Fine particulate matter components associated with exacerbated depressive symptoms among middle-aged and older adults in China

Growing awareness acknowledges ambient fine particulate matter (PM2.5) as an environmental risk factor for mental disorders, especially among older people. However, there remains limited evidence regarding which specific chemical components of PM2.5 may be more detrimental. This nationwide prospective cohort study included 22,126 middle-aged and older adult participants of the China Health and Retirement Longitudinal Study (CHARLS, 2011-2016), to explore the individual and joint associations between long-term exposure to various PM2.5 components (sulfate, nitrate, ammonium, organic matter, and black carbon) and depressive symptoms. The depressive symptoms were assessed using the 10-item Center for Epidemiological Studies-Depression Scale (CES-D-10). Using the novel quantile-based g-computation for multi-pollutant mixture analysis, we found that exposure to the mixture of major PM2.5 components was significantly associated with aggravating depressive symptoms, with the exposure-response curve exhibiting consistent linear or supra-linear shape without a lower threshold. The estimated weight index indicated that, among major PM2.5 components, only nitrate, sulfate, and black carbon significantly contributed to the exacerbation of depressive symptoms. Given the expanding aging population, stricter regulation on the emissions of particularly toxic PM2.5 components may mitigate the escalating disease burden of depression.

Validation of the Perceived Community Support Questionnaire for Older Chinese

BACKGROUND AND OBJECTIVES

Community support has a profound positive impact on older people's health and plays a crucial role in facilitating aging in place. This impact is particularly significant in the Chinese context, where community support can alleviate the pressure on traditional family caregiving. This study translated, adapted, and validated the perceived community support questionnaire (PCSQ) for use with older Chinese.

RESEARCH DESIGN AND METHODS

Data for this validation study were collected from a cross-sectional survey of 1,064 Chinese aged 65 years and above. Following the cultural adaptation of the PCSQ-14, confirmatory factor analysis (CFA) was conducted to examine its factor structure. Criterion validity, convergent and discriminant validity, internal consistency reliability, and test-retest reliability of the scale were also assessed.

RESULTS

Based on the CFA results, the adapted PCSQ-14 was found to have a 3-factor solution for community integration, community participation, and community organizations. The criterion-related validity was supported by its significant correlation with depression. Convergent and discriminant validity were established, with the internal consistency of the scale being 0.90. The test-retest reliability intraclass correlation coefficient for the scale was 0.78.

DISCUSSION AND IMPLICATIONS

The adapted version of the PCSQ-14 demonstrated promising psychometric properties in assessing perceived community support in older Chinese. The adapted PCSQ-14 could assist researchers in determining older Chinese adults' perceptions of community support, and could also assist practitioners and policymakers in developing targeted services for older people and allocating resources more effectively.

The Association between Residential Environment and Self-Rated Mental Health among Older Canadians: The Moderating Effects of Education and Gender

This study examined the associations between residential environment and self-rated mental health (SRMH) among Canadians aged 65 or older (n = 16,304) and whether education and gender moderated the associations. Data came from the 2018 Canadian Housing Survey. Hierarchical multiple regressions were conducted to test the associations. Analyses revealed that increased dwelling size was associated with better SRMH among older women with high school education. Older adults with higher satisfaction with their dwelling design were more likely to report better SRMH, except for women with some college education. Feeling safer in the community was uniquely associated with better SRMH for men with high school education and women with a university degree. Results confirmed significant associations between specific home and residential environment features and SRMH for each gender-by-education group. Environmental programs designed to improve SRMH for older adult populations should consider within- and between-group diversity.

Co-occurrence of depressive and anxious symptoms and their influence on self-rated health: a national representative survey among Chinese older adults

OBJECTIVES

The prevalence of the co-occurrence of depressive and anxious symptoms (CO) and their influence on perceived overall health were not clear in community dwelling Chinese older adults. The aims of the study were to investigate the prevalence of CO and to explore its influence on self-rated health (SRH).

METHOD

This study included 12301 individuals aged ≥65 years from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationally representative survey of older adults in mainland China. Participants received face-to-face interviews and assessments of depressive symptoms and anxious symptoms via 10-item of the Center for Epidemiologic Studies Depression Scale (CES-D-10) and 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), respectively. SRH was measured by self-reported. A logistic regression model was used to examine the association between CO and SRH after adjusting for confounding variables.

RESULTS

The average age was 83.4 (SD: 11.0) years and there were 6576 (53.5%) females. The age- and sex-standardized prevalence of depressive symptoms only (DSO) was 38.6%, anxious symptoms only (ASO) was 1.5%, and CO was 10.8%. Compared with those without depressive and anxious symptoms, the older adults with DSO or ASO were more likely to have significant influence on SRH. And particularly, CO was likely to produce the greatest decrement in the level of SRH.

CONCLUSION

CO was not rare in Chinese older adults nationwide. The older adults having CO had increased risk for lower level of SRH than having DSO or ASO. More attention should be given to CO among the older adults.

1 km of living area: age differences in the association between neighborhood environment perception and self-rated health among Chinese people

OBJECTIVES

This study aimed to explore the age differences in the relationship between neighborhood environment perception and self-rated health among Chinese people.

STUDY DESIGN

This is cross-sectional study.

METHODS

The participants were 2,631 residents aged 18 and above from 2021 Chinese General Social Survey (CGSS). Self-rated health was reported by residents. Neighborhood environment was measured by respondents' subjective perception of 1 km living area. Ordered logit regression models were used to examine the relationship between neighborhood environment perception and self-rated health.

RESULTS

In summary, 42.08% were classified as young adults, and 57.92% were classified as middle-aged and older adults. Young adults with higher perception of neighborhood social environment were more likely to perceive good health. Neighborhood built environment was significantly associated with self-rated health among middle-aged and older adults.

CONCLUSION

The neighborhood environment is an important predictor of the health of its residents. Neighborhood environmental modifications should be tailored to meet the needs of different age groups, promoting health equity.

Links between life-course SES and frailty trajectory moderated by community environment resources: Person-environment Fit perspective

INTRODUCTION

Drawing from the life course and person-environment fit perspectives, this study examined whether life-course SES disadvantages during childhood, adulthood and old- age influence frailty development in late- life and how community environment resources moderated the association between life-course SES disadvantages and frailty trajectories over a seven-year follow-up period.

METHODS

Data from 11,675 participants aged ≥ 50 years at baseline who participated in the four waves (2011-2018) of the China Health and Retirement Longitudinal Survey (CHARLS) were used. Life-course SES disadvantages were self-reported, and community environment resources (basic infrastructure and voluntary organizations) were ascertained from informed officials in the community. Frailty development was measured at each wave by the Frailty Index (FI) based on 39 potential deficits. Multilevel growth modeling was used to examine the interactive effect of life-course SES disadvantages and community environment resources on frailty development.

RESULTS

Life-course SES disadvantage exerted cumulatively negative effects on frailty trajectory, and individuals with SES disadvantages in two or three life stages reported higher initial levels of and faster increases in frailty scores. Community environmental resources (basic infrastructure and voluntary organizations) had a protective effect on frailty development and buffered the negative effects of SES vulnerability experiences accumulated over the life course. Community basic infrastructure resources played an important role in slowing the progression of frailty for individuals with cumulative SES disadvantage and downward mobility.

