Urban-rural disparities in the healthy ageing trajectory in China: a population-based study

Profiles of physical frailty, social frailty, and cognitive impairment among older adults in rural areas of China: a latent profile analysis

Background

As China rapidly ages, it has now become a deeply aging society with the largest number of older individuals in the world. The issue is particularly severe in rural areas. With the aging population growing and the older population expanding, health problems are becoming more prevalent among older individuals, particularly frailty and cognitive impairments. This study aimed to identify the profiles of physical frailty, social frailty, and cognitive impairment among older adults and explore the influencing factors.

Methods

In this cross-sectional study, participants were recruited from six villages in four cities in Shandong Province, China from July to October 2023 through cluster random sampling. Latent profile analysis was used to determine the profiles of physical frailty, social frailty, and cognitive impairment. Chi-square tests and Mann-Whitney U tests were used for univariate analysis, while binary logistic regression was used to analyze the related factors.

Results

Seven hundred and sixty-nine older adult care in rural areas showed two profiles: the "high cognitive function and low frailty" group (73.7%, n = 567) and the "low cognitive function and high frailty" group (26.3%, n = 202). A binary logistic regression found that older people were more likely to be aged 80 or older (OR = 2.253, p = 0.029), have a low income level (OR = 1.051, p = 0.007), have one or two (OR = 2.287, p = 0.004), or more than three chronic diseases (OR = 3.092, p = 0.002), and report moderate (OR = 3.406, p = 0.024) or poor health status (OR = 9.085, p < 0.001) in the "low cognitive function and high frailty" group. Meanwhile, older adults who have completed high school (OR = 0.428, p = 0.005) or junior college and above (OR = 0.208, p = 0.009), and engage in adequate physical activity (OR = 0.319, p < 0.001) were more likely to be in the "high cognitive function and low frailty" group.

Conclusion

In the future, medical professors should increasingly prioritize promptly identifying and intervening in cognitive decline and frailty status in older individuals without delay.

Prospective Impacts of Social Participation Activities on Cognitive and Psychopathological Statuses in Community-Dwelling Older Adults

OBJECTIVES

This study investigated the impact of social activities on cognitive functioning and psychopathological symptoms.

METHODS

Participants aged 55 or older were enrolled through communities. Initial measures assessed demographic data, neuropsychological functioning, psychopathological state, and happiness. Social activities were evaluated using a modified 12-item tool, with 3-4 activities as the cutoff. Follow-up after 6-9 months included Mini-Mental State Examination (MMSE), Beck Depression Inventory - II (BDI-II), Beck Anxiety Inventory (BAI), Health Assessment Questionnaire (HAQ), and Patient Health Questionnaire-15 (PHQ-15) measurements. Predictive models for psychiatric and cognitive statuses were built using multiple linear regression, adjusting for baseline conditions.

RESULTS

Initially, 516 older individuals enrolled, with 403 undergoing follow-up. During follow-up, the low participation group reported lower MMSE scores, higher BAI scores, and increased PHQ-15 risk. Negative correlations between social activity numbers and PHQ-15 results were found. Engagement in social clubs correlated positively with higher MMSE scores, while regular interactions with one's adult child(ren) were linked to decreased BAI scores.

CONCLUSIONS

The quantity of social activities was associated with lower somatic distress. Social club engagement positively influenced cognition, and regular interactions with one's adult child(ren) mitigated anxiety among older individuals.

CLINICAL IMPLICATIONS

Enough types of social activities, participating in social clubs, and adequate interactions with children protected against psychopathologies.

Examining dynamic developmental trends: the interrelationship between age-friendly environments and healthy aging in the Chinese population-evidence from China Health and Retirement Longitudinal Study, 2011-2018

BACKGROUND

The objective of this research is to investigate the dynamic developmental trends between Age-Friendly Environments (AFE) and healthy aging in the Chinese population.

METHODS

This study focused on a sample of 11,770 participants from the CHARLS and utilized the ATHLOS Healthy Aging Index to assess the level of healthy aging among the Chinese population. Linear mixed model (LMM) was used to explore the relationship between AFE and healthy aging. Furthermore, a cross-lagged panel model (CLPM) and a random-intercept cross-lagged panel model (RI-CLPM) were used to examine the dynamic developmental trends of healthy aging, taking into account both Between-Person effects and Within-Person effects.

