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Jiang Z, Chen H, Lu T, Yin F, Ma Y. The Association Between Family Support and Changes in Self-Rated Health Among Chinese Older Adults: How Living Arrangements Moderate the Association? J Am Med Dir Assoc 2024; 25:810-816.e5. [PMID: 38182124 DOI: 10.1016/j.jamda.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES The study intends to investigate the association between family support and older adult health as well as the interaction between family support and living arrangements on their health. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Samples included in the final analysis (N = 11,430) come from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). METHODS Multiple logistic regression analysis was used to analyze the associations between family supports, multiplicative interaction of family supports and living arrangements, and self-rated health change. Subgroup analysis on disabled older adults was supplemented. RESULTS Older adult individuals who received functional support, provided financial support, and had frequent emotional communication with their children in the past year reported better self-rated health. Moreover, having frequent emotional communication with children could bring better self-rated health for the older adults living with spouses and children (ORbetter vs same = 2.765, P < .01) and empty nesters who lived without children (ORbetter vs same = 1.551, P < .05). CONCLUSIONS AND IMPLICATIONS Our findings imply that functional support and emotional support may play an increasingly important role in the health of Chinese older individuals. The interaction between emotional support and 2 living arrangements mentioned above is relevant to better health of older individuals. We advocate for culturally tailored Age-Friendly Communities augmenting the geriatric health care framework. While bolstering social support for seniors, prioritizing fundamental needs is paramount for those with disabilities.
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Affiliation(s)
- Zixuan Jiang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chen Du, China
| | - Hongyu Chen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chen Du, China
| | - Tianren Lu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chen Du, China
| | - Fei Yin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chen Du, China
| | - Yue Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chen Du, China; Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chen Du, China.
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Wang J, Zhang L, Wang S, Zhang L. Living arrangements, health lifestyles, and health outcomes among Chinese oldest-old. Front Public Health 2023; 11:1235768. [PMID: 37876711 PMCID: PMC10591327 DOI: 10.3389/fpubh.2023.1235768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/04/2023] [Indexed: 10/26/2023] Open
Abstract
Background Prior literature has documented a strong correlation between living arrangements and older adults' health outcomes. However, few studies have explained why this association exists. This study took the health lifestyle theory approach and brought health lifestyles into the link between living arrangements and Chinese oldest-old health outcomes. It examined (1) whether healthy lifestyle behaviors among the oldest-old varied by household contexts and (2) whether the health disparities among the Chinese oldest-old in different household contexts could be partially explained by their healthy lifestyles. Methods Using the most recent 2018 data released by the Chinese Longitudinal Healthy Longevity Survey (CLHLS), latent class analysis was applied to identify predominant health lifestyles among the Chinese oldest-old aged 85-105 years. Regression analyses were used to test the mediating effect of health lifestyles. Results Three distinct classes representing the health lifestyles of Chinese oldest-old emerged; health lifestyle patterns were found to vary by elders' living arrangements. The respondent's health lifestyles in diverse residential structures served as a mediator which can partially explain the health disparities among the oldest-old. Conclusion The results suggested that health lifestyles can serve as a mediator to explain the association between oldest-old living arrangement patterns and their health outcomes. The findings highlighted the importance of family, lifestyles, and cultural contexts to the health of the oldest-old.
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Affiliation(s)
- Jie Wang
- School of Law, Anhui Normal University, Wuhu, Anhui, China
| | - Lanxi Zhang
- Department of Sociology and Anthropology, School of Oriental and African Studies, University of London, London, United Kingdom
| | - Shen Wang
- School of International Relations, Beijing International Studies University, Beijing, China
| | - Li Zhang
- School of Sociology, China University of Political Science and Law, Beijing, China
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Pu L, Zhang J, He X, Pan D, Wang H, Zhang X, Sun X, Liu X, He S, Li J. Association of living arrangements with all-cause mortality among older adults: a propensity score-matched cohort study. BMC Public Health 2023; 23:1821. [PMID: 37726743 PMCID: PMC10508011 DOI: 10.1186/s12889-023-16749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Many studies exist on the living arrangements and health status of older adults, but the findings have been inconsistent. Therefore, we examined the relationship between living arrangements and all-cause mortality in older adults. METHODS This perspective study was based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2011 to 2018. We used a sample aged 65 years and over included in the study in 2011. Propensity score matching was performed to minimize bias and Cox proportional hazards regression models were conducted. RESULTS A total of 7,963 participants were included. Of these, 1,383 were living alone, 6,424 were living with families, and 156 were living in nursing homes. In the propensity score-matched cohort, older adults living alone had a significantly lower risk of all-cause mortality than those living with families (hazard ratio 0.85; 95% confidence intervals 0.76 to 0.95). Living alone was prominently associated with a decline in mortality compared with living in nursing homes (hazard ratio 0.61; 95% confidence intervals 0.44 to 0.84). There was no significant difference in mortality between living in nursing homes and living with families (hazard ratio 1.19; 95% confidence intervals 0.89 to 1.60). Subgroup analyses indicated that there was no significant interaction with age, sex, education, or residence. CONCLUSIONS The risk of all-cause mortality was significantly lower in older adults living alone than in those living with families or living in nursing homes. This article's findings suggest the need to adopt multiple approaches to meet the needs of senior care services.
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Affiliation(s)
- Lining Pu
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Jingni Zhang
- Department of Science and Education, Qinghai Provincial People's Hospital, Xining, 810007, Qinghai Province, China
| | - Xiaoxue He
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Degong Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Huihui Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Xue Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Xian Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Xiaojuan Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Shulan He
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Jiangping Li
- Department of Epidemiology and Health Statistics, School of Public Health, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China.
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China.