DISCUSSION

Our findings provided new evidence of person-environmental docility among older adults, documenting the role of community resources in buffering SES disparities in health during later-life.

Spirituality and Attitudes Toward Death Among Older Adults in Rural and Urban China: A Cross-Sectional Study

The purpose of this study was to investigate spirituality and attitudes toward death among rural and urban elderly. We asked 134 older adults from rural areas and 128 from urban areas to complete a self-administrated questionnaire including the Spiritual Self-assessment Scale and Death Attitude Scale. The fear and anxiety of death, escape acceptance, natural acceptance, approach acceptance, and death avoidance scores of older adults living in rural areas were higher than those living in urban areas. The construction of social infrastructure and medical care should be strengthened in rural areas so as to improve older adults' attitudes toward death.

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.

Neighborhood and Depressive Symptoms in Older Adults Living in Rural and Urban Regions in South Korea

Neighborhoods have a significant impact on depressive symptoms in older adults. In response to the increasing depression of older adults in Korea, this study aims to identify the relationship between perceived and objective neighborhood characteristics in depressive symptoms and find differences between rural and urban areas. We used a National survey collected in 2020 of 10,097 Korean older adults aged 65 and older. We also utilized Korean administration data for identifying the objective neighborhood characteristics. Multilevel modeling results indicated that depressive symptoms decreased when older adults perceived their housing condition (b = -0.04, p < 0.001), their interaction with neighbors (b = -0.02, p < 0.001), and overall neighborhood environment (b = -0.02, p < 0.001) positively. Among the objective neighborhood characteristics, only nursing homes (b = 0.09, p < 0.05) were related to depressive symptoms of older adults living in urban areas. For older adults living in rural areas, the number of social workers (b = -0.03, p < 0.001), the number of senior centers (b = -0.45, p < 0.001), and nursing home (b = -3.30, p < 0.001) in the neighborhood were negatively associated with depressive symptoms. This study found that rural and urban areas have different neighborhood characteristics related to older adults' depressive symptoms in South Korea. This study encourages policymakers to consider neighborhood characteristics to improve the mental health of older adults.

Education, neighborhood environment, and cognitive decline: Findings from two prospective cohort studies of older adults in China

INTRODUCTION

The impacts of education on cognitive decline across different neighborhood environments (NEs) have rarely been studied.

METHODS

We investigated and compared the associations between educational attainment and cognitive decline using data of 1286 participants from the Taizhou Imaging Study (TIS) and the Shanghai Aging Study (SAS).

RESULTS

Compared with low-educated participants, in TIS with disadvantaged NE, high-educated participants manifested a significantly slower decline in global cognition (.062 Z score per year, P < .001), memory (.054 Z score per year, P < .05), and attention (.065 Z score per year, P < .01), whereas in SAS with advanced NE, highly educated individuals exhibited a slower decline only in attention (.028 Z score per year, P < .05).

DISCUSSION

We observed the additive effect of educational attainment and NE on cognitive decline in older adults. Education is especially important for maintaining cognitive health in a disadvantaged environment.

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.

Healthy aging index and its link with relative education between individual and neighborhood: a population-based, cohort study

OBJECTIVES

There is increasing recognition of the importance of neighborhood socioeconomic status (SES) for establishing an age-friendly society. Despite the benefits of improved neighborhood SES, little is known about the link of relative education between individuals and neighborhoods with healthy aging. This study aims to construct a healthy aging index (HAI) accounting for indicators' interlinkages and to test the association of the HAI with relative education between neighborhoods and individuals.

METHODS

The study used data from the China Health and Retirement Longitudinal Study from 2011 to 2018, including middle-aged and older adults (≥ 45 years). The final sample comprised 11633 participants residing in 443 neighborhoods with 34123 observations. Based on 13 health indicators, a hybrid method integrating network analysis with TOPSIS was applied to construct a HAI accounting for health interlinkages. Weighted multilevel linear and ordered logistic models were used to estimate the effects of neighborhood education.

RESULTS

Among the 11633 participants (mean [SD] age, 58.20 [8.91] years; 6415 women [52.82%]), the mean (SD) HAI was 48.94 (7.55) at baseline, showing a downward trend with age. Approximately 10% of participants had a HAI trajectory characterized by a low starting point and fast decline. A one-year increase in neighborhood education was independently associated with a 0.37-point increase (95% CI, 0.23-0.52) in HAI. Regardless of individual education, each participant tended to gain benefits from a neighborhood with higher education. However, the effects of increased neighborhood education were weaker for individuals whose education was lower than the neighborhood average.

CONCLUSIONS

The HAI is an interaction system. Improving neighborhood education was beneficial to healthy aging, but individuals with lower education relative to the neighborhood average may experience poor person-environment fit and obtain fewer benefits from improved neighborhood education. Thus, in the process of improving neighborhood SES, individual-based interventions should be conducted for individuals whose education level is lower than the neighborhood average to achieve person-environment fit.

Perceived neighborhood environment and depressive symptoms among older adults living in Urban China: The mediator role of social capital

An increasing number of studies have focused on the relationship between neighbourhood environment and depressive symptoms among older people. However, the underlying mechanisms are still unclear. This study examined the association between neighbourhood environment and depressive symptoms among older urban Chinese adults and the mediator role of social capital in this association. Using a quota sampling approach, 472 respondents aged 60 years or older were recruited from 23 urban communities of Shanghai, China, in 2020. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale. Social capital was measured by two latent constructs: cognitive social capital (e.g., trust, reciprocity, belongingness) and structural social capital (e.g., memberships, social participation). Perceived physical neighbourhood environment was assessed in terms of health care, security, and public transportation status. Structural equation modelling was conducted to test the study hypotheses. Health care services in the community had a direct effect on depressive symptoms (β = -0.097, p < .05). Cognitive social capital played a mediator role in the relationship between physical neighbourhood environment and depressive symptoms (community health care: β = -0.124, p < .01; community security: β = -0.284, p < .01). The mediator effect of structural social capital in the relationship between physical neighbourhood environment and depressive symptoms was not significant. The findings highlight the role of physical neighbourhood environment in fostering community-based social capital and promoting mental health among older adults in urban China. Policy strategies could focus on improving community health care and security to promote mental health.

The association between street connectivity and depression among older Japanese adults: the JAGES longitudinal study

Mental health is important in older age; neighborhood environment is considered a protective factor of depression. Research has established that a critical indicator of neighborhood environment, street connectivity, is related to older people's health. However, little is known about the relationship between street connectivity and depression. We examined the relationship between street connectivity and depression among older people. Using Japan Gerontological Evaluation Study 2013-2016, the target population comprised 24,141 independent older people without depression (Geriatric Depression Scale scores below 5) in 2013. The outcome variable was depression in 2016; the explanatory variable was street connectivity calculated by intersection density and space syntax within 800 m around the subject's neighborhood in 2013. We used logistic regression analysis to calculate the odds ratio and 95% confidence interval for the new occurrence of depression among participants in 2016. This analysis demonstrated incidence of new depression after 3 years that is 17% and 14% lower among participations living in high-intersection density and high-street-connectivity areas, respectively, than those living in low-intersection density and low-street-connectivity areas. The association held after adjusting for physical activities and social interaction. Given the established connection between street connectivity and mental health, the findings can contribute to healthy urban planning.

