Improvement of social support in empty-nest elderly: results from an intervention study based on the Self-Mutual-Group model

Health inequality of rural-to-urban migrant workers in eastern China and its decomposition: a comparative cross-sectional study

Objectives

As a specific group with high health inequality, it is crucial to improve the health status and health inequalities of rural-to-urban migrant workers. This study aimed to evaluate the health inequality of migrant and urban workers in China and decompose it.

Methods

A cross-sectional study was carried out, using a standardized questionnaire to obtain basic information, self-rated health to evaluate health status, concentration index to measure health inequalities, and WDW decomposition to analyze the causes of health inequalities.

Results

The concentration index of health for migrants was 0.021 and 0.009 for urban workers. The main factors contributing to health inequality among rural-to-urban migrant workers included income, exercise, and age. In contrast, the main factors of health inequality among urban workers included income, the number of chronic diseases, social support, and education.

Conclusion

There were health inequalities in both rural-to-urban migrant and urban workers. The government and relevant authorities should formulate timely policies and take targeted measures to reduce income disparities among workers, thereby improving health inequality.

Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries

BACKGROUND

There is a significant research gap in the field of universal, selective, and indicated prevention interventions for mental health promotion and the prevention of mental disorders. Barriers to closing the research gap include scarcity of skilled human resources, large inequities in resource distribution and utilization, and stigma.

OBJECTIVES

To assess the effectiveness of delivery by primary workers of interventions for the promotion of mental health and universal prevention, and for the selective and indicated prevention of mental disorders or symptoms of mental illness in low- and middle-income countries (LMICs). To examine the impact of intervention delivery by primary workers on resource use and costs.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, Global Index Medicus, PsycInfo, WHO ICTRP, and ClinicalTrials.gov from inception to 29 November 2021.

SELECTION CRITERIA

Randomized controlled trials (RCTs) of primary-level and/or community health worker interventions for promoting mental health and/or preventing mental disorders versus any control conditions in adults and children in LMICs.

DATA COLLECTION AND ANALYSIS

Standardized mean differences (SMD) or mean differences (MD) were used for continuous outcomes, and risk ratios (RR) for dichotomous data, using a random-effects model. We analyzed data at 0 to 1, 1 to 6, and 7 to 24 months post-intervention. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥ 0.80 large clinical effects. We evaluated the risk of bias (RoB) using Cochrane RoB2.

MAIN RESULTS

Description of studies We identified 113 studies with 32,992 participants (97 RCTs, 19,570 participants in meta-analyses) for inclusion. Nineteen RCTs were conducted in low-income countries, 27 in low-middle-income countries, 2 in middle-income countries, 58 in upper-middle-income countries and 7 in mixed settings. Eighty-three RCTs included adults and 30 RCTs included children. Cadres of primary-level workers employed primary care health workers (38 studies), community workers (71 studies), both (2 studies), and not reported (2 studies). Interventions were universal prevention/promotion in 22 studies, selective in 36, and indicated prevention in 55 RCTs. Risk of bias The most common concerns over risk of bias were performance bias, attrition bias, and reporting bias. Intervention effects 'Probably', 'may', or 'uncertain' indicates 'moderate-', 'low-', or 'very low-'certainty evidence. *Certainty of the evidence (using GRADE) was assessed at 0 to 1 month post-intervention as specified in the review protocol. In the abstract, we did not report results for outcomes for which evidence was missing or very uncertain. Adults Promotion/universal prevention, compared to usual care: - probably slightly reduced anxiety symptoms (MD -0.14, 95% confidence interval (CI) -0.27 to -0.01; 1 trial, 158 participants) - may slightly reduce distress/PTSD symptoms (SMD -0.24, 95% CI -0.41 to -0.08; 4 trials, 722 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD -0.69, 95% CI -1.08 to -0.30; 4 trials, 223 participants) Indicated prevention, compared to usual care: - may reduce adverse events (1 trial, 547 participants) - probably slightly reduced functional impairment (SMD -0.12, 95% CI -0.39 to -0.15; 4 trials, 663 participants) Children Promotion/universal prevention, compared to usual care: - may improve the quality of life (SMD -0.25, 95% CI -0.39 to -0.11; 2 trials, 803 participants) - may reduce adverse events (1 trial, 694 participants) - may slightly reduce depressive symptoms (MD -3.04, 95% CI -6 to -0.08; 1 trial, 160 participants) - may slightly reduce anxiety symptoms (MD -2.27, 95% CI -3.13 to -1.41; 1 trial, 183 participants) Selective prevention, compared to usual care: - probably slightly reduced depressive symptoms (SMD 0, 95% CI -0.16 to -0.15; 2 trials, 638 participants) - may slightly reduce anxiety symptoms (MD 4.50, 95% CI -12.05 to 21.05; 1 trial, 28 participants) - probably slightly reduced distress/PTSD symptoms (MD -2.14, 95% CI -3.77 to -0.51; 1 trial, 159 participants) Indicated prevention, compared to usual care: - decreased slightly functional impairment (SMD -0.29, 95% CI -0.47 to -0.10; 2 trials, 448 participants) - decreased slightly depressive symptoms (SMD -0.18, 95% CI -0.32 to -0.04; 4 trials, 771 participants) - may slightly reduce distress/PTSD symptoms (SMD 0.24, 95% CI -1.28 to 1.76; 2 trials, 448 participants).