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Wang N, Evandrou M, Falkingham J, Xu M. Typologies of Intergenerational Relations in Urban and Rural China: A Latent Class Analysis. J Appl Gerontol 2023; 42:313-323. [PMID: 36283809 DOI: 10.1177/07334648221133811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Understanding intergenerational relations in China has become increasingly important against a backdrop of rapid social and demographic transitions and an ongoing urban-rural divide. From the parental perspective, this research investigates patterns and determinants of intergenerational relations between middle-aged and older parents and their non-coresident children in urban and rural China using data from the China Health and Retirement Longitudinal Study (2018) (N = 14,616). Latent class analysis revealed three typologies of intergenerational relations found across both urban and rural China - Tight-knit, Support-at-distance and Material-oriented-detached, and one typology particularly for urban China - Staying-in-touch-but-independent. The observed patterns suggest intergenerational bonds remain solid alongside the emergence of new trends, reflecting the modernization process. Multivariate multinomial regression analysis identified determinants for membership of each relationship typology. The findings will inform policy-makers and care professionals, supporting the identification of the vulnerable groups and the design of targeted policies for older parents with different family resources.
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Affiliation(s)
- Ning Wang
- School of Social and Public Administration, 47860East China University of Science and Technology, Shanghai, China
| | - Maria Evandrou
- Centre for Research on Ageing, Faculty of Social Sciences, 7423University of Southampton, Southampton, UK.,ESRC Centre for Population Change, Faculty of Social Sciences, 214229University of Southampton, Southampton, UK
| | - Jane Falkingham
- ESRC Centre for Population Change, Faculty of Social Sciences, 214229University of Southampton, Southampton, UK
| | - Maodi Xu
- Research Institute of Social Development, 12603Southwestern University of Finance and Economics, Chengdu, China
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Jiang Y, Li M, Chung T. Living alone and all-cause mortality in community-dwelling older adults: The moderating role of perceived neighborhood cohesion. Soc Sci Med 2023; 317:115568. [PMID: 36442301 PMCID: PMC9839549 DOI: 10.1016/j.socscimed.2022.115568] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/23/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The adverse effect of living alone on health has been well-documented in community-dwelling older adults. A less understood topic in this research area is whether some neighborhood characteristics may mitigate the negative impact of living alone on health outcomes and mortality. This study aimed to extend the existing work on living arrangements and health by examining the potential interactive effect of living alone and perceived neighborhood cohesion on all-cause mortality among older Chinese Americans. METHODS Data were drawn from 3154 (58.0% female) participants from a prospective cohort study of community-dwelling US older Chinese adults aged 60 and older in the greater Chicago area. Living arrangements and perceived neighborhood cohesion were assessed at baseline from 2011 to 2013. Mortality status was tracked through December 2021. Covariates, including sociodemographic characteristics, health and behavioral covariates, loneliness, depression, and social engagement, were assessed at baseline. Cox proportional hazards regression model was used to test our hypotheses. RESULTS Living alone was significantly associated with an increased risk of all-cause mortality among participants reporting low levels of perceived neighborhood cohesion but not among those reporting high levels of perceived neighborhood cohesion. This protective effect of perceived neighborhood cohesion was robust to the inclusion of covariates. CONCLUSIONS Our results suggest that strong perceived neighborhood cohesion may protect against the increased risk of premature mortality associated with living alone in community-dwelling older Chinese Americans.
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Affiliation(s)
- Yanping Jiang
- Center for Population Behavioral Health, Institute for Health, Health Care Policy and Aging Research, The State University of New Jersey, New Brunswick, NJ, United States; Department of Family Medicine and Community Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States.
| | - Mengting Li
- Department of Social Security, School of Labor and Human Resources, Renmin University of China, Beijing, China
| | - Tammy Chung
- Center for Population Behavioral Health, Institute for Health, Health Care Policy and Aging Research, The State University of New Jersey, New Brunswick, NJ, United States; Department of Psychiatry, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
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Sandoval MH, Alvear Portaccio ME. Marital Status, Living Arrangements and Mortality at Older Ages in Chile, 2004-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13733. [PMID: 36360612 PMCID: PMC9659010 DOI: 10.3390/ijerph192113733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
The risk of mortality in old age is associated with marital status and living arrangements. There is still little knowledge about this in Latin America. Our objectives are to examine the association between marital status, living arrangements and mortality of older adults (>60 years) in Chile, and to test whether this association varies when demographic, socioeconomic and health factors are included. We used data from the Social Protection Survey, and mortality data were linked to the Civil Registry. We estimate a series of Poisson regression models. Our results show a clear association between marriage and longevity, since even controlling for demographic, socioeconomic and health factors, we found that separated or divorced, widowed, and unmarried people showed higher relative mortality compared to married people (IRR1.24, IRR1.33, IRR1.35, respectively). Considering only living arrangements, the results show that living alone, alone with children, with children and other relatives or in other arrangements is associated with higher mortality (IRR1.22, IRR1.27, IRR1.35, IRR1.35, respectively) compared to those living with their partners and children. However, considering marital status and living arrangements together, we find that survival among older adults was strongly associated with marital status. Marital status continues to be a direct measure of living arrangements among older adults in Chile.
