Widowhood, widowhood duration, and loneliness among older adults in China

Factors associated with loneliness among individuals aged 80 years and over: Findings derived from the nationally representative "Old Age in Germany (D80+)" study

OBJECTIVES

To clarify the factors associated with loneliness in individuals aged 80 years and older in Germany (also stratified by sex).

METHODS

Data from the nationally representative "Old Age in Germany (D80+)" were employed. The analytic sample equaled 10,031 individuals. The D80+ study included community-dwelling and institutionalized individuals ≥ 80 years in Germany. Multiple linear regressions were used (with sociodemographic and health-related explanatory factors). The collection of data occurred between November 2020 and April 2021 (written questionnaire).

RESULTS

Higher loneliness was significantly associated with not being married (e.g., widowed compared to being married, β=0.37, p<.001), being institutionalized (β=0.33, p<.001), low education (high education compared to low education, β=-0.07, p<.01), a higher number of chronic conditions (β=0.02, p<.001), poor self-rated health (β=-0.19, p<.001) and greater functional impairment (β=0.15, p<.001). Sex-stratified regressions produced comparable results. However, low education was only associated with higher loneliness among men, but not women (with significant interaction: education x sex).

CONCLUSION

Several sociodemographic and health-related factors can contribute to loneliness among the oldest old in Germany, with sex-specific associations between education and loneliness. Overall, such knowledge can aid to address individuals with higher loneliness levels.

Effects of Wisdom-Enhancement Narrative-Therapy and Empathy-Focused interventions on loneliness over 4 weeks among older adults: A Randomized Controlled Trial

OBJECTIVE

In this three-armed RCT, we tested the effects of a telephone-delivered wisdom enhancement narrative therapy-based intervention (Tele-NT) and a telephone-delivered empathy-focused intervention (Tele-EP) in reducing loneliness against an active control group that received regular call (ACG) at the 4-week follow-up assessment.

DESIGN, SETTING, INTERVENTION, AND PARTICIPANTS

To evaluate the effects of the interventions on loneliness, we randomized 287 older adults based in Hong Kong, ages 65 to 90, into Tele-NT (N = 97), Tele-EP (N = 95), or ACG (N = 95).

MEASUREMENT

The primary outcome was loneliness, calculated using the De Jong Gierveld Scale and the UCLA Loneliness Scale. Secondary outcomes were sleep quality, depressive symptoms, social network engagement, and perceived social support. Assessments were done before training and 4 weeks after the intervention period.

RESULTS

Results from linear mixed models showed significant positive effects of Tele-NT on loneliness measured by the De Jong Gierveld Loneliness Scale compared to ACG. Compared to the ACG, the Tele-NT group significantly reduced loneliness at the 4-week follow-up (mean difference = -0.51, p = 0.019, Cohen's d = 0.60). However, the difference between Tele-EP and the ACG at the 4-week follow-up was not significant (MD = -0.34, p = 0.179, Cohen's d = 0.49). Tele-NT and Tele-EP did not show significant effects on the secondary outcomes, compared to the ACG.

CONCLUSIONS

In this randomized clinical trial, we found that a 4-week wisdom enhancement narrative therapy program significantly reduced feelings of loneliness. This effective telephone-based, lay-therapist-delivered program is scalable for broader implementation.

Pre-widowhood social support is linked to loneliness patterns: a growth mixture model using the health and retirement study

OBJECTIVES

The first aim of the study is to compare loneliness levels between widowed and non-widowed older adults. The second aim is to identify distinct loneliness patterns among widowed individuals and explore the impact of pre-spousal loss social support on loneliness during and after bereavement.

METHOD

Data from the Health and Retirement Study were utilized to compare loneliness levels between widowed (n = 137) and non-widowed (n = 2361) older adults (Mage = 69.01). T-tests and latent growth curve models were conducted to compare loneliness levels between the two groups. Growth mixture models were computed to identify distinct loneliness patterns among the widowed individuals. A multinomial logistic regression analysis was conducted to determine how pre-widowhood social support was associated with the obtained classes.

RESULTS

The results revealed that widowed individuals reported significantly higher levels of loneliness at T2. Among widowed individuals, three distinct loneliness patterns were identified: Increased Loneliness (IL) group (n = 32); Low and Stable Loneliness (LSL) group (n = 88); and Decreased Loneliness (DL) group (n = 17). The IL and DL group were less likely to receive social support from spouse, children, and friends compared to the LSL group.