AUTHORS' CONCLUSIONS

The evidence indicated that prevention interventions delivered through primary workers - a form of task-shifting - may improve mental health outcomes. Certainty in the evidence was influenced by the risk of bias and by substantial levels of heterogeneity. A supportive network of infrastructure and research would enhance and reinforce this delivery modality across LMICs.

The Moderation Role of Neuroticism for Anxiety among Burdened Dementia Caregivers: A Study on Care Giver-Recipient Dyads

Caregiving burden proves to be a risk factor of anxiety disorders and anxiety affection. The current study investigates how an endogenous personality dimension - neuroticism - moderates the association between caregiving burden and anxiety affection. Between 2015 and 2017, the study deployed a cross-sectional survey of 674 (response rate = 89%) older adults who were hospitalized for dementia at two hospitals. From all primary caregivers of these patients, 661 agreed to participate in the survey which yielded 661 matched dyads as the final sample. Caregiving burden, neuroticism, and anxiety affection were each measured by established assessment instruments. We employed multivariate OLS regression to test the moderator and regressor effects. We found that care burden is a significant risk factor of higher levels of anxiety affection (β = .17, p < .001), and accounts for 4.6% of the variance in anxiety. Neurotic personality is also significantly associated with a greater level of anxiety (β = .26, p < .001). Neurotic personality moderates the association between anxiety and care burden (β = .24, p < .001). Our findings suggest that social and healthcare workers should assess caregiver personality and burden as well as provide support, resources, and coping strategies to those with neurotic personality traits or high care burden in an effort to reduce anxiety among caregivers.

Can leisure and entertainment lifestyle promote health among older people living alone in China?-A simultaneous equation approach

Objectives

With the surging number of older people living alone, their lifestyles and health status have aroused increasing concern. This study aims to investigate whether a leisure and entertainment lifestyle (LEL) can improve the multidimensional health among older people living alone and try to identify the latent mechanisms among them.

Method

For this purpose, we extracted data from the Chinese General Social Survey (CGSS) and established a simultaneous equations model, comprising ordinary least square regression (OLS), two-stage least squares (2SLS), and the mediating effect model.

Results

Older people living alone in China reported relatively better mental health status (3.64 ± 1.07), followed by physical health (3.41 ± 1.26) and social health (2.75 ± 1.18). In the OLS model, LEL significantly improved the social health of older people living alone (β = 0.054, P < 0.01), followed by physical health (β = 0.042, P < 0.01) and mental health (β = 0.027, P < 0.01). After endogenous tests from 2SLS model and robustness tests, we found that more active LEL was associated with higher levels of physical health and mental health. However, LEL had no significant effect on the improvement of the social health of the older people living alone. Using the mediation analysis, exercise efficacy partially mediated the relationship of LEL with physical health and mental health, and the ratios were 19.75 and 24.85%, respectively. Similarly, positive life attitudes partially mediated the relationship between LEL and physical health, and LEL and mental health, with ratios of 10.65 and 26.83%, respectively.