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Affiliation(s)
- Moisés H. Sandoval
- Institute of Nutrition and Food Technology (INTA), University of Chile, Macul 7830490, Chile
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Cui L, Li J, Xie D, Wang M, He F, Chen J, Ding D. Role of the Social Support and Health Status in Living Arrangement Preference of the Elderly in China—A Cross-Sectional Study. Front Public Health 2022; 10:860974. [PMID: 35903382 PMCID: PMC9314664 DOI: 10.3389/fpubh.2022.860974] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Living arrangement of the elderly is one of the most important components that affect their quality of life in later years. The aging, with the phenomenon of low fertility rate and family structure transformation, has caused changes in the living arrangements of the elderly. This research aimed to find the elderly's living arrangement preferences and influencing factors. Methods The data were obtained from The Chinese Longitudinal Healthy Longevity Survey (CLHLS) in the 2018, and the sample was comprised of 9,638 individuals aged ≥ 60 years. Independent variables were divided into social support, health status and so-economic status. Chi-square test and binary logistic regression were used to analyze the relationship between the above variates and living arrangement preferences. Results Currently, in terms of living arrangement preferences, nearly half (45.6%) of the respondents choose not to live with their children. The binary model results showed that elderly who were married (OR = 0.166, 95% CI: 0.147–0.187), experienced more than 6 years of education (OR = 0.600, 95% CI: 0.517–0.695), ability of daily living (ADL) impaired (OR = 0.810, 95% CI: 0.720–0.912), suffering from multiple chronic diseases (OR = 0.803, 95% CI: 0.720–0.912), and obtained community services (OR = 0.884, 95% CI: 0.803–0.972) incline to not live with their children. The elderly who living in rural areas (OR = 1.244, 95% CI: 1.129–1.371), with an income of more than 500,000 yuan per year (OR = 1.557, 95% CI: 1.380–1.757), having children visiting regularly (OR = 1.405, 95% CI: 1.161–1.707) and receiving children's financial support (OR = 1.194, 95% CI: 1.080–1.319) are more likely to choose to live with their children. Conclusions This study found that the living arrangement preferences of the elderly were affected by social support and health status, and living with children is no longer the only option for the elderly these days. The elderly care services provided by communities or professional care institutions may become the mainstream of taking care of the elderly citizens in the aging society. Improving the types and forms of community nursing services to increase the accessibility of these services; setting up elderly care institutions reasonably and equipping adequate professional nursing staff should be considered as priority measures.
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Bates DW, Zebrowski J. Medication safety in nursing home patients. BMJ Qual Saf 2022; 31:849-852. [PMID: 35790384 DOI: 10.1136/bmjqs-2022-014791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Affiliation(s)
- David W Bates
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jonathan Zebrowski
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Lee YH, Lin CH, Chang JR, Liu CT, Shelley M, Chang YC. Transition of Living Arrangement and Cognitive Impairment Status among Chinese Older Adults: Are They Associated? MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57090961. [PMID: 34577884 PMCID: PMC8467768 DOI: 10.3390/medicina57090961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 01/23/2023]
Abstract
Background and Objectives: Living arrangement is a crucial factor for older adults' health. It is even more critical for Chinese older adults due to the tradition of filial piety. With the aging of China's population, the prevalence of cognitive impairment among older adults has increased. This study examines the association between living arrangement transition and cognitive function among Chinese older adults. Materials and Methods: Using three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS; 2008-2009, 2011-2012, and 2014), we analyzed data for older adults (age ≥ 65) who lived with other household members and reported good cognitive function or mild cognitive impairment when they participated in the survey. Multistate Cox regression was employed to study changes in cognitive function. Results: Older adults who transitioned to living alone had lower risk of cognitive impairment (hazard ratio (HR) = 0.66, 95% CI: 0.52, 0.83; p < 0.01), compared with those who continued to live with other household members. Moving into an institution was also not associated with cognitive impairment. Conclusions: With older adults' transition to living alone, public health practitioners or social workers might educate them on the benefits of such a living arrangement for cognitive function.
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Affiliation(s)
- Yen-Han Lee
- Department of Public Health and Sports Medicine, McQueary College of Health and Human Services, Missouri State University, Springfield, MO 65897, USA
- Correspondence: (Y.-H.L.); (Y.-C.C.)
| | - Chia-Hung Lin
- Department of Nursing, Taipei Veterans General Hospital, Taipei City 112, Taiwan; (C.-H.L.); (J.-R.C.)
| | - Jia-Ren Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei City 112, Taiwan; (C.-H.L.); (J.-R.C.)
| | - Ching-Ti Liu
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA 02118, USA;
| | - Mack Shelley
- Department of Political Science, Iowa State University, Ames, IA 50011, USA;
- Department of Statistics, Iowa State University, Ames, IA 50011, USA
| | - Yen-Chang Chang
- Center for General Education, National Tsing Hua University, Hsinchu City 300, Taiwan
- Correspondence: (Y.-H.L.); (Y.-C.C.)
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Bai L, Gu S, Gu H, Xu X, Nan C, Li D, Di W. The Impact of Disability on Intergenerational Care Needs of the Elderly in China. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211018283. [PMID: 34027690 PMCID: PMC8150436 DOI: 10.1177/00469580211018283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper discussed the influence of disability and the degree of disability on the intergenerational needs of the elderly in terms of time and economy. The data is from the CLHLS in 2018. And the study discussed from 3 dimensions: nursing time, economic support, and medical cost support provided by children. The results showed that disability had a significant impact on the care time and medical expenses provided by adult children (care time: β = 45.631, P < .001; medical expenses: β = 2017.664, P < .01). Compared with the elderly with low degree of disability, the economic intergenerational care needs of the elderly with severe disability increased significantly (β = 2108.078, P < .01). The results of sub sample regression show that the intergenerational care needs of the elderly in China are restricted by objective factors and have not been met. These findings revealed the current situation of intergenerational support for the disabled in China, and emphasized that the government should establish and improve the social formal care, gradually reduce the burden of care for children with disabled elderly families, and improve the quality of life of the disabled elderly.
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Affiliation(s)
- Lan Bai
- Nanjing University, Nanjing, Jiangsu, China,Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Shuyan Gu
- Nanjing University, Nanjing, Jiangsu, China
| | - Hai Gu
- Nanjing University, Nanjing, Jiangsu, China,Hai Gu, Center for Health Policy and Management Studies, Nanjing University, 22 Hankou Road, Nanjing, Jiangsu 210093, China.
