Factors affecting the evolution of Chinese elderly depression: a cross-sectional study

Association of social frailty, sarcopenia, and oral frailty with depressive symptoms in Chinese older adults: a cross-sectional study

BACKGROUND

Depressive symptoms are a serious health issue that can cause profound, lifelong suffering for people who are affected by it. This study aimed to evaluate the effect of sarcopenia, oral frailty, and social frailty on depressive symptoms among Chinese participants aged ≥ 60 years old in China.

METHODS

This research utilized a cross-sectional design and used convenience sampling to select participants from Anhui Province, China. Demographic questionnaire, SARC-F (Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls), OFI-8 (Oral Frailty Index-8), the HALFT (Help, Participation, Loneliness, Financial, Talk) scale, and PHQ-9 (Patient Health Questionnaire-9) were used to conduct the survey. A chi-square test was performed to evaluate the differences between categorical variables, spearman correlation analysis was used to find the correlation between depressive symptoms and factors. Four regression models were set up to evaluate the effect of factors on depressive symptoms and select the appropriate adjustment variables.

RESULTS

Of 1453 participants, 33.5% had sarcopenia, 51.4% had oral frailty, 31.5% had pre-social frailty, 14.5% had social frailty, and 32.2% had depressive symptoms. Spearman correlation analysis indicated that depressive symptoms significantly correlated with sarcopenia (r = 0.415), oral frailty (r = 0.282), and social frailty (r = 0.410). In crude analysis, sarcopenia (OR = 0.179, 95%CI 0.141-0.227), oral frailty (OR = 3.946, 95%CI 3.101-5.021), pre-social frailty (OR = 4.449, 95%CI 3.401-5.818), and social frailty (OR = 12.552, 95%CI 8.833-17.837) were significantly associated with depressive symptoms in older adults. After adjusting for the covariates, sarcopenia (OR = 4.301, 95%CI 3.322-5.569), oral frailty (OR = 3.136, 95%CI 2.430-4.046), pre-social frailty (OR = 3.664, 95%CI 2.775-4.836) and social frailty (OR = 9.488, 95%CI 6.560-13.723) were significantly associated with depressive symptoms. (P <0.05).

CONCLUSION

This research indicated that sarcopenia, oral frailty, pre-social frailty, and social frailty, were significant and positively associated with depressive symptoms. These results provide clinicians with a reference for identifying high-risk older adults and give public health policymakers a scientific approach to taking targeted interventions. Future research should further explore the two-way relationship between these factors and depressive symptoms and assess the effectiveness of different interventions. This will help to improve the quality of life and mental health.

Reciprocal effects of sleep duration and depressive symptoms among Chinese couples: A longitudinal dyadic analysis

BACKGROUND

The reciprocal effects between sleep and depression have been widely demonstrated. However, current understanding has focused on the association at the individual level. The present study aims to explore the longitudinal, dyadic, and reciprocal associations between sleep duration and depressive symptoms on a couple level and test whether these effects vary by gender.

METHODS

Using data from the China Health and Retirement Longitudinal Study (CHARLS; 2011 and 2018), we analyzed 5683 couples (11,366 individuals) aged 45 and older (Meanage = 58.69, SD = 8.55). Sleep duration was measured by self-report of sleep hours, and depressive symptoms were measured by the CES-D scale. We used actor-partner interdependence models for the analysis.

RESULTS

We found a significant longitudinal and reciprocal association between sleep duration and depressive symptoms for both wives and husbands. Moreover, cross-partner effects differed by gender: Husbands' sleep and depressive symptoms predicted their wives' sleep and depressive symptoms respectively, but the reverse effects from wife to husband were not statistically significant.

LIMITATIONS

The measure of sleep duration relied on self-report and we lacked information about whether couples slept in the same room.

DISCUSSIONS

The results highlight a gendered interdependent influence of sleep duration and depressive symptoms over the 7-year follow-up, particularly from husbands to wives. Further investigation is necessary to understand the underlying mechanisms driving these observed patterns.