Conclusion

Our findings suggested that LEL is significantly associated with better physical and mental health for older people living alone in China, and the association is mediated by exercise efficacy and positive attitudes toward life. Promoting more leisure and recreational activities, upgrading exercise efficacy, and encouraging positive life attitudes are necessary health promotion measures in active aging policies for the wellbeing of older people living alone.

Social exclusion and health outcomes among empty nest and non-empty nest older people in China

Many existing studies lack a comprehensive picture of the social exclusion statuses and health outcomes of empty nesters and those empty nesters living alone or with a spouse only. Cross-sectional analysis was conducted on representative national data from the 2014 China Longitudinal Aging Social Survey, focusing on respondents aged 60 and above (N = 7,923). Four dimensions of social exclusion (social relationships, subjective feeling of being excluded, social activities and financial products) and three health outcomes (self-reported health (SRH), activities of daily living (ADLs) and depression), were considered. Results show that ‘empty nest’ older people were more likely to be excluded from social relationships and to experience subjective feelings of being excluded, and were less likely to participate in social activities than non-empty nesters. Empty nesters were significantly less likely to report fair SRH and ADL difficulties than non-empty nesters, but they were more likely to report having depression than non-empty nesters. Among ‘empty nest’ older people, empty nesters who were living alone were associated with higher levels of being excluded from social relationships and to experience subjective feelings of being excluded than those who were living with a spouse only. Future research could focus on the development of age-friendly communities which act as health interventions to address relevant situations of social exclusion and depression among empty nesters.

The association between health-promoting-lifestyles, and socioeconomic, family relationships, social support, health-related quality of life among older adults in china: a cross sectional study

Objectives

Lifestyles, accounting for 53% in determining death, play a vital role in improving the health of older adults. Thus, this study aimed to explore the influencing factors of the health-promoting-lifestyles and interaction mechanisms among older adults.

Methods

A total of 8526 elders were selected by a three-stage stratified random cluster sampling method. Socioeconomic status, family relationships, social support, health-related quality of life (QOL), and health-promoting-lifestyles (HPLP) of older adults were assessed with the Social Support Rating Scale, the short form 36 health survey (SF-36) and Health-Promoting Lifestyle Profile. A structural equation model (SEM) was conducted to test the direct and indirect association between influencing factors with HPLP.

Results

In this study, there were 4901 older adults who were empty nesters, and 3625 were non-empty nesters. Of all respondents, the average QOL score of older adults was 62.28 ± 16.51, average social support score was 78.06 ± 7.50. The HPLP score of older adults was 105.9 ± 19.6, and the average score of subscales was 2.5 ± 0.5, which was at the medium level. Social support had a positive and direct effect on HPLP of older adults (total effect, 0.34). Meanwhile, social support mediated the relationship between socioeconomic (total effect, 0.17), QOL (total effect, 0.33) and HPLP. Family relationships had a small indirect effect on HPLP via social support (0.01).

Conclusions

Social support is the strongest influencing factor in the health-promoting-lifestyles among older adults, followed by socioeconomic, health-related quality of life and family support. Thus, maintaining higher social support was important to improve the HPLP of older adults.

Urban-Rural Differences: The Impact of Social Support on the Use of Multiple Healthcare Services for Older People

Background

There are many kinds of chronic diseases, high incidence and high hospitalization rate in older people caused by population aging. The increasing demand for healthcare services has become an increasingly prominent problem in Chinese society. The purpose of this paper is to explore the influence of social support on multiple healthcare services for older people and the urban-rural differences among them.

Methods

The data are from our field survey in Shaanxi province in 2019. Using the Anderson model as the basic explanatory framework, this paper uses the Tobit-model to analyses the impact of social support for older people on the utilization of therapeutic healthcare services, and the Logit-model to analyze the impact of living arrangements and social support on the utilization of preventive healthcare services for older people.

