Fifteen-year disability trends among older persons in the Beijing municipality of China

Activity Limitations and Depression Among Middle-Aged and Older Adults in China: The Moderating Impact of Assistance Adequacy

This study aimed to examine the risk and protective factors associated with depression in middle-aged and older Chinese adults with activity limitations. Data were obtained from the 2018 Wave 4 Survey of the China Health and Retirement Longitudinal Study. In the logistic regression analysis, health and functioning, losing a child, and a perceived lack of future assistance with daily activities increased the odds of depression. Conversely, receiving adequate assistance with daily activities lessened the depressive impacts of activity limitations, as indicated by a significant interaction effect. Enhanced long-term support for individuals with disabilities is necessary to improve mental health.

Associations of blood pressure components with risks of cardiovascular events and all-cause death in a Chinese population: A Prospective Study

The associations of blood pressure components with cardiovascular risks and death remain unclear, and the definition of wide pulse pressure (PP) is still controversial. Using data from 1257 participants without a history of cardiovascular disease, who were followed for 4.84 years, we performed multivariable Cox regression analyses to assess how systolic blood pressure (SBP), diastolic blood pressure (DBP), and PP contribute to risks of cardiovascular events and all‐cause death. Among all participants, SBP and PP were significantly associated with the risks of cardiovascular events and all‐cause death (all p < .05). DBP was not significantly associated with the risk of all‐cause death; rather, it was only associated with a marginally significant 1% increased risk for cardiovascular events (p = 0.051). In participants aged < 65 years, DBP was significantly associated with a 3% increased risk for cardiovascular events (hazard ratio [HR]: 1.03, 95% confidence interval [95% CI]: 1.01–1.06). The association between PP and cardiovascular events appeared to be J‐shaped in comparison to participants with the lowest‐risk PP (50–60 mmHg), with adjusted HRs of 1.71 (95% CI: 1.03–2.85), 1.63 (95% CI: 1.00–2.68), and 2.13 (95% CI: 1.32–3.43) in the <50, 60.0–72.5, and ≥72.5 mmHg subgroups, respectively. The optimal cutoff points of a wide PP for predicting the risks of cardiovascular events and all‐cause death were 70.25 and 76.25 mmHg, respectively. SBP and PP had a greater effect on cardiovascular risk, whereas DBP independently influenced cardiovascular events in middle‐aged participants. Considerable PP alterations should be avoided in antihypertensive treatment.

Healthcare for older people in lower and middle income countries

Two-thirds of the world's population aged 60 years and over will reside in lower and middle income countries (LMIC) by 2050. Many LMICs are experiencing rapid population ageing at a faster rate than in Western Europe and North America, but may not have the resources to respond to the World Health Organization's call to action. As population ageing is a global issue, effective and sustainable global solutions are much needed. Proposed strategies include stemming the outflow of trained healthcare workers to high-income nations where migrants from LMICs often contribute to the work force caring for older people. Public education, preventive measures and innovative approaches to training are additional proposed solutions. Higher income countries have a responsibility to contribute towards the development of healthcare services for older people in LMICs.

Homocysteine, hypertension, and risks of cardiovascular events and all-cause death in the Chinese elderly population: a prospective study

BACKGROUND

Increased homocysteine levels are associated with the risk of cardiovascular disease (CVD) and death. However, their prevention has not been effective in decreasing CVD risk. This study investigated the individual and combined associations of hyperhomocysteinemia and hypertension with incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.

METHODS

This prospective study was conducted among 1,257 elderly participants (mean age: 69 years). A questionnaire survey, physical examinations, and laboratory tests were conducted to collect baseline data. Hyperhomocysteinemia was defined as homocysteine level ≥ 15 µmol/L. H-type hypertension was defined as concomitant hypertension and hyperhomocysteinemia. Multivariate Cox regression analysis was used to evaluate individual and combined associations of hyperhomocysteinemia and hypertension with the risks of incident CVD events and all-cause death.

RESULTS

Over a median of 4.84-year follow-up, hyperhomocysteinemia was independently associated with incident CVD events and all-cause death. The hazard ratios (HRs) were 1.45 (95% CI: 1.01−2.08) for incident CVD events and 1.55 (95% CI: 1.04−2.30) for all-cause death. After adjustment for confounding factors, H-type hypertension had the highest HRs for incident CVD events and all-cause death. The fully adjusted HRs were 2.44 for incident CVD events (95% CI: 1.28−4.65), 2.07 for stroke events (95% CI: 1.01−4.29), 8.33 for coronary events (95% CI: 1.10−63.11), and 2.31 for all-cause death (95% CI: 1.15−4.62).

