Moving beyond living arrangements: the role of family and friendship ties in promoting mental health for urban and rural older adults in China

Effects of Electronic Serious Games on Older Adults With Alzheimer's Disease and Mild Cognitive Impairment: Systematic Review With Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Serious games (SGs) are nonpharmacological interventions that are widely applied among older adults. To date, no evidence has been published regarding the effect of digital SGs on cognitive ability, daily behavioral capacity, or depression in older adults with Alzheimer's disease (AD) and mild cognitive impairment (MCI).

OBJECTIVE

This study aimed to assess the effect of SGs on older adults with AD and MCI by summarizing and pooling the results of previous studies.

METHODS

This meta-analysis examined the effectiveness of digital SGs in improving cognitive ability, enhancing daily behavioral capacity, and alleviating depression in older adults with AD and MCI. We searched the following databases up to December 31, 2023, to identify relevant high-quality randomized controlled trials (RCTs): PubMed, Embase, Web of Science, Scopus, and Cochrane Library. Stata 15.1 and Review Manager 5.3 were used to screen the 14 studies, extract data, code the data, and perform meta-analysis. Mean differences and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. Eligibility criteria were developed in accordance with the Population, Intervention, Comparison, Outcomes, and Study Design framework: (1) population (older adults with AD and MCI), (2) intervention (digital SG intervention), (3) comparison (digital SG intervention vs routine health care), (4) outcomes (cognitive ability, daily behavioral capacity, and depression), and (5) study or research design (RCT). Sensitivity analysis was performed, and a funnel plot was constructed.

RESULTS

From January 2017 to December 2023, we enrolled 714 individuals across 14 RCTs, with 374 (52.4%) in the severe game group using digital SGs and 340 (47.6%) in the control group using traditional methods. The results of our meta-analysis indicated that using digital SGs in older adults with AD and MCI is more effective than traditional training methods in several key areas. Specifically, digital SG therapy significantly increased cognitive ability, as found in the Mini-Mental State Examination (SMD 2.11, 95% CI 1.42-2.80; P<.001) and the Montreal Cognitive Assessment (SMD 2.75, 95% CI 1.98-3.51; P<.001), significantly increased daily behavioral capacity (SMD 0.53, 95% CI 0.06-0.99; P=.03), and significantly reduced depression (SMD -2.08, 95% CI -2.94 to -1.22; P<.001) in older adults with AD and MCI. No publication bias was detected based on the results of Begg and Egger tests.

CONCLUSIONS

Digital SGs offer a viable and effective nonpharmacological approach for older adults with AD and MCI, yielding better results compared to traditional formats. However, caution is warranted in interpreting these findings due to limited RCTs, small sample sizes, and low-quality meta-analyzed evidence.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews: CRDCRD42023486090; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=486090.

The association of social networks and depression in community-dwelling older adults: a systematic review

BACKGROUND AND OBJECTIVE

Depression is a globally prevalent mental condition, particularly among older adults. Previous research has identified that social networks have a buffering effect on depression. Existing systematic reviews have either limited their research to specific geographic areas or provided evidence from over a decade ago. The vast body of recent literature particularly from the last decade emphasizes the need for a comprehensive review. This systematic review aims to analyze the association of structural aspects of social networks and depression in older adults.

METHODS

The electronic databases APA PsycINFO, ProQuest, PSYINDEX, PubMed, Scopus, SocINDEX, and Web of Science were searched from date of data base inception until 11 July 2023. Studies were eligible for inclusion if they reported on community-dwelling older adults (defined as a mean age of at least 60 years old), had an acceptable definition for depression, referred to the term social network in the abstract, and were published in English. Quality was appraised using the Newcastle Ottawa Scale for cross-sectional and longitudinal studies. Outcome data were extracted independently from each study and analyzed by direction of the relationship, social network domain and cross-sectional or longitudinal study design.

RESULTS

In total, 127 studies were included. The study categorizes structural network aspects into seven domains and finds that larger and more diverse networks, along with closer social ties, help mitigate depression. The literature on the relationships between depression and network density, homogeneity, and geographical proximity is scarce and inconclusive. DISCUSSION AND IMPLICATIONS: Despite inconsistent findings, this review highlights the importance of quantifying complex social relations of older adults. Limitations of this review include publication and language bias as well as the exclusion of qualitative research. Further research should use longitudinal approaches to further investigate the reciprocal relationship between social networks and depression. Following this review, interventions should promote the integration of older adults in larger and more diverse social settings. Other: This work was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Grant [454899704]. This systematic review was pre-registered. The review-protocol can be accessed at https://doi.org/10.17605/OSF.IO/6QDPK .

Perceived Neighborhood Conditions, Psychosocial Factors, and Sleep Problems Among Urban and Rural Older Adults in China

OBJECTIVES

To examine the associations between perceived neighborhood conditions and older Chinese adults' sleep problems, and whether these associations are mediated by psychosocial factors and moderated by urban-rural residence.

METHODS

Data were from the World Health Organization Study on global Ageing and Adult Health. We used OLS, binary, and multinomial logistic regression analyses. Karlson-Holm-Breen decomposition method was used to test mediation effects.

RESULTS

Positively perceived neighborhood social cohesion was associated with fewer insomnia symptoms and decreased odds of poor sleep quality, sleepiness, lethargy, and short sleep duration. Positively perceived neighborhood safety was related to decreased risks of poor sleep quality and sleepiness. Depression and perceived control partially mediated the effects of perceived neighborhood on sleep. Furthermore, the protective effects of neighborhood cohesion against sleep problems were more pronounced among older urban adults than their rural counterparts.

DISCUSSION

Interventions that make neighborhoods safer and more integrated will improve late-life sleep health.

Association between residential environment and emotional wellbeing among older adults in China: the mediating effect of health lifestyle

Introduction

The association between the residential environment and emotional wellbeing (EWB) in older adults has received extensive attention from gerontologists, especially during the COVID-19 pandemic; however, the mediating mechanism of how residential environment affects emotional wellbeing has not been fully explored. This study examined the effects of the residential environment on EWB and the mediating role of health lifestyle.

