The aging population in China: Subjective well-being of empty nesters in rural eastern China

The association between quality of life and subjective wellbeing among older adults based on canonical correlation analysis

Introduction

The study explored the relationship between subjective well-being and the quality of life among older adults. It highlights the importance of understanding how these factors are interconnected in the context of an aging population.

Methods

Descriptive statistics were used to analyze the scores of general demographic characteristics, subjective wellbeing and quality of life. Simple correlation analysis and canonical correlation analysis were employed to analyze the relationship between subjective wellbeing and quality of life among older adults.

Results

Data from 892 older adults were collected. Canonical correlation analysis revealed four pairs of canonical variables, with the first four pairs of canonical correlation coefficients all being statistically significant (0.695, 0.179, 0.147, 0.121) (p < 0.05), and the first pair of canonical variables explaining 93.03% of the information content. From the canonical loading coefficients, Vitality and mental health contributed the most to the quality of life (U1) canonical variable. The canonical variable V1, which corresponded to subjective wellbeing, was reflected by a combination of positive affect, negative affect, positive experience and negative experience. X1 (physical functioning), X2 (role-physical), X3 (bodily pain), X4 (general health), X5 (vitality), X6 (social functioning), X7 (role-emotional) and X8 (mental health) were positively correlated with Y1 (positive affect) and Y3 (positive experience), negatively correlated with Y2 (negative affect) and Y4 (negative experience). Cross-loadings revealed that physical functioning, bodily pain, general health, vitality, social functioning and mental health were the main factors reflecting the subjective wellbeing of older adults.

Discussion

As quality of life among older adults was highly correlated with subjective wellbeing, appropriate measures should be taken to account for individual characteristics of older adults, and various factors should be integrated to improve their subjective wellbeing.

Health and wellbeing among the empty nest and non-empty nest elderly in China-Results from a national cross-sectional study

BACKGROUND

The number of empty nest elderly in China has gradually increased in recent years. There is growing concern about the physical and mental health of this population as empty nest elderly are commonly at the risk of compromising health, home safety and quality of life. This study reported the health and well-being of empty nest elderly with regards to their health status, depression and satisfaction, lifestyle as compared to non-empty nest elderly in China.

METHODS

Data was collected from the 2018 follow-up interviews of China Health and Retirement Longitudinal Survey. We included 4,630 empty nest elderly and 6,188 non-empty nest elderly. Chi-square Test and Logistic Regression were used to compare the differences between these two groups.

RESULTS

As compared to the non-empty nest elderly, there was higher proportion of empty nest elderly who suffered from dyslipidemia, diabetes, chronic lung diseases, heart attack (27.0% vs. 25.0%; 16.6% vs. 15.1%; 19.4% vs. 16.4%; 26.3% vs. 23.4%, P < 0.05). The empty nest elderly had higher proportion of participants who drank more than once a month (25.3% vs. 23.9%, P < 0.05), who felt satisfied with their marriage (71.6% vs. 66.2%, P < 0.001), who were satisfied with their children's relationship (85.2% vs. 83.2%, P < 0.001). However, these significances disappeared in the Logistic Regression analysis (P > 0.05).

CONCLUSION

Our study showed that significant between-group difference was found between empty nest elderly and non-empty nest elderly in their health and wellbeing. However, disappearance of such difference in the multivariable analysis may indicate improved health and wellbeing among the empty nest elderly. Even though our study still suggested the importance of improving the health, lifestyles and family dynamics of the elderly and promoting the integration of health and social care for the elderly, especially among the empty nest elderly.

Exploring the relationship between mental health and dialect use among Chinese older adults: a moderated mediation estimation

Background

Mental health, conceptualized as psychological status that includes rational cognition, emotional stability, and interpersonal harmony, is highly relevant to the expected health and well-being of all humans. China is facing the dual risk of increased aging and mental health disorders in older adults, while the established studies have rarely focused on the influence of dialect on the mental health of Chinese older adults. The present study aims to capture the relationship between dialect and mental health in Chinese older adults.

Methods

We use cross-sectional data from the nationally representative China Family Panel Studies, which encompasses the dialect use, mental health, and other socioeconomic features of 4,420 respondents. We construct a moderated mediation model that uses dialects and mental health as the independent and dependent variables and income inequality and subjective well-being as the mediator and moderator to reveal the relationship between dialect and mental health in Chinese older adults.

