Association of Religious Participation With Mortality Among Chinese Old Adults

Social connections and participation among people with mild cognitive impairment: barriers and recommendations

Objective

Social connections and participation are essential for individuals with mild cognitive impairment (MCI) to prevent the progression of cognitive decline and enhance their overall well-being. However, existing research has primarily focused on environmental barriers, overlooking personal factors and the interconnected nature of these barriers. Moreover, there is a lack of understanding regarding social connections and participation challenges specific to people with MCI in low- and middle-income countries. Therefore, this study aimed to explore the barriers that hinder social connections and participation among people with MCI in China and investigate opportunities to design appropriate supportive interventions.

Methods

Thirty-one people with MCI (13 males and 18 females; mean age = 82.74 years, SD = 7.69; mean MoCA score = 21.26, SD = 2.44) and 13 caregivers were recruited to attend focus groups. In addition, 10 therapists were interviewed using a semi-structured interview guide. Focus groups and interviews were audio-recorded, transcribed, and analyzed using a framework analysis approach.

Results

We found that the ability to build social connections among people with MCI is affected by mobility challenges, intensive grandparenting responsibilities, availability of suitable activities, and feelings of exclusion in a closed-minded community environment. Personal reasons, such as lower social efficacy, inability to find suitable social activities, and intensive family responsibilities, discourage people with MCI from social participation. The digital literacy of people with MCI depends on their motivation to learn and use digital tools; people with MCI who live in a community have a higher digital literacy than those living in care centers. The motivation to achieve digital literacy is affected by perceived benefits, costs of technology use, and social influence.

Conclusion

Multidimensional initiatives are needed to address barriers to social connections, participation, and technology adoption among individuals with MCI. This includes organizing and engaging in social activities, promoting awareness and education on the importance of social participation, and exploring technology-based interventions to improve memory and storytelling abilities. These efforts can create a supportive environment and empower individuals with MCI to participate actively in social interactions, enhancing their overall well-being.

Evaluating the Correlation of Death Anxiety With Spirituality, Religious Attitude, and Resilience in Patients With Cardiovascular Diseases

This study aimed to determine the correlation between spirituality, religious attitude, and resilience with death anxiety in cardiovascular patients in Sanandaj, Iran. This study was conducted on 414 cardiovascular patients, who were selected by convenience sampling method. Demographic information forms, Spiritual Well Being Scale, Golriz and Burhani's Religious Attitude, Connor-Davidson Resilience Questionnaire, and Templer's Death Anxiety Scale were used to collect data. Results indicated that compared to urban areas, living in rural areas significantly increased the average score of death anxiety by 0.55 points (p = 0.026). Additionally, a one-unit increase in religious attitude and resilience significantly reduced the mean score of death anxiety by 0.05 (p = 0.003) and 0.13 (p <0.001) on average, respectively. Spearman rank correlation indicated that religious attitudes and resilience were inversely and significantly correlated with death anxiety. Therefore, providing counseling sessions with psychologists and clergy seems necessary for a favorable change in the state of death anxiety in these patients.

Health Effects of Religion, Spirituality, and Supernatural Beliefs in Mainland China: A Systematic Review

Effects of religion, spirituality and supernatural beliefs (RSS) upon health in mainland China remain poorly understood, despite strong RSS beliefs influencing Chinese society. We conducted a Chinese-English bilingual systematic review to summarize the state of RSS-health research in mainland China. Study quality was assessed using the Critical Appraisal Skills Program tool. We screened 1858 studies, 162 of which were included in the review. From 2000-2004 to 2015-2019, the number of RSS-health studies in China increased from five to 73. However, only 7% of studies were rated as higher quality. Cross-sectional and case-control studies represented the vast majority of study designs (94%) and religious affiliation was the only RSS measure for 58% of studies. Higher, moderate, and lower quality studies indicated that RSS has both beneficial and adverse health implications. RSS-health research in China has accelerated rapidly in the last 20 years, but fundamental gaps in knowledge remain. Longitudinal study designs and nuanced RSS measures are needed to advance understanding of RSS health effects in China.