CONCLUSION

This study provides evidence of the protective effect of pre-widowhood social support on the psychological well-being of older adults after spousal loss.

"I Love You to Death": Social Networks and the Widowhood Effect on Mortality

Research on "the widowhood effect" shows that mortality rates are greater among people who have recently lost a spouse. There are several medical and psychological explanations for this (e.g., "broken heart syndrome") and sociological explanations that focus on spouses' shared social-environmental exposures. We expand on sociological perspectives by arguing that couples' social connections to others play a role in this phenomenon. Using panel data on 1,169 older adults from the National Social Life, Health, and Aging Project, we find that mortality is associated with how well embedded one's spouse is in one's own social network. The widowhood effect is greater among those whose spouses were not well connected to one's other network members. We speculate that the loss of a less highly embedded spouse signals the loss of unique, valuable, nonredundant social resources from one's network. We discuss theoretical interpretations, alternative explanations, limitations, and directions for future research.

The Relationships Among Family Functioning, Sleep Quality and Quality of Life in Chinese Community-Dwelling Older Adults with Insomnia: A Structural Equation Model

OBJECTIVES

The proportion of individuals with insomnia is increasing, and many older adults have insomnia. This study aimed to explore the relationships between family functioning and quality of life (QOL) among community-dwelling older adults with insomnia, as well as to explore the mediating role of sleep quality in this relationship.

METHODS

The participants were 225 older adults with insomnia from community health service centers in Chongqing, China. The Family Care Index (APGAR) was used to assess family functioning, the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, and the 36-item Short-Form Health Survey (SF-36) was used to assess QOL.

RESULTS

The results showed that family functioning would be positively associated with QOL (p = .005) and that this relationship would be partially mediated by higher sleep quality (p < .001).

CONCLUSIONS

Family functioning has a direct effect on QOL and an indirect effect on QOL through the regulation of sleep quality. Maintaining good family functioning is important for improving sleep quality and QOL in older adults with insomnia.

CLINICAL IMPLICATIONS

Developing family functioning-based assessments and targeted intervention strategies could be beneficial for older adults with insomnia.

An exploratory study on material deprivation and loneliness among older adults in Hong Kong

BACKGROUND

Poverty, as a risk factor for loneliness, has been understudied, and there is a need to gain a better understanding of the relationship between poverty examined by material deprivation and loneliness among older adults in Hong Kong. It also aimed to explore the possible mediation and moderation effects of social support, social networks, neighborhood collective efficacy, and social engagement in the link between material deprivation and loneliness.

METHODS

1696 Chinese older adults aged 60 years and above (Mage = 74.61; SD = 8.71) participated in a two-wave study. Older adults reported their loneliness level, material deprivation, perceived level of social support, social network, neighborhood collective efficacy, social engagement, and sociodemographic information. Logistic regression was conducted to examine the effect of material deprivation on loneliness, as well as the mediation and moderation models.

RESULTS

The results indicated that material deprived older adults reported a significantly higher level of loneliness 2 years later when controlling for demographic variables, health-related factors, and loneliness at baseline. We also found that engagement in cultural activities partially mediated the effect of material deprivation and loneliness. Furthermore, neighborhood collective efficacy and engagement in cultural activities were significant moderators that buffer the relationship between material deprivation and loneliness.

CONCLUSIONS

Our results suggested the need to alleviate the negative impact of material deprivation on loneliness by developing interventions focused on promoting neighborhood collective efficacy and social engagement, which could be aimed at building meaningful bonds among Chinese older adults in Hong Kong.

Interaction of widowhood, gender, and age in predicting loneliness among older adults in China

BACKGROUND

Loneliness is a significant issue for the elderly, and widowhood is considered a major risk factor. However, research on the intersectional effects of gender, age, and widowhood on loneliness is limited, especially within the Chinese cultural context.

METHODS

Using six waves (2002-2018) of national longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (N = 22,777), this study employed multilevel mixed-effects ordered logistic regression to analyze the impact of widowhood on loneliness. Moderating roles of gender and age were examined through interaction effects.