| | - Xinpeng Xu
- Nanjing University, Nanjing, Jiangsu, China
| | - Cui Nan
- Nanjing University, Nanjing, Jiangsu, China
| | - Decheng Li
- Nanjing University, Nanjing, Jiangsu, China
| | - Wu Di
- Nanjing University, Nanjing, Jiangsu, China
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Hamid TA, Din HM, Bagat MF, Ibrahim R. Do Living Arrangements and Social Network Influence the Mental Health Status of Older Adults in Malaysia? Front Public Health 2021; 9:624394. [PMID: 34026706 PMCID: PMC8131656 DOI: 10.3389/fpubh.2021.624394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/15/2021] [Indexed: 01/07/2023] Open
Abstract
Living arrangement has been reported to have a significant influence on several mental health statuses of older adults, but their social network may confound this association. This study is aimed at examining the interactive effect of living arrangements and social network on the mental health status among older adults in Malaysia. A total of 2,188 Malaysian older adults living nationwide were included in this cross-sectional study. Participants were classified into four groups according to their living arrangements (living alone or not living alone) and social network size (assessed using Lubben's Social Network Scale-6). Poor social network was defined as the lowest quartile (fourth quartile) of the score. Mental health statuses, which include flourishing in life, life satisfaction, cognitive functions, loneliness, depression, and perceived stress, were measured. Multiple linear regression models, adjusted for age, gender, education, and comorbidities, revealed that a good social network was significantly associated with an increase on the flourishing scale scores, regardless of living arrangements. Not living alone and having good social network was significantly associated with increased Montreal Cognitive Assessment scores and decreased loneliness scores. This study found that living arrangements are not always a risk factor for the mental health status of older adults. However, it may be confounded by the level of their social networks. The results suggested that the effects of social network may exceed the impact of living arrangements. It is recommended that health professionals pay more attention to the social networks of older Malaysians to harness its benefits in improving their mental health status.
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Affiliation(s)
- Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Hazwan Mat Din
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | | | - Rahimah Ibrahim
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia.,Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Malaysia
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Living alone, social cohesion, and quality of life among older adults in rural and urban China: a conditional process analysis. Int Psychogeriatr 2021; 33:469-479. [PMID: 32611467 DOI: 10.1017/s1041610220001210] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To test the independent and combined impact of social cohesion and geographic locale (urban/rural) on quality of life (QoL) for older adults in China. Using conditional process analysis, we tested three hypotheses: (1) QoL will be lower for persons living alone than those who live with family; (2) social cohesion will mediate the association of living arrangement and QoL; and (3) geographic locale will moderate direct and indirect pathways in the mediation model. DESIGN Cross-sectional data from WHO Study on Global Aging and Adult Health (SAGE) (China, Wave 1, 2007-2010). SETTING National probability sample of 74 primary sampling units in China, 32 in urban, and 32 in rural areas. PARTICIPANTS A total of 9,663 adults aged 50 years and older. MEASUREMENTS We measured QOL with the 8-item version of the WHOQOL-Bref; living arrangement as alone versus with family; and social cohesion with an 9-item index of frequency of a range of social activities in the previous 12 months. We controlled for sociodemographic characteristics and health and mental health variables in multivariate analyses. RESULTS Data supported the first two hypotheses; however, the mediating effects of social cohesion held only in urban areas. CONCLUSION This study advances the large body of work on living arrangements and well-being of older adults in China. Social cohesion contributed to better QoL regardless of living arrangement, and cohesion mediated the association of living arrangement and QOL in urban but not rural areas. Programs and policies that strengthen social cohesion through older adults' community involvement, especially in urban areas, will help to enhance QoL.
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Rueda-Salazar S, Spijker J, Devolder D, Albala C. The contribution of social participation to differences in life expectancy and healthy years among the older population: A comparison between Chile, Costa Rica and Spain. PLoS One 2021; 16:e0248179. [PMID: 33711063 PMCID: PMC7954322 DOI: 10.1371/journal.pone.0248179] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/19/2021] [Indexed: 11/18/2022] Open
Abstract
We study the health trajectories of the population aged over 60, comparing between one European and two Latin American countries (Spain, Chile and Costa Rica) which have similar longevity patterns. Our focus is on functional limitation and mortality risks, considering differences by gender, education and social participation. Data come from national panel surveys (EPS, CRELES, SHARE). Multistate modelling is used to estimate transition probabilities between two health states: healthy to unhealthy, unhealthy to healthy as well as the transition to death from healthy or unhealthy states, to estimate the duration of stay in a specific state (computing healthy and unhealthy life expectancies) and the effect of the selected covariates. Results show that older Costa Ricans have the smallest gender gap in life expectancy but women have a lower healthy life expectancy compared to those in Chile and Spain. Participation in social activities leads to higher healthy life expectancy among the elderly in Costa Rica and Spain, whilst there were no relevant educational differences observed in longevity in the analysed countries. To conclude: despite the different patterns observed in health transitions and survival across the three countries, social participation is associated with greater health and longevity among people of old age, with little effect coming from educational attainment. Public policies should therefore be aimed at reducing unhealthy life years and dependency at advanced ages by promoting more engagement in social activities, especially among vulnerable groups who are more likely to experience impairment from a younger age.
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Affiliation(s)
- Sarahí Rueda-Salazar
- Centre d’Estudis Demogràfics (CED), Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Jeroen Spijker
- Centre d’Estudis Demogràfics (CED), Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Daniel Devolder
- Centre d’Estudis Demogràfics (CED), Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Cecilia Albala
- Unidad de Nutrición Pública, Instituto de la Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
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Age-Related Changes in the Association Between Traumatic Brain Injury and Dementia in Older Men and Women. J Head Trauma Rehabil 2020; 36:E139-E146. [PMID: 33201033 DOI: 10.1097/htr.0000000000000624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate age-related changes in the association between traumatic brain injury (TBI) and dementia in older men and women separately. SETTING A total of 243 general practices in the UK. PARTICIPANTS This study included 4760 patients who received a first TBI diagnosis between 1995 and 2010 (index date), and 4760 patients without TBI who were matched to those with TBI by age, sex, index year, Charlson Comorbidity Index, alcohol dependence, and physician (index date: a randomly selected visit date). DESIGN Retrospective cohort study. MAIN MEASURES Incidence of dementia in the decade following index date. RESULTS Within 10 years of index date, 8.8% of men with TBI and 4.8% of those without TBI were diagnosed with dementia, while the respective figures were 9.0% and 6.7% in women (P values < .01). There was a significant association between TBI and dementia in men (hazard ratio [HR] = 2.29, 95% confidence interval [CI]: 1.64-3.19) and in women (HR = 1.33, 95% CI: 1.07-1.64). Furthermore, the association between TBI and dementia was significant in men aged 60 to 70 (HR = 2.51, 95% CI: 1.27-4.96) and 71 to 80 years (HR = 3.00, 95% CI: 1.82-4.93), whereas the relationship was only significant and potentially unreliable in women aged 81 to 90 years (HR = 1.49, 95% CI: 1.03-2.14). CONCLUSIONS The age-related relationship between TBI and dementia differed between men and women. More research of a prospective nature and including behavioral data is needed to better understand these differences.
