Social participation and the onset of hypertension among the middle-aged and older population: Evidence from the China Health and Retirement Longitudinal Study

Mechanism of the impacts of older adults social participation on their health

Purpose

Against the background of population aging challenges in China, focusing on health, security, and social participation as core elements of positive aging, this study aims to formulate strategies for promoting the health of the older adults and reveal the pathways and trends of social participation in promoting health.

Method

The study analyzed 1,015 randomly selected older adults individuals living at home in Beijing using household survey questionnaires. Drawing on group dynamics theory and structural equation modeling, the study proposed hypotheses regarding the relationships between social participation, group cohesion, and health status.

Results

First, the triangular path model of social participation, group cohesion, and health status among the older adults was established. The direct path coefficient of social participation on health status was 0.15, that of social participation on group cohesion was 0.56, and that of group cohesion on health status was 0.32. The indirect path coefficient of social participation on health status through group cohesion was calculated at 0.56 × 0.32 = 0.18. Second, of the older adults age groups-younger, middle, and older-social participation's direct path effects on health status were present only in the older age group. Social participation's indirect path effects on health status through group cohesion were relatively high in all three groups, with a slight increase in the older age group.

Conclusion

First, just the older adults participation in social activities serves as a benign stimulus to physical and mental health. Additionally, group cohesion formed through interaction with others during social activities encourages self-improvement behaviors, indirectly promoting health. In fact, indirect pathways of health promotion through group cohesion are stronger than direct pathways, highlighting the importance of group cohesion during social participation. Second, participation in activities alone can provide only sufficient benign stimuli for the older adults aged 80 and above, with the direct path effect of social participation on health beginning to appear only with increasing age. With age, selectivity of interaction with others decreases, and dependence increases; social participation's indirect path effect on health through group cohesion continues to grow slightly.

Association of social isolation and loneliness with the risk of hypertension in middle aged and older adults: Findings from a national representative longitudinal survey

BACKGROUND

Social isolation and loneliness have been proved to be associated with many adverse health outcomes, but their influence on hypertension remains unclear. This study aimed to assess the relationship of social isolation and loneliness with hypertension risk among middle-aged and older adults in China.

METHODS

We used data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study. Participants were assessed for social isolation and loneliness at baseline, and hypertension was identified by self-report and blood pressure measurement at follow-up in 2015. Binary logistic regression analyses were conducted to assess the association of social isolation and loneliness with the risk of hypertension.

RESULTS

A total of 3711 residents were included. 13.7 % of the participants had high level of social isolation and 18.1 % felt lonely. During the four-year follow up period, 651 participants developed hypertension. People with high level of social isolation had an increased risk of hypertension (odds ratio [OR]: 1.40, 95 % confidence interval [CI]: 1.09-1.79). Similar results were found between social isolation score and hypertension risk (OR: 1.14, 95 % CI: 1.04-1.26). No significant association between loneliness and hypertension or any interaction effect of social isolation and loneliness on hypertension were observed.

LIMITATIONS

Limited by the structure of questionnaire, some of the information was derived by self-report, which may lead to recalling bias.

CONCLUSION

Social isolation, rather than loneliness was associated with hypertension for middle aged and older adults. Social support needs to be strengthened for hypertension prevention in community.

Association between workplace social capital and systolic blood pressure among 23 173 workers at 367 small-sized and medium-sized enterprises in Japan: a cross-sectional study

OBJECTIVES

Social capital (SC) has been shown to be inversely associated with elevated blood pressure. While SC in the workplace may also be associated with blood pressure, it has not been extensively studied. We aimed to investigate the association between workplace SC and systolic blood pressure (SBP).

DESIGN

A cross-sectional study.

SETTING

367 small-sized and medium-sized companies in Japan.

PARTICIPANTS

A total of 23 173 participants (15 991 males and 7182 females) aged ≥18 years.

EXPOSURE OF INTEREST

SC was assessed using individual responses to eight 4-point Likert questions used in the Brief Job Stress Questionnaire. Workplace SC was assessed as the mean of individual-level responses to the SC questions from those working in the same company.

OUTCOME MEASURE

Systolic blood pressure (SBP) RESULTS: A multilevel linear regression model revealed that higher workplace-level SC was linked with lower SBP (coef.=-0.53 per 1SD increment in workplace SC, 95% CI=-1.02 to -0.05) among females in the age-adjusted model, which remained statistically significant after adjusting for other covariates. After adjusting for individual-level SC, this association was attenuated and became non-significant (coef.=-0.41, 95% CI=-0.87 to 0.05), while individual-level SC was inversely associated with SBP (coef.=-0.43, 95% CI=-0.73 to -0.13). Among males, we did not find any evidence of significant inverse associations either in relation to workplace SC (coef.=-0.12, 95% CI=-0.46 to 0.21) or individual-level SC (coef.=0.19, 95% CI=-0.01 to 0.39).