CONCLUSIONS

Hyperhomocysteinemia was an independent risk factor, and when accompanied by hypertension, it contributed to incident CVD events and all-cause death in the Chinese elderly population without a history of CVD.

Homocysteine and the Risk of Cardiovascular Events and All-Cause Death in Elderly Population: A Community-Based Prospective Cohort Study

Background

The association between homocysteine and cardiovascular diseases (CVD) and all-cause death was inconclusive. A community-based prospective cohort study was carried out in Beijing to evaluate this association in elderly population for more effective clinical prediction and primary prevention of CVD.

Patients and Methods

Participants were randomly selected from Beijing, China. Questionnaire survey, physical examinations, and laboratory tests were carried out to collect baseline information and investigate clinical characteristics. Each participant was predetermined to be followed by 5 years. CVD events and death were collected as primary variables. A Cox regression analysis was performed to assess the risk of CVD events, CVD death, and all-cause death contributed by homocysteine as well as some other risk factors.

Results

A total of 1257 participants with an average age of 69.16 years were enrolled in this study. After adjusting for confounders, the hazard ratios (HRs) and 95% confidence intervals of CVD event, CVD death, and all-cause death caused by intermediate-to-severe hyperhomocysteinemia as compared with normal homocysteine levels were 1.68 (95% CI 1.06–2.67), 1.97 (95% CI 0.95–4.29) and 2.02 (95% CI 1.26–3.24), respectively. Intermediate-to-severe hyperhomocysteinemia increased the risks of CVD event (HR 2.07, 95% CI 1.01–4.26) and all-cause death (HR 3.08, 95% CI 1.56–6.07) among male participants. However, the positive association was not statistically significant among female participants (HR 1.59, 95% CI 0.83–3.04 for CVD event and HR 0.90, 95% CI 0.52–6.07 for all-cause death). Every 5μmol/L increment in homocysteine concentration was shown to be associated with a 4% (HR 1.04, 95% CI 1.01–1.07) and 5% (HR 1.05, 95% CI 1.01–1.07) higher risk of CVD events and all-cause death in all participants. There was no significant association between moderate hyperhomocysteinemia and the risk of the CVD events and all-cause death.

Conclusion

Intermediate-to-severe hyperhomocysteinemia was significantly associated with CVD events and all-cause death in elderly population without a history of ischemia or congestive heart failure (CHF). The positive association was pronounced among males.

Are China's oldest-old living longer with less disability? A longitudinal modeling analysis of birth cohorts born 10 years apart

BACKGROUND

China has transitioned from being one of the fastest-growing populations to among the most rapidly aging countries worldwide. In particular, the population of oldest-old individuals, those aged 80+, is projected to quadruple by 2050. The oldest-old represent a uniquely important group-they have high demand for personal assistance and the highest healthcare costs of any age group. Understanding trends in disability and longevity among the oldest-old-that is, whether successive generations are living longer and with less disability-is of great importance for policy and planning purposes.

METHODS

We utilized data from successive birth cohorts (n = 20,520) of the Chinese oldest-old born 10 years apart (the earlier cohort was interviewed in 1998 and the later cohort in 2008). Disability was defined as needing personal assistance in performing one or more of five essential activities (bathing, transferring, dressing, eating, and toileting) or being incontinent. Participants were followed for age-specific disability transitions and mortality (in 2000 and 2002 for the earlier cohort and 2011 and 2014 for the later cohort), which were then used to generate microsimulation-based multistate life tables to estimate partial life expectancy (LE) and disability-free LE (DFLE), stratified by sex and age groups (octogenarians, nonagenarians, and centenarians). We additionally explored sociodemographic heterogeneity in LE and DFLE by urban/rural residence and educational attainment.

RESULTS

More recently born Chinese octogenarians (born 1919-1928) had a longer partial LE between ages 80 and 89 than octogenarians born 1909-1918, and octogenarian women experienced an increase in partial DFLE of 0.32 years (P = 0.004) across the two birth cohorts. Although no increases in partial LE were observed among nonagenarians or centenarians, partial DFLE increased across birth cohorts, with a gain of 0.41 years (P < 0.001) among nonagenarians and 0.07 years (P = 0.050) among centenarians. Subgroup analyses revealed that gains in partial LE and DFLE primarily occurred among the urban resident population.

