Association between social activity frequency and overall survival in older people: results from the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

Facilitating Domestic and Civic-Style Activity in the Later Life of Army Veterans: The Influencing Culture of the Royal Hospital Chelsea

The Royal Hospital Chelsea has been home to veterans of the British Army since 1692. Opportunities to remain physically active throughout the life course of its residents include participation in numerous hobbies within the quasi-military environment, and in the civic engagement representational role of the Chelsea Pensioner. This study examines the influence the Royal Hospital Chelsea culture has on resident opportunities to remain active. A non-traditional mixed-methods convergent design was used across three participant groups. Staff and established residents engaged in semi-structured qualitative interviews, with established residents and a cohort of new residents completing Quality of Life questionnaires. The findings indicate established Chelsea Pensioners experienced a sense of pride and purpose, elevated social status, and increased life satisfaction as a result of engaging in multiple activities. New Chelsea Pensioners demonstrated a trend towards increased quality of life after six months' residence at the Royal Hospital Chelsea. Further research is required to explore the transferability of similar interventions into other residential establishments.

Association of increased participation in social activity in later life with risk of all-cause mortality and heart diseases in older people: results from the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

Background

Previous studies have shown social activity is associated with reduced risk of health outcomes. However, among older people (≥65 years) who were socially inactive at baseline, limited study explored whether increased participation in social activity in later life was associated with reduced risk of health outcomes; therefore, using the data from the Chinese Longitudinal Healthy Longevity Survey, the study was performed.

Methods

The study outcomes were 10-year all-cause mortality (sample number = 9,984) and 10-year heart diseases (sample number = 7,496). The exposure was the change of social activity frequency. Cox regression analysis was used for data analysis.

Results

During the follow-up, there were 6,407 all-cause mortalities and 1,035 heart diseases, respectively. Kaplan-Meier analysis demonstrated that cumulative incidences of all-cause mortality were significantly lower in participants with changes into more frequent social activity (log-rank p < 0.001), while no significant difference was observed for heart diseases (log-rank p = 0.330). Compared with the subgroup who never participated in social activity at baseline, adjusted HRs of all-cause mortality were 0.79 (95% CI: 0.70-0.90, p < 0.001), 0.78 (95% CI: 0.63-0.96, p = 0.019), 0.74 (0.59-0.92, p = 0.006), and 0.70 (95% CI: 0.56-0.88, p = 0.002) for the subgroup of switching to sometimes, the subgroup of switching to once a month, the subgroup of switching to once a week, and the subgroup of switching to everyday, respectively. The corresponding HRs of heart diseases were 0.83 (95% CI: 0.65-1.08, p = 0.170), 0.82 (95% CI: 0.51-1.31, p = 0.412), 0.91 (0.58-1.42, p = 0.675) and 0.75 (95% CI: 0.47-1.20, p = 0.227), respectively. Stratified and sensitivity analyses revealed similar results.

Conclusion

Among older people who never participated in social activity, increased participation in social activity in later life was associated with reduced risk of all-cause mortality, but was not associated with reduced risk of heart diseases.

Effect of social participation on the trajectories of activities of daily living disability among community-dwelling older adults: a 7-year community-based cohort

INTRODUCTION

Studies examining the effects of social participation on activities of daily living (ADL) disability are still scarce.

AIM

To assess the reciprocal relationship between ADL disability trajectories and social participation among older Chinese people aged ≥ 60 years.

METHODS

This study included 2976 participants aged ≥ 60 years in six waves of a community-based survey from 2015 to 2022. Basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were used to assess the ADL disability in each survey. Social participation was assessed by involvement in four social activities and an extensive social participation score. Group-based trajectory modeling was used to identify potential heterogeneity in longitudinal changes over 7 years and explore associations between baseline predictors of group membership and these trajectories.

RESULTS

Two BADL disability trajectories were identified: stable (94.8%) and increase (5.2%). Additionally, three IADL disability trajectories were distinguished: stable (73.2%), moderate (20.2%), and increase (6.6%). After controlling for the potential covariates, each point increase in the extensive social participation score correlated with a 17% decrease in the odds of older individuals belonging to the increase BADL trajectory group (OR = 0.83, 95% CI = 0.68-1.00). For IADL, it decreased the odds of being assigned to the moderate trajectory group by 16% (OR = 0.84, 95% CI = 0.75-0.95) and to the increase trajectory group by 23% (OR = 0.77, 95% CI = 0.64-0.93).