Depression status and risk factors analysis based on the 'individual-social-health system' dimension: evidence from middle-aged and elderly people in China

BACKGROUND

Depression, as a common mental illness, is harmful and burdensome. As a country with a large elderly population, China has a heavy burden of depression going in the future. The study aims to portray the current situation of depression occurrence in middle-aged and elderly people in China and capture the risk triggers, in order to provide a theoretical basis for the improvement of the mental health status of middle-aged and elderly people, and the development of depression prevention, control and intervention strategies.

METHOD

The study used 2020 China Health and Retirement Longitudinal Study (CHARLS) data and 18 950 respondents aged >45 years as the study sample. Depression status was calculated according to the simplified version of the Depression Scale (CES-D10) and logistic regression analysis was used to explore the factors affecting depression.

RESULT

There were 34.14% of the 18 950 respondents who were depressed. The results of logistic regression showed that factors such as being under 65 years of age, female, living in rural areas, having low education, and poor health status were risk factors for depression.

CONCLUSION

The mental health of the middle-aged and elderly population is poor and affected by multidimensional factors. The Chinese government should continue to strengthen its efforts to prevent and treat depression in the middle-aged and elderly population, and establish individualised and comprehensive strategies and measures to enhance the operational effectiveness of the policy.

Depression, Anxiety, and Stress Symptoms (DASS-21) in Elderly Women in Association with Health Status (SHSQ-25): A Cross-Sectional Study

Background/Objectives: International studies state that older adults are at an increased risk of mental health symptoms and disorders (depression, anxiety, and stress), especially elderly women aged >65 years. The literature on this topic is scarce, and there is a need for studies that investigate the associations between mental health issues and overall health in elderly women. This study aimed to investigate depression, anxiety, and stress symptoms in elderly women in association with health status. Methods: A community-based cross-sectional study was conducted in Klaipeda, Lithuania, in 2020. The survey included elderly women (n = 306) aged 65 to 80 years studying at the Third Age University in Klaipeda city. The DASS-21 and SHSQ-25 scales were used for the survey. Associations and correlations between both scale indicators were calculated. Results: Sociodemographic factors such as age, marital status, and place of residence were not statistically significant in terms of mental health, except for women living alone, who had slightly lower levels of depressive symptoms (p = 0.015). Mental health issues were quite common; almost half of the participants had higher than normal levels of anxiety (49.0%) and depression (48.4%), and one-third (29.8%) experienced stress. A strong positive correlation was observed between mental health symptoms and physical health, with anxiety having the greatest effect size on fatigue (Cohen's d = 0.950, p < 0.001), cardiovascular symptoms (Cohen's d = 0.757, p < 0.001), and mental status (Cohen's d = 1.036, p < 0.001). Depressive symptoms had a large effect size on fatigue (Cohen's d = 0.764, p < 0.001) and mental status (Cohen's d = 0.816, p < 0.001), while stress had a moderate effect size on all health domains. Conclusions: The findings highlight that anxiety symptoms are a major contributor to mental health conditions and overall health in elderly women. This study's results emphasise the need for targeted interventions to address mental health challenges in elderly women.

The association between post-lunch napping duration and social participation among the Chinese older adults: a cross-sectional study

BACKGROUND

Social participation (SP) affects the physical and mental health of older adults. Post-lunch napping is a prevalent lifestyle practice observed among older adults, and it may have an impact on their SP. However, research that explores the association between these factors is limited, and we thus aimed to examine this association.

METHODS

We conducted a cross-sectional study using data from the China Health and Retirement Longitudinal Study (CHARLS), focusing on participants aged 60 and older. SP was measured by both the number and frequency of activities based on participant self-reports. The duration of post-lunch napping was also self-reported. We explored the association between post-lunch napping duration and SP using logistic regression, subgroup analysis, and Restrictive Cubic Spline (RCS) analysis.