CONCLUSIONS

Successive generations of China's oldest-old are living with less disability as a whole, and LE is expanding among octogenarians. However, we found a widening urban-rural disparity in longevity and disability, highlighting the need to improve policies to alleviate health inequality throughout the population.

The Protective Effects of Informal Care Receipt Against the Progression of Functional Limitations Among Chinese Older People

Objective

This study investigates the impacts of receiving informal care on the progression of functional limitations among older people aged 60 and older in China.

Methods

The data come from three waves of the China Health and Retirement Longitudinal Survey, which collected health- and aging-related information on a nationally representative sample of Chinese older people from 2011 to 2015. Multilevel regression models were used to analyze the data.

Results

The protective effect of receiving informal care is stronger for the first 2 years after the baseline survey and tends to fade away or be reversed 4 years later. The protective effect is stronger among older people receiving low-intensity informal care and is gradually weakened with an increase in care intensity.

Discussion

Trajectories of function capabilities are deeply embedded in social relationships. In the context of rapid population aging and increasing demand for informal care, government support for caregivers is needed to sustain the protective effects of informal care.

Cognitive and physical function of people older than 80 years in China from 1998 to 2014

Objectives This study was performed to describe the health status of Chinese oldest-old individuals aged ≥80 years from 1998 to 2014 and explore differences in their health status based on demographic characteristics and socioeconomic status. Methods Data were obtained from the seven waves of the Chinese Longitudinal Healthy Longevity Survey. The Mini Mental State Examination, Katz Index of Independence in Activities of Daily Living, and chair stand test were used to examine cognitive and physical function. Logistic regression was used to evaluate the changes in health outcomes. Results Regression results showed increasing cognitive impairment trends and decreasing disability trends, indicating that the oldest-old individuals had worse body function in more recent years. Older people and women had a weaker health status. Rural elders had better physical performance but worse cognitive function. Participants with an education had better overall functioning. Individuals with severe disability had the shortest survival time among the study population. Conclusions From 1998 to 2014, the health status of oldest-old individuals was relatively stable in China. These findings indicate the need for specific and continuing attention to the oldest-old population to improve their health condition.

The relationship and mechanism between education and functional health status transition among older persons in China

BACKGROUND

Despite decades of study, debates exist surrounding the relationship between education and functional health status transition among elderly populations. This study aims to add evidence to the debates using China as a case study. Specifically, this study analysed the association of education with functional health status transition and then the mechanism behind that association using the budget constraint relax hypothesis and the efficiency improvement hypothesis among elderly population in China.

METHODS

Based on data from the Chinese Longitudinal Healthy Longevity Surveys from 2008 and 2011, this study focussed on adults aged 65 years and above, with a final sample size of 12,112. A generalised structural equation model was used to analyse the relationship between education and functional health status transition and the mechanism behind that association.

RESULTS

During the three examined years, among elderly adults who were nondisabled at baseline, 53.1% stayed nondisabled, 14.6% became disabled, and 32.3% died; among those disabled in 2008, 8.1% recovered, 21.6% stayed disabled, and 70.3% died. Compared with older adults without any education, those who had attended primary schools had both lower mortality and disability, whereas those who had attended high schools and above only had a lower mortality rate. The budget constraint relax hypothesis and the efficiency improvement hypothesis explained the majority of the relationship between education and transition from non-disability to death, but hardly explained the transition from non-disability to disability. Furthermore, once a person was disabled, education had no significant relationship with functional ability recovery or mortality.

CONCLUSIONS

Attending primary school seems to provide the highest benefit to functional health status transition among older and nondisabled persons in China. Those who attended high schools and above are expected to live a longer life with disability. The mechanism between education and the onset of disability needs more discussion.

Trends in Incidence of Disability in Activities of Daily Living in Chinese Older Adults: 1993-2006

OBJECTIVES

To investigate time trends in incidence of activity of daily living (ADL) disability of Chinese older adults and to explore factors potentially contributing to trends.

DESIGN

Population-based prospective study using a multistage, randomized, cluster sampling process.

SETTING

Nine provinces of China.