CONCLUSIONS

Higher levels of social participation among older individuals were more likely to be classified as stable trajectories in both BADL and IADL. Increased participation in social activities by community-dwelling elderly adults may promote healthy aging.

The effect of clean cooking on the social participation of middle-aged and older adults in China: A prospective cohort study

BACKGROUND

Indoor air pollution stemming from the use of solid fuels, such as biomass and coal, is a significant public health concern, especially in developing countries. Understanding the connection between indoor air quality and social participation is essential for crafting effective interventions and enhancing the well-being of these populations. This study aims to investigate the influence of indoor air pollution on social participation among middle-aged and olderly individuals in China.

METHODS

This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), encompassing 17,711 samples, to investigate the link between cooking fuel type and social participation. Survival analysis Cox regression was used, complemented by logistic regression for supplementary analyses.

FINDINGS

Upon accounting for confounding factors, the analysis revealed that individuals who consistently used clean fuels and those who switched to clean fuels exhibited a significantly higher likelihood of increased social participation compared to those using solid fuels. The hazard ratios were 1.31 (95 % CI: 1.19-1.44) and 1.39 (95 % CI: 1.28-1.51), respectively. These findings remained consistent across various regression models and showed no signs of population heterogeneity. Furthermore, this study found that in the investigation of mediating effects, chronic disease did not demonstrate any mediating effect on social participation. However, the mediating effects of depression level and IADL (Instrumental Activities of Daily Living) were significant, accounting for 1.82 % and 7.35 % of the impact of clean cooking on social participation, respectively.

INTERPRETATION

This study provides compelling evidence that adopting clean cooking practices positively influences social participation among middle-aged and older individuals in China. We recommend that governments, communities, and individuals prioritize measures to enhance indoor air quality.

Associations between self-perceptions of aging and social functioning in older adults: An analysis based on health and retirement study data

OBJECTIVES

Self-perception of aging (SPA) and social functioning are two important variables in the process of healthy aging, but the relationship between them is still unclear. This study aimed to explore the association between SPA and social functioning in older adults.

METHODS

We conducted a longitudinal study utilizing data from the Health and Retirement Study. The sample comprised individuals aged 50 and above. Socio-demographic, psychosocial, and lifestyle information of study participants was systematically collected at baseline (2012 and 2014) and during follow-up four years later (2016 and 2018). SPA was measured using a scale assessing individuals' attitudes toward their aging process. Social functioning was evaluated through 22 questions, reflecting individuals' abilities to engage in and perform various roles and tasks in their daily lives. Multilevel modeling was employed to analyze the relationship between SPA and social functioning. Differences in social functioning changes among various SPA groups were assessed through the Generalized Estimating Equations methodology.

RESULTS

The study included 8,454 participants with an average age of 68.3 years (SD = 9.92). The multilevel model revealed a significant correlation between SPA and social functioning (β = 0.131; P < 0.001). This relationship persisted after adjusting the model (β = 0.088; P < 0.001). Generalized Estimating Equations indicated noteworthy differences in social functioning changes among distinct SPA groups (P = 0.034).

DISCUSSION

Positive SPA is associated with the healthy social functioning of older adults. Healthcare providers could target modifiable aspects of SPA to enhance the social function of older adults and promote successful aging.

Association of physical activity with socio-economic status and chronic disease in older adults in China: cross-sectional findings from the survey of CLASS 2020 after the outbreak of COVID-19

BACKGROUND

In 2021, China had a population of 264·01 million individuals over the age of 60, indicating a high prevalence of chronic diseases. Among older adults, physical inactivity (PI) is a significant risk factor for chronic diseases. However, few studies have been conducted on the correlation of physical activity (PA) with the economic status, geography and chronic disease risks in Chinese elderly. The objectives of this study were to better understand the distribution of PA among older adults in China and its relationship with economic status, geography, and chronic disease risks.