Methods

This study analyzed the survey data of 493 rural and 515 urban older adults from 2021 Chinese General Social Survey. General linear regression and structural equation models were used to examine the effects of residential environment and health lifestyle.

Results

Urban participants exhibited clear advantages in EWB, residential environment, and physical activity. Residential environment significantly affected the EWB of older adults, and health lifestyle played a mediating role in this relationship. The residential environment and health lifestyle did not significantly affect EWB in rural participants.

Discussion

This study revealed differences in the effects of health lifestyles and residential environments on EWB among older adults in rural and urban settings in China. This study provided empirical evidence of mental health disparities between older rural and urban Chinese residents.

Association between disability and cognitive function in older Chinese people: a moderated mediation of social relationships and depressive symptoms

Objective

Many previous studies have found that disability leads to cognitive impairment, and in order to better understand the underlying mechanisms between disability and cognitive impairment, the present study aimed to investigate the moderating role of social relationships, including their role as mediators between disability and cognitive impairment in depressive symptoms.

Study design

This is a cross-sectional study.

Methods

A total of 5,699 Chinese older adults from the 2018 China Longitudinal Healthy Longevity Survey (CLHLS) were included in this study, and PROCESS macro was used to perform simple mediator and moderator mediator analyses, which were used to analyze the relationship between depressive symptoms and social relationships between disability and cognitive impairment.

Results

The results of this study showed significant correlations between disability, cognitive impairment, depressive symptoms, and social relationships, and that depressive symptoms mediated the relationship between disability and cognitive functioning [B = -0.232; 95% CI: (-0.304, -0.164)], and that social relationships mediated disability and cognitive functioning through pathway a (Disability-Depressive Symptoms) [B = 0.190; 95% CI: (0.020, 0.036)], path b (depressive symptoms-cognitive impairment) [B = 0.029; 95% CI: (0.015, 0.042)], and path c' (incapacitation-cognitive impairment) [B = 0.492; 95% CI: (0.298, 0.685)] to modulate the effect of incapacitation on cognitive impairment. In addition, social activities and social networks moderated the mediation model directly or indirectly, whereas social support moderated only the direct effect.

Conclusion

This study explains the intrinsic link between incapacitation and cognitive impairment in Chinese older adults, and that social relationships and depressive symptoms can directly or indirectly modulate the effects between them. This provides a basis for healthcare professionals to be able to better develop interventions that can be used to improve the level of cognitive functioning and mental health of older adults.

The effects of living arrangements and leisure activities on depressive symptoms of Chinese older adults: Evidence from panel data analysis

BACKGROUND

Livable environment and ways, as the necessary conditions for the elderly to enjoy their old age, have a significant impact on their mental health and happiness. It's crucial to understand how living arrangements affect depressive symptoms in China. Studies on how various leisure activities modify this association are yet limited.

METHODS

This study relies on panel data derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), collected during waves spanning 2008/2009, 2011/2012, 2014, and 2018. The primary objective is to examine the relationship between living arrangements, leisure activities, and depressive symptoms of elderly individuals. Linear mixed-effects models were used to analyze the data.

RESULTS

A total of 26,342 observations aged 65 and over were included in this paper. Older adults living alone (β = 0.66, 95 % CI: 0.55, 0.76) or living in institutions (β = 0.69, 95 % CI: 0.40, 0.98) had more depressive symptoms than those living with family. Leisure activities were negatively associated with depressive symptoms (β = -0.16, 95 % CI: -0.18, -0.15). Moreover, there was significant interactions between living arrangements and leisure activities. No matter which kind of living arrangements, participating in physical, productive or social activity was associated with a lower risk of depressive symptoms.

LIMITATIONS

Study design might introduce bias, and it cannot establish causality between the tested variables.

CONCLUSIONS

Older adults living alone or in institutions have more possibility to develop depressive symptoms than those living with family, and such a relationship among Chinese older adults can be moderated by participating in leisure activities.

Intergenerational reciprocity and WHO function ability domains predict loneliness in older Chinese adults

OBJECTIVES

To examine loneliness in old age and whether intergenerational reciprocity and WHO functional ability predicted loneliness.

METHODS

Using the China Health and Retirement Longitudinal Study Wave 4 (2018) database (CHARLS), logistic regression models were adopted to investigate the relationships.

RESULTS

The prevalence of loneliness was 28% in older people in China. Corresponding to the five domains of functional abilities, providing financial support to adult children (adj. OR 0.83, 95% CI 0.70-0.99), self-perceived health (adj. OR 1.30, 95% CI 1.19-1.41), having a retirement pension (adj. OR 0.73, 95% CI 0.57-0.93), the ability to decide on taking medications (adj. OR 1.32, 95% CI 1.10-1.58), as well as being able to get up from a chair (adj. OR 1.15, 95% CI 1.02-1.3), and having paid work (adj. OR 0.72, 95% CI 0.54-0.95) were associated with less loneliness. On the contrary, infrequent contact (once a month) with adult children (adj. OR 1.18, 95% CI 1.01-1.38), troubling body pain (adj. OR 1.16, 95% CI 1.10-1.23) and falling since the last interview (adj. OR .23, 95% CI 1.04-1.45) were positively associated with loneliness.

CONCLUSIONS

In this study, functional abilities of meeting basic needs, making decisions, being mobile and contributing to the support of adult children and society were protective factors for experiencing loneliness in late life. We need to rethink interventions for addressing loneliness in the context of healthy ageing and specific cultural values, taking into account not only providing services to older adults but also supporting them to gain values by contributing to society.

Is living alone beneficial to older adults during the COVID-19 pandemic? Examining associations between living arrangements and life satisfaction by gender in Korea

OBJECTIVES

This study examines associations between living arrangements and life satisfaction and the associated effects of gender among Korean older adults during the pandemic.

METHOD

Data were drawn from the 2020 National Survey of Older Koreans-a nationally representative survey. Living arrangements were categorized into four groups: living alone; living with spouse only; living with family and spouse; and living with family without spouse. Logistic regression analyses were used to examine associations between living arrangements and life satisfaction measured as a binary outcome.

