The impact of chronic diseases on depressive symptoms among the older adults: The role of sleep quality and empty nest status

The independent and combined effects of physical activity and depressive symptoms on frailty in community-dwelling older adults: A cross-sectional study

AIMS

To investigate the independent and combined effects of physical activity (PA) and depressive symptoms on the risk of frailty in community-dwelling older adults.

BACKGROUND

Older adults face a high risk of frailty which is commonly used to predict adverse health outcomes in older patients. Engaging in PA and without depressive symptoms are crucial factors to prevent frailty. It is essential to investigate the independent and combined effects of these two variables on the risk of frailty.

METHODS

We included 3392 community-dwelling older adults. The FRAIL Scale was used to assess older adults' frail status (robust, prefrail and frail). Multiple logistic regression was utilized to examine the independent and combined effects of PA and depressive symptoms on the risk of prefrailty and frailty. The combined effects were visualized by marginal plots.

RESULTS

The prevalence of prefrailty and frailty in older adults were 42.16% and 10.58%. Compared with the group of "Light physical activity and With depressive symptoms", "Vigorous physical activity and Without depressive symptoms" had the lowest risk of prefrailty and frailty.

CONCLUSIONS

Older adults who do not engage in PA or have depressive symptoms increased the risk of frailty, but older adults with depressive symptoms could lower the risk of frailty through PA.

RELEVANCE TO CLINICAL PRACTICE

It is effective to reduce the risk of frailty by directing older adults to do moderate physical activity, although they have depressive symptoms. The focus should also be on older adults with depressive symptoms, who have at least more than twice and fourfold risk of prefrailty and frailty compared to those without.

IMPACT

This study offers insights for future interventions aimed at preventing frailty in older adults.

REPORTING METHOD

This study adhered to the STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTIONS

Older adults participated in this study and completed questionnaires.

Intervention effects of telenursing based on M-O-A model in empty-nest older adult individuals with chronic diseases: a randomized controlled trial

Aim

This study aims to verify the effectiveness of M-O-A telenursing intervention model in improving the health status and quality of life of the empty-nest older adult individuals with chronic diseases by a randomized comparative trial.

Methods

M-O-A telenursing intervention model was constructed based on the needs of the participants. The control group (N = 39) received routine nursing, the experimental group (N = 39) received M-O-A telenursing intervention in addition to routine nursing. After 12 weeks of intervention, the intervention effects of being a participant in the two groups were evaluated. SPSS 26.0 was used for data analysis.

Results

After 12 weeks of intervention, for the experimental group, each dimension of quality of life based on EQ-5D-3L became better, especially for "pain/discomfort," "anxiety/depression," "HRQoL" and "EQ-VAS" (all p < 0.05) and each dimension of quality of life based on SF-36 became better too, especially for "GH," "BP," "RE," "MH," "VT," "SF," "PCS," "MCS," "SF-36" (all p < 0.05). In addition, there was a statistical downward trend in blood pressure, blood glucose, weight, BMI, fat rate, nap duration, number of nocturnal awakenings, light sleep rate and a statistical upward trend in water rate, basal metabolic rate, nighttime sleep duration, deep sleep rate, rapid eye movement sleep rate, especially at the end of intervention (all p < 0.05). While for the control group, there was no statistical improvement in all these aspects.

Conclusion

The M-O-A telenursing model could effectively regulate quality of life and health condition of the empty-nest older adult individuals with chronic diseases, making it worthy of further promotion and application.

Depressive symptoms and all-cause mortality among middle-aged and older people in China and associations with chronic diseases

Introduction

It remains unclear whether depressive symptoms are associated with increased all-cause mortality and to what extent depressive symptoms are associated with chronic disease and all-cause mortality. The study aims to explore the relationship between depressive symptoms and all-cause mortality, and how depressive symptoms may, in turn, affect all-cause mortality among Chinese middle-aged and older people through chronic diseases.