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Trends in living arrangements and their impact on the mortality of older adults: Belgium 1991‒2012. DEMOGRAPHIC RESEARCH 2020. [DOI: 10.4054/demres.2020.43.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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16
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Wu F, Sheng Y. Differences in social isolation between young and old elderly in urban areas of Beijing, China: A cross-sectional study. Int J Nurs Sci 2019; 7:49-53. [PMID: 32099859 PMCID: PMC7031121 DOI: 10.1016/j.ijnss.2019.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/07/2019] [Accepted: 11/27/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives To understand the differences in social isolation among older adults and to identify risks associated with social isolation. Methods Totally 485 participants aged 60 and older were recruited for this study. The Lubben Social Network Scale-6 and the Chinese version of the Medical Outcomes Study Social Support Survey were used to measure social isolation and the different types of social support that the participants experienced. Results The proportions of young elderly (60–74 years of age) and old elderly (greater than 74 years of age) that experienced social isolation in this study were 24.4% and 33.1%, respectively. For the young elderly, three types of social support were observed to be protective factors to help avoid social isolation, and the positive effect of social support obtained from friends and neighbors was slightly stronger than that of family members. Old elderly with only a senior high school education background were at high risk of being socially isolated. Only support from friends was observed to be a protective factor for the old elderly. Conclusions The study indicated that different ages of older adults experienced different aspects of social relationships. We propose that nursing interventions for the elderly should focus on individualized social support as a protective factor to help older adults avoid being socially isolated.
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Affiliation(s)
- Fan Wu
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Yu Sheng
- School of Nursing, Peking Union Medical College, Beijing, China
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17
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Palese A, Grassetti L, Bressan V, Decaro A, Kasa T, Longobardi M, Hayter M, Watson R. A path analysis on the direct and indirect effects of the unit environment on eating dependence among cognitively impaired nursing home residents. BMC Health Serv Res 2019; 19:775. [PMID: 31666063 PMCID: PMC6822399 DOI: 10.1186/s12913-019-4667-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 10/21/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study aims to estimate the direct and indirect effects of the unit environment alongside individual and nursing care variables on eating dependence among residents who are cognitively impaired and living in a nursing home. METHOD A multicentre observational study was carried out in 2017: 13 Italian nursing homes were involved in data collection. Included residents were aged > 65 at baseline, living in the considered facility for the last 6 months and during the entire study period and having received at least one comprehensive assessment. Data were collected (a) at the individual level: eating dependence using the Edinburgh Feeding Evaluation in Dementia Scale and other clinical variables; (b) at the nursing care level with daily interventions to maintain eating independence assessed with a checklist; and (c) at the nursing home level, using the Therapeutic Environment Screening Survey for Nursing Homes. RESULTS One thousand twenty-seven residents were included with an average age of 85.32 years old (95% CI: 84.74-85.89), mainly female (781; 76%). The path analysis explained the 57.7% variance in eating dependence. Factors preventing eating dependence were: (a) at the individual level, increased functional dependence measured with the Barthel Index (β - 2.374); eating in the dining room surrounded by residents (β - 1.802) as compared to eating alone in bed; and having a close relationship with family relatives (β - 0.854), (b) at the nursing care level, the increased number of interventions aimed at promoting independence (β - 0.524); and (c) at the NH level, high scores in 'Space setting' (β - 4.446), 'Safety' (β - 3.053), 'Lighting' (β - 2.848) and 'Outdoor access' (β - 1.225). However, environmental factors at the unit level were found to have also indirect effects by influencing the degree of functional dependence, the occurrence of night restlessness and the number of daily interventions performed by the nursing staff. CONCLUSION Eating dependence is a complex phenomenon requiring interventions targeting individual, nursing care, and environmental levels. The NH environment had the largest direct and indirect effect on residents' eating dependence, thus suggesting that at this level appropriate interventions should be designed and implemented.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, Udine University, Viale Ungheria, 20, 33100 Udine, Italy
| | - Luca Grassetti
- Department of Economics and Statistics, Udine University, Via Francesco Tomadini, 30, 33100 Udine, Italy
| | - Valentina Bressan
- Department of Medical Sciences, Udine University, Viale Ungheria, 20, 33100 Udine, Italy
| | - Alessandro Decaro
- Department of Medical Sciences, Udine University, Viale Ungheria, 20, 33100 Udine, Italy
| | - Tea Kasa
- Department of Medical Sciences, Udine University, Viale Ungheria, 20, 33100 Udine, Italy
| | - Melania Longobardi
- Department of Medical Sciences, Udine University, Viale Ungheria, 20, 33100 Udine, Italy
| | - Mark Hayter
- Faculty of Health Sciences, Hull University, Hull, HU6 7RX UK
| | - Roger Watson
- Faculty of Health Sciences, Hull University, Hull, HU6 7RX UK
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Gu D, Feng Q, Yeung WJJ. Reciprocal Dynamics of Solo-Living and Health Among Older Adults in Contemporary China. J Gerontol B Psychol Sci Soc Sci 2019; 74:1441-1452. [PMID: 30476326 DOI: 10.1093/geronb/gby140] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Solo-living has far-reaching implications for older adults' well-being. The causal impacts and the pathways of solo-living on health and well-being of older adults are still unclear. This study examines the correlates of solo-living and subsequent health outcomes of solo-living among older adults in mainland China. METHODS We draw data from four waves of a nationwide survey with a total of 9,714 older adults aged 65 or older who had at least three interviews in 2005-2014. A generalized structural equation modeling approach was applied to examine what factors are associated with solo-living status and whether and how the antecedent of solo-living status subsequently affects well-being and health. RESULTS Owning a home, having no living child, and a preference to live independently are positively correlated with living alone, whereas living in a city, having economic independence, being educated, and having poor physical and cognitive functions are associated with lower odds of solo-living. Older Chinese adults who live alone are more likely to feel lonely and have a lower life satisfaction, yet they are more likely to be involved in social/leisure activities, and have fewer physical disabilities and a lower mortality risk. DISCUSSION There is a bi-directional relationship between solo-living and well-being/health among the Chinese older adults. Solo-living is a conditioned choice of a set of critical factors among older Chinese. The greater involvement in social/leisure activities is likely a key for Chinese solo-living older adults to mitigate the negative impact of their lower psychological well-being on subsequent mortality.