Results

(1) Dialects are shown to have a negative influence on the mental health of older adults in the current study (coefficient = -0.354, 95% CI = [-0.608, -0.097]). (2) Income inequality positively mediates the correlation between dialects and mental health (coefficient = 0.019, 95% CI = [0.010, 0.045]). (3) Subjective well-being negatively moderates the potential mechanism between dialects and mental health (coefficient = -0.126, 95% CI = [-0.284, -0.010]).

Conclusion

The use of dialects is associated with worse mental health outcomes in Chinese older adults, while this negative influence is positively mediated by income inequality and negatively moderated by subjective well-being, simultaneously. This study contributes to the knowledge enrichment of government workers, older adults with mental disorders, medical staff, and other stakeholders.

The causal association between empty nest and depressive symptoms with cognitive impairments in China

BACKGROUND

In the context of rapid aging, "empty nest syndrome" is becoming a major public health concern. The causal effects of empty nest on depressive symptoms have been studied in developed countries, but the mediating mechanism of depressive symptoms in the association between empty nest and cognitive impairments has not been studied. This study estimated the causal association of empty nest with depressive symptoms and cognitive impairments in China, and then estimated how depression mediates the association between empty nest and cognitive impairments.

METHODS

Using data of 23,614 urban older adults (65+) obtained from the Shandong Province Aging and Mental Health Survey in 2020, a weighted linear regression model combined with instrumental variable was applied to explore the causal effects of empty nest, and a four-step mediation model was run to test the mediator of depressive symptoms. The Ascertain Dementia 8-item Questionnaire and Patient Health Questionnaire-9 were used to measure cognitive impairments and depressive symptoms.

RESULTS

Empty nest was associated with 0.13 (95%CI: 0.04-0.23) and 0.23 (95%CI: 0.14-0.33) increases in the Ascertain Dementia 8-item Questionnaire and the Patient Health Questionnaire-9 scores, respectively. The association between empty nest and the Ascertain Dementia 8-item Questionnaire scores was mediated by the Patient Health Questionnaire-9 scores.

CONCLUSIONS

Empty nest affected depression in adulthood with cognitive impairments. A focus on integrative intervention for empty nesters is recommended, taking depression and cognition into account.

LIMITATIONS

It is a cross-sectional study and the data is not nationally representative.

Self-Care Experiences of Empty-Nest Elderly Living With Type 2 Diabetes Mellitus: A Qualitative Study From China

Background

The number of type 2 diabetes mellitus (T2DM) cases among empty-nest elderly increases with increasing aging in China. Self-care plays an important role in preventing and reducing adverse outcomes of diabetes; however, few studies focus on self-care experiences of empty-nest elderly with T2DM.

Objective

To explore self-care experiences for a chronic disease among empty-nest elderly patients with T2DM in mainland China.

Methods

A descriptive phenomenological design was used in this study. Semi-structured interviews were conducted for 15 empty-nesters with T2DM. Interviews were implemented in department of endocrinology at a tertiary teaching hospital located in Shandong province, east of China.

Results

The participants were poorly adept with monitoring their blood glucose and lacked the ability to deal with abnormal blood glucose levels. Most participants had a good relationship with medication and physical activity. Living without children was perceived as a benefit that improved dietary management and is a disadvantage in terms of economic and emotional support and access to medical resources. Elderly empty-nesters also lacked knowledge about diabetes and paid little attention to potential complications.

Conclusion

Empty-nest elderly patients with T2DM value medication compliance and lifestyle modification more than blood glucose monitoring, complication prevention, and coping with negative emotions. Friends and spouses play indispensable roles in patients' self-care motivation and maintenance. Diabetes education on self-care, access to medical resources, and social support is needed for better diabetes management.