RESULTS

Widowhood significantly increased loneliness across genders and age groups, but this effect diminished with age. Widowed men experienced greater loneliness than women, but this difference converged by age 90. The buffering effect of age on the widowhood-loneliness link was less pronounced among older women.

CONCLUSION

The study unravels the complexity of how gender, age, and widowhood interact to shape loneliness in later life. Targeted interventions considering these intersections are needed to alleviate loneliness among Chinese widowed elderly.

Widowhood and bereavement in late life

Bereavement is a common and often challenging experience in late life. Evidence shows that while many older adults manage to adjust well and demonstrate resilience in response to the death of a close person, bereavement puts a substantial minority at risk of adverse mental and physical health impacts including mortality. Current research further indicates that 1) this is the case across different countries and cultures across the globe; 2) that the COVID-19 pandemic posed unprecedented challenges for coping with late-life bereavement; 3) that loneliness and social isolation among bereaved older adults tend to be prevalent and harmful, particularly under pandemic but also in nonpandemic circumstances; and, recently, 4) that bereavement may be a risk factor for cognitive decline in this population.

Patterns in suicide by marital status in Hong Kong, 2002-2020: Is marriage still a protective factor against suicide?

BACKGROUND

Marriage has long been considered protective against suicide, but shifting social norms since 2000 in Hong Kong raise doubts regarding whether this is still the case. The aim of the study was to investigate the changing association between suicide and marital status.

METHODS

Official suicide data for 2002-2020 in Hong Kong were obtained. Suicide rates and suicide risk ratios were calculated by gender, age group, and marital status (married, never-married, widowed, divorced/separated).

RESULTS

Suicide risk decreased significantly over time for men and women of all ages. People who were never-married, divorced/separated, had significantly higher suicide risks than their married counterparts. Increasing suicide risks over time were observed for never-married men aged 20-49 years, never-married women aged 35-49 years, and divorced/separated men aged 20-34 years. Widowed men and women of any age had higher suicide risks compared with previous studies in Hong Kong.

LIMITATIONS

Marital status is a time-varying covariate, and the time spent in a given marital status could affect suicide risk. Some age and gender subgroups had much smaller sample sizes than others, thus it is possible that our suicide risk estimates were overestimated.

CONCLUSIONS

Despite rapidly social changing in Hong Kong during the study period, marriage remains a strong protective factor against suicide for men and women. The protective effect is particularly evident for younger people. Increasing suicide rates for divorced/separated, never-married, or widowed people suggest that they require more psychosocial support.

Reciprocal associations between social media use and self-perception of aging among older adults: Do men and women differ?

PURPOSE

Despite the positive impact of social media use in late adulthood, social media use is still low among older adults. Research in technology adoption and utilization indicates the importance of age-specific factors, such as self-perception of aging (SPA). As it is unclear whether SPA facilitates social media use or social media use promotes SPA, reverse causality has emerged as a major point of contention within this literature, with several studies reporting conflicting results. Thus, in this study, we aim to contribute unique insight by examining (1) whether positive and negative SPAs demonstrate unique associations with social media use and (2) whether these reciprocal associations differ by gender.

METHODS

Using two waves (2014 and 2018) from the Health and Retirement Study, 4101 older Americans (age ≥65 years) with normal baseline cognition were included in this study. Autoregressive cross-lagged analyses were conducted to assess reciprocal associations between SPA and social media use among the total sample and by gender subgroups.

RESULTS

Controlling for covariates, we found that more frequent social media use marginally predicted higher positive SPA four years later (B = 0.02, p = .07), and higher negative SPA marginally predicted less frequent social media use four years later (B = -0.07, p = .08). However, the by-gender analysis showed that the positive effect of social media use on positive SPA was only significant among older men (B = 0.04, p < .05), whereas the negative impact of negative SPA on social media use only existed among older women (B = -0.13, p < .01).

CONCLUSIONS

The reciprocal associations between SPA and social media use differ by the valence of SPA (positive/negative) and gender. Future interventions for SPA and digital technology use among older adults should be gender-tailored.