RESULTS

Older adults living alone were more likely to be satisfied with life compared with those who lived with a spouse only. However, living alone became nonsignificant after controlling for social contact with friends or neighbors and social participation. Interestingly, there was a significant interaction between living arrangements and gender, showing that living alone was beneficial to older women but not to men. Subsample analysis by gender confirmed that older women living alone had a greater likelihood of being satisfied with life than those living with a spouse only, whereas men living alone had lower life satisfaction.

CONCLUSION

Findings suggest that living alone is not always deleterious to older adults, particularly women. During the pandemic, older Korean women living with their spouse and/or family might be less satisfied with life due to the dual burden of family care and housework, associated with traditional gendered norms and social context.

The Contribution of the Internet to Promoting Mental Health for Older Adults: Cross-Sectional Survey in China

BACKGROUND

Health is an important topic for everyone and essential to high-quality economic and social development. Recently, some researchers have suggested that older adults' internet use may have a health effect.

OBJECTIVE

This study specifically aims to clarify the relationship between internet use and the mental health of older adults, for which other surveys present contradictory results.

METHODS

Data were obtained from the China Longitudinal Aging Social Survey conducted in 2018. A total of 6648 participants were included. Mental health was assessed by the 12-item Center for Epidemiological Studies Depression Scale. Ordinary least squares regression was adopted to explore the relationship between internet use (independent variable) and the mental health of older adults. Robustness analysis, sensitivity analysis, and heterogeneity analysis were conducted in detail to verify the empirical result. A mediating effect analysis was further conducted to discover the effect mechanism between the dependent and independent variables.

RESULTS

It was found that internet use and smartphone use can significantly improve the mental health of older adults (ordinary least squares, β=.075; P<.001). After endogenous and robustness tests were conducted, the aforementioned conclusion remained robust. In particular, participation in voluntary activities played a mediating role in the relationship between internet use and the mental health of older adults. In addition, younger subjective age enhanced the positive effect of internet use on the mental health of older adults.

CONCLUSIONS

Internet users showed higher levels of mental health among Chinese older adults. To improve the mental health of older adults, the government should not only cultivate the ability to use the internet but also encourage greater participation in voluntary activities among older adults.

Association between living arrangements and health risk behaviors among the Hakka older adults in Fujian, China

BACKGROUND

Behavioral lifestyles are important social determinants of health. The impact of changes in living arrangements on behavioral lifestyles is currently under-explored. This study aims to examine the association between living arrangements and health risk behaviors among the Hakka older adults.

METHODS

Data were extracted from China's Health-Related Quality of Life Survey for Older Adults 2018. Living arrangements were divided into five categories: living alone, living with spouse only, living with child, mixed habitation, and others. Five health risk behaviors, including unhealthy dietary patterns, drinking, smoking, irregular sleep practices, and physical inactivity were measured. Logistic regression analysis was used to assess the association between living arrangements and specific health risk behaviors, and generalized linear models were established to test the association between living arrangements and the number of health risk behaviors.

RESULTS

A total of 1,262 Hakka older adults were included in this study. Compared to those living alone, those living with spouse only were less likely to have unhealthy dietary patterns (OR = 0.45, P < 0.05) and drinking (OR = 0.50, P < 0.05), those living with the child were less likely to experience unhealthy dietary patterns (OR = 0.35, P < 0.001), drinking (OR = 0.32, P < 0.001), smoking (OR = 0.49, P < 0.05), and physical inactivity (OR = 0.13, P < 0.01). Moreover, those who were living with child (β = -0.78, P < 0.001) or mixed habitation (β = -0.33, P < 0.05) tended to engage in fewer health risk behaviors than those living alone.

CONCLUSIONS

This study suggests significant differences in health risk behaviors among the Hakka older adults with different living arrangements. Living with the child could reduce the occurrence of health risk behaviors in the Hakka older adults and thus maintain their health status.

Understanding and Addressing Older Adults' Loneliness: The Social Relationship Expectations Framework

Loneliness is an experience resulting from a perceived discrepancy between expected and actual social relationships. Although this discrepancy is widely considered the "core mechanism" of loneliness, previous research and interventions have not sufficiently addressed what older adults specifically expect from their social relationships. To address this gap and to help situate research on older adults' loneliness within broader life span developmental theories, we propose a theoretical framework that outlines six key social relationship expectations of older adults based on research from psychology, gerontology, and anthropology: availability of social contacts, receiving care and support, intimacy and understanding, enjoyment and shared interests, generativity and contribution, and being respected and valued. We further argue that a complete understanding of loneliness across the life span requires attention to the powerful impacts of contextual factors (e.g., culture, functional limitations, social network changes) on the expression and fulfillment of older adults' universal and age-specific relationship expectations. The proposed Social Relationship Expectations Framework may fruitfully inform future loneliness research and interventions for a heterogeneous aging population.

Happiness in Old Age: The Daughter Connection

Family and intergenerational relationships are becoming increasingly important as sources of support and care for the elderly population in rapidly ageing Asian societies. However, this has also raised concerns over reinforcement of cultural preference for sons as a source of old-age security. This paper therefore revisits the question-what determines happiness in old age-by investigating the role of adult children's gender in the context of Thailand, an ageing Asian country with no legacy of sex-preference in fertility. We employ nationally representative data to examine the association between old-age happiness and presence of a co-residing child. Compared to living alone, living with at least one child is found to positively associate with older persons' happiness. However, this result is specific to daughters. Moreover, compared to older men, women systematically benefit from a "daughter effect". Co-residing daughters with university education and those who maintain a good relationship with their parents help explain the positive happiness effect on older persons. Co-residing daughters are also positively linked to  reduced loneliness; improved self-rated health; and improved economic conditions of older parents. Our findings suggest that policies that increase human capital of the girl child and enhance family solidarity are likely to have long term intergenerational wellbeing benefits.

Widowhood, social networks, and mental health among Chinese older adults: The moderating effects of gender

Objectives

This study aimed to examine the three-way interaction between widowhood, social ties, and gender and its effects on older adults’ mental health, including depressive symptoms and life satisfaction, in the context of China.