Results

This paper examines the impact of formal and informal support on outpatient, inpatient, and preventive healthcare services for older people, provides an in-depth analysis of the differences in the impact of social support on healthcare service utilization between urban and rural older people and analyses the contribution of various factors to the impact. The coefficient effect is divided into two parts: the coefficient “premium” of urban older people relative to urban and rural older people as a whole, which accounts for 10.8% of the total difference; and the “premium” of urban and rural older people as a whole to rural older people, which accounts for 18.9% of the total difference. The coefficient effect accounts for 29.7 per cent of the total difference.

Conclusions

Rural older people place greater importance on the quantity of formal social support, while urban older people place greater importance on the quality of formal social support. The phenomenon of raising children for old age was evident in the use of healthcare services by rural older people, while the phenomenon of distant relatives being better than close neighbors was evident in the use of healthcare services by urban older people. Free preventive healthcare services in rural China have largely compensated for the lack of health benefits for rural older people.

Seeking medical services among rural empty-nest elderly in China: a qualitative study

Background

The number of empty-nest elderly in China is rapidly increasing. Empty-nest elderly could not receive adequate daily care, economic support and spiritual consolation from their children. Rural empty-nest elderly are facing more serious health challenges than those in urban areas.

Objective

This study aimed to understand the experiences of rural empty-nest elderly in seeking medical services in China.

Methods

The method of inductive content analysis was used to collect and analyze data. Data were collected by in-depth interviews. A total number of 16 participants were involved in this study. A semi-structured interview guideline, which was discussed in depth and agreed upon by all researchers, was used to encourage participants to talk about their experiences in seeking medical services.

Results

Rural empty-nest elderly is facing a great challenge in seeking medical services in China. There are some barriers for rural nest elderly to get access to healthcare services, such as low-income status, high expenditure of medical treatment and inadequate health insurance coverage. Due to the absence of the companionship of their adult children, empty-nest elderly have to rely on their neighbors and relatives to seek medical services.

Conclusions

Rural empty-nest elderly have great difficulty in seeking medical services in China. More efforts should be made to get medical services more accessible to rural empty-nest elderly.

Depression symptoms and quality of life in empty-nest elderly among Chengdu: A cross-sectional study

OBJECTIVES

To estimate the prevalence of depression symptoms and quality of life (QoL) and examined the influence of factors in the empty nest elderly.

METHODS

This was a cross-sectional study, which was conducted from February 2022 to May 2022. We recruited a convenience sample of no empty-nest elderly and empty-nest elderly (≥60 years) living in Chengdu. QoL was assessed using WHOQOL-BREF, Geriatric Depression Scale (GDS-15) was used to assess depression symptoms. Multivariable logistic regression was used to analyze data between independent variables with depression symptoms.

RESULTS

Two thousand twenty-six participants were included in this study, 39.0% (660/1,082) experienced depression symptoms among empty-nest elderly. Age (aOR, 1.02; 95% CI, 1.00-1.04; P = 0.046), chronic disease≥2 (aOR, 3.29; 95% CI, 2.50-4.33; P < 0.001) were associated with increased risk of depression symptoms, and physical activity (aOR, 0.59; 95% CI, 0.40-0.87; P = 0.008), physical health (aOR, 0.93; 95% CI, 0.88-0.99; P = 0.026), psychological health (aOR, 0.93; 95% CI, 0.87-0.98; P = 0.013), and total score (aOR, 0.97; 95% CI, 0.96-0.99; P < 0.001) were associated with decreased risk of depression symptoms among empty-nest elderly.

CONCLUSIONS

Depression symptoms are common mental health problems among empty-nest elderly. We found that age, chronic disease ≥2 and physical activity were important factors that have an impact on depressive symptoms. Empty-nest elderly would have lowered QoL score.

Perceived social support in Chinese family caregivers of patients with dementia

AIM

This study aimed to describe levels of social support and explore the factors predictive of social support for Chinese family caregivers of patients with dementia.

BACKGROUND

Social support levels and their predictive factors in Chinese dementia caregivers have not been well documented, which need to be further clarified to provide a basis for creating effective social support strategies.

METHODS

This was a cross-sectional study with 91 participants who completed a demographic questionnaire and the Social Support Rating Scale from 2015 to 2016.

