05%) for patients. Aging and suffering with other diseases were negatively associated with HRQoL among rural patients, while high socioeconomic status and healthy lifestyles corresponded with high HRQoL.

Conclusions

Hypertension did push considerable pressures on patients’ HRQoL. Maintaining healthy lifestyles and improving the socioeconomic status of patients were advisable ways to reduce this burden.

Trial registration The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). http://www.chictr.org.cn/showproj.aspx?proj=11375

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01879-6.

Impact of socioeconomic status on depression clinical outcomes at six months in a Midwestern, United States community

INTRODUCTION

Lower socioeconomic status (SES) has been associated with poor healthcare outcomes in depression. However, reliable individual-level SES data rarely exists for clinical research. The HOUSES index relies on publicly available data allowing for evaluation of individual-level SES on patient outcomes.

HYPOTHESIS

Primary care patients with depression within the lower SES quartile (Quartile 1 vs. Quartile 4, of the HOUSES index) would experience worse clinical outcomes of their symptoms six months after diagnosis.

STUDY DESIGN

A retrospective cohort study which followed 4313 adult primary care patients that were diagnosed with depression during the study period of 2008-2015. The outcome measures were the six month PHQ-9 scores.

RESULTS

At six months, a higher HOUSES quartile was associated with greater odds of remission of depressive symptoms (RDS) and lower odds of persistent depressive symptoms (PDS), after controlling for covariates. Patients in Quartile 4 had 27% more likelihood of RDS and a 24% lower likelihood of PDS at six months compared to a Quartile 1 patient.

LIMITATIONS

As a retrospective study only can observe associations but not causation. Only one institution participated and not all treatments were readily available, limiting the generalizability of these findings.

CONCLUSIONS

Lower SES as demonstrated by a lower HOUSES quartile (Quartile 1 versus 4) was associated with lower odds of RDS and increased odds of PDS at six months. HOUSES index is a useful tool for identifying patients at risk for worse clinical outcomes and may help health care systems plan resource allocation for depression care.

Health-related quality of life among rural adults with type 2 diabetes mellitus: a cross-sectional study

BACKGROUND

Previous reports about health-related quality of life (HRQoL) of type 2 diabetes mellitus (T2DM) concentrated on general patients rather than patients in rural areas with poor infrastructure and limited resources. Thus, the aims of this study were to evaluate the HRQoL of diabetics in the countryside and explore its influencing factors.

METHODS

A total of 23 053 participants aged from 18 to 79 years were drawn from the Henan Rural Cohort Study for this cross-sectional study. The HRQoL of participants were assessed by utility index and VAS-score of European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) instrument. Binary logistic regression, generalized linear and tobit regression models were used to estimate the potential influencing factors on HRQoL.

RESULTS

This study (23 053 participants) included 2231 T2DM patients with a crude prevalence of 9.68%. The utility index and VAS-score in health group were 0.96 ± 0.10 and 78.85 ± 14.53, while in T2DM group were 0.93 ± 0.15 and 74.09 ± 16.09, respectively. In total, most diabetics reported problem about pain/discomfort dimension. Being old, poverty, low physical activity, and with comorbidities was negatively related to HRQoL of diabetics, while high educational level was positively related to HRQoL.

CONCLUSION

HRQoL of rural T2DM patients depended on several sociodemographic factors. More attention should be paid to diabetics with poor socioeconomic status in rural areas.

CLINICAL TRIAL REGISTRATION

The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699) http://www.chictr.org.cn/showproj.aspx?proj=11375.

Exploring the influencing factors of quality of life among the empty nesters in Shanxi, China: a structural equation model

Background

As China’s aging trend intensifies and the proportion of empty nests increases, the health-related quality of life of the elderly is the focus of social attention. Previous studies focused on the quality of life of the elderly, rather than empty nesters, and lacked the discussion of the mechanism of influencing factors. Thus, this study aimed to explore the influencing factors of the quality of life (QOL) and interaction mechanisms among empty nesters in Shanxi Province, China, so as to provide practical reference for improving the QOL of empty nesters.