RESULTS

We included 4259 participants in the study. Post-lunch napping demonstrated a significant association with decreased odds ratio of poor SP in fully adjusted logistic regression models (odds ratio = 0.77, 95% CI: 0.66 ~ 0.90, p = 0.011). Subgroup analysis indicated consistent proportional effects across all subgroups (p > 0.05). RCS analysis revealed a non-linear "J"-shaped relationship between post-lunch napping duration and SP, with the lowest odds ratio corresponding to a duration of 34.37 min.

CONCLUSION

Our study suggests that a moderate duration of post-lunch napping, ideally around 34 min, might have the potential to enhance SP, whereas exceeding this duration could could potentially have a limiting effect. This observation implies that incorporating moderate post-lunch napping into health management strategies for older adults might offer some advantages.

Relieving Depressive Symptoms Through Chinese Relational Culture Among Older Adults with Multimorbidity: Evidence from CHARLS

Background

Depressive symptoms and multimorbidity are global public health concerns, the relationship between the two variables remains unclear. This study was an intervention attempt through the lens of regional relational culture to identify and reduce adverse consequences of this relationship. We aimed to explore the prevalence of multimorbidity and depressive symptoms among older Chinese adults, the association between the two variables, and the underlying moderating mechanism.

Methods

This study extracted data from the China Health Retirement Longitudinal Study (CHARLS) of 8356 older adults aged 60 years and older and analyzed the correlation between multimorbidity and depressive symptoms in this population using Stata 16.0. Moreover, the correlation between multimorbidity and depressive symptoms was verified using logistic regression analysis, and a hierarchical multiple regression analysis was used to test the existence of moderating effects between the two variables.

Results

The prevalence of multimorbidity and depressive symptoms among seniors aged 60 years and older was 66.16 and 36.85%, respectively. Multimorbidity was positively associated with depressive symptoms (p<0.001), and relationship satisfaction, social activity, and information isolation moderated this association (p < 0.05).

Conclusion

Older adults with multimorbidity are more likely to develop depressive symptoms, and regional relational culture can play a moderating role between them. The government, as well as aging-related sectors, can reduce the risk of depressive symptoms by improving relationship satisfaction, increasing social activity, and decreasing information isolation among older adults.

Priorities in tackling noncommunicable diseases among the population aged 60 years and older in China, 1990-2021: A population-based study

OBJECTIVE

In China, it is expected that every one in three people will be aged 60 years and above in 2040, surpassing other low- and middle-income countries. The noncommunicable disease (NCD) burden and trends among elderly people must be clarified.

METHODS

In this trend analysis based on the Global Burden of Diseases Study 2021, we reported NCDs per 100,000 people and average annual percentage changes (AAPCs) in disability-adjusted life-years (DALYs), mortality, and incidence at three levels of the GBD 2021 hierarchy by age subgroups and by sex in the older population aged 60 years and above in China during 1990-2021.

RESULTS

In 2021, there were 382 million incident cases of NCDs among elderly individuals in China, leading to 201 million DALYs and 9 million deaths in the same year. During 1990-2021, although cardiovascular diseases substantially reduced both DALYs (-1.2 %/year) and mortality (-1.08 %/year), cardiovascular diseases still accounted for the greatest percentage of DALYs (31000 per 100,000 population [95 % UI 26071-35908]) and mortality (2025 [1678-2355]) in 2021. During 1990-2021, while the total incidence of NCDs decreased (-0.01 %/year), the incidence of mental disorders (0.68 %/year) rapidly increased. Among all level 3 causes, depressive disorder caused the greatest increases in DALYs (0.74%/year), while chronic respiratory diseases showed the most rapid decreases in both DALYs (-3.6 %/year) and mortality (-3.6 %/year). The priorities of NCD control in each age subgroup and sex among elderly individuals varied. In 2021, males had a greater DALY rate from NCDs per 100,000 people than females did (96409 [95 % UI 80625-112283] vs. 67112 [56878-77547]), but females had a greater incidence rate of NCDs than males did (150276 [139285-163373]) vs. 137571 [127439-148789]). High systolic blood pressure had surpassed household air pollution from solid fuels as the leading risk factor for DALYs among the elderly, and it continued to be the top risk factor for mortality in this population.