CONCLUSIONS

Our study findings suggested that workplace-level SC can affect SBP differently by sex.

Association between social participation and hypertension control among older people with self-reported hypertension in Japanese communities

Hypertension control remains poor worldwide despite well-established strategies for lowering blood pressure. Social participation has been associated with a lower prevalence of hypertension, but evidence is scarce regarding hypertension control. The aim of this study was to examine the relationship between social participation and hypertension control among older people. We used cross-sectional data from participants of the 2019 wave of the Japan Gerontological Evaluation Study (JAGES; n = 13,629). Social participation was defined as no participation, participation in one group, or participation in two or more groups. After adjusting for covariates, modified Poisson regression analysis showed that participation in two or more groups (prevalence ratio [95% confidence interval]: 1.08 [1.03-1.13]) was associated with better control of hypertension than no participation, but participation in one group (1.02 [0.96-1.08]) was not. Social participation in multiple groups was associated with better control of hypertension among older people in Japan.

Can social support buffer the association between loneliness and hypertension? a cross-sectional study in rural China

Objectives

Hypertension has reached epidemic levels in rural China, where loneliness has been a major problem among community dwellers as a consequence of rural-to-urban migration among younger generations. The objective of the study is to investigate the association between loneliness and hypertension, and whether social support can buffer the association (i.e., stress buffering theory), using cross-sectional data from 765 adults (mean age: 59.1 years) in rural Fujian, China.

Methods

Social support was measured as the reciprocal instrumental social support from/to neighbors and the reciprocal emotional support (i.e., the number of close friends that the respondent could turn to for help immediately when they are in trouble). A mixed-effect Poisson regression model with a robust variance estimator was used to investigate the association between loneliness, social support, and hypertension.

Results

Analysis revealed that those who were lonely had a higher prevalence ratio for hypertension (prevalence ratio = 1.12, 95% confidence interval 0.99–1.26) compared to those who reported not being lonely. There was an interaction between social support and loneliness in relation to hypertension. Specifically, contrary to the stress buffering theory, the positive association between loneliness and hypertension was more pronounced among those who reported higher social support compared to those who reported lower support (p for interaction <0.001 for instrumental support).

Conclusion

The results suggest that being lonely despite high levels of social support poses the greatest risk for hypertension. This study did not confirm a buffering effect of social support on the association between loneliness and hypertension.

Predictors and Importance of Social Aspects in Ikigai among Older Women

Ikigai is a unique Japanese concept that encompasses not only joy and happiness, but also the purpose and meaning of life. The purpose of this study was to explore the factors that contribute to Ikigai, an important concept in the health of older women, and to clarify the relationship between Ikigai and the enhancement of the social aspects of their health. The participants in this longitudinal study, conducted between October 2017 and February 2020, were physically healthy older women aged 65 years and above (N = 132). Physical function and social activity were used as predictors of Ikigai. In addition, willingness for new interactions was used to examine the social aspects of health. A causal model was created from these factors, and path analysis was performed. The results demonstrated that participating in numerous interpersonal activities was predictive of increased Ikigai, but physical function was not. In addition, Ikigai was found to affect the willingness for new interactions. Further, Ikigai could be related to the willingness for new interactions. To enhance the social aspects of older women’s health, it is necessary to focus on Ikigai.

Physical Multimorbidity and Social Participation in Adult Aged 65 Years and Older From Six Low- and Middle-Income Countries

OBJECTIVES

Multimorbidity is common among older adults from low- and middle-income countries (LMICs). Social participation has a role in protecting against negative health consequences, yet its association with multimorbidity is unclear, particularly in LMICs. Thus, this study investigated the relationship between physical multimorbidity and social participation among older adults across 6 LMICs.

METHOD

Cross-sectional, community-based data including adults aged 65 years and older from 6 LMICs were analyzed from the WHO Study on Global AGEing and adult health survey. The association between 11 individual chronic conditions or the number of chronic conditions (independent variable) and social participation (range 0-10 with higher scores indicating greater social participation; dependent variable) was assessed by multivariable linear regression analysis.

RESULTS

14,585 individuals (mean age 72.6 [SD 11.5] years; 54.9% females) were included. Among individual conditions, hearing problems, visual impairment, and stroke were significantly associated with lower levels of social participation. Overall, an increasing number of chronic conditions was dose-dependently associated with lower levels of social participation (e.g., ≥4 vs 0 conditions: β = -0.26 [95% CI = -0.39, -0.13]). The association was more pronounced among males than females.

