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Fang Y, Ma L, Chen H, Cai S, Jiang W, Luo F, Wang J, Zheng E, Zhou C, Zhu L, Guo Q, Yin Z. The effect of social isolation on the cognitive ability of the oldest old in Chinese nursing homes in post-COVID-19: a moderated chain mediation model. Front Psychol 2024; 15:1421729. [PMID: 39286555 PMCID: PMC11404041 DOI: 10.3389/fpsyg.2024.1421729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/02/2024] [Indexed: 09/19/2024] Open
Abstract
Background Both pre-or post-COVID-19, older adults residing in nursing homes are at significant risk for social isolation, which is negatively associated with cognitive ability. Currently, the elderly aged 80 years and older are the fastest-growing age group globally. The extent of social isolation within this group post-COVID-19 and its impact on cognitive abilities remain inadequately explored. Objective This research aimed to evaluate the prevalence of social isolation among the oldest old in Chinese nursing homes post-COVID-19 and to investigate the mediating and moderating roles of basic activities of daily living (BADL), depression, and subjective socioeconomic status in the relationship between social isolation and cognitive ability. Methods This cross-sectional study included 453 participants aged 80 years and older from 11 nursing homes in Ningbo, Zhejiang Province, China. Social isolation was assessed using the Lubben Social Network Scale-6 (LSNS-6), cognitive ability using the Mini-Mental State Examination (MMSE), BADL using the Barthel Index (BI), and depression using the Patient Health Questionnaire-9 items (PHQ-9). Mediation and moderation effects were statistically analyzed using SPSS 23.0 and PROCESS 3.5. Results The mean age of the study sample was 87.1 ± 3.8 years, among whom 60.3% (n = 273) were female, and 56.1% experienced social isolation, with 41.1% and 63.1% being isolated from family and friends, respectively. Social isolation indirectly affected cognitive ability through BADL and depression, respectively, and through the chain mediation effect of BADL and depression. Subjective socioeconomic status moderated the relationships between social isolation and BADL and between social isolation and depression. However, no moderating effect of subjective socioeconomic status was found between social isolation and cognitive ability. Conclusion This study deepens our understanding of the current state of social isolation and its mechanisms of action in the oldest old post-COVID-19 and provides a new basis for future public health policy development and related research.
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Affiliation(s)
- Yi Fang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Linlin Ma
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Huixian Chen
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Shuya Cai
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Wen Jiang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Fen Luo
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Jialu Wang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Enjie Zheng
- School of Nursing, Wenzhou Medical University, Wenzhou, China
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chuncong Zhou
- School of Nursing, Wenzhou Medical University, Wenzhou, China
- Nursing Department, Naval Hospital of Eastern Theater, Zhoushan, China
| | - Lijuan Zhu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Qiaoqiao Guo
- School of Renji, Wenzhou Medical University, Wenzhou, China
| | - Zhiqin Yin
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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Wang P, Tao C. The influence of intergenerational support on cognitive functioning among middle-aged Chinese: Moderation by personal income. Arch Gerontol Geriatr 2024; 122:105393. [PMID: 38452651 DOI: 10.1016/j.archger.2024.105393] [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: 12/17/2023] [Revised: 02/27/2024] [Accepted: 03/02/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To analyze the effects of personal income on the relationship between intergenerational support (IS) and cognitive functioning. METHODS Data were obtained from four waves of nationally representative surveys of the 2011-2018 China Health and Retirement Longitudinal Study (CHARLS), involving 8,207 participants aged 45 ∼ 60 at baseline. Multivariate linear regression models using generalized estimating equations were used to analyze the effects of three forms of intergenerational mutual supports on cognitive functioning in middle-aged adults, and subgroup regressions were used to analyze the moderating role of personal income in this relationship. RESULTS The results showed that financial and caregiving support from children impaired the cognitive functioning of their parents; whereas providing financial support to children and mutual emotional support with them positively affected their cognition; however, childcare was not significantly associated with cognitive levels in middle-aged adults. Moreover, the effect of IS on the cognitive level of Chinese middle-aged people disappeared or was attenuated by having pensions or earning their own post-tax income. CONCLUSION IS has a significant effect on cognitive functioning in middle-aged adults, but this effect is moderated by personal income. These results are informative for the development of intergenerational relationship intervention programs for the prevention of cognitive decline in middle-aged adults with different personal income.