CONCLUSIONS

The total NCD burden among elderly people in China has been decreasing and changing. Substantial reductions in cardiovascular diseases and chronic respiratory disease have been observed, while rapid increases in mental disorders has also been found. Policies need to be updated to reflect the changing risk landscape. Target interventions should consider age subgroups and sex differences among this population.

The association between living alone and depressive symptoms in older adults population: evidence from the China Health and Retirement Longitudinal Study

Objective

The goal of this research was to reveal the association between living alone and depressive symptoms in older adults. It also aims to explore the mediating role of social activity and adult children's relationship satisfaction. Ultimately, the study seeks to add to the body of knowledge for lowering the risk of depression among older people and promoting positive aging.

Methods

Based on information from the 2020 China Health and Retirement Longitudinal Study, the ordinary least square (OLS) regression model and propensity score matching (PSM) were used to investigate the association between living alone and depressive symptoms in older adults and to explore possible heterogeneity in different groups. Utilizing the SPSS PROCESS macro application, the mediation model was constructed. The significance of the mediation effect was investigated using the Bootstrap technique.

Results

The average level of depressive symptoms of older people living alone (10.55 ± 6.962) was higher than that of older people who do not live alone (8.80 ± 6.363). The baseline regression analysis revealed a significant connection between living alone and the depressive symptoms of older people (β = 0.842, p < 0.001). The association between living alone and the level of depressive symptoms was significantly higher in those aged 60-74 years (β = 1.698, p < 0.001) than in those aged 75 and older (β = 0.953, p < 0.05). The association between living alone and depressive symptoms was significantly higher in rural older adults (β = 1.512, p < 0.001) than in urban older adults (β = 1.141, p < 0.001). Between living alone and the level of depressive symptoms experienced by older people, there was a substantial mediation impact on social engagement and adult children's relationship satisfaction, which contributed to 2.91 and 13.62% of the overall effect.

Conclusion

For older age groups, living alone is associated with higher levels of depressive symptoms. This effect is stronger in older adults aged 60-74 or rural areas. In older age groups, the association between living alone and depressive symptoms is mediated by social activity and adult children's relationship satisfaction.

Identifying potentially depressed older Chinese adults in the community: Hong Kong's Elderly Health Service cohort

BACKGROUND

Depression is common at older ages, but is under-recognized due to stigma, misperception, and under-diagnosis; its manifestations may vary by setting. Identifying older adults at risk of depression in the community is urgently needed for timely support and early interventions. We assessed the performance of an existing risk prediction model developed in a European setting (i.e., Depression Risk Assessment Tool (DRAT-up)), and developed a new model (i.e., EHS-Depress model) to predict 2-year risk of the onset of later life depressive symptoms in older Chinese adults.

METHODS

Among 185,538 participants aged ≥65 years from Hong Kong's Elderly Health Service (EHS) cohort, 174,806 without depressive symptoms at baseline were included. Two-thirds were randomly sampled for recalibration and new model development using Cox proportional-hazards models with backward elimination. Overall predictive performance, discrimination, and calibration were assessed using the remaining.

RESULTS

The original DRAT-up model underestimated the risk of developing depressive symptoms in older Chinese adults; recalibrating it improved calibration. The new EHS-Depress model had better discrimination (Harrell's C statistic 0.68 and D statistic 2.74) and similarly good calibration (calibration slope 1.18 and intercept -0.002) probably due to the inclusion of more specific health measures, socio-demographics, lifestyle factors, and regular social contact as predictors.

LIMITATIONS

Predictors of depressive symptoms included in our models depend on the data availability.