The Mechanism of Human Connectedness in Relationship to Physical Health, Mental Health, and Cognitive Function Among the Elderly in Rural China

Background: Elderly people face particular challenges in their everyday lives, and these are likely to be caused by physical health, mental health, cognitive function, and lack of maintaining a connection to other people. This study aims to explore a meaningful measure of human connectedness among the elderly in rural China and to examine the extent to which it impacts elderly people's physical and mental health as well as their cognitive function. Methods: Survey data were collected from 483 participants who were aged 60 and older in northeast rural China. The outcome variables included cognitive function, which was assessed by the Short Portable Mental Status Questionnaire; depressive symptoms, which were measured by the 10-item version of the Center for Epidemiologic Studies Depression Scale; and the participants' physical health, which was assessed by a 15-item checklist. On the other hand, human connectedness was constructed by perceived family support, which was measured by the Multidimensional Scale of Perceived Social Support; the sense of community, which was measured by the Brief Sense of Community Scale; and the satisfaction of connectedness with others (i.e., with family members and friends). Results: Structural equation modeling analysis confirms that perceived family support, community feelings, and perceived satisfactory connections with family and friends constitute a sufficient representation of human connectedness. Moreover, human connectedness also significantly predicted one's mental and physical well-being as well as cognitive function (b = 0.11, SD = 0.02, β = 0.50, p < 0.001; model fitting indexesX ( 16 ) 2 = 17.27, p = 0.368, CFI = 0.998, and RMSEA = 0.013). Conclusion: The present study is the first attempt to explore the latent structure of human connectedness and its positive impact on cognitive function as well as physical and mental health among elderly people. The implications and the importance of fostering a stronger social support network, especially for the aging population, are discussed.

Cognitive frailty and suicidal ideation among Chinese rural empty-nest older adults: Parent-child geographic proximity as a possible moderator?

BACKGROUND

Few studies explored the relationship between cognitive frailty and suicidal ideation (SI), and whether geographic variable modified this relationship. This study aimed to explore the association between cognitive frailty and SI, and investigated whether parent-child geographic proximity is a moderator in this relationship among Chinese rural empty-nest older adults.

METHODS

A total of 2,549 rural empty-nest older adults (60+) were included in the analysis. SI was assessed using questions from the National Comorbidity Survey. Fried frailty phenotype and Mini Mental State Examination were used to measure cognitive frailty. Moderating effect analysis was performed using logistic regression models and margins plot.

RESULTS

The prevalence of SI and cognitive frailty were 10.1% and 6.2% among Chinese rural empty-nest older adults. Participants with cognitive frailty were more likely to suffer from SI (OR=1.16, 95% CI=1.03-2.86). We found that far geographic distance may aggravate this relationship (OR=4.30, 95% CI=1.02-10.24), especially for rural empty-nest older adults whose nearest adult child lived outside the same prefectural city with them.

LIMITATIONS

The results cannot be interpreted as causality of the data due to cross-sectional design.

CONCLUSIONS

Our findings suggested that cognitive frailty was associated with SI and parent-child geographic proximity moderated this relationship. Improving the cognitive frailty of older adults is helpful to prevent SI. Adult children living far away from rural empty-nest older adults should increase intergenerational contact and pay attention to their parents' physical and mental health.

The effect of square dance on family cohesion and subjective well-being of middle-aged and empty-nest women in China

Researchers in this study aimed to examine the effect of square dance on the subjective well-being of middle-aged and empty-nest women, as well as the potential moderating role of group belongingness in the relationship between family cohesion and subjective well-being. A total of 331 middle-aged and empty-nest Chinese women participated in a survey to measure their family adaptability and cohesion, group belongingness, general well-being, and square-dancing participation information. The results were found as follows: (a) Chinese middle-aged and empty-nest women's family cohesion was positively associated with subjective well-being, and their group belongingness in square dance was positively associated with subjective well-being; (b) participation in square dance can be the moderator the relationship between family cohesion and subjective well-being; (c) group belongingness was found to be a moderator in the relationship between family cohesion and subjective well-being.

The Relationship Between Health Literacy, Social Support, Depression, and Frailty Among Community-Dwelling Older Patients With Hypertension and Diabetes in China