RESULTS

Chinese family caregivers of patients with dementia received moderate social support. Caregivers' subjective support domain scores and support utilization domain scores were significantly lower than those of the normal Chinese population, whereas caregivers' total social support scores were higher than those of the normal Chinese population. Family caregivers' monthly household income, educational level and place of residence were predictors of their own social support.

CONCLUSION

Social support in Chinese caregivers of patients with dementia needs to be improved, especially the subjective support and support utilization. Healthcare professionals should pay special attention to caregivers with a lower monthly household income and educational level and caregivers who lived in the suburban area.

SUMMARY STATEMENT

What is already known about this topic? Social support is important for family caregivers of patients with dementia. Social support levels and their predictive factors in Chinese dementia caregivers have not been well documented. What this paper adds? Caregivers' subjective support and support utilization were significantly lower than the normal Chinese population; caregivers' total social support was significantly higher than the normal Chinese population. The best predictors of caregivers' social support were the monthly household income, educational level and place of residence of the caregivers. The implications of this paper: Healthcare professionals should pay special attention to caregivers with a lower monthly household income and educational level and caregivers who lived in the suburban area. Future research is needed to create effective nursing regimes, paying attention to caregivers with a lower educational level and caregivers who lived in the suburban area.

Efficacy of the self-mutual-group model targeting quality of life improvement among empty-nest older adults in Taiyuan, China: an intervention study

Background

In China, more and more older people have encountered a situation called “empty nest.” Meanwhile, the health status of empty-nest older adults is an increasing public health concern. This research aims to examine the effectiveness of Self-Mutual-Group (SMG) model in improving quality of life of the empty-nest older adults to provide a scientific evidence for improving their health.

Methods

A prospective intervention study was conducted among empty-nest older adults in Taiyuan, Shanxi. Multi-stage stratified random cluster sampling was employed to selected participants. A total of 396 empty nesters were enrolled as participants, of which 204 and 192 were in the intervention and control group, respectively. The intervention group received a seven-month SMG-based intervention. A participant’s quality of life was measured at the baseline and seven months after using the Short Form 36-Item Health Survey (SF-36).

Results

No significant difference was found between the intervention and control groups in terms of participant characteristics at baseline (P > 0.05). After the intervention, participants’ scores on Mental Component Summary (MCS), Physical Component Summary (PCS), role emotional (RE), vitality (VT), social function (SF), mental health (MH) and general health (GH) increased significantly in the intervention group. Additionally, these scores differed significantly from those in the control group (P < 0.05).

Conclusion

This study showed that the SMG-based health management is effective in improving quality of life among empty-nest older adults after seven months.

Trial registration

Study on the ‘SMG’ Health Management Model Based on Community Organization Theory among empty-nest older adults (ChiCTR1800015884). Registration date: 26-04-2018. Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02155-4.

Urban-rural differences in the effect of empty-nest on mental health and behaviors of Chinese older population

This study aimed to comprehensively analyze the effect of empty-nest on mental health and behaviors of the older population and explore the urban-rural differences. Data from the Cohort of Older People Health and Environment Controllable Factors were used, including 1071 older people aged 60 or over from a rural and an urban. Mental health, daily life behaviors, chronic physical diseases, and activities of daily living were evaluated. Logistic regression was used. The prevalence of empty-nest in older people was 55.0% in urban and 58.7% in rural. The empty-nest older people in urban were more likely to participate in physical exercise (OR[95%CI]: 1.55[1.03-2.31]), while the empty-nest older people in rural had lower rate of smoking (OR[95%CI]: 0.46[0.28-0.76]) and religious belief (OR[95%CI]: 1.61[1.01-2.58]), and higher prevalence of depression (OR[95%CI]: 1.55[1.03-2.35]) and higher level of total cholesterol (OR[95%CI]: 1.51[1.03-2.19]) compared with the non-empty-nest older people. In conclusion, the prevalence of empty-nest in older people was high both in rural and urban in China. Empty-nest exerts greater influences on the older people in rural than in urban, which should be given more attention, especially the depression and high total cholesterol.