DISCUSSION

Older people with multimorbidity had lower levels of social participation in LMICs. Future longitudinal studies are warranted to further investigate temporal associations, and whether addressing social participation can lead to better health outcomes among older people with multimorbidity in LMICs.

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.

Social Engagement and Sleep Quality among Older Adults in Rural China: Is There a Sex Difference?

OBJECTIVES

Sleep quality plays a crucial role in maintaining the health of older people and has become a major public health concern throughout the world. Social engagement, as a core component of "Active Ageing", is one of the key determinants of health outcomes of older adults. This study estimated the relationship between social engagement and sleep quality among older adults living in rural China, and to determine whether there is a sex difference in these associations.

DESIGN

A cross-sectional design. Multilevel, multiple linear regression models were used to examine the independent associations between each type of social engagement and sleep quality. All standard errors were clustered at the community level.

SETTING AND PARTICIPANTS

Data were from 3243 adults age 60 years or older from rural areas in China.

METHODS

Sleep quality was measured by the Pittsburgh Sleep Quality Index. Social engagement was measured by 3 types of social groups' activity in this study, including participation in hobby groups, community-related organization, and sports groups.

RESULTS

Participating in hobby groups, community-related organization, and sports groups with high frequency are all associated with better sleep quality. In addition, the positive relation between participating in community-related organization and sleep quality is stronger for older male than female adults, and the positive association between participating in hobby groups/sports groups is stronger for older female than male adults.

CONCLUSIONS AND IMPLICATIONS

Older adults with high-frequency of social engagement may have better sleep quality. This study offers new insight for the sleep quality from the perspective of social engagement among older people, implies that encouraging targeted social engagement in older people with different sex may be effective in promoting sleep quality in rural China.

Stroke disease-specific quality of life trajectories after rehabilitation discharge and their sociodemographic and clinical associations: A longitudinal, multicentre study

AIM

To investigate the longitudinal growth trajectories of disease-specific quality of life (QoL) dimensions and their associations over 1 year.

DESIGN

A longitudinal design. Data were collected between February 2015-May 2017.

METHODS

Four hundred and fifteen stroke survivors (mean age 70.6 years; 81% ischaemic stroke) were recruited after discharge from rehabilitation hospitals and were followed up every 3 months for 1 year. Changes in Stroke Impact Scale (SIS) dimension scores were evaluated using hierarchical linear models (HLMs) and linear, logarithmic, quadratic, and cubic time slope.

RESULTS

We observed a significant linear and quadratic increase in most SIS dimensions from the baseline to 12-month follow-up, especially in physical dimensions. The communication dimension was stable over time, while the memory dimension increased only linearly. Higher physical dimension scores were significantly associated with lower age, hypercholesterolaemia, and better physical functioning at baseline, while higher communication was associated with lower age, better physical functioning, and a diagnosis of peripheral vascular disease. Better memory was associated with lower age, married status, better physical functioning, and left-hemisphere stroke. Better participation was associated with lower age and better physical functioning. No significant associations were observed for emotion.

CONCLUSIONS

This study provides important information about the trajectories of stroke survivors' specific QoL and their associated variables.

IMPACT

Stroke has a great impact on stroke survivors' QoL. Disease-specific QoL significantly increases from the baseline to 12-month follow-up, especially in physical dimensions. Lower age, hypercholesterolaemia, better physical functioning, and diagnosis of peripheral vascular disease seem to be associated with better QoL. Through the analyses of associated variables, we identified stroke survivors who are more at risk and who need more tailored interventions to improve their physical, psychological, emotional, and social dimensions.

Willingness to engage in and current status of social participation among Chinese merchant sailors

China has the largest population of sailors in the world, but little is known of their social participation. This study examined Chinese merchant sailors' social participation using a nationwide survey. Across 12 Chinese provinces, 7,296 merchant sailors completed the questionnaire on sailor' willingness to engage in and status of social participation. The results showed that most Chinese merchant sailors were willing to participate in social affairs, but few of them reported having joined relevant social organizations, over half of sailors reported never having participated in public affairs, and half of them chose to ignore when they faced with an obvious mistake in shipping-related information in the media. Most of sailors reported unknowing the role of the labor union related to Chinese seafarers and NGO related to navigation well, and their evaluation of these organizations were mostly negative. Chinese merchant sailors reported higher expectations of services in terms of protection of rights, providing information and technology, and providing employment opportunity. We conclude that Chinese merchant sailors have willingness to social participation although the reality is not positive and discuss implications for improving the social participation of Chinese merchant sailors.