Methods

Data were collected from the China Health and Retirement Longitudinal Study (CHARLS). This cohort study involved 13,855 individuals from Wave 1 (2011) to Wave 6 (2020) of the CHARLS, which is a nationally representative survey that collects information from Chinese residents ages 45 and older to explore intrinsic mechanisms between depressive symptoms and all-cause mortality. The Center for Epidemiological Studies Depression Scale (CES-D-10) was validated through the CHARLS. Covariates included socioeconomic variables, living habits, and self-reported history of chronic diseases. Kaplan-Meier curves depicted mortality rates by depressive symptom levels, with Cox proportional hazards regression models estimating the hazard ratios (HRs) of all-cause mortality.

Results

Out of the total 13,855 participants included, the median (Q1, Q3) age was 58.00 (51.00, 63.00) years. Adjusted for all covariates, middle-aged and older adults with depressive symptoms had a higher all-cause mortality rate (HR = 1.20 [95% CI, 1.09-1.33]). An increased rate was observed for 55-64 years old (HR = 1.23 [95% CI, 1.03-1.47]) and more than 65 years old (HR = 1.32 [95% CI, 1.18-1.49]), agricultural Hukou (HR = 1.44, [95% CI, 1.30-1.59]), and nonagricultural workload (HR = 1.81 [95% CI, 1.61-2.03]). Depressive symptoms increased the risks of all-cause mortality among patients with hypertension (HR = 1.19 [95% CI, 1.00-1.40]), diabetes (HR = 1.41[95% CI, 1.02-1.95]), and arthritis (HR = 1.29 [95% CI, 1.09-1.51]).

Conclusion

Depressive symptoms raise all-cause mortality risk, particularly in those aged 55 and above, rural household registration (agricultural Hukou), nonagricultural workers, and middle-aged and older people with hypertension, diabetes, and arthritis. Our findings through the longitudinal data collected in this study offer valuable insights for interventions targeting depression, such as early detection, integrated chronic disease care management, and healthy lifestyles; and community support for depressive symptoms may help to reduce mortality in middle-aged and older people.

The Migrant-Local Difference in the Relationship Between Social Support, Sleep Disturbance, and Loneliness Among Older Adults in China: Cross-Sectional Study

BACKGROUND

Driven by the accelerated aging of the population of China, the number of older adults has increased rapidly in the country. Meanwhile, following children, migrant older adults (MOA) have emerged as a vulnerable group in the process of fast urbanization. Existed studies have illustrated the association between social support and loneliness and the relationship between sleep disturbance and loneliness; however, the underlying mechanisms and the migrant-local difference in the association between social support, sleep disturbance, and loneliness have not been identified.

OBJECTIVE

This study aimed to clarify the migrant-local difference in the relationship between social support, sleep disturbance, and loneliness in older adults in China.

METHODS

Multistage cluster random sampling was used to select participants: 1205 older adults (n=613, 50.9%, MOA and n=592, 49.1%, local older adults [LOA]) were selected in Weifang City, China, in August 2021. Loneliness was assessed with the 6-item short-form University of California, Los Angeles Loneliness Scale, social support was evaluated with the Social Support Rating Scale, and sleep disturbance was measured with the Pittsburgh Sleep Quality Index. The chi-square test, t test, and structural equation modeling (SEM) were adopted to explore the migrant-local difference between social support, sleep disturbance, and loneliness among the MOA and LOA.

RESULTS

The mean score of loneliness was 8.58 (SD 3.03) for the MOA and 8.00 (SD 2.79) for the LOA. SEM analysis showed that social support exerts a direct negative effect on both sleep disturbance (standardized coefficient=-0.24 in the MOA and -0.20 in the LOA) and loneliness (standardized coefficient=-0.44 in the MOA and -0.40 in the LOA), while sleep disturbance generates a direct positive effect on loneliness (standardized coefficient=0.13 in the MOA and 0.22 in the LOA).