Methods

A total of 4901 empty nesters in Shanxi Province, China, were selected using multi-stage random cluster sampling method in this cross-sectional study. The quality of life was assessed with the Short Form 36 Health Survey (SF-36). Multiple linear regression analysis (stepwise) was performed to examine the factor associated with QOL. Structural equation model (SEM) approach was conducted to test the direct and indirect association between QOL influencing factors with QOL.

Results

The average QOL score of empty nesters was 63.34 (SD = 17.23). The multiple linear regression revealed that gender, age, education, monthly income, drinking status, exercise frequency, physical examination frequency, attention to daily nutritional health, relationship with a spouse and relationship with children were significant predictors of the empty nester’s QOL (P < 0.05) (R² = 0.128). SEM showed that behavioral lifestyle had a direct effect on QOL (β = 0.446, P < 0.001). Socio-economic status had an indirect effect (β = 0.288, P < 0.001) on QOL through behavioral lifestyle. The family relationship had an indirect effect (β = 0.115, P < 0.001) on QOL.

Conclusion

Behavioral lifestyle was the strongest influencing factor in the quality of life among empty nesters, followed by socio-economic status and family relationships. Thus, maintaining a healthy behavioral lifestyle was important to improve the QOL of the empty nesters. Our findings provide a concrete and strong reference for the formulation of targeted intervention strategies.

Depressive Symptoms among Rural "Left-Behind" Older Adults: A Test of the High Outmigration Penalty Hypothesis

OBJECTIVES

We investigated whether there was a "high outmigration penalty" for psychological health among older adults in rural China by assessing two potential community stressors associated with major sociodemographic changes in the community - increased outmigration and older adult density. We also investigated whether disparities in community economic conditions moderated the association between community stressors and depressive symptoms.

METHODS

We employed three waves of data from the China Health and Retirement Longitudinal Study (2011-2015), using multilevel negative binomial models to address our research questions.

RESULTS

Our results supported the "high outmigration penalty" hypothesis. Older adults living in low-income rural communities may experience an aggravated mental health penalty compared to those living in high-income rural communities. Higher older adult density was also associated with more depressive symptoms but only in less wealthy communities. Community differences in economic conditions were key factors buffering the high outmigration disadvantage associated with the psychological health of older Chinese adults.

DISCUSSION

Rural outmigration may have deepened existing inter-community health disparities among older adults. Policies should be developed to address community-level factors negatively associated with the well-being of older Chinese adults living in high outmigration and less wealthy rural communities.

Cognitive frailty and suicidal ideation among Chinese rural empty-nest older adults: Parent-child geographic proximity as a possible moderator?

BACKGROUND

Few studies explored the relationship between cognitive frailty and suicidal ideation (SI), and whether geographic variable modified this relationship. This study aimed to explore the association between cognitive frailty and SI, and investigated whether parent-child geographic proximity is a moderator in this relationship among Chinese rural empty-nest older adults.

METHODS

A total of 2,549 rural empty-nest older adults (60+) were included in the analysis. SI was assessed using questions from the National Comorbidity Survey. Fried frailty phenotype and Mini Mental State Examination were used to measure cognitive frailty. Moderating effect analysis was performed using logistic regression models and margins plot.

RESULTS

The prevalence of SI and cognitive frailty were 10.1% and 6.2% among Chinese rural empty-nest older adults. Participants with cognitive frailty were more likely to suffer from SI (OR=1.16, 95% CI=1.03-2.86). We found that far geographic distance may aggravate this relationship (OR=4.30, 95% CI=1.02-10.24), especially for rural empty-nest older adults whose nearest adult child lived outside the same prefectural city with them.

LIMITATIONS

The results cannot be interpreted as causality of the data due to cross-sectional design.

CONCLUSIONS

Our findings suggested that cognitive frailty was associated with SI and parent-child geographic proximity moderated this relationship. Improving the cognitive frailty of older adults is helpful to prevent SI. Adult children living far away from rural empty-nest older adults should increase intergenerational contact and pay attention to their parents' physical and mental health.