Methods

Participants were 7,601 Chinese older adults. Their social network was divided between family and friendship ties, and their mental health was measured by depressive symptoms and life satisfaction. Linear regression was employed to analyze the associations between widowhood, social networks, and mental health, as well as to explore the moderating effect of gender.

Results

Widowhood is associated with more depressive symptoms, but not with life satisfaction, while family and friendship ties are associated with less depressive symptoms and greater life satisfaction. Furthermore, the lack of family ties is associated with more depressive symptoms for widowed men compared to married older men, while it is associated with lower life satisfaction for widowed women compared to married older women.

Conclusion

Family ties are the most important social support resource for Chinese older adults, especially for the widowed group. The vulnerability of older widowed men who lack family ties in China deserves public concern and attention.

Accompanying your children: Living without parents at different stages of pre-adulthood and individual physical and mental health in adulthood

Objectives

This study examined how living without parents at different stages of childhood and adolescence affects physical and mental health in adulthood.

Methods

The data came from 3,464 survey respondents aged 18–36 in the 2018 China Labor-Force Dynamics Survey. Physical health was self-rated. Mental health was measured by the Center for Epidemiological Studies Depression scale. The ordered probit and ordinary least-squares regression analyses were employed to determine the associations between growing up without parents at different stages in pre-adulthood and individual physical and mental health in adulthood.

Results

Individuals who did not live with their parents during their minor years were more likely to report worse physical and mental health in adulthood, compared to those who lived with their parents. This difference was heterogeneous among different age stages and genders.

Conclusions

Absence of parents in the household has long-term impacts on the physical and mental health of children in adulthood, especially for females. The government should make feasible institutional arrangements to avoid the separation of minor children from their parents.

Effects of family multi-generational relationship on multimorbidity and healthy life expectancy for second generations: insight from the China Health and Retirement Longitudinal Study

OBJECTIVE

In the context of aging, Chinese families consisting of more than three generations (grandparents, parents, children) are the norm. The second generation (parents) and other family members may establish a downward (contact only with children) or two-way multi-generational relationship (contact with children and grandparents). These multi-generational relationships may have the potential effect on multimorbidity burden and healthy life expectancy in the second generation, but less is known about the direction and intensity of this effect. This study aims to explore this potential effect.

METHODS

We obtained longitudinal data from the China Health and Retirement Longitudinal Study from 2011 to 2018, which included 6,768 people. Cox proportional hazards regression was used to assess the association between multi-generational relationships and the number of multimorbidity. The Markov multi-state transition model was used to analyze the relationship between multi-generational relationships and the severity of multimorbidity. The multistate life table was used to calculate healthy life expectancy for different multi-generational relationships.

RESULTS

The risk of multimorbidity in two-way multi-generational relationship was 0.830 (95% CIs: 0.715, 0.963) times higher than that in downward multi-generational relationship. For mild multimorbidity burden, downward and two-way multi-generational relationship may prevent aggravation of burden. For severe multimorbidity burden, two-way multi-generational relationship may aggravate the burden. Compared with two-way multi-generational relationship, the second generations with downward multi-generational relationship has a higher healthy life expectancy at all ages.

CONCLUSION

In Chinese families with more than three generations, the second generations with severe multimorbidity burden may aggravate the condition by providing support to elderly grandparents, and the support provided by offspring to the second generations plays a vital positive role in improving the quality of life and narrowing the gap between healthy life expectancy and life expectancy.

Internet access, support, usage divides, and depressive symptoms among older adults in China: A nationally representative cross-sectional study

OBJECTIVE

This study examines the associations between multiple sub-dimensions of the digital divide, including Internet access, support, usage divides, and depressive symptoms among older adults as well as the potential moderating effects of rural/urban status on these associations in China.

METHODS

Data were obtained from the 2018 China Longitudinal Aging Social Survey, which provided a nationally representative sample of 11,418 participants aged 60 years and older. Multivariate linear regression models were used to analyze the associations between digital divide and depressive symptoms. The moderating role of rural/urban status was tested based on the interaction terms.

RESULTS

After controlling for the covariates, access to Internet devices, support for Internet use from family, and using the Internet for communication, entertainment, or as instruments, were found to be significantly associated with a lower level of depressive symptoms (P < 0.05), and compared with no access to the Internet, accessing and using the Internet was significantly related to decreased depressive risks (P < 0.001), whereas access to the Internet with non-use was not statistically significant. Additionally, the associations between multidimensional aspects of the digital divide and depressive symptoms were moderated by rural/urban status, with these associations being significantly stronger among rural older adults (P < 0.05).

CONCLUSIONS

This study highlights the importance of assessing the associations between digital divide and depressive symptoms from the multidimensional perspectives of access, support, and usage. Policy interventions targeting various aspects of the digital divide should be implemented to ensure active Internet engagement among older adults, especially those living in rural areas.

Separated kin: location of multiple children and mental health trajectories of older parents in rural China

OBJECTIVE

This study examines the longitudinal association between the location of multiple children and depressive symptoms of older parents in rural China, where massive rural-to-urban migration has profoundly altered the family life of the aging population.

METHODS

Using seven waves of panel data from the Longitudinal Study of Older Adults in Anhui Province (2001-2018, N = 8,253) and multilevel growth curve models, this study compares mental health trajectories of old parents across different compositions of local and migrant children over an 18-year time period.

RESULTS

The results show that older parents with a greater share of adult children who had migrated away not only scored worse mental health on average, but also experienced a more rapid increase in depressive symptoms across ages, after accounting for other covariates. Further, older adults who had their most children migrated away for a longer period of time suffered from the steeper rate of increase in depressive symptoms as they got older.

CONCLUSIONS

We suggest that it is not the geographic locality of a single child but the location of multiple children that matters for parental mental health in later life.

Relationship Between Typology of Internet Users and Social Networks in Chinese Older Adults

Objectives: This study aims to generate a typology of Internet users, examine the association between this typology of Internet users and social network characteristics, and assess the moderating effect of rural-urban residence among older adults in China. Methods: Data were from the 2018 China Longitudinal Aging Social Survey. Latent class analysis and OLS regression with interaction terms were used. Results: Four types of Internet users were identified: Socializers, Social and Leisure Users, Leisure Users, and Advanced Users. Socializers were associated with larger and more supportive social networks, family networks, and friend networks than Leisure and Advanced Users. In addition, compared to their urban counterparts, older Internet users living in rural areas benefitted more from online social communication. Discussion:This study highlights the need to increase awareness among gerontological practitioners with respect to patterns of Internet use among older adults as a potential for enhancing their social well-being.