The role of religiosity and religious participation in the relationship between depressive symptoms and cognitive impairment among older Indian adults

Due to different nature of social engagements of older adults in South Asian countries specially attributed to the traditional family-based care and support, beneficial effects of religiosity and religious involvement on mental health and cognitive function in older age might be different than those in the Western world. Yet, there is a paucity of research in these countries on the role of religion in moderating the relationship between late life depression and cognition. This study explored the association of depressive symptoms with cognitive impairment and the moderating effects of religiosity and religious participation in those associations among older Indian adults. A cross-sectional study was conducted on data that were drawn from the Longitudinal Ageing Study in India wave-1, collected during 2017-2018. The sample size comprised of 31,464 older adults aged 60 years and above. Shortened 10-item Centre for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. Items from the Mini-Mental State Examination and the cognitive module of the China Health and Retirement Longitudinal Study and the Mexican Health and Aging Study were adapted for measuring cognitive impairment. Moderated multiple linear regression models were used to test the research hypotheses of the study. The proportion of older adults who reported religion as less important to them was 21.24%, whereas, only 19.31% of the respondents participated in religious activities. The mean score of cognitive impairment (on a scale of 0-43) in the current sample was 19.43 [confidence interval (CI): 19.32-19.53] among men and 23.55 [CI: 23.44-23.66] among women. Older adults with depressive symptoms had significantly higher likelihood of cognitive impairment [aCoef: 0.18, CI: 0.16-0.20] in comparison to older adults with no depressive symptoms. Older individuals who were religious were significantly less likely to have cognitive impairment [aCoef: - 0.43, CI: - 0.61 to - 0.25] than their non-religious counterparts. Compared to older adults who did not participate in religious activities, those who participated in religious activities were less likely [aCoef: - 0.52, CI: - 0.69 to - 0.34] to have cognitive impairment. Further, significant moderating effects of religiosity and religious participation in the relationship between depressive symptoms and cognitive impairment were observed. The current study contributes to advancing knowledge about the mental health benefits of religiosity and religious participation by focusing on older adults in India who culturally have limited chances to participate in social activities. The findings suggest that older adults with depressive symptoms may participate in religious activities which may reduce their chances of cognitive impairment. This protective effect of religiosity and religious participation on late life cognitive health has important implications for promoting alternative social support mechanisms for older adults in terms of enhancing their mental wellbeing and contributing to active aging.

Are Older Persons in China Living More Years in an Independent Living Arrangement? Estimates Using Multistate Life Tables

Adopting a multistate life table approach, this study estimates number of years the very old in China expect to live in an independent living arrangement (alone or with spouse only)-an estimate we term "independent living life expectancy" (ILLE)-as opposed to in coresidence with adult children or others. We also estimate how ILLE and proportion of total life expectancy (TLE) residing independently has changed over time. The backdrop for this study is a society experiencing both increasing longevity and social changes that influence the tendency to live in an independent living arrangement. The study concentrates on assessing whether changes in ILLE match or surpass gains in TLE experienced by oldest-old Chinese adults. Data are from the 2002-2014 Chinese Longitudinal Healthy Longevity Survey, and estimation is conducted using the Stochastic Population Analysis for Complex Events software. Results suggest that on balance, gains in ILLE are proportionately greater than gains in TLE, indicating an expansion of ILLE for most Chinese elders. Males, septuagenarian females, and disabled septuagenarians are the most likely to be living proportionately longer lives in an independent living arrangement. In contrast, extremely old (nonagenarian and centenarian) females and extremely old disabled individuals are least likely to have experienced dramatic changes in proportion of life residing independently. The findings imply some support for the hypothesis that given the maintenance of family solidarity in China, those in greatest need are least likely to encounter the most extreme changes toward independent living arrangements.