Longitudinal relationship between sensory impairments and depressive symptoms in older adults: The mediating role of functional limitation

BACKGROUND

The underlying mechanism between sensory impairments (SIs) and depressive symptoms among Chinese older adults is not well understood. This study aims to explore the mediating role of functional limitation on the longitudinal relationship between SIs and depressive symptoms among older adults in China.

METHODS

A total of 4130 older adults who participated in the 3-year follow-up China Health and Retirement Longitudinal Study (CHARLS) were included in the analysis. The hierarchical multiple linear regression model and nonparametric bootstrapping method were employed to explore the relationship between SIs and depressive symptoms, and the mediating role of functional limitation in this link.

RESULTS

The prevalence of self-reported hearing impairment (HI) only, vision impairment (VI) only, and dual sensory impairment (DSI) at baseline were 5.7%, 22.2%, and 58.6%, respectively. After adjusting for controlling variables, older adults with DSI had significantly higher levels of depressive symptoms compared with those without SIs at baseline (β = .07, p = .005). The magnitude of mediation effect from DSI to depressive symptoms via functional limitation was a*b = 0.060 (BCa 95% confidence interval: 0.031-0.094).

CONCLUSIONS

Functional limitation partially mediated the relationship between DSI and depressive symptoms among Chinese older adults. Interventions of DSI and functional limitation should be included in depressive symptoms prevention among older adults in China.

Social capital, perceived neighborhood environment, and depressive symptoms among older adults in rural China: the role of self-rated health

OBJECTIVES

This study examined the relationships between social capital, perceived neighborhood environment, and depressive symptoms among older adults living in rural China, and the moderating effect of self-rated health (SRH) in these relationships.

PARTICIPANTS

A quota sampling method was applied to recruit 447 participants aged 60 years and older in rural communities in Jilin province, China in 2019.

MEASUREMENTS

Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale. Structural equation modeling was used to build latent constructs of social capital and test the proposed model. Multiple group analysis was used to test the moderation effects.

RESULTS

Cognitive social capital and structural social capital were both associated with depressive symptoms controlling for participants' demographics, socioeconomic status, and health status. After adding perceived environment variables in the model, the relationship between cognitive social capital and depressive symptoms became nonsignificant, while structural social capital remained became a significant factor (β = -.168, p < .01). Satisfaction with health care was significantly associated with depressive symptoms among those with poor SRH (β = -.272, p < .01), whereas satisfaction with security and transportation were strongly associated with depressive symptoms among those with good SRH (security: β = -.148, p < .01; transportation: β = -.174, p < .01).

CONCLUSIONS

Study findings highlighted the importance of social capital and neighborhood environment as potential protective factors of depressive symptoms in later life. Policy and intervention implications were also discussed.

The role of community factors in predicting depressive symptoms among Chinese workforce: a longitudinal study in rural and urban settings

Background

The dual urban–rural division system in China has led to distinguishes in economic development, medical services, and education as well as in mental health disparities. This study examined whether community factors (community cohesion, supportive network size, foreseeable community threat, and medical insurance coverage) predict the depressive symptoms of Chinese workers and how community factors may work differently in rural and urban settings.

Methods

This secondary data analysis was conducted using data from the 2014 and 2016 China Labor-force Dynamics Survey (CLDS). The sample of this study includes 9,140 workers (6,157 rural labors and 2,983 urban labors) who took part in both the 2014 and 2016 CLDS. This study discusses the relation between community factors and depressive symptoms of Chinese workers by correlation analysis and regression analysis. All analyses were conducted using SPSS 24.0.

Results

The results indicate that rural workers have higher levels of depressive symptoms than urban workers. Medical benefits coverage predicts depressive symptoms of rural workforces (B = -0.343, 95%CI = -0.695 ~ 0.009, p < . 10), and community supportive network size predicts depressive symptoms of urban workforces (B = -.539, 95%CI = -0.842 ~ 0.236, p < . 01).

Conclusions

Policymakers may address depressive symptoms of rural labor through improved coverage of medical benefits. In urban areas, efforts can be made to strengthen community supportive network for the urban labor force.

The influence mechanism of community-built environment on the health of older adults: from the perspective of low-income groups

BACKGROUND

With the rapid development of population ageing, the international community has been paying more attention to the health problems of older adults and the age-friendly community. But there has not been enough discussion about the internal mechanism of the community-built environment that influences the health of older adults. The aim of our study was to explore the complex relationships among community-built environment, social participation, outdoor exercise, and health of older adults, as well as the differences among older adults in different income groups, particular attention was paid to the situation of low-income group.

METHODS

This study used descriptive statistical analysis and structural equation Modeling (SEM) to make a group comparison among older adults in different income groups. The data of this study came from a sample survey in Shanghai, China.

RESULTS

The study found that health difference exists among older adults in China: the lower the income, the worse the community-built environment, the worse the health. The community-built environment had an important impact on the health of older adults, especially the low-income older adults. And the community-built environment influenced the health of older adults through the intermediary role of outdoor exercise and social participation. Furthermore, the lower the income level of older adults, the stronger the direct effect of the community-built environment on their health; the higher the income level of older adults, the stronger the mediating effect of outdoor exercise and social participation on the impact of the community-built environment on their health.

CONCLUSION

Governments should pay more attention to the health and living conditions of low-income older adults and take proactive steps to help them. Community design and construction should pay more attention to the demands of low-income older adult groups, which will help to improve the health inequality of older adults, consequently enhancing older adults' overall health.

Understanding the longitudinal dynamics of rural-urban mental health disparities in later life in China

OBJECTIVES

Understanding longitudinal patterns of rural-urban mental health disparities is vital for effective intervention and policy development in China. However, few studies have estimated separate effects of birth-cohort and ageing and examined the role of community resources on health inequalities.

METHODS

Drawing data from the China Health and Retirement Longitudinal Study (2011-2018), this study employed multilevel modelling to identify the mental health trajectories of rural, peri-urban, urban older adults by cohort and the community effects.

RESULTS

The changes in the mental health gap between rural, peri-urban and urban older adults over time varied by birth cohorts. Among younger cohorts aged under 65, the mental health disparities between rural, peri-urban and urban residents increased as they got older. Underdeveloped community infrastructure greatly explained the rural health disadvantage.

CONCLUSION

The study indicates increasing rural-urban health disparities at the onset of later life. Improving community infrastructure in rural and peri-urban areas is vital to minimise rural-urban health gaps.

Neighborhood Environment and Depressive Symptoms among Chinese Older Immigrants in the U.S.: The Mediation Effects of Coping Resources

BACKGROUND AND OBJECTIVES

Studies have shown that neighborhood environment shapes older Americans' aging experience and health. However, it remains largely unknown whether and how neighborhood environment influences the wellbeing of older Asian Immigrants. Guided by the neighborhood stress process model, this study aims to investigate 1) the associations between neighborhood environmental stressors and depression among Chinese older immigrants, and 2) the potential mediation effects of intrapersonal (sense of mastery, sense of hopefulness) and interpersonal coping (social engagement) resources in such associations.