Reconfiguring Social Disconnectedness and Its Link to Psychological Well-Being among Older Adults in Rural China

Using data from 2015 to 2018 waves of the Longitudinal Study of Older Adults in Anhui Province, China, this study investigated associations between different forms of social disconnectedness (social isolation, loneliness, living alone) and psychological well-being of older adults longitudinally. The results showed that social isolation and loneliness were independently associated with psychological well-being, whereas living alone was not. Different forms of social disconnectedness had additive and interactive effects on psychological well-being of older adults. Those who were exposed to all three forms of social disconnectedness suffered from the lowest level of psychological well-being. Moreover, the adverse effects of social disconnectedness on psychological well-being were found to be stronger for older women than for older men. The results underscore the necessity to consider multiple forms of social disconnectedness as well as their different combinations in explaining psychological well-being in later life.

The contribution of the smartphone use to reducing depressive symptoms of Chinese older adults: The mediating effect of social participation

Background

Depression is a prevalent mental health disorder. Although Internet use has been associated with depression, there is limited data on the association between smartphone use and depressive symptoms. The present study aimed to investigate the relationship between smartphone use and depressive symptoms among older individuals in China.

Methods

5,244 Chinese older individuals over the age of 60 were selected as the sample from the China Longitudinal Aging Social Survey (CLASS) 2018 dataset. The dependent variable "depression symptoms" was measured using the 9-item Center for Epidemiologic Studies-Depression (CES-D) scale. The study employed multiple linear regression to investigate the relationship between smartphone use (independent variable) and depressive symptoms in older people. Thorough analyses of robustness, sensitivity, and heterogeneity were conducted to ensure the robustness and sensitivity of the findings. Additionally, mediating effect analysis was performed to elucidate the mechanism through which the dependent and independent variables were related.

Results

Empirical study indicated that smartphone use had a negative impact on depressive symptoms among older adults, specifically leading to a reduction in such symptoms. The above-mentioned result was verified through endogenous and robustness tests. The heterogeneity analysis revealed that older individuals aged 70 years and above, male, and residing in urban areas exhibited a stronger association between smartphone use and depressive symptoms. Furthermore, the mediating effect model indicated that political participation, voluntary participation, and active leisure participation mediated the relationship between smartphone use and lower levels of depression symptoms among the older adults. However, passive leisure participation had a suppressing effect on the relationship between smartphone use and reduced depressive symptoms among the older adults.

Limitations

The causal relationship between variables required further investigation with a longitudinal design.

Conclusion

These findings suggested that smartphone use may be considered an intervention to reduce depression symptoms among older people by increasing levels of political participation, voluntary participation, and active leisure participation.

By Internal Network or by External Network?-Study on the Social Network Mechanism of Reducing the Perception of Old-Age Support Risks of Rural Elders in China

Nowadays, it is a general trend for China to enter a deep aging society, and the aging situation of the rural population is particularly severe. As informal endogenous resources in rural areas, social networks play an essential role in ensuring elders' later life. Data were drawn from a questionnaire survey of 1126 rural elders in 11 provinces of China. Descriptive statistics and an ordinary least square regression model were conducted to explore the impact of social networks on the perception of old-age support risks of rural elders. There was a significant positive association between the social network size and the reduction in perception of old-age support risks of rural elders. The reduction effect was mainly reflected in the internal network size, whereas it was not evident in the external network size. There was a significant positive association between the heterogeneity of the network and the perceived level of old-age support risks of rural elders. There was a significant positive association between the communication frequency of external network relationships and the perceived level of old-age support risks of rural elders. We found a significant negative association between the ratio of communication frequency between the internal and external network relationships and the perception of old-age support risks of rural elders. Compared with the external network, the internal network had a more evident reduction effect on the social network mechanism of perception of old-age support risks of rural elders.

The effect of perceived social support on frailty and depression: A multicategorical multiple mediation analysis

The mediating effects of three sources of perceived social support on frailty severity and depression were examined. Conducted in rural China, data on 570 frail older women were studied. Results showed that significant others' support (mainly daughters) (β = 0.177 for frailty score = 3) mediated the relationship between frailty severity and depression, and the 95 % bias-corrected bootstrap confidence intervals did not straddle zero (0.013-0.419), while the mediating effects of family support (mainly sons) and friends support were not observed. Support from daughters contributes to frail mothers' mental health.

The effects of changes in daily life due to the COVID-19 pandemic on the depressive symptoms among community-dwelling older adults in Korea

This study aims to identify the effects of daily life changes due to the coronavirus disease 2019 pandemic on the depressive symptoms among community-dwelling older adults. This cross-sectional and secondary data analysis study collected and analysed the data of 72 335 older adults aged older than 65 who participated in the 2020 Korean Community Health Survey. Changes in daily life due to the coronavirus disease 2019 pandemic were measured by changes in physical activity, sleep duration, consumption of instant foods or soda drinks, alcohol consumption, smoking, and social contact compared to before the pandemic as perceived by the participants. The Patient Health Questionnaire-9 was used to assess depressive symptoms, and multiple logistic regression analysis was conducted to explore the relationship between the two. After adjusting for socio-demographic and health-related factors, changes in daily life due to the coronavirus disease 2019 pandemic that affected depressive symptoms in older adults living in the community were observed. This study confirmed that changes in daily life due to the coronavirus disease 2019 pandemic negatively affected the mental health of older adults. Thus, there is a need to improve social support and care systems, by including non-face-to-face programmes using remote communication technology. It will allow older adults to maintain their daily lives and mental health during the COVID-19 pandemic.

Association between internet use and successful aging of older Chinese women: a cross-sectional study

BACKGROUND

The internet has become ubiquitous in contemporary human life. However, little is known about the association between internet use and older people's aging process, especially that of older women.