Interventions to reduce loneliness among Chinese older adults: A network meta-analysis of randomized controlled trials and quasi-experimental studies

This meta-analytic study investigates the effectiveness of different interventions in alleviating loneliness among Chinese older adults aged 50 years and above. We searched eight English databases, four Chinese databases, and grey literature. Thirty-four studies, including four randomized controlled trials (RCTs) and 30 quasi-experimental studies, were eventually included in the meta-analysis (n = 3843). Quality appraisal indicated risks of bias in the included studies. The pooled effect size was large and significant (Hedge's g = 0.84, 95% CI [0.54, 1.15]), indicating the effectiveness of interventions in reducing loneliness. However, the effect size may be overestimated due to publication bias. Moderation analyses showed significant differences in effect sizes by study designs and regions of studies. Network meta-analysis (NMA) indicated that hybrid and psychological interventions appeared to be advantageous over others. In addition, group-based delivery modes can add extra benefits to the interventions. This study adds to the knowledge of the effectiveness of current interventions in reducing Chinese older people's loneliness. However, the findings need to be interpreted with caution due to the relatively low study quality, considerable heterogeneity, and publication bias. Despite the limitations, this study offers valuable insights for future research, practice, and policy-making in reducing older people's loneliness.

Home Alone: Widows' Well-Being and Time

Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE, 2004-17) and time diaries from Poland (2013), the U.S. (2006-16), the U.K. (2014-15) and France (2009-10), we examine differences between widowed and partnered older women in well-being and its development in widowhood. Most importantly, our analysis accounts for time use, an aspect which has not been studied previously. We trace the evolution of well-being of women who become widowed by comparing them with their matched non-widowed 'statistical twins' and examine the role of an exceptionally broad set of potential moderators of widowhood's impact on well-being. We confirm a dramatic decrease in mental health and life satisfaction after the loss of partner, followed by a slow partial recovery over a 5-year period. An extensive set of controls recorded prior to widowhood, including detailed family ties and social networks, provides little help in explaining the deterioration in well-being. Unique data from time-diaries kept by older women in several European countries and the U.S. tell us why: the key factor behind widows' reduced well-being is increased time spent alone.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10902-023-00622-w.

Prevalence of and Factors Associated with Negative Psychological Symptoms among Elderly Widows Living Alone in a Chinese Remote Sample: A Cross-Sectional Study

(1) Background: Research indicates that most elderly widows are at a high risk of experiencing negative psychological symptoms. It is common for elderly women in rural and remote areas to live alone without family support to cope with stress due to the mass rural-to-urban migration of China’s youth labor force. Such a situation further worsens their psychological health and well-being. However, the prevalence of and risk factors associated with negative psychological symptoms (loneliness, depression, and anxiety) among remote elderly widows living alone in China are currently unclear; (2) Methods: A cross-sectional study was conducted in Hunan Province, China. The loneliness was assessed through the University of California at Los Angeles Loneliness Scale (ULS-8). The depression and anxiety were assessed with the Short Form Geriatric Depression Scale (GDS-15) and Generalized Anxiety Disorder Scale (GAD-7), respectively. The Chi-square test and correlation analysis were conducted to identify factors associated with negative psychological symptoms. Logistic regression was performed to predict risk and protective factors contributing to loneliness, depression, and anxiety symptoms. The significance level was set as p < 0.05; (3) Results: A total of 271 remote elderly widows living alone were enrolled in the present study. Additionally, 234 valid questionnaires were returned (valid response rate = 86.3%). The prevalence of loneliness, depression and anxiety was 8.1%, 44.0%, and 16.7%, respectively. Acute or chronic medical conditions, marital happiness, being the primary caregiver before widowhood and anticipating the death of the spouse differed significantly in the distribution of negative psychological symptoms. Logistic regression analysis predicted that participants who were satisfied with their marriage had a lower likelihood to experience loneliness, depression, and anxiety (p < 0.05). Being the spouse’s primary caregiver before widowhood was more likely to have symptoms of loneliness (p < 0.01). Those with various acute or chronic medical conditions were more likely to suffer from depression (p < 0.01); (4) Conclusions: Remote elderly widows living alone in China are prone to loneliness, depression, and anxiety symptoms. Being the primary caregiver before widowhood and having many acute or chronic medical conditions are risk factors for loneliness and depression, respectively. Marital happiness is the protective factor against negative psychological symptoms. To accomplish the goal of equitable access to mental health care in China, evidence-based policy and resource development to support psycho-social interventions that prevent and manage negative psychological symptoms for remote elderly widows living alone are urgently needed.