CONCLUSIONS

The EHS-Depress model predicted 2-year risk of developing depressive symptoms better than the original and recalibrated DRAT-up models. The setting-specific risk prediction model is more applicable to older Chinese adults in primary care settings.

Diversity of purposes of use, time spent online, and depression among older Chinese Internet users

Objectives: Previous studies on the associations between Internet use and older people's depression have mostly focused on single types of online activities, especially online social engagement. The current study investigated the diversity of purposes of Internet use and its interaction with the time spent online in shaping older Chinese Internet users' depression.

Method: A sample of 974 Internet users aged 60 and above was adopted from the 2020 China Family Panel Studies wave. We adopted a latent class analysis (LCA) to explore the diverse purposes of internet usage.

Results: The participants were classified into three distinct types: socializers, basic users, and maximizers. Basic users and maximizers use the Internet for various purposes, despite different intensities; socializers use the Internet only to keep connected with families and friends. Compared with basic users and maximizers, a longer time spent online among socializers was significantly associated with a higher level of depression.

Conclusion: This study calls for a closer examination of online profiles among older Internet users; more attention should be paid to the potential harms of excessive Internet use for social reasons only among older adults. Practitioners should enhance older Internet users' digital literacy to maximize the wide-range benefits of Internet use and reduce potential health inequality.

Study on plasma metabolomics profiling of depression in Chinese community-dwelling older adults based on untargeted LC/GC‒MS

Depression is a serious psychiatric illness that causes great inconvenience to the lives of elderly individuals. However, the diagnosis of depression is somewhat subjective. Nontargeted gas chromatography (GC)/liquid chromatography (LC)-mass spectrometry (MS) was used to study the plasma metabolic profile and identify objective markers for depression and metabolic pathway variation. We recruited 379 Chinese community-dwelling individuals aged ≥ 65. Plasma samples were collected and detected by GC/LC‒MS. Orthogonal partial least squares discriminant analysis and a heatmap were utilized to distinguish the metabolites. Receiver operating characteristic curves were constructed to evaluate the diagnostic value of these differential metabolites. Additionally, metabolic pathway enrichment was performed to reveal metabolic pathway variation. According to our standard, 49 people were included in the depression cohort (DC), and 49 people age- and sex-matched individuals were included in the non-depression cohort (NDC). 64 metabolites identified via GC‒MS and 73 metabolites identified via LC‒MS had significant contributions to the differentiation between the DC and NDC, with VIP values > 1 and p values < 0.05. Three substances were detected by both methods: hypoxanthine, phytosphingosine, and xanthine. Furthermore, 1-(sn-glycero-3-phospho)-1D-myo-inositol had the largest area under the curve (AUC) value (AUC = 0.842). The purine metabolic pathway is the most important change in metabolic pathways. These findings show that there were differences in plasma metabolites between the depression cohort and the non-depression cohort. These identified differential metabolites may be markers of depression and can be used to study the changes in depression metabolic pathways.

Personality traits and depressive symptoms among Chinese older people: A network approach

BACKGROUND

The present study aims to investigate the network structure of depressive symptoms, the interrelationships between individual personality traits and depressive symptoms, and gender differences among Chinese older people aged 60 and above.

METHOD

We performed network analyses with a regularized Graphical Gaussian Model and a case-dropping bootstrap approach. A sample of 4876 older Chinese people aged 60+ was included in the analyses. We investigated the central symptoms in the depression network and the bridge nodes that connect personality facets and depressive symptoms. Gender differences were investigated by testing the global strength, network invariance, and edge weights.

RESULTS

Sadness and depressed mood were the most central depressive symptoms, while somatic symptoms such as restless sleep were the least central. Neurotic facets, particularly "worry a lot" and "get nervous easily", played significant bridging roles in the web of personality traits and depressive symptoms. Gender differences were observed in three edges among different personality traits (rude-worried, original-worried, and forgiving-nervous).

LIMITATION

The study adopts a cross-sectional dataset, and therefore, cannot track the network changes over time or conclude a causal relationship.