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Affiliation(s)
- Ping Wang
- School of Statistics and Data Science, Jiangxi University of Finance and Economics, Nanchang, Jiangxi, 330013, China; Institute of Traditional Chinese Medicine, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, 330004, China.
| | - Chunhai Tao
- School of Statistics and Data Science, Jiangxi University of Finance and Economics, Nanchang, Jiangxi, 330013, China.
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Jiang Z, Liu H, Deng J, Ye Y, Li D. Influence of intergenerational support on the mental health of older people in China. PLoS One 2024; 19:e0299986. [PMID: 38635847 PMCID: PMC11025908 DOI: 10.1371/journal.pone.0299986] [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: 09/10/2023] [Accepted: 02/20/2024] [Indexed: 04/20/2024] Open
Abstract
Today, population aging is the main trend of population development. Home-based care is mainly adopted in Chinese society, and scholars have paid ample attention to the effect of intergenerational support on the mental health of older people. However, research conclusions differ. This study uses data from the 2018 China Health and Pension Tracking Survey (CHARLS), which we analyzed with STATA software to construct least squares regression and two-stage least squares regression models. The regression model included 6,647 respondents to investigate the mental health status of older people based on depression status. Intergenerational support was defined as economic support, emotional support, and daily care provided by the children of older people. We studied the impact of three aspects of intergenerational support on the mental health of the elderly. We performed a robustness test using the variable replacement and propensity score matching methods, and analyzed age, gender, and urban-rural heterogeneity. The results showed that economic support had no significant impact on the mental health of older people, while emotional support and daily care had a positive effect. The heterogeneity results indicated that the relationship between intergenerational support and mental health of older people differed significantly based on age, gender, and urban and rural areas. Therefore, children should raise their awareness of supporting their parents, pay attention to their parents' mental health, and provide emotional support and daily care. Furthermore, community work improves family relations, creates a good social environment, and encourages young people to respect and be filial to older people. The government should improve the medical security system and old-age service system, and provide policy support to help the mental health of older people.
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Affiliation(s)
- Zicheng Jiang
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Data Science and Innovative Development of Chinese Medicine in Anhui Province Philosophy and Social, Hefei, China
| | - Huan Liu
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Data Science and Innovative Development of Chinese Medicine in Anhui Province Philosophy and Social, Hefei, China
| | - Jing Deng
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Data Science and Innovative Development of Chinese Medicine in Anhui Province Philosophy and Social, Hefei, China
| | - Yizhong Ye
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Data Science and Innovative Development of Chinese Medicine in Anhui Province Philosophy and Social, Hefei, China
| | - Dexun Li
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Data Science and Innovative Development of Chinese Medicine in Anhui Province Philosophy and Social, Hefei, China
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Xing M, Zhao Y, Li Z, Zhang L, Yu Q, Zhou W, Huang R, Lv X, Ma Y, Li W. Development and validation of a stacking ensemble model for death prediction in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Maturitas 2024; 182:107919. [PMID: 38290423 DOI: 10.1016/j.maturitas.2024.107919] [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: 04/24/2023] [Revised: 11/12/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE This study aimed to develop and validate a mortality risk prediction model for older people based on the Chinese Longitudinal Healthy Longevity Survey using the stacking ensemble strategy. MATERIAL AND METHODS A total of 12,769 participants aged 65 or more at baseline were included. Ensemble machine learning models were applied to develop a mortality prediction model. We selected three base learners, including logistic regression, eXtreme Gradient Boosting, and Categorical + Boosting, and used logistic regression as the meta-learner. The primary outcome was five-year survival. Variable importance was evaluated by the SHapley Additive exPlanations method. RESULTS The mean age at baseline was 88, and 57.8 % of participants were women. The CatBoost model performed the best among the three base learners, the area under the receiver operating characteristics curve (AUC) reached 0.8469 (95%CI: 0.8345-0.8593), and the stacking ensemble model further improved the discrimination ability (AUC = 0.8486, 95%CI: 0.8367-0.8612, P = 0.046). Conventional logistic regression had comparable performance (AUC = 0.8470, 95 % CI: 0.8346-0.8595). Older age, higher scores for self-care activities of daily living, being male, higher objective physical performance capacity scores, not undertaking housework, and lower scores on the Mini-Mental State Examination contributed to higher risk. CONCLUSIONS We successfully constructed and validated a few death risk prediction models for a Chinese population of older adults. While the stacking ensemble approach had the best prediction performance, the improvement over conventional logistic regression was insubstantial.