CONCLUSIONS

Both MOA and LOA have a low level of loneliness, but the MOA show higher loneliness than the LOA. There is a negative correlation between social support and loneliness as well as between social support and sleep disturbance among the MOA and LOA (MOA>LOA), while loneliness is positively associated with sleep disturbance in both populations (MOA Collapse

Key Words

• loneliness
• migrant-local difference
• older adults
• sleep disturbance
• social support
• structural equation modeling

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MESH Headings

• Child
• Humans
• Aged
• Cross-Sectional Studies
• Loneliness
• Transients and Migrants
• China/epidemiology
• Sleep Wake Disorders/epidemiology
• Social Support
• Sleep

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Affiliation(s)

Mingli Pang Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Jieru Wang Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Mingyue Zhao Human Resource Department, The Second Hospital of Shandong University, Jinan, China
Rui Chen Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Hui Liu Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Xixing Xu Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Shixue Li Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Fanlei Kong Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China

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Association of sleep status with depressive state in centenarians: Evidence from Hainan centenarian cohort

OBJECTIVE

The objective of this study is to analyze the association between sleep quality, sleep duration, sleep patterns, and depressive states among centenarians due to the crucial impact of depression on the well-being of elderly individuals, particularly the oldest. Recognizing easily identifiable manifestations and risk factors is essential since the onset of depressive states tends to be insidious.

METHODS

The baseline data from the China Hainan Centenarians Cohort Study (CHCCS) served as the basis for this study. Questionnaire surveys were conducted to obtain research indicators, with depressive states evaluated using the GDS-15 scale and sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression was employed to describe the association between sleep status and depressive states.

RESULTS

A total of 994 centenarians, with an age range of 100-116 years and a mean age of 102.77 ± 2.75 years, were included in this study. Among these participants, 815 were female, accounting for 82.0 %. After adjustment, the odds ratio (OR) for the association between poor sleep quality and depressive states was 2.07 (95 % CI: 1.54-2.77) compared to those with normal sleep quality. Additionally, there were associations between depressive states and both nighttime sleep duration and total sleep duration. After adjustment, the strongest association between depressive state and sleep patterns was found for those who had >9 h of nighttime sleep and ≥2 h of daytime sleep (OR = 1.80, 95%CI: 1.02-3.16). Moreover, compared to centenarians with 7-9 h of sleep duration and good sleep quality, the highest odds ratio (OR = 3.44, 95%CI: 2.18-5.43) for the association between depressive states and sleep duration ≤7 h and poor sleep quality was observed.

CONCLUSION

The findings of this study indicate that there is an association between poor sleep quality and depressive states in centenarians. Furthermore, both sleep quality and long/short total sleep duration are associated with depressive states in this population. Therefore, special attention should be given to the psychological state of elderly individuals with short sleep duration and poor sleep quality in order to prevent depression and minimize its negative impact on their overall health.

Global epidemiology of geriatric burns, capacities of care, and injury outcomes: Perspectives from the World Health Organization global burn registry

BACKGROUND

An increasing aging population alongside a potentially increasing injury risk emphasizes a critical need for evidence-based burn care regarding preventive and therapeutic strategies tailored to the unique needs of older adults. However, we note a critical gap in understanding geriatric burn trends on a global scale and the care capacity across settings. Thus, this study sought to ascertain the global trend of geriatric burns with a focus on patient demographics, injury characteristics, capacities of care, and injury outcomes.

METHODS

A retrospective design focusing on older adults aged ≥ 60 years with burns recorded in the World Health Organization Global Burn Registry as of 31st May 2023 was employed. Descriptive statistics were employed to analyze the data.

RESULTS

Of the 9277 records obtained from the Global Burn Registry, 849 participants (9.2%) were aged ≥ 60 years with the majority of these reported from the Eastern Mediterranean (EMRO) and Southeast Asia (SEARO) regions. More females than males were involved in burn injuries with the most common aetiological factor being flame. Most burns occurred in the home/ domestic setting with a seasonal variation (more injuries occurred in December and January). In terms of burn care capacity, the data suggest the availability of specialized services in most settings albeit the AFRO and SEARO regions still lacked the resources to offer specialized burn care. While most injured older adults were discharged home with no physical impairment (395, 46.5%), a substantial number died (250, 29.4%) during hospitalization, particularly in the African (AFRO) region and 111 (11.1%) left the facility against medical advice with the majority from the SEARO region (88).

CONCLUSION

Burn injuries in older adults remain a public health issue. On the preventive aspect, the results demonstrate a need to intensify safety in the home or domestic setting, and during festive seasons. Therapeutically, the findings underscore a need to consider the inclusion of more specialist geriatric and palliative care services in the burn management process. Additionally, we identified a need to strengthen burn care capacity in the AFRO and SEARO regions.