DISCUSSION

The study calls for more focus and prioritization on sadness, depressed mood and neurotic traits in the identification of depression among older Chinese people. Future researchers and practitioners should better understand of older Chinese adults' worry and nervousness to develop appropriate practices and policies.

Frailty, cognitive impairment, and depressive symptoms in Chinese older adults: an eight-year multi-trajectory analysis

BACKGROUND

Frailty, cognitive impairment, and depressive symptoms are closely interrelated conditions in the aging population. However, limited research has longitudinally analyzed the concurrent trajectories of these three prominent conditions in older adults in China. This study aimed to explore the eight-year trajectories of frailty, cognitive impairment, and depressive symptoms, and to identify individual-level and structural-level factors associated with the trajectories.

METHODS

Four waves of data from the China Health and Retirement Longitudinal Study (2011-2018) were used to identify 6,106 eligible older adults. The main measures included frailty by the frailty index constructed using 30 indicators, cognitive impairment by the summary score of immediate and delayed word recall, figure drawing, serial subtraction, and orientation, and depressive symptoms by the Center for Epidemiologic Studies Depression Scale. Multi-trajectory models identified the trajectories of frailty, cognitive impairment, and depressive symptoms over time. Multinomial logistic regression was employed to estimate the associations between individual-level capital factors and one structural factor (hukou and geographic residency) with the identified trajectories, adjusting for demographic characteristics.

RESULTS

Four trajectories emerged: (1) worsening frailty, worsening cognitive impairment, depression (14.0%); (2) declining pre-frailty, declining cognition, borderline depression (20.0%); (3) pre-frailty, worsening cognitive impairment, no depression (29.3%); and (4) physically robust, declining cognition, no depression (36.7%). Using the "physically robust, declining cognition, no depression" as the reference, not working, no social activity participant, worse childhood family financial situation, and poorer adult health were most strongly associated with the "worsening frailty, worsening cognitive impairment, depression" trajectory; worse health during childhood had the highest association with the "declining pre-frailty, declining cognition, borderline depression" trajectory; less education, lower household consumption, and rural hukou had the greatest association with the increased likelihood of the "pre-frailty, worsening cognitive impairment, no depression" trajectory.

CONCLUSIONS

Findings could inform the understanding of the interrelationship of frailty, cognitive impairment, and depressive symptoms in older adults in China and may help practitioners detect adults at risk for adverse trajectories to implement strategies for proper care.

The relationship between frailty, walking ability, and depression in elderly Chinese people

To explore the relationship between depression symptoms, frailty, and walking ability in Chinese elderly people, and to provide new evidence for research on the prevention and treatment of depression in Chinese elderly people. The data of this study is sourced from the 2018 CHARLS data (China Health and Retirement Longitudinal Study). Z-test, logistic regression, and linear stratified regression were used to analyze the walking ability, frailty, and depressive symptoms of 2927 participants. Good walking ability and non frailty were significantly negatively correlated with depression symptoms in the elderly (P < .05). This important negative association persists even after adjusting for demographic, health condition, and lifestyle factors. (P < .05). Elderly women are at a higher risk of developing depression than men, while elderly people with good walking ability and no frailty are at a lower risk of developing depression. At the same time, elderly people with disabilities, hypertension, arthritis, and low levels of physical activity are more likely to experience depressive symptoms. It is recommended that elderly people pay attention to maintaining walking ability and avoiding frailty to reduce the risk of depression.

Living arrangements and depression of the older adults- evidence from the Chinese longitudinal healthy longevity survey

BACKGROUND

The mental health and living arrangements of older adults are worthy of attention. Previous studies have pointed out that the living arrangements may be related to older adults' depression. However, it has not been found that studies concern the relationship between actual living arrangements, living arrangement preferences, and the fit between living arrangement preferences and reality and depression in older adults, so we carried out this study.

