1
|
Kwok MK, Lee SY, Schooling CM. Identifying potentially depressed older Chinese adults in the community: Hong Kong's Elderly Health Service cohort. J Affect Disord 2024; 360:169-175. [PMID: 38797391 DOI: 10.1016/j.jad.2024.05.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024]
Abstract
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.
Collapse
Affiliation(s)
- Man Ki Kwok
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Siu Yin Lee
- Department of Health, Hong Kong Government, Hong Kong, China
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; City University of New York Graduate School of Public Health and Health Policy, New York, United States
| |
Collapse
|
2
|
Li J, Wang Q, Zhou X. Diversity of purposes of use, time spent online, and depression among older Chinese Internet users. Aging Ment Health 2024; 28:1216-1224. [PMID: 38436261 DOI: 10.1080/13607863.2024.2323953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
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.
Collapse
Affiliation(s)
- Jia Li
- Department of Social Work, Faculty of Social Science, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Qi Wang
- School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
| | - Xiaochen Zhou
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong
| |
Collapse
|
3
|
Guo J, Han P, Zheng Y, Wu Y, Zheng K, Huang C, Wang Y, Chen C, Qi Y, Chen X, Tao Q, Zhai J, Guo Q. Study on plasma metabolomics profiling of depression in Chinese community-dwelling older adults based on untargeted LC/GC‒MS. Sci Rep 2024; 14:10303. [PMID: 38705886 PMCID: PMC11070417 DOI: 10.1038/s41598-024-60836-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/28/2024] [Indexed: 05/07/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Jiangling Guo
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Peipei Han
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, China
| | | | - Yahui Wu
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Kai Zheng
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Chuanjun Huang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yue Wang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Cheng Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, China
- School of Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Yiqiong Qi
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xiaoyu Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, China
| | - Qiongying Tao
- Jiading Subdistrict Community Health Center, Shanghai, China
| | - Jiayi Zhai
- Jiading Subdistrict Community Health Center, Shanghai, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, 279 Zhouzhu Highway, Pudong New Area, Shanghai, 201318, China.
- Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| |
Collapse
|
4
|
Li J, Zhang J. Personality traits and depressive symptoms among Chinese older people: A network approach. J Affect Disord 2024; 351:74-81. [PMID: 38281593 DOI: 10.1016/j.jad.2024.01.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 01/30/2024]
Abstract
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.
Collapse
Affiliation(s)
- Jia Li
- Department of Social Work, Faculty of Social Science, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Jihong Zhang
- Department of Counseling, Leadership, and Research Methods, University of Arkansas, United States of America
| |
Collapse
|
5
|
Yuan Y, Peng C, Burr JA, Lapane KL. Frailty, cognitive impairment, and depressive symptoms in Chinese older adults: an eight-year multi-trajectory analysis. BMC Geriatr 2023; 23:843. [PMID: 38087208 PMCID: PMC10717397 DOI: 10.1186/s12877-023-04554-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Yiyang Yuan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, 01605, Worcester, MA, USA.
| | - Changmin Peng
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Jeffrey A Burr
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, 01605, Worcester, MA, USA
| |
Collapse
|
6
|
Yin H, Gao C, Quan Z, Zhang Y. The relationship between frailty, walking ability, and depression in elderly Chinese people. Medicine (Baltimore) 2023; 102:e35876. [PMID: 37960734 PMCID: PMC10637547 DOI: 10.1097/md.0000000000035876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Hang Yin
- School of Sports Medicine, Anshan Normal University, Anshan, China
| | - Caizhu Gao
- College of Physical Education, Kookmin University, Seoul, South Korea
| | - Zhengri Quan
- School of Physical Education, Changchun Normal University, Changchun, China
| | - Yaqun Zhang
- School of Sports Medicine, Anshan Normal University, Anshan, China
| |
Collapse
|
7
|
Jia Q, Duan Y, Gong R, Jiang M, You D, Qu Y. Living arrangements and depression of the older adults- evidence from the Chinese longitudinal healthy longevity survey. BMC Public Health 2023; 23:1870. [PMID: 37759168 PMCID: PMC10523833 DOI: 10.1186/s12889-023-16730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Qingwen Jia
- Organization and Personnel Department, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Yanhan Duan
- Medicine-Education Coordinateion and Medical Education Research Center, Hebei Medical University, Shijiazhuang, China
| | - Rui Gong
- Department of Adult Internal Medicine, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Meijun Jiang
- Graduate School, Hebei Medical University, Shijiazhuang, China
| | - Dianping You
- Party and Government Integrated Office, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Yi Qu
- Scientific Research Division, Children's Hospital of Hebei Province, 133 Jianhua Street, Yuhua District, Shijiazhuang, Hebei, China.