METHODS

This study utilized data from the China Longitudinal Aging Social Survey (CLASS) in 2020, post-COVID-19. The study employed a stratified, multistage, probabilistic sampling approach and included 11,396 adults over the age of 59 from 28 provinces in China. Data on demographics, the duration and intensity of PA, history of diseases and personalized factors influencing PA were collected via structured interviews by researchers. In this study, we conducted a comprehensive analysis, employing a range of statistical methods including descriptive analysis, Wilcoxon rank-sum tests, Bayesian networks, and chi-square tests.

RESULTS

The prevalence of PI among older adults over 59 in China is 28·82%. Significant regional differences were observed in the duration of PA at different intensities. Older adults residing in more economically developed areas were more likely to engage in moderate-to-vigorous physical activity (MVPA) and exhibited longer sedentary behavior. Economic status and urban-rural disparities consistently emerged as direct influential factors across all intensity types. Chronic disease risks were significantly lower in active older adults compared to inactive ones. Lack of social guidance, family support, and personal inclination towards sedentary behavior were the main personalized factors affecting PA among older adults, and these factors could be relatively easily modified.

CONCLUSIONS

Economic status, geography, and living areas (urban and rural) significantly influenced the distribution of physical activities in China. Particularly, economic status and living areas acted as direct factors. Older adults reaching the recommended standards for PA had significantly lower chronic disease risks, highlighting the importance of improving personalized factors which are crucial for promoting PA.

Disparities in overall survival by varying duration of disability in activities of daily living in older people: A population-based cohort from Chinese Longitudinal Healthy Longevity Survey (CLHLS)

OBJECTIVES

To investigate the association between duration of disability in activity of daily living (ADL) and overall survival in older individuals.

DESIGN

A prospective cohort study.

SETTING

Community-based data from Chinese Longitudinal Healthy Longevity Survey.

PARTICIPANTS

In total, 13,560 participants without ADL disability and 2772 participants with ADL disability at baseline were included.

MEASUREMENTS

ADL disability was assessed using Katz index scale, which included six essential ADLs: dressing, bathing, transferring, toileting, continence, and eating. Dependence of each item was scored on a scale of 1, the maximum total score was 6. At baseline, duration of ADL disability was defined as the maximum duration among the six items. The study outcome was overall survival. Accelerated failure time models were constructed to investigate the association between duration of ADL disability and overall survival. Subgroup analyses by sex, age, and multimorbidites, as well as sensitive analyses were conducted.

RESULTS

During 81,868.7 person-years follow-up, 11,092 deaths were recorded. Overall, ADL disability was associated with lower overall survival compared to non-ADL disability. With duration of ADL disability extending, the overall survival strikingly dropped in the first 12 months, reaching its lowest point with adjusted time ratio (TR) at 0.66 (95%CI: 0.61-0.72, p < 0.001), then moderately grew until the 60th month, finally stayed constant thereafter. Participants with ADL scores of 1-3 had higher survival compared to those with scores of 4-6, and both groups followed a similar trend of varied survival to the whole cohort. Moreover, subgroup analyses and sensitivity analyses showed the robustness of these findings.

CONCLUSIONS

Our findings first address a golden time window for the older individuals with ADL disability. More attention should be given to them, especially in the first 12 months since diagnosis, to reduce mortality and extend the lifespan.

Decomposing the change in the cognitive function gap between older men and women over time in China: The Chinese Longitudinal Healthy Longevity Survey

Background

This study explored how modifiable social determinants of cognitive function can influence these gender gaps.

Methods

We utilized six waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 56,127 individuals aged 65+. The Kitagawa-Oaxaca-Blinder decomposition approach was used for the analysis.

Results

Older women consistently had lower average levels of cognitive function than men in each period, but the gap is narrowing. From 2002 to 2018, the gender gap in cognitive function decreased by 1.45 (95% confidence interval (CI) = -1.843, -1.097) points. The coefficients for the endowment effects decreased from 0.387 (95% CI = -0.563, -0.211) to 1.789 (95% CI = -2.471, -1.107) from 2005 to 2018. Lifestyle changes, social participation, and physical health factors significantly contributed to explaining the changes in gender gaps in cognitive function.

Conclusions

Among these contributing factors, lifestyle, social participation, and physical health have emerged as pivotal elements in reducing the gender gap in cognitive function. Targeted interventions for these variables are essential among older women to narrow the cognitive gender gaps effectively.