The impact of untreated hearing loss on depression, anxiety, stress, and loneliness in tonal language-speaking older adults in China

BACKGROUND

Age-related hearing loss, mental health conditions, and loneliness commonly affect older adults. This study aimed to determine whether untreated hearing loss is independently associated with depression, anxiety, stress, and loneliness in tonal language-speaking older adults in China.

STUDY DESIGN

Observational, cross-sectional study.

METHODS

293 older adults (111 males, M = 70.33 ± 4.90 years; 182 females, M = 69.02 ± 4.08 years) were recruited. All participants completed a pure tone audiometric hearing assessment, and provided information on living arrangements, marital status, leisure activities, tobacco and alcohol use, and medical history. The Mandarin version of the De Jong Gierveld Loneliness Scale was used to measure loneliness, and the Mandarin version of the 21-item Depression Anxiety Stress Scale (DASS-21) was used to assess a range of symptoms common to depression, stress, and anxiety of the participants. The analysis focused on determining the predictors of depression, anxiety, and stress, and the predictors of measures of loneliness.

RESULTS

Multiple stepwise regression analyses revealed that the emotional loneliness (β = 0.303, p < 0.001) and living status (β = 0.110, p = 0.048) significantly predicted DASS depression scores; emotional loneliness (β = 0.276, p < 0.001) and a history of vascular disease (β = 0.148, p = 0.009) were significantly related to DASS anxiety scores; emotional loneliness (β = 0.341, p < 0.001) and a history of vascular disease (β = 0.129, p = 0.019) significantly predicted DASS stress scores. Furthermore, multiple stepwise regression analyses showed that DASS stress scores (β = 0.333, p < 0.001), education years (β = -0.126, p = 0.020), marriage status (β = 0.122, p = 0.024), and a history of vascular disease (β = 0.111, p = 0.044) significantly predicted emotional loneliness; four-frequency average hearing loss (β = 0.149, p = 0.010) and DASS stress scores (β = 0.123, p = 0.034) significantly predicted social loneliness scale; and four-frequency average hearing loss (β = 0.167, p = 0.003) and DASS stress scores (β = 0.279, p < 0.001) also significantly predicted overall loneliness. There were no significant associations with high-frequency hearing loss.

CONCLUSION

This study revealed that loneliness has a significant relationship both with hearing loss and aspects of mental health in an older adult Mandarin-speaking population. However, mental health was not significantly associated with hearing loss in this population.

Can community-based care moderate widowhood's health impact? -A longitudinal study among older Chinese adults

The plethora of pathways leading to health problems of later life has made the causal assessment of widowhood on the health of older adults difficult. This research aimed to assess the short-term impact of widowhood on the objective health of older adults and to the moderating role of community-based care (CBC) in improving the health outcomes of older adults. In this study, the activities of daily living (ADLs) and number of hospitalisations of older adults were measured, and PSM-DID models were conducted. Widowhood had a significant negative impact on the objective health of older adults. Widowed adults had higher ADL scores (B = 0.569, 95 percent CI: 0.295 to 0.844) and more hospitalisations (B = 2.551, 95 percent CI: 1.189 to 3.914) than nonwidowed adults. Meanwhile, CBC in urban areas can significantly reduce ADL scores (B = -0.154, SE = 0.082) and the number of hospitalisations (B = -1.402, SE = 0.348) in older adults, whereas CBC in rural areas can only significantly reduce ADL scores (B = -0.197, SE = 0.087). Taken together, there is an urgent need to focus on the health of widowed and older adults and to provide CBC in both urban and rural areas equally.

The Widowhood Effect on Mortality in Older Patients with Hip Fracture

Objective

Widowed people have increased mortality than married people of the same age, a phenomenon known as the widowhood effect. This study aimed to investigate whether this effect exists in older patients with hip fracture.

Methods

Using our own hip fracture database, a total of 1101 hip fracture patients were consecutively included from January 2014 to December 2021. Marital status was stratified as married (n = 793) and widowed (n = 308). Patients survival status was obtained from medical records or telephone follow-ups, and the outcomes were all-cause mortality at 30 days, 1 year and at latest follow-up. Univariate and multivariate Cox proportional hazard models were used to assess the association between marital status and mortality, and subgroup analyses according to sex were also conducted.