Financial Strain and Psychological Distress Among Middle-Aged and Older Adults: A Moderated Mediation Model

This study investigates the association between financial strain and psychological distress among middle-aged and older adults, exploring how this association is mediated by sleep problems and moderated by marital status. A subsample of 12,095 adults aged 50 and older was selected from the 2018 National Health Interview Survey. Results showed that financial strain was associated with higher psychological distress, and sleep problems partially mediated this association. Marital status moderated the association between sleep problems and psychological distress, and between financial strain and psychological distress, but not between financial strain and sleep problems. These findings partially support the stress-buffering role of marriage. The study offers valuable insights into the complex relationship between financial strain, sleep problems, marital status, and psychological distress among middle-aged and older adults in the United States, highlighting the need for interventions targeting financial stressors and sleep problems, especially for unmarried individuals, to improve mental health outcomes in this population.

The role of life satisfaction and living arrangements in the association between chronic disease and depression: a national cross-sectional survey

Introduction

For middle-aged and older people, depression is a frequent and prevalent illness. The purpose of this study was to examine the moderating function of living arrangements in the mediating model as well as the mediating role of life satisfaction in the association between chronic diseases and depressive symptoms.

Methods

The China Health and Retirement Longitudinal Study (CHARLS) provided the data for this investigation (2018). Respondents were grouped according to depression status to compare the differences between middle-aged and older people with different depression statuses. The moderating effect of living arrangements and the mediating effect of life satisfaction were tested using the Bootstrap program and the simple slope approach.

Results

The population's total prevalence of depressive symptoms was 30.3%. According to the mediating effect research, middle-aged and older people with chronic diseases experienced substantial direct effects on depressive symptoms (β = 1.011, p < 0.001). It has been established that life satisfaction has an 18.6% mediation effect between depressive symptoms and chronic diseases. Regarding the further moderating influence, it was discovered that chronic diseases had a more significant impact on the life satisfaction of middle-aged and older people who are in live alone than those who are living with others (β = 0.037, p < 0.05).

Conclusion

In middle-aged and older people, chronic diseases have a major influence on depressive symptoms. Life satisfaction mediated the relationship between chronic diseases and depressive symptoms, and living arrangements moderated the first part of the route in the mediation model. Therefore, life satisfaction and living arrangements should be important considerations to decrease the prevalence of depressive symptoms in middle-aged and older people.

Unraveling the Nexus: Exploring the Relationship between Exercise Habits and Sleep Quality in Older Adults

The objective of this study is to investigate the impact of exercise habits on enhancing the sleep quality of older adults. The Pittsburgh Sleep Quality Scale and other questionnaires were utilized to assess the sleep quality of older adults aged 60 years and above in the H district. The sampling method employed was stratified random sampling. To analyze the influencing factors of sleep quality, the average treatment effect was estimated, the robustness of the results was assessed and statistical methods such as Logit regression and propensity score matching were employed. The study revealed that exercise habits strongly correlated with improved sleep quality in the older adult (p < 0.05), with the average total sleep quality score being 6.22 (±3.53). It was observed that older adults who engaged in exercise habits experienced a significant 12.66% increase in the likelihood of achieving good sleep. This investigation highlights the positive association between exercise habits and enhanced sleep quality among older adults. Additionally, age, physical pain and self-rated health statuses were identified as significant factors influencing sleep quality in this population. To enhance the sleep quality of older adults, this article recommends promoting relevant exercise habits, thus contributing to their overall well-being and quality of life.

Longitudinal association of chronic diseases with depressive symptoms in middle-aged and older adults in China: Mediation by functional limitations, social interaction, and life satisfaction

Background

Several previous studies have shown that the development of depression is often accompanied by chronic diseases; although closely related, the mechanism between them is not clear. Here we investigate the potential role of functional limitations, social interaction, and life satisfaction in the relationship between chronic diseases and depressive symptoms in middle-aged and older adults in China.

Methods

We selected 2407 respondents aged ≥45 from the China Health and Retirement Longitudinal Study conducted in 2013, 2015, and 2018. We established panel data to estimate the longitudinal impact of chronic diseases on depressive symptoms and the mediating role of functional limitations, social interaction, and life satisfaction.