Religiosity and health among Chinese older adults: a meta-analytic review

The ageing population has been rapidly growing over recent years. Theoretically, religion seemingly plays an important role in improving older people's health. This study examines whether believing in religion is related to better health conditions among Chinese older adults through a meta-analysis. Two researchers independently extracted the studies from a comprehensive database and grey literature search and evaluated their scientific quality. From the 3,777 potentially eligible papers, just 76 were selected. The pooled effect size detected no significant difference between Chinese religious and non-religious older adults’ overall health and wellbeing. Dividing the outcomes into different categories, religious older adults reported both a higher level of anxiety (Hedge's g = −0.392, 95% confidence interval (CI) = −0.494, −0.290; p = 0.004) and yet a higher level of happiness (Hedge's g = 0.342, 95% CI = 0.074, 0.610; p = 0.018). Having a higher proportion of females in the sample is related to a smaller effect size in overall health outcomes (β = −2.205, 95% CI = −3.800, −0.613; p = 0.007) and social support specifically (β = −4.660, 95% CI = −6.261, −3.058; p < 0.0001). This study is among the first to synthesise the quantitative evidence regarding health differences between older religion believers and non-believers in China. It calls for future studies investigating the pathways underlying the religion–health relationship.

Leisure Activities and All-Cause Mortality Among the Chinese Oldest-Old Population: A Prospective Community-Based Cohort Study

OBJECTIVE

To investigate associations between leisure activities, examining each activity separately and in combination, and all-cause mortality among the Chinese oldest-old (≥80 years) population.

DESIGN

Prospective cohort study.

SETTING

Community-living, the oldest-old from 22 provinces in China.

PARTICIPANTS

We included 30,070 Chinese individuals aged ≥80 years (mean age: 92.7 years) from the Chinese Longitudinal Healthy Longevity Survey from 1998 to 2014.

MEASUREMENTS

Cox proportional hazards models were used to estimate relationships between leisure activities and all-cause mortality, adjusting for covariates including sociodemographic and lifestyle factors, self-reported medical history, and other potential confounders.

RESULTS

During 110,278 person-years of follow-up, 23,661 deaths were documented. Participants who engaged in watching TV or listening to the radio, playing cards or mah-jong, reading books or newspapers, gardening, keeping domestic animals or pets, or attending religious activities "almost every day" had a significantly lower mortality risk (adjusted hazard ratios ranged from 0.82 to 0.89; P < .01 for all) than did participants who "never" engaged in those activities. Furthermore, engagement in multiple leisure activities was associated with a reduced risk of all-cause mortality (P for the trend < .001).

CONCLUSIONS AND IMPLICATIONS

Frequent participation in leisure activities might help decrease the risk of death in the Chinese oldest-old population. This finding has important implications for public health policy and encourages the incorporation of a broad range of leisure activities into the daily lives of oldest-old individuals.

Social Participation and Self-Perception of Being Old in China

Longer life expectancy means that chronological age is no longer a useful indicator of defining old age. This study included 6,452 participants aged 60 years and older from the 2014 China Longitudinal Aging Social Survey to investigate the relationships between different types of social participation and self-perception of being old in China. Ordinary least square regression was applied. Results show that respondents who engaged in political participation or community participation reported higher self-perception of being old than those who did not engage in these social participations. Respondents who provided more care for grandchildren reported self-perception of being old at younger age. In the context of delaying retirement in China, obligatory participation was associated with an earlier start of the self-perception of being old. Elimination of mandatory retirement and separating that from pension eligibility may be good choices for promoting active aging.

Religiosity Dimensions and Disability-Free Life Expectancy in Taiwan

Objectives: Eight years of panel data are used to investigate the association between three dimensions of religiosity and total and disability-free life expectancy (TLE/DFLE) in Taiwan. Method: Data come from the 1999 "Taiwan Longitudinal Study on Aging" (TLSA; N = 4,440; Age 55+). Dimensions of religiosity are public, private, belief, and coping. Mortality is linked to a national database. Disability is activities of daily living (ADLs). TLE/DFLE estimates use the Stochastic Population Analysis for Complex Events (SPACE) software. Results: Those who engage in public and private religiosity live longer and more years disability-free than others, but proportion of life disability-free does not differ across levels of religiosity. Coping is less associated with TLE and DFLE. Coping however associates with more years disabled among men. Findings are robust to model specifications. Discussion: The way in which religiosity associates with health depends upon the definition. When it does associate, religiosity increases TLE and DFLE proportionately.