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Affiliation(s)
- Muqi Xing
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yunfeng Zhao
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zihan Li
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lingzhi Zhang
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qi Yu
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wenhui Zhou
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang 110122, China
| | - Rong Huang
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang 110122, China
| | - Xiaozhen Lv
- Peking University Institute of Mental Health (Sixth Hospital), National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Peking University, 51 Huayuan North Road, Haidian District, Beijing 100191, China.
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang 110122, China.
| | - Wenyuan Li
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Xian G, Chai Y, Gong Y, He W, Ma C, Zhang X, Zhang J, Ma Y. The relationship between healthy lifestyles and cognitive function in Chinese older adults: the mediating effect of depressive symptoms. BMC Geriatr 2024; 24:299. [PMID: 38549104 PMCID: PMC10979595 DOI: 10.1186/s12877-024-04922-5] [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: 11/29/2023] [Accepted: 03/26/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Previous studies have proven the positive relationship between healthy lifestyles and cognitive function in older adults. However, the specific impacts and mechanisms require further investigation. Therefore, this study aimed to investigate whether healthy lifestyles and cognitive function were associated with Chinese older adults and whether depressive symptoms mediated their association. METHODS 8272 valid samples were included using the latest data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Pearson's test was applied to investigate the relationship between the key variables. Regression models were employed to examine the mediating effects of healthy lifestyles, using Sobel's test and the bootstrap method to confirm path effects. RESULTS There was a significant correlation between healthy lifestyles, depressive symptoms, and cognitive function (p < 0.01). Healthy lifestyles directly impact cognitive function (β = 0.162, p < 0.01). Healthy lifestyles had a significant effect on depressive symptoms (β=-0.301, p < 0.01), while depressive symptoms have a significant impact on cognitive function (β=-0.108, p < 0.01). Depressive symptoms partially mediated the effect of healthy lifestyles on cognitive function (β = 0.032, p < 0.01). The Sobel and bootstrap tests confirmed the robustness of the regression analysis results. CONCLUSION Depressive symptoms mediate the relationship between healthy lifestyles and cognitive function. Our findings suggest that prevention strategies for cognitive impairment in older adults should focus on healthy lifestyles and mental health.
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Affiliation(s)
- Guowei Xian
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Yulin Chai
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Yunna Gong
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Wenfeng He
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Chunxiao Ma
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Xiaolin Zhang
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Jing Zhang
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China
| | - Yong Ma
- School of Management, Shandong Second Medical University, 261053, Weifang, Shandong, China.