RESEARCH DESIGN AND METHODS

This study analyzed data collected from 2,801 Chinese older immigrants in the greater Chicago area. Structural equation modeling (SEM) with bootstrap resampling was used to fit path models on neighborhood environmental stressor, intra- and interpersonal coping resources, and depression.

RESULTS

Findings showed that neighborhood social disintegration and physical disorder were associated with more depressive symptoms directly and indirectly via lower intra- and inter-personal coping resources. Specifically, older immigrants living in neighborhoods with greater social disintegration reported lower sense of mastery and social engagement, which in turn were associated with more depressive symptoms (partial mediation). Older immigrants living in neighborhoods with greater physical disorder reported lower sense of hopefulness and mastery, which subsequently were associated with more depressive symptoms (full mediation).

DISCUSSION AND IMPLICATIONS

The findings showed that neighborhood environmental stressors are risk factors for mental health of older Chinese immigrants and coping resources may serve as pathways of the associations. The implications for future research and practice were discussed.

Province- and Individual-Level Influential Factors of Depression: Multilevel Cross-Provinces Comparison in China

Rapid social change has given rise to a general increase in psychological pressure, which has led to more and more Chinese people suffering from depression over the past 30 years. Depression was influenced not only by individual factors but also by social factors, such as economy, culture, politics, etc. These social factors were measured at the national, provincial, or community levels. However, little literature reported the influence of province-level factors on the depression of Chinese. This study examined the effects of province-level and individual-level factors on depression of Chinese respondents aged 16–97 years. We conducted a multilevel analysis of the 2018 wave survey of the Chinese Family Panel Studies (CFPS), with 19,072 respondents nested within the 25 Chinese provinces. Data for the province-level were extracted from the National Bureau of Statistics of China, including three predictors: gross regional product (GRP) per capita, expenditure for social security and employment (ESSE), and rural and urban household income inequality. Depression was measured with the eight-item short version of the Center for Epidemiologic Studies Depression Scale (CES-D8). The study found that respondents who were female, 30–59 years, divorced or widowed, less educated, rural residents, less body mass index (BMI), or had lower household income tended to report higher levels of depressive symptoms. After adjustment for individual-level features, a significant effect of provinces still survived. The respondents who lived in a province with higher GRP, higher ESSE, or smaller rural and urban household income inequality reported lower depressive symptoms. Our results demonstrated that individual features did not fully explain depression. Economic and social factors appeared to impact depression and have to be considered when the government planned for improved public depression. Meanwhile, our research also provided a suggestion for the government of some provinces to investigate and improve depression.

The association between community-level socioeconomic status and depressive symptoms among middle-aged and older adults in China

BACKGROUND

There was little evidence concerning the association of community socioeconomic status (SES) and the cross-level interaction between community- and individual-level SES with depressive symptoms in China. This study aimed to investigate the association of community-level SES with depressive symptoms among Chinese middle-aged and older people and to examine whether individual-level SES moderates this relationship.

METHODS

Using data from the China Health and Retirement Longitudinal 2011-2018 Study, the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) short form was used to measure depressive symptoms in 35,546 Chinese individuals aged 45 years and older. Community SES was calculated as a sum of z scores of the average years of schooling and household income per capita, which were derived by aggregating the individual measures to the community level. Two-level hierarchical linear regression was used.

RESULTS

Community SES was negatively related to CES-D-10 scores (coef=-0.438). A 1-SD increase in individual SES was associated with lower CES-D-10 scores (coef=-0.490). The cross-level interaction on individual- and community-level SES was significantly associated with depressive symptoms, indicating that with the increase of individual-level SES, the effect of community-level SES on depression decreases. Stratified analyses observed robust associations of community SES with CES-D scores between urban and rural residents.

CONCLUSIONS

This study showed that individuals who live in lower-SES communities had more severe depressive symptoms, particularly individuals with low SES. Additional attention should be given to the community socioeconomic context of middle-aged and older adults with lower SES, which may be helpful to reduce SES inequalities in depressive symptoms in China.

Community welfare resources and late-life depression among older adults in Seoul: A multi-level analysis

OBJECTIVES

This study aimed to examine whether community welfare resources in neighborhoods (recreational facilities, healthcare access, and public welfare expenditure) are associated with late-life depression among older adults in Seoul, South Korea.

METHODS

Data for this study were obtained by merging two different data sources: the 2018 Seoul Elderly Survey for individual-level variables and publicly available administrative data for neighborhood-level variables. The sample included 3036 older adults (unweighted n = 3034) living in 25 neighborhoods (Gu) in Seoul. Multilevel regression models examined the effects of neighborhood-level variables on late-life depression while controlling for individual-level variables. We also explored the extent to which individual characteristics moderate the main effects of neighborhood characteristics on late-life depression.

RESULTS

The results indicated that recreational facilities, health care centers, and public welfare expenditure in the neighborhoods were associated with late-life depression among older adults beyond individuals' predisposing conditions. Also, the effects of recreational facilities and public welfare expenditure on depressive symptoms were larger for those with higher education level.

CONCLUSIONS

Older adults living in neighborhoods with more recreational facilities, more health care centers, and high public welfare expenditure were less likely to experience late-life depression. Of note is that the effects of neighborhoods' recreational facilities and public welfare expenditure varied by certain individual characteristics. Hence, local governments should introduce neighborhood-based health promotion policies to prevent depression among older adults. In doing so, local governments should also consider ways to improve access to community welfare resources for underprivileged older adults.

A Policy Framework for Producing Age-Friendly Communities from the Perspective of Production of Space

Given various hindrances in the macro context, how to efficiently develop age-friendly community policies requires further research. Currently, such kinds of frameworks are lacking. This paper aims to develop a policy framework to minimise cost and resolve conflict of interest between different generations in age-friendly community development. The study adopted a scientometric method to review the theoretical development of age-friendly community studies. Firstly, with a search for the keywords "age-friendly" and "community" on Web of Science, 72 English academic papers were found containing explicit theories. Most of the studies were conducted in the Global North. Then, a mixed analytical method was used to find a suitable theory, "the production of space", to develop the policy framework. Lastly, a policy framework was developed to overcome barriers to age-friendly community development strategically. Echoing previous studies, this paper proposes a way to counter financial austerity in age-friendly initiative investment and balance the consideration for older and younger populations in urban development. For practice, the policy framework can provide a reference for more efficient age-friendly community policymaking in different regions. For future research, the framework provides a model for more empirical studies considering the social dynamics in age-friendly community development.

Association between community environment and depressive symptoms among Chinese middle-aged and older adults: evidence from national longitudinal surveys from 2011 to 2018

BACKGROUND

Despite the growing evidence on the relationship between community environment and depressive symptoms, little is known about the longitudinal relationship in older adults. This study aimed to examine the longitudinal association between community environment and depressive symptoms based on a nationally representative survey among Chinese middle-aged and older adults.