Prospective association between social engagement and cognitive impairment among middle-aged and older adults: evidence from the China Health and Retirement Longitudinal Study

OBJECTIVES

Cognitive impairment is a precursor of dementia. This study aimed to examine the association of social engagement with cognitive decline during the process of normal ageing.

METHODS

We used data from the China Health and Retirement Longitudinal Study. The cognitive functions were tested at baseline, and 2-year and 4-year follow-up visits. Social engagement was constructed as a comprehensive measure including the quantity and frequency of social activities. Activities of social engagement were classified into three types. Multilevel logistic model was fitted to evaluate the prospective association between social engagement and cognitive impairment.

RESULTS

After 2-year follow-up, compared with participants with the lowest level of social engagement, those with level-2, level-3 and level-4 social engagement had a 12% (OR=0.88, 95% CI 0.71 to 1.09, p=0.242), 17% (OR=0.83, 95% CI 0.71 to 0.97, p=0.020) and 25% (OR=0.75, 95% CI 0.61 to 0.93, p=0.008) lower risk for developing cognitive impairment, respectively. A similar pattern of significantly protective association was found at 4-year follow-up. Combined effect analysis showed that participants who attended one type of social engagement had a lower risk of developing cognitive impairment and the protective effect was even larger with those who attended two or three types of social engagement.

CONCLUSIONS

Social engagement had a protective effect on cognitive impairment among middle-aged and older adults in China. Given the growing epidemic of dementia and rapid pace of ageing in low-income and middle-income countries, our study shed lights on comprehensive and tailored public health programmes for improving social engagement, to delay cognitive impairment at mid-age and later life.

Variety, frequency, and type of Internet use and its association with risk of depression in middle- and older-aged Chinese: A cross-sectional study

BACKGROUND

Internet use is beneficial to mental health has been acknowledged, but its specific patterns await further investigation in China's context of urban-rural disparity. Therefore, we aimed to understand the patterns of Internet use and measure their associations with risk of depression in China from three dimensions: variety, frequency and type.

METHODS

We selected 18,492 urban and rural Chinses respondents aged 45 years and older from China Health and Retirement Longitudinal Study (CHARLS) 2015 dataset. Risk of depression was measured by 10-item Centre for Epidemiologic Studies (CES-D 10). Internet use was measured from three dimensions: variety, frequency and type, whereas its relationship with risk of depression was examined by multivariate logistic regression model.

RESULTS

In the whole sample, 67.2% of respondents had no risk of depression, and approximately 7% used Internet, which was inversely associated with risk of depression (AOR=0.617, 95% CI=0.444, 0.858). Rural respondents had higher risk of depression (37.1% VS 26.2%) and lower prevalence of Internet use (2.6% VS 13%). Among rural respondents, using Internet occasionally (AOR=0.338; 95% CI=0.130, 0.881), using one type of device (AOR=0.293; 95% CI=0.113, 0.760), especially mobile phone (AOR=0.427; 95% CI=0.187, 0.978) were associated with lower odds of depression. No significant associations were observed in urban respondents.

LIMITATIONS

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

CONCLUSION

Internet use was negatively associated with risks of depression, especially in rural but not in urban participants. Rural-urban disparities should be considered when designing strategies to encourage moderate Internet use.

Impact of social participation on health among middle-aged and elderly adults: evidence from longitudinal survey data in China

BACKGROUND

Social participation (SP) is known to have a favourable impact on health. However, studies on this issue have been conducted mainly in advanced countries, and results in China have been mixed. This study examined the impact of SP on health outcomes of middle-aged and elderly adults in China, adjusted for simultaneity and heterogeneity biases.

METHODS

In total, 57,417 observations of 28,935 individuals obtained from the population-based, three-wave panel survey, Chinese Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015 were used. The associations between one- or two-wave-lagged SP and health outcomes (mental health, self-rated health [SRH], activities of daily living [ADL], and diagnosed diseases) were examined by linear regression models. Individual-level heterogeneity was addressed by the random-effects estimation method.

RESULTS

SP was found to have a positive impact on mental health and ADL. Specifically, one-wave-lagged SP improved mental health measure (range: 10-70) by 0.820 (standard error [SE]: 0.199, p <  0.001), the basic ADL measure (range: 6-24) by 0.147 (SE: 0.043, p <  0.001), and the instrumental ADL measure (range: 5-20) by 0.159 (SE: 0.035, p <  0.001). In contrast, SP did not significantly affect SRH or diagnosed diseases. The impact of SP differed by SP type; playing Mah-jong (Chinese traditional game), chess, or cards, or going to the community club had the most favourable effect. The impact of SP on health was also greater for women than men and greater for individuals aged 60-69 years than those aged 45-59 years and aged 70 and older.