RESULTS

The results from LMM showed a positive correlation between AFE and healthy aging (β = 0.087, p < 0.001). There was a positive interaction between the geographic distribution and AFE (central region * AFE: β = 0.031, p = 0.038; eastern region * AFE: β = 0.048, p = 0.003). In CLPM and RI-CLPM, the positive effect of healthy aging on AFE is a type of Between-Person effects (β ranges from 0.147 to 0.159, p < 0.001), while the positive effect of AFE on healthy aging is Within-Person effects (β ranges from 0.021 to 0.024, p = 0.004).

CONCLUSION

Firstly, individuals with high levels of healthy aging are more inclined to actively participate in the development of appropriate AFE compared to those with low levels of healthy aging. Furthermore, by encouraging and guiding individuals to engage in activities that contribute to building appropriate AFE, can elevate their AFE levels beyond the previous average level, thereby improving their future healthy aging levels. Lastly, addressing vulnerable groups by reducing disparities and meeting their health needs effectively is crucial for fostering healthy aging in these populations.

Healthy aging trajectories and their predictors among Chinese older adults: Evidence from a 7-year nationwide prospective cohort study

OBJECTIVES

This study aimed to identify healthy aging trajectories of Chinese older adults, and explore the factors contributing to these trajectories.

METHODS

We used data from four waves (2011-2018) of China Health and Retirement Longitudinal Study. We developed a healthy aging metric based on the healthy aging framework of World Health Organization (WHO) and Bayesian multilevel item response theory (IRT) method. The healthy aging trajectories were identified using the latent class growth analysis. The predictors of trajectories were explored using multinomial logistic regression analysis. Additionally, we developed two alternative metrics for healthy aging based on the Chinese Healthy Ageing Index (CHAI) and Rowe and Kahn's model of successful aging, respectively. We compared these metrics to the one developed based on the WHO's healthy aging framework.

RESULTS

We identified three distinct healthy aging trajectories with varying scores and decline rates. Individuals who were female, had lower educational levels, resided in rural areas, experienced depression, had more chronic diseases, participated in fewer social activities, had fewer childhood friends, experienced more adverse childhood events, and had worse family financial status in childhood were more likely to experience a worse healthy aging trajectory compared to their counterparts. Supplementary analysis showed that healthy aging metric based on WHO definition and IRT method had the strongest association with health outcomes compared to the metrics based on CHAI, as well as Rowe and Kahn model.

CONCLUSIONS

Our findings provide a foundation for the development of tailored interventions to enhance and sustain healthy aging among Chinese older adults.

Socioeconomic disparities in the association of age at first live birth with incident stroke among Chinese parous women: A prospective cohort study

Background

Stroke has become a significant public health issue in China. Although studies have shown that women's age at first live birth (AFLB) might be associated with incident stroke, there is limited evidence on this relationship among Chinese parous women. Likewise, the nature of this association across urban-rural socioeconomic status (SES) has yet to be explored. In this prospective study, we sought to investigate the associations of women's AFLB with the risk of incident stroke and its subtypes (ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage) and to explore the differences of these associations as well as the population-level impacts across SES classes.

Methods

We used data on 290 932 Chinese parous women from the China Kadoorie Biobank who were recruited in the baseline survey between 2004 and 2008 and followed up until 2015. We used latent class analysis to identify urban-rural SES classes and Cox proportional hazard regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for AFLB's association with incident stroke. We then calculated population attributable fraction (PAF) to demonstrate the population-level impact of later AFLB on stroke.

Results

Around 8.9% of parous women developed stroke after AFLB. Compared with women with AFLB <22 years, those with older AFLB had a higher risk of total stroke, with fully adjusted HRs (95% CI) of 1.71 (95% CI = 1.65-1.77) for 22-24 years and 3.37 (95% CI = 3.24-3.51) for ≥25 years. The associations of AFLB with ischaemic stroke were stronger among rural-low-SES participants. We found the highest PAFs of ischaemic stroke (60.1%; 95% CI = 46.2-70.3) associated with later AFLB for urban-high-SES individuals.