Population aging is one of the major challenges facing modern society and has attracted global attention. With population aging becoming a global phenomenon, the impact of age-related diseases on health is increasing rapidly. Frailty is one of the most pressing issues facing older adults. The purpose of this study was to explore the interrelationship between health literacy, social support, depression, and frailty among older patients with hypertension and diabetes in China. No studies have investigated the mediating effects of social support and depression between health literacy and frailty. The findings of this study can be applied to help ameliorate frailty in older hypertensive and diabetic patients. Data were collected from 637 older hypertensive and diabetic patients aged 65 years and older in Sichuan Province, China. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. The results showed that 42.4% of the participants suffered from frailty. The mean scores for health literacy, social support, depression, and frailty were 13.6 ± 5.7, 35.7 ± 6.5, 4.0 ± 3.4, and 3.5 ± 2.1, respectively. Social support had a direct negative association with frailty (β = −0.128, 95%CI: [−0.198, −0.056]), and depression had a direct positive association with frailty (β = 0.326, 95%CI: [0.229, 0.411]), while social support had no direct association with depression. Health literacy had a direct positive association with social support (β = 0.151, 95%CI: [0.077, 0.224]) and a direct negative association with depression (β = −0.173, 95%CI: [−0.246, −0.1]), while health literacy had an indirect negative association with frailty through the mediating effect of social support and depression. To mitigate frailty in older patients with hypertension and diabetes, measures that provide social support, and enhance health literacy, while alleviating depression, should be considered, along with greater attention to patients who are divorced, widowed, or unmarried, those with comorbidities, and those with lower socioeconomic status.

Migration of adult children and mental health of older parents 'left behind': An integrative review

Background

Although a number of studies have examined the effect of the out-migration of children on the mental health of ‘left behind’ elderly parents, research on the consequences of children’s migration on the mental health and well-being of elderly parents left behind is inconclusive and a systematic review is warranted.

Objectives

To identify the association between the left behind or empty nest status and the mental health of older parents, and to identify common risk factors for poor mental health among those left behind.

Methods

Online databases CINAHL, PsycINFO, PubMed, Scopus and ProQuest were searched for research (2000-September 2017) that focused on the relationship between the migration of adult children and the mental health of the older parents (≥50 years) left behind. The JBI Checklist for Analytical Cross Sectional Studies was used to assess the methodological quality of the articles.

Results

25 articles met the inclusion criteria. The studies identified that left behind older parents had higher levels of mental health problems compared to non-left behind. Left behind parents had higher depressive symptoms, higher levels of loneliness, lower life satisfaction, lower cognitive ability and poorer psychological health. A number of risk factors were identified for mental health disorders among the left behind parents, which included living arrangements, gender, education, income, physical health status, physical activity, family and social support, age, rural residence and frequency of children’s visit.

Conclusions

This review synthesised the various studies related to the mental health of left behind parents, advancing the theoretical and empirical understanding of the implications of out-migration of adult children on the psychological health and well-being of older parents. More responsive preventive measures and effective management approaches are required for this vulnerable cohort.

Efficacy of Danhong Injection on Serum Concentration of TNF-α, IL-6 and NF-κB in Rats with Intracerebral Hemorrhage

Objective

To investigate the efficacy of Danhong injection on the serum concentration of tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6) and nuclear factor kappa-light-chain-enhancer of activated B (NF-κB) in rats with intracerebral hemorrhage (ICH) and evaluate its therapeutic effects on inflammation and cerebral edema.

Methods

Sixty male Wistar rats were randomly divided into control, model and Danhong groups with 25 rats in each group. Intracerebral injection of autologous arterial blood was performed on model and Danhong groups in order to establish intracerebral hemorrhage model. Rats in the control group were given the same operation procedure without blood injection. After successfully establishing the intracerebral hemorrhage model, the rats were given Danhong (2ml/kg/d) through intraperitoneal injection. Rats in the control and model groups were given the same amount of normal saline respectively. The brain water content (BWC) and serum level of TNF-α, IL-6 and NF-κB were measured in all groups at the time points of day 1, 3, 5, 7 and 9.

Results

The neurological deficit score (NDS) were not statistical different in days 1, 3 and 5 between the model and Danhong group (P>0.05); However, on day 7 and 9 after modeling, the NDS in the Danhong group was significant lower than that of the Model group (P<0.05). The brain water content in the model and Danhong groups were significantly elevated compared to control group (P<0.05). The brain water content was significant elevated after modeling in the model and Danhong groups on day 3 and gradually decreased over the next 6 days.

The brain water content was significantly higher in the model group for days 3 to 9 compared to the Danhong group (P<0.05). Compared to the model group, the serum NF-κb was significantly lower in the Danhong group for the time point of day 3 and 5 (P<0.05); However, compared to the model group, the serum TNF-α and IL-6 levels in the Danhong group were significantly lower for each time point (P<0.05). Conclusion Danhong injection can reduce cerebral edema in rats with cerebral hemorrhage, and protect the brain nerve function. These effects may be related to its function of regulating serum TNF-α, NF-κB and IL-6 expression.