Results

Chronic diseases were associated with more depressive symptoms. All of the mediating pathways examined passed functional limitations, and approximately 43.4% of the association between chronic diseases and depressive symptoms was explained by these three mediating variables.

Conclusions

The impact of chronic diseases on depressive symptoms was primarily mediated by functional limitations, and the mediating role of social interaction and life satisfaction was also confirmed. Therefore, attention should be paid to reducing the level of functional limitation in middle-aged and older adults with chronic diseases and improving life satisfaction by increasing social opportunities to alleviate depressive symptoms in middle-aged and older adults.

Moderating Effect of Self-Esteem on the Relationship between Depression and Family Conflict Coping Strategies in the Elderly with Chronic Diseases in Korea

(1) Background: The elderly with chronic diseases often experience high levels of depression, which can negatively affect their family conflict coping strategies. Additionally, as the level of depression increases, self-esteem tends to decrease. This study aims to investigate whether self-esteem plays a moderating role in the relationship between depression and family conflict coping strategies among the elderly with chronic diseases. (2) Method: The subjects were 2501 older adults with chronic diseases included in the 16th Korean Welfare Panel Study. The CES-D scale, Rosenberg Self-Esteem Scale, and the tool of Family Conflict Coping Strategies were used. (3) Results: Depression was negatively correlated with self-esteem and coping strategies for family conflict, while self-esteem was positively correlated with coping strategies for family conflict. In the multiple regression model, self-esteem had a moderating effect (F = 43.20, p < 0.001). This result indicated that as self-esteem increases, the negative influence of depression on family conflict coping strategies becomes weaker (β = -0.08, t = -3.04, p = 0.002). (4) Conclusions: When addressing family conflict coping strategies in the elderly with chronic diseases, it is crucial to focus on enhancing self-esteem. Additionally, it may be beneficial to classify the elderly into groups based on their level of self-esteem.

The relationship between living alone or not and depressive symptoms in older adults: a parallel mediation effect of sleep quality and anxiety

BACKGROUND

With modernization and ageing in China, the population of older adults living alone is increasing. Living alone may be a potential risk factor for depressive symptoms. However, no parallel mediation model analysis has investigated the mediating factors for living alone or not (living arrangements) and depressive symptoms.

METHODS

This cross-sectional study included a total number of 10,980 participants from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), 1699 of whom lived alone and 9281 of whom did not live alone. Binary logistic regression and parallel mediation effect model were used to explore the relationship between living alone or not and depressive symptoms and possible mediation effects. Bootstrap analysis was used to examine the mediation effect of living alone or not on depressive symptoms.

RESULTS

Compared to the participants who were not living alone, the living alone group had a higher rate of depressive symptoms. The binary logistic regression showed that after adjusting for other covariates, the risk of depressive symptoms was approximately 0.21 times higher for living alone compared to not living alone (OR = 1.21, 95% CI: 1.06, 1.37). Further, the results of the bootstrap analysis supported the partial mediating role of sleep quality and anxiety. Mediation analysis revealed that sleep quality and anxiety partially mediate the relationship between living alone and depressive symptoms (β = 0.008, 95% CI [0.003, 0.014]; β = 0.015, 95% CI [0.008, 0.024], respectively).

CONCLUSIONS

Sleep quality and anxiety were identified as partially parallel mediators between living alone or not and depressive symptoms. Older adults living alone with poorer sleep quality and more pronounced anxiety were positively associated with higher levels of depressive symptoms. Older adults living alone should be encouraged to engage in social activities that may improve sleep quality, relieve anxiety, and improve feelings of loneliness caused by living alone. Meanwhile, older adults living alone should receive attention and support to alleviate their depressive symptoms.