METHODS

Using the nationally representative dataset of the China Longitudinal Aging Social Survey 2016, we examined the relationship between internet usage and the successful aging of older Chinese women. The sample in this study consisted of 2713 respondents with an average age of 69.963 years. Successful aging was defined as no major diseases, no disability, high cognitive functioning, high physical functioning, and active engagement with life. Older women's internet use behavior was represented by internet use frequency. Probit and instrumental variable models were employed to test the association between internet use frequency and successful aging of older women. The Karlson/Holm/Breen (KHB) mediation analysis was used to estimate the mediating effect of social capital on the relationship between internet use frequency and older women's successful aging.

RESULTS

Using a probit model (coefficient = 0.030, p < 0.001) and an instrumental variable probit model (coefficient = 0.287, p < 0.001), it was found that a successful aging status was significantly correlated with an increase in internet use frequency. The functional mechanism analysis suggested that social capital partially mediated the overall association between internet use frequency and successful aging.

CONCLUSIONS

This study suggests that the more frequently older Chinese women use the internet, the greater the possibility of successful aging. Our findings provide new evidence from China about the determinants of older women's aging process and aid in formulating targeted aging policies for older women in developing countries and regions.

Internet Use, Social Networks, and Loneliness Among the Older Population in China

While the rate of Internet use among the older population in China is rapidly increasing, the outcomes associated with Internet use remain largely unexplored. Currently, there are contradictory findings indicating that Internet use is sometimes positively and sometimes negatively associated with older adults' subjective well-being. Therefore, we examined the associations between different types of Internet use, social networks, and loneliness among Chinese older adults using data from the Chinese Longitudinal Ageing Society Survey (N = 1863). Internet use was classified as interpersonal communication and information acquisition, and social networks were divided into family and friendship ties. The results showed that both interpersonal communication and information acquisition were associated with lower loneliness. Interpersonal communication can increase social networks, and family ties have a mediating effect on the association between Internet use for interpersonal communication and loneliness. Although information acquisition can directly decrease loneliness in older adults, it can also damage existing social networks and further increase loneliness. Family ties act as a suppressor in the association between Internet use for information acquisition and loneliness. Our study further discusses important implications for improving the subjective well-being of older adults in the digital era, based on the empirical findings.

The mediating effect of coping style on the relationship between perceived stress and mental health in Chinese rural older adults living alone: A cross-sectional study

AIM

Older adults living alone is becoming the main family structure in rural China. This study aimed to explore the mediating effect of coping style on the relationship between perceived stress and mental health in rural older adults living alone in China.

METHODS

356 rural older adults living alone were recruited in Huzhou, China. Subjects were investigated using the Chinese Perceived Stress Scale (CPSS), Chinese Coping Style Questionnaire (CCSQ), and Mental Health Questionnaire (MHQ). Data were analysed using a structural equation. Bootstrapping was used to validate the mediation effects.

RESULTS

Mental health showed significant correlations with a sense of nervousness, of uncontrollability, and with positive and negative coping styles (P < 0.05). The results of structural equation modeling showed a good fit for the total sample (χ² /df = 2.684, NFI = 0.927, GFI = 0.944, RMSEA = 0.069). Perceived stress (sense of nervousness and uncontrollability) impacted the mental health of rural older adults living alone mainly through two mediating variables, including positive and negative coping styles. The double mediating contribution rates were 42.11%, and 61.82%.

CONCLUSION

Coping style partially mediated the relationship between perceived stress and mental health of rural older adults living alone in China. Consequently, to improve the mental health of rural older adults living alone, perceived stress and coping styles should be the focus. Geriatr Gerontol Int 2022; ••: ••-••.

Adolescent Self-Control and Individual Physical and Mental Health in Adulthood: A Chinese Study

Despite its association with individual health, few studies have focused on the relationship between adolescent self-control and individual physical and mental health in adulthood. We aimed, therefore, to explore the impact of adolescent self-control on individual physical and mental health in adulthood. We employed the dataset of China Labor-Force Dynamics Surveys [CLDS] (2016). 13,389 respondents with an average age of 45.621 years are consisted in this study. The respondents were asked to report their adolescent self-control through recall. The ordered probit and the ordinary least squares (OLS) models were employed to estimate the effects of adolescent self-control on physical and mental health in adulthood, respectively. We adopted the propensity score matching (PSM) method to address the self-selection bias of samples. The results indicated that adolescent self-control significantly affected individual physical health (coefficient = 0.0126, p < 0.01) and mental health (coefficient = −0.1067, p < 0.01) in adulthood. The mechanism analysis suggested that adolescent self-control partially promoted physical and mental health in adulthood by education and income instead of self-control in adulthood. In conclusion, paying attention to the cultivation of self-control before adulthood may be an effective way to improve individual physical and mental health in adulthood.

Negative Life Events, Social Ties, and Depressive Symptoms for Older Adults in China

Although it is widely acknowledged that older adults who have gone through negative life events are more likely to develop depression, there is limited evidence on whether and which type of social ties moderate this perceived relationship. Based on 2016 and 2018 waves of Chinese Longitudinal Aging Social Survey (4,466 individuals, 8,932 observations), we apply linear fixed effects models and confirm that negative life events are associated with depressive symptoms for older adults (Coef. = 0.35; 95% CIs 0.11–0.61), and social ties are negatively associated with depression (Coef. = −0.08; 95% CIs −0.10 to −0.07). Our study further suggests that the association between negative life events and depressive symptoms is significantly moderated by friendship ties (Coef. = −0.18, 95% CIs −0.30 to −0.07), rather than family ties (Coef. = −0.03, 95% CIs −0.09 to 0.15). Moreover, the buffering effects of friendship ties are more prominent for the less resilient and less privileged groups, namely male, rural, and less educated older adults. Our findings point to the importance of expanding and strengthening social networks for Chinese older adults in promoting their psychological health.