Conclusions

Older AFLB was associated with higher risks of incident stroke and its subtypes among Chinese parous women, with stronger associations between AFLB and ischaemic stroke among rural-low-SES participants. Targeted medical advice for pregnant women of different ages could have long-term benefits for stroke prevention.

The impact of grandparenting on mental health among rural middle-aged and older adults in China: exploring the role of children's support

Objectives

In the rural regions of China, characterized by a pronounced aging demographic and limited resources, a substantial proportion of middle-aged and older adults engage in grandparenting roles. Yet, the literature lacks consistent evidence regarding the effects of grandparenting on the mental health of this cohort. Accordingly, this study aimed to explore the impact of grandparenting on the mental health of rural middle-aged and older adults, as well as the underlying mechanisms.

Methods

This analysis encompassed 10,881 middle-aged and older adults, utilizing data from the 2018 Harmonized China Health and Retirement Longitudinal Study (CHARLS). The mental health of participants was assessed using the Center for Epidemiological Studies Depression-10 (CESD-10) scale, while support from children was categorized into financial and emotional types. The study employed logistic and OLS regression models to identify the mediating role of child support and utilized the Karlson-Holm-Breen (KHB) method for decomposing this mediating effect.

Results

The findings demonstrated that grandparenting had a significant negative impact on depression among rural middle-aged and older adults. Furthermore, children's support played a vital role in mediating this relationship, accounting for approximately one-third of the overall influence. Moreover, the decomposition analysis revealed that both emotional and economic support from adult children equally contributed to the declination of depression among rural middle-aged and older adults.

Conclusion

Grandparenting significantly enhances mental well-being in rural middle-aged and older adults, with the support from adult children serving as a vital pathway for this positive impact. Both economic and emotional assistance from children hold equal importance in this dynamic. It underscores the necessity of fortifying the family support system to amplify the support provided by children, which in turn could significantly enhance the mental health of rural middle-aged and older adults.

The association between smoking and family health with the mediation role of personality among Chinese people: nationwide cross-sectional study

BACKGROUND

There may be unexplored interactions between family health, personality, and smoking that could help provide new perspectives on tobacco control.

OBJECTIVE

To examine the relationship between the health of one's family and their smoking habits, as well as investigate the potential influence of personality on this relationship.

METHODS

For this cross-sectional investigation, a national survey conducted in China in 2022 recruited a total of 21,916 individuals. The Family Health Scale was utilized to assess the health of the family. The 10-item Big Five Inventory scale was utilized to assess the Big five personality traits. The relationship between big five personality, family health, and smoking were investigated using binary and linear logistic regression. The indirect effects mediated by Big five personality were analyzed using mediation analysis with Sobel tests, and the indirect effects were composited using the Karlson-Holm-Breen method.

RESULTS

The overall prevalence of smoking in the study population was 14.87%, 26.19% for males and 3.54% for females. Urban and rural smoking prevalence was 13.81% and 16.10% respectively. Binary logistic regression analysis revealed a significant negative relationship between smoking and family health (odds ratio 0.964, 95% CI 0.959, 0.970, P < 0.001) with covariates controlled. The Karlson-Holm-Breen composition facilitated the connection between extraversion (47.81%) and nervousness (52.19%).

CONCLUSIONS

Preventive interventions for smoking behavior should prioritize family health and the Big five personality as significant areas to focus on. According to this study, in addition to implementing various interventions for different personalities, family health should be strengthened to reduce smoking behavior.

Decomposition analysis of the difference in depressive symptoms between urban and rural employed people in China: Unpaid work plays an important role

OBJECTIVE

Focusing on the relationship between unpaid labor and the occurrence of depressive symptoms, this study aimed to explore the factors influencing the inequality of depressive symptoms and their contribution among Chinese urban and rural employed people.

METHODS

This study utilized the 2020 China Family Panel Studies' national resampling data. Multivariate logistic regression was used to explore the factors influencing the occurrence of depressive symptoms among employed persons in urban and rural areas in China, respectively. Fairlie decomposition was used to explore the contribution of influencing factors such as unpaid labor to the difference in the occurrence of depressive symptoms between urban and rural areas.