CLRD: Collaborative Learning for Retinopathy Detection Using Fundus Images

Retinopathy, a prevalent disease causing visual impairment and sometimes blindness, affects many individuals in the population. Early detection and treatment of the disease can be facilitated by monitoring the retina using fundus imaging. Nonetheless, the limited availability of fundus images and the imbalanced datasets warrant the development of more precise and efficient algorithms to enhance diagnostic performance. This study presents a novel online knowledge distillation framework, called CLRD, which employs a collaborative learning approach for detecting retinopathy. By combining student models with varying scales and architectures, the CLRD framework extracts crucial pathological information from fundus images. The transfer of knowledge is accomplished by developing distortion information particular to fundus images, thereby enhancing model invariance. Our selection of student models includes the Transformer-based BEiT and the CNN-based ConvNeXt, which achieve accuracies of 98.77% and 96.88%, respectively. Furthermore, the proposed method has 5.69-23.13%, 5.37-23.73%, 5.74-23.17%, 11.24-45.21%, and 5.87-24.96% higher accuracy, precision, recall, specificity, and F1 score, respectively, compared to the advanced visual model. The results of our study indicate that the CLRD framework can effectively minimize generalization errors without compromising independent predictions made by student models, offering novel directions for further investigations into detecting retinopathy.

Late-life depression: Epidemiology, phenotype, pathogenesis and treatment before and during the COVID-19 pandemic

Late-life depression (LLD) is one of the most common mental disorders among the older adults. Population aging, social stress, and the COVID-19 pandemic have significantly affected the emotional health of older adults, resulting in a worldwide prevalence of LLD. The clinical phenotypes between LLD and adult depression differ in terms of symptoms, comorbid physical diseases, and coexisting cognitive impairments. Many pathological factors such as the imbalance of neurotransmitters, a decrease in neurotrophic factors, an increase in β-amyloid production, dysregulation of the hypothalamic-pituitary-adrenal axis, and changes in the gut microbiota, are allegedly associated with the onset of LLD. However, the exact pathogenic mechanism underlying LLD remains unclear. Traditional selective serotonin reuptake inhibitor therapy results in poor responsiveness and side effects during LLD treatment. Neuromodulation therapies and complementary and integrative therapies have been proven safe and effective for the treatment of LLD. Importantly, during the COVID-19 pandemic, modern digital health intervention technologies, including socially assistive robots and app-based interventions, have proven to be advantageous in providing personal services to patients with LLD.

The Effect of Chronic Disease and Mental Health on Sleep Quality among Migrant Elderly Following Children in Weifang City, China

Few studies have focused on the sleep quality among migrant elderly following children (MEFC). This study aimed to investigate the effects of chronic disease and mental health on the sleep quality of MEFC in Weifang, China. A cross-sectional study was conducted by multi-stage cluster random sampling, and in total 613 participants were enrolled. Sleep quality and mental health were assessed by the Pittsburgh Sleep Quality Index (PSQI) and the Depression, Anxiety, and Stress Scale (DASS-21), respectively. Chronic disease was assessed by the question "how many chronic diseases do you have?" A descriptive analysis and chi-square test were used to describe participants' sociodemographic variables, chronic disease, mental health, and sleep quality. The relationship between chronic disease, mental health, and sleep quality was explored by establishing binary logistic regression models. The results showed that 18.3% of MEFC's sleep quality was poor. MEFCs who were male were more likely to report good sleep quality. MEFCs who have similar monthly family income compared with others around, with multimorbidity, depression, and anxiety were more likely to report poor sleep quality. Nearly 1/5 of MEFCs were having poor sleep quality in this study. Results indicated that chronic diseases, depression, and anxiety were risk factors for the sleep quality of MEFC. Implications for the government, communities, and families of MEFC were given for improving their sleep quality.

Demand analysis of telenursing among empty-nest elderly individuals with chronic diseases based on the Kano model

Aim

The increase in empty-nest elderly individuals with chronic diseases poses a major challenge to the provision of public health services in China. Telenursing can effectively relieve the pressure of public health services to a certain extent. This study aims to explore the telenursing needs of empty-nest elderly individuals with chronic diseases based on the Kano model to provide references for improving the quality of telenursing.

Methods

Participants were selected from five rural communities and five urban communities in Yangzhou and Nantong, Jiangsu Province, China. A total of 348 empty-nest elderly individuals with chronic diseases were included. The participants received a sociodemographic characteristics questionnaire, and their telenursing needs were surveyed and analyzed based on the Kano model.