What Could Interfere with a Good Night's Sleep? The Risks of Social Isolation, Poor Physical and Psychological Health among Older Adults in China

This study provides one of the first population-based investigations of the longitudinal association between social isolation and sleep difficulty among older adults in China. We analyzed three waves of longitudinal data from the China Longitudinal Aging Social Survey (2014-2018), in which 8456 respondents contributed 16,156 person-year observations. Results from multilevel logistic regression models showed that social isolation was related to a higher risk of sleep difficulty. We also found that socially isolated older adults were more likely to report higher levels of depressive symptoms, a greater prevalence of loneliness and pain, and more chronic diseases compared to their socially integrated counterparts, which in turn increased their risks of sleep difficulty. Moreover, socially isolated older adults with chronic diseases were particularly vulnerable to the risk of sleep difficulty. These findings provide helpful guidance for policymakers and practitioners to design effective intervention strategies to help older adults with sleep problems.

Friendship and Cognitive Functioning among Married and Widowed Chinese Older Adults

OBJECTIVES

Guided by the social convoy model, this study investigated the association between friendship and cognitive functioning among older Chinese adults, as well as the moderating effect of marital status (married vs. widowed). We also explored whether depression might account for the link between friendship and cognitive functioning.

METHOD

We used data from the China Longitudinal Aging Social Survey in 2014 (N = 8,482). Cognitive functioning was measured with the Mini-Mental State Examination instrument and friendship was assessed with a three-item Lubben Social Network Scale. Linear regression and path analyses within a structural equation modeling framework were performed to examine the hypotheses.

RESULTS

Results indicated that friendship was significantly related to better cognitive functioning among older Chinese adults (β = 0.083, p <.001) and marital status moderated this association (β = -0.058, p <.01). In addition, depression partially mediated the relationship between friendship and cognitive functioning (β = 0.015, p <.001).

DISCUSSION

The results implied that friendship is important for maintaining cognitive functioning in later life and widowed older Chinese adults may benefit more from friendship in its relationship to cognitive functioning than married older Chinese adults. Further, one potential pathway linking friendship to cognitive functioning may be through depression; however, more research is needed to support this finding. Intervention programs aimed at building friendship opportunities may be one way to achieve better cognitive aging.

Whose migration matters? The role of migration in social networks and mental health among rural older adults in China

The dual demographic changes in massive rural-to-urban labour migration and population ageing have significantly impacted the lives of older adults, who have either been left behind in rural regions or migrated to urban areas. While many extant studies on migration and wellbeing of older adults have focused on either migrating or left-behind older adults, a very limited number of studies have directly compared these two groups. Utilising data from the China Longitudinal Ageing Social Survey, this study examines the impacts of different migration patterns (i.e. migrating older adults, left-behind older adults and non-migrating older adults) on the social networks and mental health of older adults in rural China. Structural equation modelling results showed that older adults who have been left behind reported weaker family ties and poorer mental health than the other older adults. Moreover, weakened family ties increased older adults’ risk of developing mental health problems. Older migrants reported the lowest level of depressive symptoms among the three groups of older adults. However, migration may be associated with poorer mental health among the older migrants due to the shrinking/weakening of family/friendship ties.

Intergenerational Emotional Cohesion and Psychological Well-being of Older Adults in Rural China: A Moderated Mediation Model of Loneliness and Friendship Ties

OBJECTIVES

Although researchers have linked intergenerational emotional cohesion (IEC) to psychological well-being (PWB) among older adults, the mechanisms and conditions under which IEC is related to PWB-particularly in rural areas-are less well understood. This study analyzed data from rural China to examine whether loneliness mediated the relation between IEC and PWB, and whether friendship ties moderated the strength of the direct and indirect relationships between IEC and PWB.

METHODS

Mediation and moderated mediation models were tested using a sample of rural adults age 60 and older (N = 958) from the Longitudinal Study of Older Adults in Anhui Province, China. Measures included IEC, friendship ties, loneliness, and two PWB indicators-depressive symptoms and life satisfaction.

RESULTS

The results revealed that IEC was negatively related to loneliness, which in turn was associated with depressive symptoms and life satisfaction. Further, this indirect pathway linking IEC and depressive symptoms (but not life satisfaction) was positively conditioned on the size of friendship ties.

DISCUSSION

This study advances our understanding of the mechanism through which IEC influences PWB in older adults. Alleviating loneliness could help boost PWB. Other implications for practice and future research are discussed.

Do Living Arrangements and Social Network Influence the Mental Health Status of Older Adults in Malaysia?

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.

Social trust and emotional health in rural older adults in China: the mediating and moderating role of subjective well-being and subjective social status

BACKGROUND

China is becoming an aging society. The emotional health of the elderly is gaining importance. Social trust is an important factor affecting emotional health, but existing studies have rarely considered the various effects of different types of social trust on rural elderly emotional health. Few studies have analysed the role of subjective well-being and subjective social status in the relationship between social trust and elderly emotional health.

METHODS

Using the data of the China Labor-force Dynamics Survey 2016 (CLDS 2016) and regression models, this study selected 2084 rural respondents aged 60 years and above to analyse the impact of social trust on their emotional health. Social trust was divided into three categories: trust in family members, trust in friends, and trust in neighbours. This study also examined the mediating and moderating effects of subjective well-being and subjective social status on the relationship between social trust and emotional health.

RESULTS

Trust in family members was significantly and positively associated with emotional health (coefficient = 0.194, P < 0.01) and subjective well-being (coefficient = 0.177, P < 0.01). Trust in friends was significantly and positively associated with emotional health and subjective well-being (coefficient = 0.097, P < 0.01; coefficient = 0.174, P < 0.01, respectively). Trust in neighbours was significantly and positively associated with emotional health and subjective well-being (coefficient = 0.088, P < 0.01; coefficient = 0.177, P < 0.01; respectively). Subjective well-being effectively reduced the impact of social trust in family, friends, and neighbours on the emotional health of the elderly by 0.023, 0.022, and 0.023, respectively. Trust in friends and neighbours significantly and positively affected respondents' subjective social status (coefficient = 0.120, P < 0.05; coefficient = 0.090, P < 0.10; respectively). Subjective social status effectively reduced the impact of social trust in friends and neighbours on the emotional health of the elderly both by 0.004. The positive relationship between trust in family members and emotional health is weakened by subjective well-being.