METHODS

A total of 6872 participants from the latest four waves (2011, 2013, 2015 and 2018) of China Health and Retirement Longitudinal Study were included. The Centre for Epidemiologic Studies Depression scale was used to measure depressive symptoms, and Cox proportional hazards regression models were conducted to investigate the longitudinal association between community environment and depressive symptoms after adjusting included covariates.

RESULTS

Both community infrastructure and organisations were significantly associated with depression, and infrastructure was associated with higher risk reduction in depression (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.66-0.89). Furthermore, we estimated the heterogeneous effects of community infrastructure and organisations for vulnerable populations. Additionally, family-based elder-care centre (HR, 0.63; 95% CI, 0.46-0.86) and outdoor exercise facilities (HR, 0.76; 95% CI, 0.68-0.84) were found as significant correlates associated with lower depressive symptom risk.

CONCLUSIONS

Our findings indicated that targeted and specific measures should be taken to improve the construction of community infrastructure and strengthen the role of community organisations. Specifically, providing a family-based elder-care centre and establishing outdoor exercise facilities might be effective methods to reduce the risk of depression and relieve related public health burdens among Chinese middle-aged and older adults.

Neighborhood Social Cohesion and the Health of Native Hawaiian and Other Pacific Islander Older Adults

Native Hawaiian and other Pacific Islander (NHPI) older adults experience various social and health challenges. There is a growing literature linking neighborhood conditions with health, yet few have focused on NHPI older adults. This study examines associations between neighborhood social cohesion and health outcomes (i.e., self-rated health, psychological distress, and memory) in this population. Data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (n=1,045 with respondents aged 50+) were analyzed with logistic regression models. The level of neighborhood social cohesion was determined by responses to items on perceptions of mutual help, dependability, trust, and close relationships within the neighborhood. Higher perceived neighborhood social cohesion was associated with lower odds of having serious psychological distress or memory problems. There was no statistical association of social cohesion with self-rated health. Socially cohesive neighborhoods are important to the health of NHPI. We discuss methods to improve neighborhood social cohesion as a way to promote health equity for NHPI older adults in the United States (U.S.).

Impact of Internet Use on Mental Health among Elderly Individuals: A Difference-in-Differences Study Based on 2016-2018 CFPS Data

The number of elderly Internet users has increased significantly in the past few years. However, the impact of Internet use on mental health remains unclear. In this study, we performed a difference-in-differences analysis using data from the 2016 and 2018 waves of the China Family Panel Studies (CFPS) to evaluate the impact of Internet usage on mental health among elderly individuals. A total of 5031 validated respondents were included to explore the relationship between Internet use and reduced levels of depression as well as improved life satisfaction among elderly individuals. The results showed that Internet use significantly reduced depression levels. Unexpectedly, Internet use was not found to improve life satisfaction. Moreover, discontinuing Internet use was not significantly associated with improvements in depression or life satisfaction. More research is needed to fully elucidate the relationship between Internet use and depression levels, as well as life satisfaction among elderly individuals.

Fatigue, Depression, Cardiovascular Risk, and Self-Rated Health: Comparing a Community Sample of Adults to Those With a History of Myocardial Infarction

This cross-sectional descriptive study was designed to compare fatigue, depression, cardiovascular risk, and self-rated health in community dwelling adults (CDA) without a history of myocardial infarction (MI) compared to adults who had experienced an MI 3 to 7 years ago. A convenience sample (n = 40) of CDA completed: demographic health form, Revised Piper Fatigue Scale, and CES-D. Age-matched controls (n = 40) were randomly selected from the Recurrence of Myocardial Infarction (ROMI) study. Most (N = 80) were White (66%) with a mean age of 58.3 (SD = 11.5; range 21-83). The ROMI group reported more diabetes, hypercholesterolemia, obesity, and hypertension, and had higher fatigue (t(61) = 4.51, p < .001). No differences were noted in depression scores (p = .952). Higher fatigue and depression scores were correlated with poorer self-rated health: r = .544 (p < .001) and r = .295 (p = .008).

Differences in depressive symptoms by rurality in Japan: a cross-sectional multilevel study using different aggregation units of municipalities and neighborhoods (JAGES)

Background

Rurality can reflect many aspects of the community, including community characteristics that may be associated with mental health. In this study, we focused on geographical units to address multiple layers of a rural environment. By evaluating rurality at both the municipality and neighborhood (i.e., a smaller unit within a municipality) levels in Japan, we aimed to elucidate the relationship between depression and rurality. To explore the mechanisms linking rurality and depression, we examined how the association between rurality and depression can be explained by community social capital according to geographical units.

Methods

We used cross-sectional data from the 2016 wave of the Japan Gerontological Evaluation Study involving 144,822 respondents aged 65 years or older residing in 937 neighborhoods across 39 municipalities. The population density quintile for municipality-level rurality and the quintile for the time required to reach densely inhabited districts for neighborhood-level rurality were used. We calculated the prevalence ratios of depressive symptoms by gender using a three-level (individual, neighborhood, and municipality) Poisson regression. Community social capital was assessed using three components: civic participation, social cohesion, and reciprocity.

Results

The prevalence of depressive symptoms was higher in municipalities with lower population density than those with the highest population density; the ratios were 1.22 (95% confidence intervals: 1.15, 1.30) for men and 1.22 (1.13, 1.31) for women. In contrast, when evaluating rurality at the neighborhood level, the prevalence of depressive symptoms was 0.9 times lower for men in rural areas; no such association was observed for women. In rural municipalities, community civic participation was associated with an increased risk of depressive symptoms. In rural neighborhoods, community social cohesion and reciprocity were linked to a lower risk of depressive symptoms.

Conclusions

The association between rurality and depression varied according to geographical unit. In rural municipalities, the risk of depression may be higher for both men and women, and the presence of an environment conducive to civic participation may contribute to a higher risk of depression, as observed in this study. The risk of depression in men may be lower in rural neighborhoods in Japan, which may be related to high social cohesion and reciprocity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12942-021-00296-8.

Prevalence of depressive symptoms and its related factors among China's older adults in 2016

BACKGROUND

Depression seriously threatens Chinese elderly. This study analysis the prevalence of depressive symptoms (DS) and its related factors among China's aging population.

METHODS

All participants were from the PINDEC project. Multi-stage clustered sampling was conducted. A total of 20,019 participants aged 60 or above completed the DS screening in 2016, and among them, 19,420 were taken into analysis. Univariate and multivariate logistic regression analysis were performed to explore the related factors of DS.

RESULTS

Of the 19,420 adults, 9,444 were male (48.63%) and 9,976 were female (51.37%). The prevalence of DS was 15.94%. The risk factors of DS were: female gender (OR=1.198, 1.097-1.308), daily alcohol consumption (OR=1.480, 1.284-1.705), disturbed sleep (OR=1.864, 1.716-2.024), chronic diseases (OR=1.214, 1.181-1.249), greater age (OR=1.012, 1.077-1.018), impaired cognition (OR=2.567,2.202-2.993), poor ADL performance (OR=1.545, 1.380-1.729), and insufficient social communication (OR=1.241, 1.134-1.358). Protective factors of DS included: higher education level, greater BMI (OR=0.986, 0.975-0.997), living in urban areas (OR=0.677, 0.611-0.749), and leisure activities such as playing cards or mahjong (OR=0.816, 0.730-0.912). For the DS risk factors, multiplicative interaction was found between cognition and ADL performance, in addition to cognition and social communication.