| |
Collapse
|
8
|
Li P, Zhong J, He Y, Yan H, Xie M, Meng L. Loneliness and depression among community-dwelling older adults in China during the COVID-19 epidemic: The mediating role of social support. Medicine (Baltimore) 2023; 102:e35171. [PMID: 37713830 PMCID: PMC10508438 DOI: 10.1097/md.0000000000035171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Pan Li
- School of Nursing, Xiangnan University, Chenzhou, China
- College of Nursing and Allied Health Sciences, St. Paul University Manila, Malate Manila, Philippines
| | - Jiaming Zhong
- University Library, Xiangnan University, Chenzhou, China
| | - Yongmei He
- School of Nursing, Xiangnan University, Chenzhou, China
| | - Hairong Yan
- School of Nursing, Xiangnan University, Chenzhou, China
| | - Mi Xie
- School of Nursing, Xiangnan University, Chenzhou, China
| | - Lingyao Meng
- School of Nursing, Xiangnan University, Chenzhou, China
- College of Nursing and Allied Health Sciences, St. Paul University Manila, Malate Manila, Philippines
| |
Collapse
|
9
|
Li T, Li J, Ke X. Exploring the relationship between mental health and dialect use among Chinese older adults: a moderated mediation estimation. Front Psychol 2023; 14:1177984. [PMID: 37575424 PMCID: PMC10416436 DOI: 10.3389/fpsyg.2023.1177984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Tianxin Li
- Department of Literature, Shaanxi Normal University, Xi'an, China
| | - Jin Li
- International School of Chinese Studies, Shaanxi Normal University, Xi'an, China
| | - Xigang Ke
- Department of Literature, Shaanxi Normal University, Xi'an, China
| |
Collapse
|
10
|
Lobanov-Rostovsky S, He Q, Chen Y, Liu Y, Wu Y, Liu Y, Venkatraman T, French E, Curry N, Hemmings N, Bandosz P, Chan WK, Liao J, Brunner EJ. Growing old in China in socioeconomic and epidemiological context: systematic review of social care policy for older people. BMC Public Health 2023; 23:1272. [PMID: 37391766 PMCID: PMC10311713 DOI: 10.1186/s12889-023-15583-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/01/2023] [Indexed: 07/02/2023] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Qianyu He
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Yuntao Chen
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
| | - Yuyang Liu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Yanjuan Wu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Yixuan Liu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Tishya Venkatraman
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
| | - Eric French
- Faculty of Economics, University of Cambridge, CB3 9DD Cambridge, UK
- Institute for Fiscal Studies, University of Cambridge, London, WC1E 7AE UK
| | - Natasha Curry
- Policy Department, Nuffield Trust, W1G 7LP London, UK
| | - Nina Hemmings
- Policy Department, Nuffield Trust, W1G 7LP London, UK
| | - Piotr Bandosz
- Department of Prevention and Medical Education, Medical University of Gdansk, Gdansk, 80-210 Poland
| | - Wing Kit Chan
- School of Government, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Eric John Brunner
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
| |
Collapse
|
11
|
Gu Y, Ali SH, Guo A. 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. Front Psychiatry 2023; 14:1162982. [PMID: 37252146 PMCID: PMC10213784 DOI: 10.3389/fpsyt.2023.1162982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Yuxuan Gu
- Center for Gerontology Research, Department of Social Security, Nanjing Normal University, Nanjing, China
| | - Shahmir H. Ali
- School of Global Public Health, New York University, New York, NY, United States
| | - Aimei Guo
- Center for Gerontology Research, Department of Social Security, Nanjing Normal University, Nanjing, China
| |
Collapse
|
12
|
Xu M, Lu S, Liu J, Xu F. Effectiveness of horticultural therapy in aged people with depression: A systematic review and meta-analysis. Front Public Health 2023; 11:1142456. [PMID: 36969640 PMCID: PMC10031070 DOI: 10.3389/fpubh.2023.1142456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/09/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundDepression, 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.ObjectivesWe 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.MethodsThis 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.ResultsWe 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.ConclusionWe 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 registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022363134, identifier CRD42022363134.
Collapse
Affiliation(s)
- Meijing Xu
- College of Horticulture, China Agricultural University, Beijing, China
| | - Shan Lu
- College of Horticulture, China Agricultural University, Beijing, China
| | - Jianjiao Liu
- Faculty of Architecture, Building and Planning, University of Melbourne, Melbourne, VIC, Australia
| | - Feng Xu
- College of Horticulture, China Agricultural University, Beijing, China
- *Correspondence: Feng Xu
| |
Collapse
|
13
|
Mu Y, Zheng Z. Multimorbidity patterns, social networks, and depression among chinese older women. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-04122-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|