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Affiliation(s)
- Danan Gu
- Population Division, United Nations, New York
| | - Qiushi Feng
- Department of Sociology, National University of Singapore.,Centre for Family and Population Research, National University of Singapore
| | - Wei-Jun Jean Yeung
- Department of Sociology, National University of Singapore.,Centre for Family and Population Research, National University of Singapore.,Asia Research Institute, National University of Singapore
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Yiannopoulou KG, Anastasiou AI, Kyrozis A, Anastasiou IP. Donepezil Treatment for Alzheimer's Disease in Chronic Dialysis Patients. Case Rep Nephrol Dial 2019; 9:126-136. [PMID: 31616673 PMCID: PMC6787415 DOI: 10.1159/000502682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/11/2019] [Indexed: 12/19/2022] Open
Abstract
Donepezil is one of the cholinesterase inhibitors that are indicated for the treatment of mild to moderate Alzheimer's disease (AD). Pharmacokinetic analysis has shown that donepezil is primarily eliminated by renal excretion rather than biliary excretion in humans. Therefore, patients with impaired renal function are at high risk of toxicity caused by accumulation of this drug. It is also well known that dialysis patients have very often cholinergic disorders. On the other hand, with the increasing number of long-term chronic dialysis patients, the prevalence of cognitive disorders is increasing in elderly dialysis patients. Because of the above-mentioned special risks of these patients, acetylcholinesterase inhibitors, such as donepezil, are avoided to be prescribed for them. We studied 5 cases of chronic hemodialysis outpatients (3 men [70, 72, and 86 years old] and 2 women [65 and 71 years old]) who were diagnosed as having moderate AD. We administered donepezil at 2.5 mg/day orally to the patients. After 1 month's treatment, their behavioral symptoms were improved, without them having any adverse events. We enhanced the dose to 5 mg/day without the patients experiencing any episodes of drug toxicity. After 3 months of treatment with the higher dose, their cognitive and executive functions were slightly improved and their behavioral disorders were remarkably milder, without them experiencing any episodes of drug toxicity. The patients' condition remained stable for 6 months after the initial administration of the drug. All of them were followed for the 10 following years, showing a mild cognitive decline per year for the first 5 years and more severe decline for the remaining years of the follow-up. Our cases indicate that donepezil treatment under prudent use may be well tolerated and have a beneficial impact on chronic hemodialysis patients with AD.
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Affiliation(s)
| | | | - Andreas Kyrozis
- First Department of Neurology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P Anastasiou
- First Urology Department, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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20
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Zhang Z, Luo Y, Robinson D. Who Are the Beneficiaries of China's New Rural Pension Scheme? Sons, Daughters, or Parents? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173159. [PMID: 31470658 PMCID: PMC6747179 DOI: 10.3390/ijerph16173159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/24/2019] [Accepted: 08/28/2019] [Indexed: 12/25/2022]
Abstract
By applying a fuzzy regression discontinuity design, this study investigates whether sons, daughters, or parents are the beneficiaries of China’s New Rural Pension Scheme. Using data drawn from the China Health and Retirement Longitudinal Survey, our results indicate that pension income crowds out approximately 27.9% of the monetary support from adult sons and decreases the likelihood that adult sons live with their parents by 6.5%. However, we do not find a significant effect of pension income on the likelihood that adult daughters live with their parents. In regards to the well-being of parents, which is measured by consumption and health outcomes, the results show that pension income increases food and non-food consumption by 16.3 and 15.1%, respectively, and improves the psychological health of the elderly. Accounting for the different effects of pension income for those with different income levels, our results show that the New Rural Pension Scheme only has a significant effect on the poor elderly.
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Affiliation(s)
- Zhaohua Zhang
- College of Economics and Management, Shandong Agricultural University, Tai'an 271018, China.
| | - Yuxi Luo
- School of Economics and Management, Guangxi Normal University, Guilin 541004, China
| | - Derrick Robinson
- Division of Agriculture and Natural Resources, University of California, San Diego, CA 92123, USA
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Lee YH, Chang YC, Chiang T, Liu CT, Shelley M. Living Arrangements and Sleep-Related Outcomes Among Older Adults in China. Int J Aging Hum Dev 2019; 91:111-126. [DOI: 10.1177/0091415019852777] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It has been discussed previously that older adults’ living arrangements are associated with mortality. This study investigated the relationships between older adults’ living arrangements and sleep-related outcomes in China. The nationally representative sample included 4,731 participants who participated on two different occasions, with a total of 9,462 observations (2012 and 2014 waves). Panel logistic regression and panel ordinary least squares regression models were estimated with outcomes of sleep quality and average hours of sleep daily, respectively. Approximately 62% of individuals reported good quality of sleep. We observed that older adults who lived with family members had 17% greater odds of reporting good quality of sleep (adjusted odds ratio = 1.17, 95% confidence interval [1.03, 1.34], p < .05) and reported longer sleep duration daily (β = .334, standard error = .069, p < .01), compared with those who lived alone. Social support is needed to strengthen the residential relationship, especially with family members.
