Health inputs and cumulative health deficits among the older Chinese

Predictors of loneliness incidence in Chinese older adults from a life course perspective: a national longitudinal study

Objectives: We aim to examine what factors are predictive of loneliness incidence from a life course perspective and whether predictors differ between women and men based on a nationally representative longitudinal dataset in China. Method: A total of 5,043 older adults aged 65 or above from the Chinese Longitudinal Healthy Longevity Survey who were not lonely in the 2008 wave were included in the analysis. Logistic regression models were applied to examine what factors in the 2008 wave predicted loneliness incidence in the 2011 wave. Analyses were also stratified by gender to examine gender differences.Results: Older ages and self-rated poor health increased the odds, whereas receiving one or more years of schooling, rural-urban migration, living with family members, having a white-collar job, having a good family economic status, being currently married, having a higher resilience and social support decreased the odds of loneliness incidence. We also found gender differences: socioeconomic factors were significant only for older men, whereas self-rated health, resilience, and social support were significant only for older women.Conclusion: This study offers insights into disentangling the complexity of factors associated with loneliness incidence in Chinese older adults from a life course perspective and from a gendered perspective.

Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit

Background.

In older adults admitted to intensive care units (ICUs), frailty influences prognosis. We examined the relationship between the frailty index (FI) based on deficit accumulation and early and late survival.

Methods.

Older patients (≥65 years) admitted to a specialized geriatric ICU at the Liuhuaqiao Hospital, Guangzhou, China between July–December 2011 (n = 155; age 82.7±7.1 y; 87.1% men) were followed for 300 days. The FI was calculated as the proportion present of 52 health deficits. FI performance was compared with that of several prognostic scores.

Results.

The 90-day death rate was 38.7% (n = 60; 27 died within 30 days). The FI score was correlated with the Glasgow Coma Scale, Karnofsky Scale, Palliative Performance Scale, Acute Physiology Score—APACHE II and APACHE IV (r² = 0.52 to 0.72, p < 0.001). Patients who died within 30 days had higher mean FI scores (0.41±0.11) than those who survived to 300 days (0.22±0.11; F = 38.91, p < 0.001). Each 1% increase in the FI from the previous level was associated with an 11% increase in the 30-day mortality risk (95% CI: 7%–15%) adjusting for age, sex, and the prognostic scores. The FI discriminated patients who died in 30 days from those who survived with moderately high accuracy (AUC = 0.89±0.03). No one with an FI score >0.46 survived past 90 days.

Conclusion.

ICU survival was strongly associated with the level of frailty at admission. An FI based on health deficit accumulation may help improve critical care outcome prediction in older adults.

Healthiness of survival and quality of death among oldest old in China using fuzzy sets

OBJECTIVE

To investigate healthiness of survival and quality of death among oldest-old Chinese.

METHODS

Grade of Membership (GoM) method is applied to fulfill our goals using a nationwide longitudinal survey in China.

RESULTS

GoM method generates six pure types/profiles for healthiness of survival and five profiles/types for quality of death. The authors combine these 11 profiles into 4 groups. On average, a Chinese oldest old from 1998 to 2000 had 48% probability of experiencing healthy survival, with 30% experiencing unhealthy survival, 11% having nonsuffering death, and 11% having suffering death. Similar memberships of dying with nonsuffering conditions are found across ages among the decedents. Men have a higher probability of being in healthy survival and nonsuffering death as compared to women. Marriage, high social connections, nonsmoking, and regular exercise are important contributors to healthy survival and quality of death.

DISCUSSION

It is possible to live to ages 100 and beyond without much suffering.