Results

Compared with married patients, widowed patients were more likely to be older, female and intertrochanteric fracture, and were less likely to be urban area, smoking, drinking, and surgical treatment (P < 0.05). After a median follow-up of 37.1 months, the 30-day mortality was 4.3% (n = 47), 1-year mortality was 19.3% (n = 178), and total mortality was 34.2% (n = 376). Multivariate Cox analysis showed that widowed marital status remained an independent risk factor for 1-year mortality (HR = 1.437, 95% CI: 1.054–1.959, P = 0.022), and total mortality (HR = 1.296, 95% CI: 1.038–1.618, P = 0.022), whereas this association was not found in 30-day mortality (HR = 1.200, 95% CI: 0.607–2.376, P = 0.599). Moreover, subgroup analyses also found that the widowhood effect on mortality was present in both male and female.

Conclusion

Widowed marital status seems to be an independent risk factor for long-term mortality in older patients with hip fracture.

Loneliness and diurnal cortisol levels during COVID-19 lockdown: the roles of living situation, relationship status and relationship quality

Loneliness and social isolation have become increasing concerns during COVID-19 lockdown through neuroendocrine stress-reactions, physical and mental health problems. We investigated living situation, relationship status and quality as potential moderators for trait and state loneliness and salivary cortisol levels (hormonal stress-responses) in healthy adults during the first lockdown in Germany. N = 1242 participants (mean age = 36.32, 78% female) filled out an online questionnaire on demographics, trait loneliness and relationship quality. Next, N = 247 (mean age = 32.6, 70% female) completed ecological momentary assessment (EMA), collecting twelve saliva samples on 2 days and simultaneously reporting their momentary loneliness levels. Divorced/widowed showed highest trait loneliness, followed by singles and partnerships. The latter displayed lower momentary loneliness and cortisol levels compared to singles. Relationship satisfaction significantly reduced loneliness levels in participants with a partner and those who were living apart from their partner reported loneliness levels similar to singles living alone. Living alone was associated with higher loneliness levels. Hierarchical linear models revealed a significant cross-level interaction between relationship status and momentary loneliness in predicting cortisol. The results imply that widowhood, being single, living alone and low relationship quality represent risk factors for loneliness and having a partner buffers neuroendocrine stress responses during lockdown.

Ageing in place and loneliness of older adults in Shanghai, China

OBJECTIVE

This study examined loneliness experiences of older adults and the relationship between ageing in place and their loneliness from the social resources perspective of social capital in Shanghai, China.

METHODS

We used the purposive sampling method and conducted face-to-face individual interviews for 21 older adults who were widowed or living alone. A semi-structured interview was carried out based on a pilot-tested interview guide, and the interviews were audio recorded and transcribed verbatim.

RESULTS

Older adults expressed a feeling of 'lonely pain', and themes identified included lack of intimacy and companionship, fear of declining health, loss and death, and a sense of disconnection from the external world. In the context of ageing in place, they mobilised the social capital embedded in the community to cope with loneliness by obtaining support, participating in activities and experiencing the trust and reciprocity that results from social networks. However, inadequate ageing in place services cannot fully alleviate the risk of loneliness for older adults, especially for those who are widowed or living alone.

CONCLUSIONS

The social capital embedded in the context of ageing in place in Shanghai partially helps older adults deal with loneliness, and future ageing in place policy and services should be improved to make older adults who wish to stay at home or in a familiar community live safely, autonomously and not feel lonely.

Comprehensive safety profile evaluation of bivalirudin in Chinese ST-segment elevation myocardial infarction patients receiving percutaneous coronary intervention: a prospective, multicenter, intensive monitoring study

Background

This prospective, multi-center, intensive monitoring study aimed to systematically assess the occurrence of adverse events (AEs) and adverse drug reactions (ADRs), especially thrombocytopenia and bleeding, as well as their risk factors in Chinese ST-segment elevation myocardial infraction (STEMI) patients receiving bivalirudin as anticoagulant for percutaneous coronary intervention (PCI).

Methods

In total, 1244 STEMI patients undergoing PCI and receiving bivalirudin as anticoagulant were enrolled in the present study. Safety data were collected from hospital admission to 72 h after bivalirudin administration; in addition, patients were further followed up at the 30th day with safety data collected at that time.