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Affiliation(s)
- Yen-Han Lee
- Department of Applied Health Sciences, School of Public Health, Indiana University Bloomington, IN, USA
| | - Yen-Chang Chang
- Center for General Education, National Tsing Hua University, Hsinchu City, Taiwan
| | - Timothy Chiang
- Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Ching-Ti Liu
- Department of Biostatistics, School of Public Health, Boston University, MA, USA
| | - Mack Shelley
- Department of Political Science, Iowa State University, Ames, IA, USA
- Department of Statistics, Iowa State University, Ames, IA, USA
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Li S, Zhang XH, Zhou GD, Wang JF. Delirium after primary percutaneous coronary intervention in aged individuals with acute ST-segment elevation myocardial infarction: A retrospective study. Exp Ther Med 2019; 17:3807-3813. [PMID: 30988767 DOI: 10.3892/etm.2019.7398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/31/2018] [Indexed: 11/05/2022] Open
Abstract
The present prospective study aimed to investigate the incidence and risk factors of delirium after primary percutaneous coronary intervention (PCI) in older adults with acute ST-segment elevation myocardial infarction (STEMI). A total of 111 patients (age, ≥65 years) with acute STEMI following primary PCI were included in the present study. Neurocognitive testing was performed using the Mini-mental State Examination on the first day of hospitalization. Post-operative delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit within the first four post-operative days. A total of 32 patients (28.8%) developed delirium after primary PCI. The independent predictors of delirium were older age [odds ratio (OR)=1.192, 95% confidence interval (CI)=1.07-1.328, P=0.001], living alone (OR=4.827, 95% CI=1.315-17.725, P=0.018), history of alcohol abuse (OR=3.875, 95% CI=1.168-12.857, P=0.026), longer duration of primary PCI (OR=1.152, 95% CI=1.077-1.232, P<0.001) and post-operative pain (current pain; OR=7.663, 95% CI=1.432-41.02, P=0.017). Compared to the patients without delirium, the participants who developed delirium had longer hospital stays and a higher rate of re-admission within 30 days after discharge. The mortality within one year after discharge (one-year mortality) was similar between patients with and without delirium. In conclusion, older patients (age, ≥65 years) with acute STEMI are at a relatively high risk of delirium following primary PCI. Higher age (≥65 years), living alone, history of alcohol dependence, longer length of primary PCI (>50 min) and post-operative pain (current pain) were determined to be risk factors for delirium after primary PCI in the present cohort.
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Affiliation(s)
- Sheng Li
- Department of Cardiology, The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230061, P.R. China
| | - Xiao-Hong Zhang
- Department of Cardiology, The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230061, P.R. China
| | - Gen-Dong Zhou
- Department of Cardiology, The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230061, P.R. China
| | - Jian-Fei Wang
- Department of Cardiology, The Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230061, P.R. China
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Wang R, Liu Y, Xue D, Yao Y, Liu P, Helbich M. Cross-sectional associations between long-term exposure to particulate matter and depression in China: The mediating effects of sunlight, physical activity, and neighborly reciprocity. J Affect Disord 2019; 249:8-14. [PMID: 30743021 DOI: 10.1016/j.jad.2019.02.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/19/2019] [Accepted: 02/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although numerous studies have speculated about the direct and indirect linkage between long-term air pollution (i.e., PM2.5) concentrations and mental health in developed countries, evidence for developing countries is limited. Our aim was to examine the mediation effects of sunlight, physical activity, and neighborly reciprocity on the association between air pollution and depression. METHODS In a sample of 20,861 individuals in China in 2016, depression was measured using the Center for Epidemiological Studies Depression screener (CES-D) and linked to annual city-wide PM2.5 data. We used multilevel regression models to assess the associations between depressive symptoms and PM2.5 and tested the mediation of sunlight, physical activity, and neighborly reciprocity in this association. Propensity score matching was used to evaluate whether selection bias may affect the association between CES-D scores and PM2.5. RESULTS PM2.5 concentration was positively associated with depression symptoms. All mediators were significantly and negatively associated with PM2.5. Our mediation analyses indicated that physical activity, neighborly reciprocity, and exposure to sunlight are important mechanisms through which PM2.5 affects depressive symptoms. LIMITATIONS The limitations of the present study were the cross-sectional nature of the data and modifiable areal unit problem. CONCLUSIONS Our findings suggest not only that PM2.5 is directly associated with depression, but also that this association seems to be partially mediated by physical activity, neighborly reciprocity, and sunlight.
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Affiliation(s)
- Ruoyu Wang
- School of Geography and Planning, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275, China; Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275, China.
| | - Ye Liu
- School of Geography and Planning, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275, China; Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275, China.
| | - Desheng Xue
- School of Geography and Planning, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275, China; Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275, China.
| | - Yao Yao
- School of Information Engineering, China University of Geosciences, Wuhan, 430074, China.
| | - Penghua Liu
- School of Geography and Planning, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275, China; Guangdong Key Laboratory for Urbanization and Geo-Simulation, Sun Yat-Sen University, Xingang Xi Road, Guangzhou, 510275, China.
| | - Marco Helbich
- Department of Human Geography and Spatial Planning, Utrecht University, The Netherlands.