Quality of life among different types of Chinese lonely elderly: A social isolation based analysis

This study aimed to understand the types and characteristics of lonely elderly from the perspective of social isolation and compare their differences in quality of life (QOL). A cross-sectional survey of 2148 lonely elderly in Shanxi province, China was conducted. The latent profile analysis was used to classify the lonely elderly and describe their characteristics. A hierarchical multilinear regression method was applied to evaluate their differences in QOL. The lonely elderly can be divided into two categories: Class-Ⅰ, in low social isolation with a significant correlation between social isolation and loneliness (p < 0.05), and Class-Ⅱ, in high social isolation with no significant correlation between social isolation and loneliness (p > 0.05). QOL of Class-Ⅰ was significantly higher than that of Class-Ⅱ. Class-Ⅱ was in a state of self-imposed isolation with poor QOL and should be the focus-group during practical intervention.

How social isolation and loneliness effect medication adherence among elderly with chronic diseases: An integrated theory and validated cross-sectional study

INTRODUCTION

Social isolation and loneliness have been described as epidemics among elderly patients with chronic disease. Those epidemics also associates with these elderly's low medication adherence behavior. However, there is a scarcity of research on establishing mechanisms of elderly patients' medication adherence referred to their social isolation and loneliness.

METHODS

A mixed-methods design with integrated theory and validated cross-sectional study was used. The integrated theory was constructed by Berkman's conceptual model and the mechanism model of loneliness. The cross-sectional survey was conducted in six districts of Taiyuan, China, through a stratified random cluster sampling method.

RESULTS

Low social support mediated the association between social isolation and suboptimal medication adherence in the whole sample, also in multimorbidity patients. Social isolation was positively associated with loneliness, but loneliness couldn't be considered as a mediator between social isolation and medication adherence. In serial mediation model, social isolation caused less social support and more loneliness, and resulted in suboptimal medication adherence in whole sample. In addition, this serial mediational model was not different between patients in non-multimorbidity and multimorbidity.

CONCLUSIONS

Social isolation and loneliness are related but independent constructs. Interconnected psychosocial mechanisms explain the influence the mechanism of medication adherence from social isolation and loneliness, and the effective paths of social isolation will increase as the chronic disease evolves. The interventions should initially focus on emotional health to establish a multi-perspective supporting system, which contains tangible support, informational and emotional support, positive social interaction, and affectionate support, especially for the multimorbidity patients.

Prevalence of Depression Among Empty-Nest Elderly in China: A Meta-Analysis of Observational Studies

BACKGROUND

Depressive symptoms are common in empty-nest elderly in China, but the reported prevalence rates across studies are mixed. This is a meta-analysis of the pooled prevalence of depressive symptoms (depression hereafter) in empty-nest elderly in China.

METHODS

Two investigators independently conducted a systematic literature search in both English (PubMed, EMBASE, PsycINFO, Web of Science, and Cochrane Library) and Chinese (CNKI and Wan Fang) databases. Data were analyzed using the Comprehensive Meta-Analysis program.

RESULTS

A total of 46 studies with 36,791 subjects were included. The pooled prevalence of depression was 38.6% (95%CI: 31.5-46.3%). Compared with non-empty-nest elderly, empty-nest elderly were more likely to suffer from depression (OR=2.0, 95%CI: 1.4 to 2.8, P<0.001). Subgroup and meta-regression analyses revealed that mild depression were more common in empty-nest elderly than moderate or severe depression (P<0.001). In addition, living alone (P=0.002), higher male proportion (β=0.04, P<0.001), later year of publication (β=0.09, P<0.001) and higher study quality score (β=0.62, P<0.001) were significantly associated with higher prevalence of depression.

CONCLUSION

In this meta-analysis, the prevalence of depression in empty-nest elderly was high in China. Considering the negative impact of depression on health outcomes and well-being, regular screening and appropriate interventions need to be delivered for this vulnerable segment of the population.