LIMITATIONS

Causality cannot be drawn from this cross-sectional survey. And the elderly who were looked after by nannies or living in nursing homes were not taken into analysis.

CONCLUSIONS

DS is prevalent among older adults in China. It is recommended that periodic screening for DS should be conducted for elderly individuals. Furthermore, it is suggested that the elderly adopt healthy lifestyles to prevent DS.

Effect of income inequality, community infrastructure and individual stressors on adult depression

This paper considers the impact of variables at three different levels-city, community and individual-on the depression of adults aged 45 years and above in China. Evidence shows that community factors, such as infrastructure and elderly centres, are critical to reduce depression but the effect of city-level factors such as lowering income inequality and improving public health investment is different for the segments of poor and non-poor as well as the rural and urban residents. This highlights the need to consider targeted policy mix options to avoid resource misallocation. Lastly, Chinese females' depression has worsened over time with ageing, particularly those who drink alcohol or are less educated are prone to depression prompting the need for specialist women health centres.

"They're not leaving their home; this is where they were born, this is where they will die.": Key Informant Perspectives From the U.S. Counties With the Greatest Concentration of the Oldest Old

The "oldest old," age 85 and older, constitute one of the fastest growing segments of the U.S. population. Yet, surprisingly little is known about the characteristics of U.S. counties with the highest percentage of the oldest old, nearly all of which are rural. We used qualitative analysis of key informant interviews (n = 50) with county commissioners and other county-level representatives from rural counties with the highest prevalence of the oldest old, targeting the 54 rural counties with ≥5% of the population age 85+. We found that the rural counties with the highest proportion of residents age 85+ face unique challenges to supporting successful aging among the oldest old, including resource constraints, limited services, isolated locations, and widespread service areas. Still, interviewees identified particular reasons why the oldest old remain in their counties, with many highlighting positive aspects of rural environments and community.

The Relationship among Community Environment, Behavior, Activity Ability, and Self-Rated Health of Older Adults: A Hierarchical and Multi-Dimensional Comparative Study

Although the community environment is a known determinant of older adults’ health, it is unclear about the logical relationships among the community environment, behavior, activity ability, and health of older adults, and the differences between the different age groups. This study used a two-stage sampling method to conduct a household survey of people over 60 years old living in Xinhua Street, Shanghai, China. In total, 2783 valid samples were obtained. Of these, 1256 were males and 1627 were females, with an average age of 71.1 years. The statistical method used in this study was the structural equation modeling method. The effects of the community environment and behavior on the activity ability and self-rated health of older adults are different, and the path of health influence of older adults is different in different age groups. Community environment has more wider effects on older adults’ self-rated health, while behavior, including walking behavior and neighbor contacts, have a more intensive effect on the activity ability of older adults. The community environment has a significant positive effect on the activity ability of the younger group but not on that of the older group, which instead was significantly affected by the neighbor contacts. Therefore, refined environmental governance and targeted improvement and resolution of different types of health problems among different groups of older persons will contribute to the overall health of older adults.

Exploring the role of built environments and depressive symptoms in community-dwelling older adults: A case of Taiwan

OBJECTIVES

Depression in older adults is a growing public health concern. However, limited research has focused on the issues of physical environments and depression in the elderly in Asia. The purpose of the study is to examine the relationship between the built environments and depressive symptoms in older adults using Taiwan as an example.

METHODS

Two national datasets were used in this study, including the 2009 National Health Interview Survey and the 2006 National Land Use Investigation in Taiwan. A total of 2,155 older adults were recruited, and eight built environments were examined among 161 townships. Depressive symptoms were measured using a 10-item CES-D scale, and four sophisticated models were built using a multi-level analysis.

RESULTS

Five types of built environments were found to be significantly associated with depressive symptoms in older adults. Among them, two types of built environments, 'health and medical services' and 'schools' were highly related to a lower CES-D score and lower odds of being depressed, whereas the other three built environments, 'cultural and historical facilities,' 'recreational and amusement areas,' and 'playgrounds and sports venues' were significantly associated with an increasing risk of being depressed.

CONCLUSIONS

Different built environments had different effects on depression and some even showed a dose-response relationship. These results can help urban planners or city designers reconsider how to facilitate the construction of built environments in neighborhoods that will improve the mental health of older adults.

Longitudinal associations between neighbourhood physical environments and depressive symptoms of older adults in Hong Kong: The moderating effects of terrain slope and declining functional abilities

Little is known about the accumulative impacts of neighbourhood physical environments on older adults' depressive symptoms over time. Based on a cohort study of 2081 older adults in Hong Kong, this study examined longitudinal relationships between neighbourhood physical environments and depressive symptoms among older adults, with a particular focus on the moderating effects of terrain slope and individual functional ability using latent growth curve modelling. Results indicated that the availability of community centres and passive leisure facilities reduced depressive symptoms over time. The protective effects of residential surrounding greenness on depressive symptoms among older adults differed by the terrain slope types. Longitudinal associations between neighbourhood physical environments and depressive symptoms varied between older adults with and without functional limitations. This study has implications for the Ecological Theory of Ageing by identifying the dynamic interplay of environment demands and individual functional ability. Planning policies for building age-friendly neighbourhoods are discussed.

Age-friendly neighbourhoods and depression among older people in China: Evidence from China Family Panel Studies

BACKGROUND

Older population with depression symptoms reached about 64 million in China. Under the World Health Organization's (WHO) age-friendly communities framework, this study explored relationships between neighbourhood environment characteristics and depressive symptoms among community-dwelling older adults in China.

METHODS

Data were obtained from the China Family Panel Studies (CFPS), a national multi-stage probability sample in China. The final analytic sample comprised 5,641 older adults in China. Neighbourhood environment characteristics were measured in three ways: objective facilities, interviewers' evaluation, and respondents' own perceptions on the neighbourhood environment. Depressive symptoms were measured by the 20-item version of the Center for Epidemiologic Studies Depression Scale (CES-D). Multilevel regression models were applied.

RESULTS

Neighbourhoods with more exercise and recreational facilities, better interviewers' evaluations, and better objective respondents' perceptions on neighbourhood environment at a neighbourhood level were significantly negatively associated with depressive symptoms, but these association were influenced by respondents' demographic characteristics, socioeconomic status and respondents' own perceptions of neighbourhood environment at the individual level. On the other hand, respondents' subjective positive perceptions of neighbourhood environment at the individual level were also significantly negatively associated with depressive symptoms.

LIMITATIONS

The actual conditions of affordability, accessibility and utilization of public facilities and social services within neighbourhoods were not known.

CONCLUSIONS

This research extended the current knowledge of the associations between neighbourhoods and mental health among older adults, to promote ageing in place in China. Great importance should be attached to the improvement of both physical and social aspects of the neighbourhoods to develop age-friendly communities.