Results

AEs, severe AEs, ADRs and severe ADRs were reported in 224 (18.0%), 15 (1.2%), 49 (3.9%) and 5 (0.4%) patients, respectively. Importantly, 4 (0.3%) patients were submitted to hospitalization and 6 (0.5%) patients died due to AEs, while 1 (0.1%) patient was submitted to hospitalization but no (0.0%) patient died due to ADRs. Meanwhile, thrombocytopenia and bleeding occurred in 24 (1.9%) and 21 (1.7%) patients, respectively. Further multivariate logistic analysis identified several important independent factors related to AEs, ADRs, thrombocytopenia or bleeding, which included history of cardiac surgery and renal function impairment, high CRUSADE risk stratification, elective operation and combination with glycoprotein IIb/IIIa inhibitors. Moreover, 4 multivariate models were constructed based on the above-mentioned factors, which all showed acceptable predictive value for AEs, ADRs, thrombocytopenia and bleeding, respectively.

Conclusion

Bivalirudin is a well-tolerant anticoagulant in Chinese STEMI patients undergoing PCI procedure.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02716-4.

Social isolation and health outcomes among older people in China

Background

Social isolation is a serious public health issue affecting a significant number of older adults worldwide. However, associations between different dimensions of social isolation and functional health are unclear. We assessed the varied effects of social isolation on health among a nationwide sample of older adults from China.

Methods

We assessed social isolation among 5,419 people aged 65 and older who took part in both the 2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey. Social isolation includes objective social isolation (kinlessness and lack of social contacts) and subjective social isolation. Four functional health outcomes were examined: self-rated health (SRH), activities of daily living (ADLs), instrumental activities of daily living (IADLs), and cognitive function measured by the Mini-Mental State Examination (MMSE). We used multivariable regression analyses to examine the associations between social isolation and health outcomes.

Results

Older people who never married or who had recently lost a spouse were more likely to report poor SRH (OR=2.44) and difficulty with IADLs (ORs=1.46) than those who were married and lived with a spouse. Older people who never gave birth were less likely to report cognitive impairment (OR=0.53) than those who had living children, while older people who had recently lost a child were more likely to report poor SRH than those who had living children (OR=1.32). Older people who had no children visiting were more likely to report difficulty with IADLs than those who had children visiting (OR=1.25). In terms of subjective social isolation, older people who felt lonely were more likely to report poor SRH, cognitive impairment, and difficulty with ADLs and IADLs (ORs=1.19, 1.27, 1.28 and 1.21, respectively), and older people who had no one to talk to were more likely to report poor SRH, cognitive decline, and difficulty with ADLs and IADLs (ORs=2.08, 5.32, 2.06 and 1.98, respectively).

Conclusions

Kinlessness, lack of social contacts and subjective social isolation may impact various dimensions of health in older people. Due to the varied health consequences of social isolation, targeted health interventions should be developed to address relevant situations of social isolation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02681-1.

The Association between Widowhood and Cognitive Function among Chinese Elderly People: Do Gender and Widowhood Duration Make a Difference?

Few studies have examined the effects of widowhood on cognitive function in Chinese elderly individuals. We conducted a longitudinal study to assess the association between widowhood and cognitive function and further explored gender differences in this association and the impact of widowhood duration. The analytical sample consisted of 5872 Chinese elderly people who participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and were followed up from 2005 to 2014. We used the Chinese version of the Mini-Mental State Examination (MMSE) to assess cognitive function. Widowhood duration was calculated from the self-reported year at which the spouse passed away. Multilevel growth models were employed to estimate the association between widowhood and cognitive function while adjusting for many demographic and socioeconomic characteristics. Widowhood status was associated with cognitive decline among Chinese elderly individuals after adjusting for covariates (B = −0.440, 95% CI −0.727 to −0.152), and this association was only statistically significant among men (B = −0.722, 95% CI −1.104 to −0.339). Being widowed for 5 years or less (B = −0.606, 95% CI −1.112 to −0.100), 16–20 years (B = −0.937, 95% CI −1.685 to −0.190), and 21+ years (B = −1.401, 95% CI −1.967 to −0.834) predicted worse cognitive function in men, while being widowed for more than 21+ years (B = −0.655, 95% CI −1.186 to −0.124) was associated with cognitive decline in women. More attention should be directed towards widowed men and long-term widowed elderly individuals.