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Wu C, Yu R, Li Q, Chen J, Wang W. Exploring the impact of cognitive impairments on treatment compliance and quality of life in patients with Continuous Ambulatory Peritoneal Dialysis (CAPD). Medicine (Baltimore) 2023; 102:e35813. [PMID: 37904409 PMCID: PMC10615453 DOI: 10.1097/md.0000000000035813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/05/2023] [Indexed: 11/01/2023] Open
Abstract
The aim of this study is to investigate the impact of cognitive impairments on treatment compliance and quality of life in patients with Continuous Ambulatory Peritoneal Dialysis (CAPD). A cross-sectional study was conducted among patients with CAPD at the Department of Nephrology, Lianshui People's Hospital from October 2021 to May 2022. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and the End-Stage Renal Disease Adherence Questionnaire was used to evaluate treatment compliance. Quality of life was assessed using the SF-36 questionnaire. Scores from all the questionnaires and demographic data were recorded. A total of 98 patients were enrolled, and the prevalence of cognitive impairment among CAPD patients was 69.39% (MoCA score < 26). Patients were divided into 2 groups: one group with normal cognitive function (MoCA score ≥ 26) and the other with cognitive impairments. There were statistically significant differences in age, dialysis age, education, urea clearance index, history of high blood pressure, and diabetes between the 2 groups (all P < .05). Patients with cognitive impairments had lower compliance levels in terms of diet fluid restriction, medication therapeutic regimens, and dialysis regimen (all P < .05). Patients with cognitive impairments also had lower quality of life scores in the dimensions of physical function, general health, social function, emotional function, and mental health (all P < .05). Cognitive impairment appears to be common among CAPD patients and may adversely affect both their treatment adherence and overall quality of life. A more comprehensive understanding of the underlying mechanisms necessitates further study.
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Affiliation(s)
- Caixia Wu
- Department of Nephrology, Lianshui People’s Hospital, Kangda College of Nanjing Medical University, Huai’an City, China
| | - Ran Yu
- Department of Nephrology, Lianshui People’s Hospital, Kangda College of Nanjing Medical University, Huai’an City, China
- Jiangsu College of Nursing, Huai’an City, China
- School of Lianshui Clinical Medicine, Medical College of Yangzhou University, Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou, China
| | - Qingju Li
- Department of Nephrology, Lianshui People’s Hospital, Kangda College of Nanjing Medical University, Huai’an City, China
- Jiangsu College of Nursing, Huai’an City, China
- School of Lianshui Clinical Medicine, Medical College of Yangzhou University, Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou, China
| | - Jiajia Chen
- Department of Nephrology, Lianshui People’s Hospital, Kangda College of Nanjing Medical University, Huai’an City, China
- Jiangsu College of Nursing, Huai’an City, China
| | - Wanpeng Wang
- Department of Nephrology, Lianshui People’s Hospital, Kangda College of Nanjing Medical University, Huai’an City, China
- Jiangsu College of Nursing, Huai’an City, China
- School of Lianshui Clinical Medicine, Medical College of Yangzhou University, Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou, China
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Sharifi S, Babaei Khorzoughi K, Khaledi-Paveh B, Rahmati M. Association of intergenerational relationship and supports with cognitive performance in older adults: A systematic review. Geriatr Nurs 2023; 52:146-151. [PMID: 37307634 DOI: 10.1016/j.gerinurse.2023.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE As individuals age, cognitive decline can significantly impact their quality of life. This systematic review aims to investigate the potential association between parent-child relationships among older adults in Eastern Asian countries and their cognitive performance. METHODS For this research, a systematic search was conducted on several electronic databases including PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar search engine, up to March 2023. RESULTS Out of 418 articles, 6 were eligible for inclusion in the study. The findings suggest that intergenerational relationships, particularly emotional support and two-way financial communications, are associated with maintaining cognitive health in older adults. CONCLUSIONS Intergenerational relationships affect cognitive health in older adults, with implications for healthcare, social welfare, and the economy. Further research is required to investigate the effects of children's visits on cognitive health and explore the complexities of intergenerational relationships on cognitive health in aging populations.
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Affiliation(s)
- Sina Sharifi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kimia Babaei Khorzoughi
- Faculty of Education and Psychology, Islamic Azad University Isfahan (Khorasgan) Branch, Isfahan, Iran
| | - Behnam Khaledi-Paveh
- Department of Geriatric and Psychiatric Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Mahmoud Rahmati
- Department of Geriatric and Psychiatric Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.
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