Neighborhood Effects on the Health of Chinese Older Adults: Beyond the Rural and Urban Dichotomy

BACKGROUND AND OBJECTIVES

The associations between physical frailty and depressive symptoms among older individuals were established in the existing literature. Taking the person-environment perspective, we argue that neighborhood environment could either buffer the stress derived from being physically vulnerable or worsen it by adding another layer of stressors in the environmental context when physical health declined. The objectives of this study were to explore to what extent the neighborhood-level characteristics moderate the relationship between physical frailty and depressive symptoms.

RESEARCH DESIGN AND METHODS

Using the China Health and Retirement Longitudinal Study 2011 wave, 6,245 individuals aged 60 years and older were included for analyses. Multilevel mixed-effects models were fitted to examine the moderating effects of urbanicity and neighborhood-level socioeconomic status (SES) on the relationship between frailty and depressive symptoms among older adults, controlling for individual-level characteristics.

RESULTS

Results showed a stronger relationship between deterioration in physical health and depressive symptoms in rural neighborhoods and neighborhoods with lower SES, after controlling for individual-level SES. Also, the moderating effects of the neighborhood-level socioeconomic factors remained after controlling for urbanicity, indicating that neighborhood SES works beyond the rural-urban contexts.

DISCUSSION AND IMPLICATIONS

Findings from this study demonstrate the important roles of neighborhood socioeconomic characteristics in reshaping, and the need to redefine, China's rural-urban dichotomy. The findings also identified neighborhoods with low SES as potential targets for policy and practice to reduce the stress associated with health decline.

Neighborhood Environment, Internet Use and Mental Distress among Older Adults: The Case of Shanghai, China

As the Internet evolves in urban communities, its consequences on mental distress have drawn significant research attention. We examine the relationships of mental distress with neighborhood environment and Internet use among older adults, using data from a representative sample of 2036 adults aged older than 60 years in Shanghai, China. We assess mental health with a 10-item scale from the Symptom Checklist 90 and Internet use with a 4-item scale and obtain information of neighborhood environment from an online map platform. Results from multilevel models show that both neighborhood environment and Internet use are significantly related to mental distress. Moreover, a worse neighborhood environment may strengthen the correlation between Internet use and mental distress, indicating the strong moderating role of the neighborhood environment. Thus, promoting Internet use among elderly people might result in a reduction in the prevalence of mental distress in disadvantaged neighborhoods.

From Traditional and Socialist Work-Unit Communities to Commercial Housing: The Association between Neighborhood Types and Adult Health in Urban China

The urban structure in China has been transformed profoundly through rounds of economic reforms. Over the past 60 years, various types of neighborhoods have emerged at different stages of economic and social transition. Formed and organized in different ways, these neighborhoods provide distinct economic, social, and physical environments to residents. However, little is known about the link between neighborhood types and the health of residents in urban China. Using longitudinal data from the China Labor-Force Dynamics Survey (2012-2014), we estimate multilevel regression models to predict self-rated health (SRH) while controlling for a lagged measure of SRH. Results show that living in traditional communities in old districts and work-unit compounds for state-owned enterprises is associated with better SRH among older adults (≥50 years old) compared with living in other types of neighborhoods, such as commercial-housing communities and migrant enclaves. Neighborhood types do not matter for the health of younger adults (< 50 years old). Neighborhood water quality and distance to facilities are associated with SRH for older adults but do not account for the relationships between neighborhood types and SRH.

Age Differences in the Influence of Residential Environment and Behavior on the Life Quality of Older Adults: The Transfer from Physical-Environment to Social-Behavior

With the development of the concept of “ageing-friendly communities”, increasing attention has been paid to the effect of residential environments on the life quality of older adults. However, the logical relationship between residential environment, individual behavior and life quality of older adults has not been clearly revealed. Based on data in Shanghai, China, this study explored the relationships between residential environments and the life quality of older adults in different age groups, and analyzed the mediating role of individual behaviors (neighborhood interaction and outdoor exercise). The findings confirmed that residential environment, neighborhood interactions and outdoor exercise have significant positive effects on the life quality of older adults. Meanwhile, the impact of residential environment on the life quality of older adults is exclusively realized through the mediating role of individual behavior. However, there were significant differences in the model paths among various age groups. With ageing, the positive effects of residential environment on the quality of life gradually weakened, while that of neighborhood interaction gradually improved. The findings prove that the influencing factors on the quality of life of older adults tend to shift from residential environment to neighborhood interaction as the age of residents advances. This knowledge is crucial with regard to the differentiated and accurate design of older communities.

Impact of Different Type and Frequency of Social Participation on Depressive Symptoms Among Older Chinese Adults: Is There a Gender Difference?

Objectives: Social participation may prevent depressive symptoms in older adults. But research to date ignores gender differences in the associations between social participation and depressive symptoms. The purpose of this study was to determine the effect of different type and frequency of social participation on depressive symptoms, as well as if there is a gender difference in these correlations among older Chinese adults. Methods: Data was obtained from adults aged 60 years or above in the 2018 China Health and Retirement Longitudinal Survey, a nationally representative sample of older adults in China. Depressive symptoms were measured using CESD-10. Social participation included participation in social groups, hobby groups, sports groups, and community-related organizations. The independent relationships between each type of social participation and depressive symptoms were assessed using multiple linear regression models. Results: A total of 6,287 older adults were included in this analysis, of whom 49.69% were women. Participating in social groups, sports groups, and community-related organizations with a frequency of one or more per week was all linked to better mental health. Furthermore, our findings suggest that the positive relationship between participation in social groups, hobby groups, and community-related organizations and depressive symptoms is more flexible for older men than for women. Conclusions: Older individuals who participate in social participation at a high frequency may have better mental health. The findings provide novel insights into mental health from the standpoint of social participation in older adults. Gender differences in the associations between social participation and depressive symptoms need to be considered when formulating interventions to prevent depression.

Neighborhood Characteristics and Frailty: A Scoping Review

BACKGROUND AND OBJECTIVES

Frailty is highly prevalent in later life and associated with early mortality and adverse health outcomes. The neighborhood has been identified as an important contributor to individual health, and neighborhood characteristics may contribute to frailty development. A scoping review was conducted of the peer-reviewed literature to better understand how physical and social neighborhood characteristics contribute to frailty.

RESEARCH DESIGN AND METHODS

Following an established scoping review methodology, we searched four peer-reviewed databases for relevant studies published from January 1, 2008, to December 31, 2018. Data extracted from studies included study characteristics, operationalization of neighborhood, the conceptual model of the neighborhood-frailty relationship, operationalization of frailty, and study findings for associations among neighborhood variables and frailty indicators.

RESULTS

A total of 522 articles were identified and 13 articles were included in the final data charting. Existing studies suggest that neighborhood characteristics are associated with frailty in later life. Few studies articulated a conceptual model identifying exact mechanisms through which neighborhood factors affected frailty. Studies designs were mostly cross-sectional. Longitudinal studies did not measure neighborhood characteristics over time. Studies varied considerably in how they operationalized the neighborhood. Frailty was most commonly assessed using a 5-point phenotype or a frailty index approach.