CONCLUSIONS

SP had a positive, albeit selective, impact on health outcomes among middle-aged and elderly adults in China. The results suggest that policy measures to encourage these individuals to engage in SP are needed to enhance their health.

Continued social participation protects against depressive symptoms across the retirement transition: Longitudinal evidence from three waves of the China Health and Retirement Longitudinal Survey

AIM

Social participation is an important social resource over retirement, but little is known about how changing social participation might affect mental health over retirement. This study examined the impact of retirement status, changes in social participation and their interactions on subsequent depressive symptoms over a 4-year period.

METHODS

Data were obtained from the first three waves of the China Health and Retirement Longitudinal Survey. The analytical sample included 2364 individuals with different retirement statuses (remained retired, transitioned to retirement, remained working). Generalized estimating equations were used to examine the impact of retirement status, changes in social participation and their interactions on depressive symptoms.

RESULTS

Compared with those who remained working, individuals who remained retired reported reduced depressive symptoms (β = -0.64, 95% CI -1.23 to -0.05); individuals who transitioned to retirement reported elevated depressive symptoms (β = 0.74, 95% CI 0.07 to 1.41). Relative to those who reported no participation over the study, individuals who maintained or increased social participation reported reduced depressive symptoms (β = -1.12, 95% CI -1.67 to -0.56; β = -1.03, 95% CI -1.90 to -0.17); individuals who decreased social participation reported elevated depressive symptoms (β = 0.70, 95% CI 0.13-1.28). Individuals with decreased social participation were more influenced by the negative impact of transition to retirement on depressive symptoms (β = 1.93, 95% CI 0.12-3.74).

CONCLUSION

These results highlighted the time-varying effects of retirement on mental health, and continued social participation acting as an adaptive strategy to protect against depressive symptoms over time. Geriatr Gerontol Int 2019; 19: 972-976.

Cystatin C and risk of new-onset depressive symptoms among individuals with a normal creatinine-based estimated glomerular filtration rate: A prospective cohort study

The association between cystatin C and depressive symptoms in the general population has not been thoroughly elucidated to date. We investigated the association of cystatin C with new-onset depressive symptoms among individuals with normal creatinine-based estimated glomerular filtration rates (eGFR). In the China Health and Retirement Longitudinal Study, 5111 participants without depressive symptoms or renal dysfunction (eGFR < 60 ml/min/1.73 m²) were included. The outcome was new-onset depressive symptoms over 4 years, defined as a score of ≥12 on the 10-item Center for Epidemiologic Studies Depressive Symptoms Scale. The incidence risk ratio (IRR) and 95% confidence interval (CI) were calculated using modified Poisson regression models. During a 4-year follow-up period, 1746 (34.16%) incidents of depressive symptoms occurred. In a multivariable-adjusted model, the risk of incident depressive symptoms was 1.07 (95% CI 1.02-1.11) per-SD change in cystatin C. A greater cystatin C level was associated with a higher risk of new-onset depressive symptoms among subjects with relatively normal renal function.

Preventive impact of social participation on the onset of non-communicable diseases among middle-aged adults: A 10-wave hazards-model analysis in Japan

Social participation (SP) is known to have a favorable impact on the health of older adults by reducing the risk of functional disability, psychological distress, cognitive impairment, and mortality. However, the preventive impact of SP on non-communicable diseases (NCDs) among middle-aged adults is largely understudied. Using the dataset from a population-based, 10-wave longitudinal survey that started with Japanese adults aged 50-59 years in 2005 (16,290 men and 17,248 women), we estimated Cox proportional hazards models to estimate the preventive impact of SP adjusted for baseline covariates. After controlling for baseline covariates, baseline participation in at least one of six types of SP prevented diabetes both for men (hazard rate [HR] = 0.86; 95% confidence interval [CI] = 0.77, 0.95) and women (HR = 0.75; 95% CI = 0.66, 0.85) and stroke both for men (HR = 0.83; 95% CI = 0.70, 0.99) and women (HR = 0.78; 95% CI = 0.64, 0.97). SP also had a preventive impact on hypertension only for women (HR = 0.91; 95% CI = 0.84, 0.99). SP did not prevent heart disease, hyperlipidemia, or cancer for either gender. We also found that SP tended to have a stronger preventive effect when it was conducted with other persons than done alone, highlighting personal interactions as a key aspect of SP for later health outcomes. Overall, the results showed that SP can prevent the onset of selected NCDs, suggesting that policy measures to encourage SP may be favorable for the health of middle-aged adults.