Association of socioeconomic status and health-related behavior with elderly health in China

Previous health studies have focused on the correlation between socioeconomic status (SES) and health. We pooled data from the Chinese Longitudinal Healthy Longevity Survey (N = 9765) conducted in 2011, and examined the association of SES and health-related behavior with elderly health in China. The cumulative health disadvantage of the elderly caused by SES can be relieved by lifelong health-related behavior. In the same SES, the odds of self-rated health (SRH) as “good,” mini-mental state examination (MMSE) as “not impaired,” and activities of daily living (ADLs) as “not impaired” among the elderly who exercised regularly, were 46.9%, 28.6%, and 62.3% lower for the elderly who rarely exercised. The elderly who started doing regular exercise from 30 years old, achieved higher SRH, ADL, and MMSE scores to some extent. The health improvement advantage for the elderly who started doing regular exercises after 60 years old, was reduced. However, the odds of SRH as “good,” MMSE as “not impaired,” and ADLs as “not impaired” were still 3.4%, 12.5%, and 17.8%, respectively, higher than the respondents who never exercised. The health-related behaviors not only promote elderly health improvement, but its duration has also been found to be associated with the extent of health improvement.

Changing perceived importance of religion in mainland China, 1990-2012: An age-period- cohort analysis

The comprehensive social reform and relaxation of religious regulation in mainland China have encouraged scholars to propose a revival thesis of religion, predicting a rising prevalence of religious adherence in the Reform Era. This study extends the revival thesis by focusing attention on people's subjective religiosity, and investigates age, period, and cohort effects on the transition in perceived importance of religion from 1990 to 2012. Capitalizing on the repeated cross-sectional data of the China sample in the World Values Survey, this study shows that (1) The senior population, relative to the younger counterpart, attaches greater importance to religion. (2) The net period effect suggests that Chinese citizens' perceived importance of religion follows an upward trend by the early 2000s, but no significant growth is detected henceforward. (3) The cohorts who experienced the anti-religion Mao's Era in their adolescent life course stage have an evidently lower probability of viewing religion to be important, in relation to the cohorts of the Reform Era. Theoretical implications of the empirical age-period-cohort patterns for the religious economies theory and change of Chinese religious landscape are discussed.

Social participation, willingness and quality of life: A population-based study among older adults in rural areas of China

AIM

The present study aimed to reflect the current situation of social participation in rural areas of China, willingness to participate in social activities, association between health-related quality of life and social participation, and factors related to social participation.

METHODS

A total of 2644 rural adults aged 60 years and older were randomly selected and surveyed with a self-rating questionnaire. We used the unified definition of social participation in our study. The Medical Outcomes Study Short-Form Health Survey was used to measure health-related quality of life.

RESULTS

The overall engagement of social activities was 26%. Those who participated in social activities were more likely to have high scores of health-related quality of life. Older men with a high educational level (OR 1.59, 95% CI 1.01-2.29) living alone or with a spouse (OR 1.51, 95% CI 1.08-2.12), high objective social support (OR 1.08, 95% CI 1.00-1.17) and high support utilization (OR 1.13, 95% CI 1.07-1.21) were inclined to engage in social participation. Older women with high individual income (OR 1.74, 95% CI 1.25-2.43), single marital status (OR 1.53, 95% CI 1.11-2.10), normal weight (OR 1.92, 95% CI 1.10-3.34), overweight (OR 2.28, 95% CI 1.24-4.19), living alone or with a spouse (OR 1.55, 95% CI 1.20-2.00), objective social support (OR 1.11, 95% CI 1.04-1.18) and subjective social support (OR 1.15, 95% CI 1.10-1.20) were more willing to engage in social participation.

CONCLUSIONS

Engagement in social activities is relatively low in rural areas, and associations of willingness and health-related quality of life with social participation were found. Policy-makers and government workers should make appropriate types of encouragement policies around social participation for older adults in rural areas. Geriatr Gerontol Int 2017; 17: 1593-1602.