METHODS

The data from the Chinese longitudinal healthy longevity survey were used in this study. With the older adults' depression as the dependent variable and the living arrangement related variables as the independent variable, we constructed three binary-logistic regression analysis models to explore the potential relationship between living arrangement related variables and depression in older adults.

RESULTS

We found that the actual living arrangements, living arrangement preferences, and the fit between living arrangement preferences and reality are significantly correlated with depression in older adults. Specifically, older adults living alone or only with the spouse are at greater risk of depression. Older adults who prefer living alone or only with the spouse are at relatively low risk of depression. Older adults whose living arrangement preferences do not match reality have a higher risk of depression.

CONCLUSION

The living arrangement related variables are significantly correlated with depression in older adults. In addition to the actual living arrangements, living arrangement preferences and whether the living arrangement preferences fit with reality are also related to the depression of older adults.

Loneliness and depression among community-dwelling older adults in China during the COVID-19 epidemic: The mediating role of social support

The psychological condition of community-dwelling older adults is a global concern under coronavirus disease 2019. Loneliness is the key risk factor for depression among community-dwelling older adults. This study aims to explore the role of social support as a mediating factor in the relationship between depression and loneliness among community-dwelling older adults. We conducted a cross-sectional study in Chenzhou, Hunan Province, China, from June to December 2021. The sample consisted of 570 community-dwelling adults aged over 60 years. Data were collected through a general information questionnaire, the Social Support Rating Scale, the University of California at Los Angeles Loneliness Scale, and the Center for Epidemiological Survey, Depression Scale. Statistical Package for the Social Sciences PROCESS macro was used to examine the mediating effect of social support between loneliness and depression. This study found that depression was negatively associated with social support (r = -0.381, P < .001), but it was positively correlated with loneliness (r = 0.403, P < .001); loneliness was a predictor of depression (B = 0.333, P < .001). In addition, social support significantly mediated the relationship between loneliness and depression, with an indirect effect of 0.239 (95% Bootstrap CI -0.264 to -0.510), the overall effect value for depression was 0.572, accounting for 56.3% of the total variance in depression within this model. In conclusion, the findings suggest that social support plays a mediating role between depression and loneliness in older adults. This implies that interventions aimed at reducing loneliness and enhancing social support have the potential to alleviate depressive symptoms among this population. By addressing these factors, healthcare professionals and caregivers can promote the mental well-being of older adults and contribute to improved overall quality of life.

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.

Growing old in China in socioeconomic and epidemiological context: systematic review of social care policy for older people

BACKGROUND

From 2020 to 2050, China's population aged ≥65 years old is estimated to more than double from 172 million (12·0%) to 366 million (26·0%). Some 10 million have Alzheimer's disease and related dementias, to approach 40 million by 2050. Critically, the population is ageing fast while China is still a middle-income country.

METHODS

Using official and population-level statistics, we summarise China's demographic and epidemiological trends relevant to ageing and health from 1970 to present, before examining key determinants of China's improving population health in a socioecological framework. We then explore how China is responding to the care needs of its older population by carrying out a systematic review to answer the question: 'what are the key policy challenges to China achieving an equitable nationwide long-term care system for older people?'. Databases were screened for records published between 1st June 2020 and 1st June 2022 in Mandarin Chinese or English, reflecting our focus on evidence published since introduction of China's second long-term care insurance pilot phase in 2020.

RESULTS

Rapid economic development and improved access to education has led to widescale internal migration. Changing fertility policies and household structures also pose considerable challenges to the traditional family care model. To deal with increasing need, China has piloted 49 alternative long-term care insurance systems. Our findings from 42 studies (n = 16 in Mandarin) highlight significant challenges in the provision of quality and quantity of care which suits the preference of users, varying eligibility for long-term care insurance and an inequitable distribution of cost burden. Key recommendations include increasing salaries to attract and retain staff, introduction of mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart old age care capacity can also support preferences to age at home.