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Finney N, Marshall A. Is migration in later life good for wellbeing? A longitudinal study of ageing and selectivity of internal migration. AREA (OXFORD, ENGLAND) 2018; 50:492-500. [PMID: 30555170 PMCID: PMC6282955 DOI: 10.1111/area.12428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 06/09/2023]
Abstract
Migration scholarship has recently paid attention to lifecourse and non-economic effects of moving house. Yet consideration of the effects of internal migration in later life has been relatively neglected despite their implications for social and spatial inequalities. Thus we address two questions: how trajectories of wellbeing in later life vary for movers and non-movers, and how the event of moving affects wellbeing. In both cases we distinguish between "voluntary" and "involuntary" movers. We use 10 years (2002-2012) of the English Longitudinal Study of Ageing (ELSA) to analyse trends in wellbeing for age cohorts and to examine how wellbeing changes through the event of moving. The Control, Autonomy, Selfrealisation and Pleasure (CASP-19) measure of wellbeing is used. We find that, after controls for demographic and socio-economic characteristics, involuntary movers have lower levels of wellbeing than stayers or voluntary movers; and involuntary movers experience a stabilisation in the decline in wellbeing following migration which is not seen for voluntary movers. So, migration in later life is good for wellbeing, maintaining advantageous wellbeing trajectories for voluntary movers and improving wellbeing trajectories for involuntary movers. These findings imply a rich potential of ELSA and similar longitudinal datasets for examining residential mobility; the need for ageing inequalities studies to take more account of residential mobility; the need for internal migration scholarship to pay greater attention to reason for move; and for policy to consider the potentially beneficial effects of residential mobility in later life, particularly for those in adverse circumstances.
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Affiliation(s)
- Nissa Finney
- School of Geography and Sustainable DevelopmentUniversity of St AndrewsSt AndrewsFifeUK
| | - Alan Marshall
- School of Social and Political ScienceUniversity of EdinburghEdinburghUK
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Alquwez N, Cruz JP, Almazan JU, Alamri MS, Mesde JJ. The Arabic version of the Kogan Attitudes toward Older People Scale among Saudi nursing students: a psychometric analysis. Ann Saudi Med 2018; 38:399-407. [PMID: 30531173 PMCID: PMC6302988 DOI: 10.5144/0256-4947.2018.399] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND With the steadily increasing size of its elderly popu.lation, Saudi Arabia is currently trying to meet the demands for com.petent care for older people. However, the lack of a valid and reliable measurement instrument in the Arab Peninsula hinders related studies among nursing students in this part of the globe. Given the importance of nursing students' attitudes toward working with older people, a specialized tool that can provide an accurate assessment of students' attitudes toward older adults is necessary. OBJECTIVE Evaluate the psychometric properties of the Kogan Attitudes towards Older People Arabic version (KAOP-A) among Saudi nursing students. DESIGN Descriptive, cross-sectional. SETTING Nursing department of a government university. SUBJECTS AND METHODS Using total population sampling, Saudi nursing students were surveyed using the KAOP-A. The tool was culturally adapted to the Arabic language using a forward and backward method. Content and construct validity were established accordingly. The internal consistency was established to support the reliability of the tool. MAIN OUTCOME MEASURES The validity and reliability of the KAOP-A. SAMPLE SIZE 164 nursing students. RESULTS The KAOP-A had acceptable content and construct valid.ity. The Exploratory Factor Analysis supported a two-factor solution for the KAOP-A with an explained variance of 60.12%. The computed Cronbach's alpha for the entire scale was 0.89. The mean score of the KAOP-A scale was 121.55 (SD=26.92, range=40-204), indicating a slightly positive attitude toward aging among the students. Nursing students belonging to extended type of family and living in rural community, as well as older students and students who reported higher degree of closeness with their grandparents, exhibited more positive attitudes towards older people. CONCLUSION The tool can be used to accurately assess student attitudes towards older people, which can inform the creation of educational policies and interventions geared towards creating a more positive outlook on older adult care among nursing students in Saudi Arabia. LIMITATIONS We did not perform test and re-test reliability analysis. CONFLICT OF INTEREST None.
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Affiliation(s)
| | - Jonas Preposi Cruz
- Dr. Jonas Preposi Cruz, Nursing Department,, College of Applied Medical Sciences, Shaqra University,, Al Dawadmi, Riyadh 11911,, Saudi Arabia, T: +966506521179, cruzjprn@gmail. com, ORCID: http://orcid.org/0000.0002-3758-1414
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Zhou Z, Zhou Z, Gao J, Lai S, Chen G. Urban-rural difference in the associations between living arrangements and the health-related quality of life (HRQOL) of the elderly in China-Evidence from Shaanxi province. PLoS One 2018; 13:e0204118. [PMID: 30235258 PMCID: PMC6147447 DOI: 10.1371/journal.pone.0204118] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/04/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND So far limited evidence exist comparing the difference between urban and rural elder residents in relation to how living arrangements correlates to health-related quality of life(HRQOL) of the elderly. OBJECTIVE This study aims to compare the HRQOL of the elderly with four living arrangements: living with spouse only (LS), living alone (LA), living with a spouse and adult children(LSC) and the single elderly living with adult children (SLC) in urban and rural areas of China. METHODS The data were drawn from the 2013 wave of Chinese National Health Service Survey in Shaanxi Province, which included 11,729 elderly people. The Chinese version of the EQ-5D-3L questionnaire was used to measure the HRQOL. Tobit regression model and logistic regression models were employed to estimate the associations between living arrangements and the HRQOL of the elderly. RESULTS The EQ-5D utility scores of the urban elderly with four different living arrangements (LS, LA,LSC and SLC) were 0.9141, 0.8392, 0.8176 and 0.9080, which were almost all higher than their rural counterparts. After controlling other confounding variables, tobit regression estimates showed that the EQ-5D utility scores of the single elderly either living alone or living with adult children were lower than the elderly living with a spouse in urban areas. In rural areas only the single elderly living with adult children were more disadvantaged. Additionally the logistic regression results showed living-alone elderly had worse psychological health and the single elderly living with adult children had worse physical health. CONCLUSION The findings suggest that the urban elderly have better HRQOL than the rural elderly and the elderly with different living arrangements in urban and rural area have different HRQOL. More attention should be given to the poor mental health of the elderly living alone and the worse physical health of the single elderly living with adult children.
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Affiliation(s)
- Zhiying Zhou
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jianmin Gao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Sha Lai
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Gang Chen
- Monash Business School, Monash University, Melbourne, Australia
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