Spirituality, religiosity, aging and health in global perspective: A review

Persistent population aging worldwide is focusing attention on modifiable factors that can improve later life health. There is evidence that religiosity and spirituality are among such factors. Older people tend to have high rates of involvement in religious and/or spiritual endeavors and it is possible that population aging will be associated with increasing prevalence of religious and spiritual activity worldwide. Despite increasing research on religiosity, spirituality and health among older persons, population aging worldwide suggests the need for a globally integrated approach. As a step toward this, we review a subset of the literature on the impact of religiosity and spirituality on health in later life. We find that much of this has looked at the relationship between religiosity/spirituality and longevity as well as physical and mental health. Mechanisms include social support, health behaviors, stress and psychosocial factors. We identify a number of gaps in current knowledge. Many previous studies have taken place in the U.S. and Europe. Much data is cross-sectional, limiting ability to make causal inference. Religiosity and spirituality can be difficult to define and distinguish and the two concepts are often considered together, though on balance religiosity has received more attention than spirituality. The latter may however be equally important. Although there is evidence that religiosity is associated with longer life and better physical and mental health, these outcomes have been investigated separately rather than together such as in measures of health expectancy. In conclusion, there is a need for a unified and nuanced approach to understanding how religiosity and spirituality impact on health and longevity within a context of global aging, in particular whether they result in longer healthy life rather than just longer life.

Social Engagement and Health

What are the social factors that matter most to the health of elderly Chinese? Are there any gender and age differences? Using a representative sample of elderly Chinese in Shanghai, the most developed city in China with the nation’s largest proportion of elderly residents, this study found that economic conditions, chronic health status, living arrangements, social activity participation, and caring for grandchildren are factors that are most important to the health of elderly Chinese. This is true for both self-rated health and psychological well-being. The beneficial effects of participation in social activities are particularly salient for elderly women and for the old–old, whereas the salutary effects of caring for grandchildren are more substantial for elderly men and for the young–old. Our findings suggest the importance of social engagement in promoting health and successful aging of elderly Chinese and disclose the moderating roles of gender and age in this focal relationship.

Religious involvement and mental disorders in mainland china

PURPOSE

The present study aims to examine the association between religious involvement and mental disorder (anxiety disorder, mood disorder, alcohol use disorder) in a general Chinese population, and explore connections between religious belief and mental disorders in the Hui and Han ethnic groups.

METHOD

Data were examined from a representative sample of 2,770 community-dwelling adults in the province of Ningxia located in western China. Self-reported religious attendance and the importance of religious in daily life were measured. The WHO Composite International Diagnostic Interview was used to diagnose mental disorders.

RESULTS

In the overall sample, the importance of religious affiliation was positively associated with mental disorders (especially anxiety) (p<0.01). No association was found between any religious characteristic and mood disorders or alcohol use disorders. With regard to analyses within different ethnic groups, religious affiliation was positively associated with mental disorder in Han ethnicity (p<0.01), but not in Hui ethnicity. When stratified by age and ethnic group, religious affiliation was associated positively with mental disorder in younger Han (p<0.01); whereas high religiosity was associated positively with mental disorder in older Hui (p<0.05). Among older Hui, however, religious affiliation was inversely associated with mood disorder (p<0.05).

CONCLUSIONS

In contrast to most previous studies in Western populations, religious involvement is less likely to be inversely related to mental disorder in Mainland China, although this association varies by age and ethnic group.

Religious involvement and tobacco use in mainland China: a preliminary study

Background

Cigarette smoking causes serious health, economic, and social problems throughout the world. Religious involvement is known to be an important predictor of health behaviors and substance use. The present study examines the correlation between religious involvements and tobacco use, and explores connections between religiosity and tobacco use in Muslims and non-Muslims in Western China.

Methods

Data were examined from a representative sample of 2,770 community-dwelling adults in the province of Ningxia located in Western China. Self-report smoking, past smoking, religious attendance and the importance of religious in daily life were measured. The WHO Composite International Diagnostic Interview was used to diagnose tobacco use disorders. Three separate logistic regression models were used to examine correlations between religious involvement and smoking status.