CONCLUSIONS

China has yet to establish a sustainable funding mechanism, standardised eligibility criteria and a high-quality service delivery system. Its long-term care insurance pilot studies provide useful lessons for other middle-income countries facing similar challenges in terms of meeting the long-term care needs of their rapidly growing older populations.

Comparing the role of social connectivity with friends and family in depression among older adults in China: evaluating the moderating effect of urban-rural status

Background

Social connectivity and support can reduce depressive symptoms. Few studies have examined urban-rural differences in the relationship between social support and depressive symptoms in the context of urbanization for Chinese older adults. The overall aim of this study is to examine urban-rural differences in the relationship between family support and social connectivity on depression among Chinese older adults.

Methods

This cross-sectional study used data from the 2010 Sample Survey on Aged Population in Urban/Rural China (SSAPUR). Depressive symptoms were measured using the Geriatric Depression Scale short-form (GDS-15). Family support was measured by structural, instrumental, and emotional support. Social connectivity was measured using the Lubben Social Network Scale-6 (LSNS-6). Descriptive analysis was conducted using chi-square and independent t-tests to examine urban-rural differences. Adjusted multiple linear regressions were conducted to examine the moderating effect of urban-rural status on the association between types of family support and social connectivity with depressive symptoms.

Results

In rural areas, respondents who felt their children exhibited filial piety (β = -1.512, p < 0.001) and had more social connectivity with family (β = -0.074, p < 0.001) were more likely to report fewer depression symptoms. In urban areas, respondents who received instrumental support from their children (β = -1.276, p < 0.01), who thought their children exhibited filial piety (β = -0.836, p < 0.01), and who had more social connectivity with friends (β = -0.040, p < 0.01) were more likely to report fewer depression symptoms. In the fully adjusted regression model, social connectivity with family was associated with decreased depressive symptoms, although to a lesser degree among urban-dwelling older adults (urban-rural interaction effect, β = 0.053, p < 0.05). Social connectivity with friends was similarly associated with decreased depressive symptoms, although this effect was greater among urban-dwelling older adults (urban-rural interaction effect, β = -0.053, p < 0.05).

Conclusion

The results of this study suggested that older adults both in rural and urban areas with family support and social connectivity were associated with fewer depression symptoms. Differences observed in the role of family and friend social connectivity by urban-rural status may provide practical information for developing targeted social support strategies for improving depressive symptoms among Chinese adults, and call for further mixed-methods research to disentangle mechanisms behind these differing associations.

Effectiveness of horticultural therapy in aged people with depression: A systematic review and meta-analysis

Background

Depression, an increasing global crisis, has affected many people's daily life, especially for older adults. Horticultural therapy has been widely used in non-pharmacological treatment for patients with depression, with a body of studies demonstrating its therapeutic effects. However, a lack of systematic reviews and meta-analyses makes it difficult to get a holistic picture of this research field.

Objectives

We aimed to evaluate the reliability of the previous studies and the effectiveness of horticultural therapy (including the intervention of environmental settings, activities, and duration) on older adults with depression.

Methods

This systematic review was conducted under the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines. We searched relevant studies in multiple databases, and the original search was finished on 25 September 2022. We included studies using randomized controlled trials (RCTs) or quasi-experimental designs.

Results

We yielded a total of 7,366 studies and finally included 13 which involved 698 aged people with depression. Results from meta-analysis indicated significant effects of horticultural therapy on reducing depressive symptoms for the older adults. Besides, we found different outcomes among various horticultural interventions (such as environmental setting, activities, and duration). Depression reduction was more effective in care-providing settings than in community settings; participatory activities were more effective in reducing depression than observational activities; intervention of 4–8 weeks might represent the optimal course of treatment compared to interventions more than 8 weeks in duration.

Conclusion

We came up with a comprehensive set of recommendations based on the meta-analysis: aged people in care-providing settings with depression could get the most benefit from horticultural therapy by participating in participatory activities for 4–8 weeks.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022363134, identifier CRD42022363134.