DISCUSSION AND IMPLICATIONS

Findings indicate that research on the relationship between neighborhood characteristics and frailty is an emerging area of inquiry. Additional studies are needed to more definitely explicate mechanisms through which neighborhoods contribute to, or protect older adults from, frailty.

Heterogeneity in the trajectories of depressive symptoms among elderly adults in rural China: The role of housing characteristics

Depression among older adults in rural areas, a multiply disadvantaged group, has become a severe public health issue in China. Few studies, however, examine the role of rural living conditions as a potential risk factor for depression. This study uses panel data from CHARLS, a Chinese population-based longitudinal study, and employs growth mixture modeling to examine the association between rural housing characteristics and the heterogeneous pattern of depression trajectories among elderly adults in rural areas. The results suggest that there is heterogeneity in elderly people's depression and that stably living in multifloor and high-quality houses is associated with a higher probability of being in the stably low-depression trajectory class.

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

Objective: This study examines the interplay among living arrangements, social networks, and depressive symptoms among Chinese older adults.Methods: Data are derived from the 2014 baseline survey of the China Longitudinal Aging Social Survey (CLASS), which provides a sample of older Chinese who had been married and had children (N = 7,662). This study examines the association between living arrangements and depressive symptoms (measured as CES-D scale, 0-18) of older adults, and addresses the moderating role of social networks (measured as family ties and friendship ties, 0-15) on this perceived association.Results: Our results show that older adults who live both with a spouse and adult children report superior mental health than those living alone (β = 1.240, p < 0.001), but no differences are seen from those living only with a spouse or children. Older adults living alone in rural areas are also more disadvantaged in comparison to those living alone in urban places (β = 0.535, p < 0.05). However, we find that the undesirable consequences associated with depression of older adults living alone can be reduced or even eliminated when older adults have strong friendship ties in rural China (β = -0.145, p < 0.01). We also find that for rural older adults living only with children, their mental health is highly contingent on their family ties, that is, they are extremely disadvantaged when having weak family ties, but benefit most significantly from strong family ties (β = -0.137, p < 0.05).Conclusions: Associations between living arrangements and mental health in later life are contingent on older adults' social networks, and these moderating effects vary between rural and urban China.

Association of Sensory Impairments With Cognitive Decline and Depression Among Older Adults in China

IMPORTANCE

Sensory impairments may heighten the risk of premature brain aging. Little is known regarding the association of sensory impairments with cognitive function and depression in China.

OBJECTIVE

To examine the association of visual and/or hearing impairments with cognitive decline and depression.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used the data from 18 038 respondents to the 2015 survey of the China Health and Retirement Longitudinal Study, a nationally representative survey of adults aged 45 years or older and their spouses.

EXPOSURES

The presence of sensory impairments was identified by self-reported assessment of visual and/or hearing functions.

MAIN OUTCOMES AND MEASURES

Overall, 3 composite measures were used to assess the respondents' cognitive performance, including episodic memory, mental intactness, and global cognitive function. Depression was examined using the 10-item Center for Epidemiological Studies-Depression scale score. Multiple generalized linear regression models, adjusting for self-reported sociodemographic characteristics, health behaviors, chronic conditions, and participants' overall health, were used.

RESULTS

Of 18 038 respondents, 9244 (51.2%) were women. The mean (SD) age was 59.9 (9.7) years. Respondents with visual impairment had poorer episodic memory (β = -0.12; 95% CI, -0.19 to -0.05) and global cognition (β = -0.16; 95% CI, -0.31 to -0.02) and a greater risk of depression (odds ratio, 1.78; 95% CI, 1.59 to 1.99) than those without visual impairment. Respondents with hearing impairment had poorer episodic memory (β = -0.24; 95% CI, -0.30 to -0.18), mental intactness (β = -0.19; 95% CI, -0.28 to -0.10), and global cognition (β = -0.43; 95% CI, -0.55 to -0.31) as well as a greater risk of depression (odds ratio, 1.57; 95% CI, 1.44 to 1.70) than those without hearing impairment. People who reported dual sensory impairment performed worse on all of the aforementioned outcome measures (episodic memory: β = -0.23; 95% CI, -0.31 to -0.14; mental intactness: β = -0.13; 95% CI, -0.27 to -0.0003; global cognition: β = -0.37; 95% CI, -0.55 to -0.19; depression: odds ratio, 2.19; 95% CI, 1.90 to 2.52).

CONCLUSIONS AND RELEVANCE

In this study, visual and hearing impairments were independently and together associated with poorer cognitive and depression outcomes. A more comprehensive and integrated system of care, covering vision, hearing, and cognition, is needed in China's health care system to address age-related sensory impairments.

Viewing an alpine environment positively affects emotional analytics in patients with somatoform, depressive and anxiety disorders as well as in healthy controls

BACKGROUND

Patients with somatoform, depressive or anxiety disorders often don't respond well to medical treatment and experience many side effects. It is thus of clinical relevance to identify alternative, scientifically based, treatments. Our approach is based on the recent evidence that urbanicity has been shown to be associated with an increased risk for mental disorders. Conversely, green and blue environments show a dose-dependent beneficial impact on mental health.

METHODS

Here we evaluate the effect of viewing stimuli of individuals in an alpine environment on emotional analytics in 183 patients with psychiatric disorders (mostly somatoform, depressive and anxiety disorders) and 315 healthy controls (HC). Emotional analytics (valence: unhappy vs happy, arousal: calm vs excited, dominance: controlled vs in control) were assessed using the Self-Assessment Manikin. Further parameters related to mental health and physical activity were recorded.

RESULTS

Emotional analytics of patients indicated that they felt less happy, less in control and had higher levels of arousal than HC when viewing neutral stimuli. The comparison alpine>neutral stimuli showed a significant positive effect of alpine stimuli on emotional analytics in both groups. Patients and HC both felt attracted to the scenes displayed in the alpine stimuli. Emotional analytics correlated positively with resilience and inversely with perceived stress.

CONCLUSIONS

Preventive and therapeutic programs for patients with somatoform, depressive and anxiety disorders should consider taking the benefits of natural outdoor environments, such as alpine environments, into account. Organizational barriers which are preventing the implementation of such programs in clinical practice need to be identified and addressed.

Trajectories of rural-urban disparities in biological risks for cardiovascular disease among Chinese middle-aged and older adults

This study examined rural-urban differences in age trajectories of biological risks for cardiovascular disease (CVD) among Chinese middle-aged and older adults. Data were from the 2011 wave of China Health and Retirement Longitudinal Study, including 11,528 respondents (M_age = 59.15) from 440 communities. CVD risk factors included C-reactive protein (CRP), high-density lipoprotein (HDL), body mass index (BMI), and waist circumference (WC). Multilevel models revealed that rural adults had higher levels of HDL and lower levels of CRP and BMI on average, compared to urban adults. We also found significant rural-urban differences in the age trajectories of CVD risks. Rural-urban disparities in CVD risks increased from middle to later life, and converged at later old age. Findings suggest that rural-urban differences in cardiovascular health are not static, but rather vary throughout adulthood.