PARTICIPANTS

Three consecutive cohorts of people aged 60 and older from the China Health and Nutrition Survey: cohort 1993-2000 (n = 831), cohort 1997-2004 (n = 1,091), cohort 2000-2006 (n = 1,152).

MEASUREMENTS

Disability in ADLs was defined as inability to perform at least one of five self-care activities (transferring, dressing, toileting, bathing, feeding). Data were analyzed using Cox and generalized estimating equation models.

RESULTS

The incidence (per 1,000 person-years) of ADL disability decreased significantly from 35.3 in 1993-2000 and 28.9 in 1997-2004 to 24.3 in 2000-2006 in Chinese older adults (P_trend < .001). The incidence of ADL disability decreased significantly in men and women, in young-old adults (aged 60-74), and in those living in rural areas (all P_trend ≤ .02) after controlling for multiple potential influential factors. Of the five ADL items, decline in incidence of disability was significant in transferring (P_trend < .001) and bathing (P_trend = .002) and marginally significant in toileting (P_trend = .06) but stable in dressing (P_trend = .38) and feeding (P_trend = .26).

CONCLUSION

The incidence of ADL disability decreased from 1993 to 2006 in older adults in China, especially in transferring and bathing, independent of sociodemographic, lifestyle, and chronic health conditions.

Prevalence of hyperuricemia among Beijing post-menopausal women in 10 years

OBJECTIVES

The objective of this study was to explore the trend and risk factors of the prevalence of hyperuricemia among post-menopausal women in Beijing over a ten years period.

METHOD

This research was based on two cross-sectional surveys in post-menopausal women in Beijing. A total of 1881 post-menopausal women were included. Subjects answered a questionnaire and underwent a physical examination and blood test. Serum uric acid >357 μmol/L was diagnosed as hyperuricemia, and another diagnosis criterion (serum uric acid >416 μmol/L) was applied in these women.

RESULTS

Serum uric acid levels and hyperuricemia prevalence increased remarkably in the 10-year period. The prevalence of hyperuricemia increased more than 2-fold after being adjusted by age. Multivariate logistic regression models revealed hyperuricemia associated with age, education level, urban residents, alcohol consumption, hypertension, obesity, and dyslipidemia. With the increasing number of traditional cardiovascular risk factors (including hypertension, obesity, diabetes, and dyslipidemia), the risk of hyperuricemia increased significantly, and the accumulative effect of the factors on the risk of hyperuricemia was determined.

CONCLUSION

The prevalence of hyperuricemia was high and exhibited a remarkable, increasing trend in Beijing community-based, post-menopausal women. Better management of relative factors could help to prevent further increases in the burden of hyperuricemia in post-menopausal women in this region.

Epidemiological Characteristics of Hypertension in the Elderly in Beijing, China

Background/Objectives

The prevalence rate of hypertension increases significantly with the aging society, and hypertension is obviously becoming a major health care concern in China. The aim of the study was to explore the epidemiological characteristics of hypertension in the elderly and to provide a basis for the prevention of hypertension.

Design

3-cross sectional studies in 2000, 2004, and 2007, respectively.

Setting

Beijing, China.

Participants

A group of 2,832, 1,828, and 2,277 elderly residents aged ≥60 years were included this study in 2000, 2004, and 2007, respectively.

Intervention

None.

Measurements

Statistical sampling techniques included cluster, stratification, and random selection. Trained staff used a comprehensive geriatric assessment questionnaire and a standard survey instrument to complete the assessments. During the person-to-person interviews, the participants’ demographic characteristics, living conditions, and health status were collected, and their blood pressure was measured.

Results

The prevalence rates (69.2%, 61.9%, and 56.0%) of hypertension and the control rates (22.6%, 16.7%, and 21.5%) lowered annually, while the awareness rates (43.7%, 55.8%, and 57.6%) of the treatment elevated annually in 2000, 2004, and 2007, respectively. There was no increase in the control rates for males (26.2%, 16.7%, and 20.8%), younger participants (28.0%, 18.4%, and 21.0%), and rural residents (19.5%, 9.6%, and 13.4%) in 2000, 2004, and 2007, respectively.

Conclusions

Our study findings indicated that the prevalence of hypertension is high in rural elderly participants, while the rates of awareness, treatment, and control were low. This suggests that effective public measures need to be developed to improve the prevention and control of hypertension.