Results

Of the 15 quality attributes evaluated by the participants, 3 telenursing services were categorized as "must-be quality", 5 were categorized as "one-dimensional quality", 5 were categorized as "attractive quality", and 2 were categorized as "indifferent quality". The proportion of individuals who desired telenursing services ranged from 47.41 to 83.62%, the better values (satisfaction) ranged from 35.29-83.98%, and the worse values (dissatisfaction) ranged from 10.91 to 63.27%. There were no significant differences in any items of telenursing needs for between participants in Yangzhou and Nantong (all P > 0.05), and there were also no significant differences in all items between rural and urban communities (all P > 0.05).

Conclusion

Based on the Kano model, it was found that empty-nest elderly individuals with chronic diseases had a positive attitude toward telenursing and that they had different levels of need for different telenursing services. These findings provided a theoretical basis for medical decision-makers to formulate medical policies and provided a scientific foundation for nursing managers to improve telenursing services to meet the needs of the empty-nest elderly individuals with chronic diseases.

Association between social capital and depression among older adults of different genders: Evidence from Hangzhou, China

In China, it is critical to help older adults cope with depression due to the emerging impacts of factors such as increased life expectancy and the "one-child" family planning policy. Meanwhile, differences in retirement age have different effects on health in older adults of different gender. The relationship of gender differences in social capital and depression across the elderly population was unclear. Focusing on this demographic, this study conducted a telephone survey to explore the relationship between social capital and depression. Referring to electronic medical records, we randomly selected 1,042 elderly respondents (426 men, 616 women) from four areas in Hangzhou. We used social capital measurements and the Geriatric Depression Scale (GDS-15) to assess social capital and depression, respectively, then employed a multivariate logistic regression and structural equation modeling to examine the associations between factors, along with a consideration of gender. This study was discovered that differences in both income and morbidity contributed to differences in social capital and depression. In our sample of elderly respondents, we also found gender-based differences in cognitive and structural social capital. Compared to men, women were more likely to attain higher social capital and less likely to develop depression. At the same time, social networking and social engagement had negative impacts on depression in women, which was not the case for men. We found that lower reciprocity (men and women), social work (men), and trust (women) indicated higher risks of depression. Reciprocity and social networks were significantly and negatively correlated with depression among male respondents; in the male model, factors of trust, reciprocity, and social participation had positive effects on reducing the risk of depression, while social networks had a negative effect. For elderly persons, these findings suggest that mental health is affected by differences in social capital caused by policy differences and cultural differences caused by gender differences.

Depression symptoms and quality of life in empty-nest elderly among Chengdu: A cross-sectional study

OBJECTIVES

To estimate the prevalence of depression symptoms and quality of life (QoL) and examined the influence of factors in the empty nest elderly.

METHODS

This was a cross-sectional study, which was conducted from February 2022 to May 2022. We recruited a convenience sample of no empty-nest elderly and empty-nest elderly (≥60 years) living in Chengdu. QoL was assessed using WHOQOL-BREF, Geriatric Depression Scale (GDS-15) was used to assess depression symptoms. Multivariable logistic regression was used to analyze data between independent variables with depression symptoms.

RESULTS

Two thousand twenty-six participants were included in this study, 39.0% (660/1,082) experienced depression symptoms among empty-nest elderly. Age (aOR, 1.02; 95% CI, 1.00-1.04; P = 0.046), chronic disease≥2 (aOR, 3.29; 95% CI, 2.50-4.33; P < 0.001) were associated with increased risk of depression symptoms, and physical activity (aOR, 0.59; 95% CI, 0.40-0.87; P = 0.008), physical health (aOR, 0.93; 95% CI, 0.88-0.99; P = 0.026), psychological health (aOR, 0.93; 95% CI, 0.87-0.98; P = 0.013), and total score (aOR, 0.97; 95% CI, 0.96-0.99; P < 0.001) were associated with decreased risk of depression symptoms among empty-nest elderly.

CONCLUSIONS

Depression symptoms are common mental health problems among empty-nest elderly. We found that age, chronic disease ≥2 and physical activity were important factors that have an impact on depressive symptoms. Empty-nest elderly would have lowered QoL score.