CONCLUSIONS

Social trust, especially family relationships, play an important role in maintaining the emotional health of the rural elderly. In response to population ageing, more social policies must be introduced to care for the rural elderly and help them lead a happy and satisfactory life.

Environmental stressors and well-being on middle-aged and elderly people: the mediating role of outdoor leisure behaviour and place attachment

This study develops a relational model of how environmental stressors, place attachment and outdoor leisure are related to urban green zones and, accordingly, Fujian Province in China is studied as our case problem. The research is participated by primarily middle-aged and elderly residents. In total, 871 valid questionnaires are retrieved. Structural equation modelling and path analysis are used to verify the model's fitness. The results indicate that environmental stressors and outdoor leisure are significantly negatively correlated. In addition, the outdoor leisure and place attachment are significantly positively correlated. As such, the place attachment and well-being are significantly positively correlated. However, the place attachment and outdoor leisure mediated the relationship between environmental stressors and well-being. The mediating path indicated that middle-aged and elderly residents face severe environmental stressors and will engage in a few outdoor leisure activities, resulting in low well-being. Furthermore, when middle-aged and elderly residents face severe environmental stressors, they have increased place attachment, thereby increasing their well-being. The findings can serve as a reference for environmental management agencies and future researchers.

Associations between Community Cohesion and Subjective Wellbeing of the Elderly in Guangzhou, China-A Cross-Sectional Study Based on the Structural Equation Model

Population aging has become one of the most prominent population trends in China and worldwide. Given the retirement and physical limitation of the elderly, the neighborhood has gradually become the center of their daily lives and communication. Community cohesion plays an essential role in improving the elderly’s subjective wellbeing. However, most present studies on the concept and relationship between different dimensions of community cohesion are mainly in western countries. Meanwhile, most of the studies on the relationship between community cohesion and subjective wellbeing only focused on one aspect of community cohesion such as community interaction. To address this research gap, this study sampled 20 communities in Guangzhou, conducted a questionnaire survey on 969 elderly people, and explored the relationship between four aspects of community cohesion (community interaction, environmental satisfaction, belonging, and participation) and their associations with subjective wellbeing using the Structural Equation Model (SEM). In addition, we performed multi-group analysis to study the association differences among older individuals in communities with different socioeconomic types. We found that: (1) The conceptual relationship between different aspects of community cohesion among older adults is significant; (2) Community environmental satisfaction, interaction, and belonging associate with the elderly’s subjective wellbeing, whereas there is no significant association between community participation and subjective wellbeing; (3) Mental health is an important mediating factor connecting community cohesion and subjective wellbeing, whereas physical health is not. (4) The association pattern of older adults in communities with different socio-economic status are identical, whereas the association strengths are different. In high Socio-Economic Status Index (SESI) communities (communities where older adults with relatively high socioeconomic attributes gather, such as high income and education level), community belonging and participation are significantly associated with community environmental satisfaction and interaction, respectively. In low SESI communities (communities in which older adults with relatively low socioeconomic attributes gather, such as low income and education level), community interaction, belonging, and participation considerably link to community environmental satisfaction, interaction, and belonging, respectively. Regarding the association between community cohesion and subjective wellbeing, community interaction has stronger linkage with the elderly’s subjective wellbeing of in high-SESI aging community than low-SESI aging community. While community environmental satisfaction has stronger association with the elderly’s subjective wellbeing of the elderly in low-SESI aging community than high-SESI aging community. Therefore, it is sensible for community planning to focus on community environment improvement and vibrant community activities organization.

Basic Public Health Service Utilization by Internal Older Adult Migrants in China

Since 2009, the Chinese government has launched a basic public health services (BPHS) equalization program to provide the same BPHS to all the citizens. However, utilization of BPHS among older migrants is still low. The purpose of this paper was to explore the determinant individual and contextual factors of older migrants’ utilization of BPHS, and to provide suggestion for the government to improve BPHS utilization. Based on Andersen’s model of health services use, data from the China’s Regional Economic Statistics Yearbook 2014 and National Health and Family Planning Dynamic Monitoring Survey on Migrant Population 2015 were analyzed using a hierarchical random intercept model for binary outcomes. Results showed that the percentage of migrant older adults receiving free physical examinations, which is an important item of BPHS, was 36.2%. Predisposing (education, hukou, living duration in the host city, and scope of migration), enabling (health insurance and social networks), and need (self-rated health and chronic conditions) factors of individuals’ characteristics had significant impact on the use of BPHS. The proportions of both migrant children enrolled in public schools and people with established health records had a positive impact on an individual’s chance of receiving free physical examinations. These findings suggest that economic development and improvement at the level of the city’s health resources cannot effectively improve access to BPHS by older adult migrants. Instead, the driving force appears to be supportive policies for the migrant population.

Factor Structures of General Health Questionnaire-12 Within the Number of Kins Among the Rural Residents in China

The 12-item general health questionnaire (GHQ-12) has been extensively used with Chinese population. Yet, it has not been used from a national representative survey in rural China. The aim of this study was to examine how number of kins associated with the factor structures of the CHQ-12 among the rural residents in China. Data were obtained from the 2009 rural-to-urban migrants survey (RUMiC). Exploratory factor analysis (EFA) (principal component analysis with varimax rotation) was performed to identify factor structures of GHQ-12 regarding number of siblings, age ranking, and number of children. To investigate the reliability of the questionnaire, Cronbach’s alpha was used. Internal consistency was assessed by confirmatory factor analysis (CFA). In all, 32171 rural residents in China from 2009 RUMiC participated in the study. The mean age of the respondents was 37.03 (SD = 19.21) years. The psychometric properties and factor structures of the GHQ-12 used were described. All of the fit indices in CFA models were satisfactory. The two-factor and three-factor structures gathered the satisfactory fit indexes in the part of 2009 subsamples. The rural version of the GHQ-12 was reliable measures of psychological distress among the rural residents in China with respect to number of kins. The two-and three-factor structures derived from the present sample, with good model fit in the CFA analysis, which suggested that two-and three-factor solution could be used to assess mental health of rural residents in rural China.