Results

In the overall sample, religious attendance was inversely associated with current smoking (p < 0.001), as was importance of religion (p < 0.05). Current smoking was also less common in those categorized as high on religious involvement. No association, however, was found between religious involvement and either past smoking or tobacco use disorders. In Muslims, both religion attendance and high religiosity were inversely associated with current smoking (p < 0.001), although no association was found in non-Muslims.

Conclusions

Religious involvement is inversely related to current smoking in Western China, although this association depends on religious affiliation.

Tea consumption and mortality in the oldest-old Chinese

OBJECTIVES

To investigate the association between tea consumption and mortality in the oldest-old Chinese.

DESIGN

Population-based longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were analyzed using a Cox semiparametric proportional hazard model.

SETTING

Six hundred thirty-one randomly selected counties and cities of China's 22 provinces.

PARTICIPANTS

Individuals aged 80 and older (N = 9,093) who provided complete data in the baseline survey (1998).

MEASUREMENTS

Self-reported current frequency of tea drinking and past frequency at approximately age 60 were ascertained at baseline survey; a follow-up survey was conducted 2000, 2002, and 2005.

RESULTS

In the oldest-old Chinese, tea consumption was associated with lower risk of mortality after adjusting for demographic characteristics, socioeconomic status, health practices, and health status. Compared with non-tea drinkers, the adjusted hazard ratio (HR) was 0.90 (95% confidence interval (CI) = 0.84-0.96) for daily tea drinkers (at the baseline survey, 1998) and 1.00 (95% CI = 1.01-1.07) for occasional tea drinkers (P for linear trend .003). Similar results were found when tea drinking status at age 60 was used in the analysis. Further analysis showed that subjects who reported frequent tea drinking at age 60 and at the baseline survey had a 10% lower risk of mortality than subjects who reported infrequent tea drinking at age 60 and at the baseline survey (HR = 0.90, 95% CI = 0.84-0.97).

CONCLUSION

Tea consumption is associated with lower risk of mortality in the oldest-old Chinese.

Religious activity, life expectancy, and disability-free life expectancy in Taiwan

Research has implicated religious activity as a health determinant, but questions remain, including whether associations persist in places where Judeo-Christian religions are not the majority; whether public versus private religious expressions have equivalent impacts, and the precise advantage expressed as years of life. This article addresses these issues in Taiwan. 3,739 Taiwanese aged 53+ were surveyed in 1999, 2003, and 2007. Mortality and disability were recorded. Religious activities in public and private settings were measured at baseline. Multistate life-tables produced estimates of total life expectancy and activity of daily living (ADL) disability-free life expectancy across levels of public and private religious activity. There is a consistent positive gradient between religious activity and expectancy with greater activity related to longer life and more years without disability. Life and ADL disability-free life expectancies for those with no religious affiliation fit in between the lowest and highest religious activity groups. Results corroborate evidence in the West. Mechanisms that intervene may be similar in Eastern religions despite differences in the ways in which popular religions are practiced. Results for those with no affiliation suggest benefits of religion can be accrued in alternate ways.

Towards Deeper Research and Better Policy for Healthy Aging --Using the Unique Data of Chinese Longitudinal Healthy Longevity Survey

The objectives of this review article are to facilitate deeper research and better policy analysis for healthy aging, which not only means surviving to old ages in good health, but also mean the economics and society of our country would be aging healthily, with sound policy and intervention programs. Toward these objectives, we introduce the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which has been conducted by Center for Healthy Aging and Development Studies, National School of Development of Peking University since 1998. We present a comprehensive and summarized introduction of the CLHLS study design, sample distributions, contents, general quality assessment and availability of the CLHLS data collected. Such an introduction would be helpful for our colleagues who may be interested in using this unique and more-than-fourteen-year longitudinal survey data resource for deeper interdisciplinary research and better policy analysis on healthy aging. To illustrate how the unique data resources of CLHLS may be useful, we also summarize and discuss ten selected healthy aging policy related research based on data from the CLHLS. Finally, we discussed the future perspectives using the unique and rich CLHLS datasets.