RESULTS

About 2,136 (21.70%) participants had depressive symptoms, of which 1,197 (24.75%) rural employed people had depressive symptoms and 939 (18.75%) urban employed people had depressive symptoms. The results of Fairlie decomposition analysis showed that 70.51% of the differences in depressive symptoms between urban and rural Chinese employed people could be explained by the covariates included in this study, including education level (52.44%), age (-11.91%), housework time (10.42%), self-rated health status (10.22%), self-rated income status (2.53%), exercise (2.36%), job satisfaction status (1.99%), chronic disease status (1.90%), and marital status (1.79%).

CONCLUSION

This study found that the proportion of depressive symptoms was lower among urban employed residents than among rural employed residents. This difference was mainly caused by unpaid labor time, socioeconomic status, personal lifestyle, and health status. Housework, which is one of the unpaid labor, contributed to this depressive symptom difference in the third place.

Does the Healthy China 2030 Policy Improve People's Health? Empirical Evidence Based on the Difference-in-Differences Approach

Background

The Healthy China 2030 (HC2030) policy is currently recognized as China's most significant and influential national health policy. However, despite its implementation in 2016, the policy's impact has yet to be comprehensively evaluated, particularly in relation to its effectiveness in enhancing population health and promoting public health equity.

Methods

We utilized the Difference-in-Differences (DiD) method to evaluate the impact of the HC2030. Our analysis utilized a panel dataset derived from five longitudinal surveys conducted by the China Family Panel Studies (CFPS).

Results

The implementation of HC2030 has improved the overall health status of residents, particularly in urban areas and the western and eastern regions. Mechanistic analysis has further unveiled that the policy's beneficial impact on health outcomes is attributed to a rise in physical activity frequency and the betterment of mental health. Additionally, female, married, and medically insured individuals have demonstrated a significant positive impact of the policy on their health outcomes.

Conclusion

Although the HC2030 appears to have effectively improved overall population health, it needs to promote equity in public health adequately. The study suggests adjustments are needed to address the unequal distribution of health outcomes between urban and rural areas and among different regions.

Housing conditions, cooking fuels, and health-related quality of life among rural middle-aged and elderly in northwest China: A ten-year balanced panel study

To investigate the impacts of improving housing conditions and transitioning to clean cooking fuels on health-related quality of life (HRQOL) among middle-aged and elderly populations in rural China.

METHODS

Using a 10-year longitudinal follow-up study, we examined changes in housing conditions, cooking fuel use, and HRQOL among 690 Chinese adults aged 45 above in rural areas. HRQOL was assessed using the European Quality of Life-5 Dimensions 3 Levels (EQ-5D-3L) questionnaire. Generalized estimating equations were utilized to analyze correlations between variables.

RESULTS

Using four-period balanced panel data of 10 years, there were significant differences in the self-reporting of mobility, self-care, usual activities, pain / discomfort and anxiety / depression in rural middle-aged and elderly people (p < 0.05). In terms of the EQ-5D index score and EQ-VAS score, showed a decreasing trend (p < 0.05). The housing area, housing material type, utilization of sanitary toilets, separation of housing and kitchen were separated and non-solid fuels used as cooking fuel were significantly associated with high HRQOL (p < 0.05).

CONCLUSIONS

This study found that good housing conditions and the use of non-solid cooking fuel had positive effects on health-related quality of life of middle-aged and elderly people in rural areas of northwest China.

Social participation in older people with hearing impairment in Chinese community: A latent profile analysis

OBJECTIVES

Hearing impairment may lead to increased communication difficulties for older people, making their social participation less optimistic. However, there is little research on the social participation of older people with hearing impairment, especially based on the characteristics of their social participation. This study aimed to identify different social participation profiles in older people with hearing impairment and to explore sociodemographic characteristics, disease-related characteristics and psychosocial factors with different social participation profiles.

METHODS

A cross-sectional study of 300 older people with hearing impairment using the sociodemographic questionnaire, the Impact on Participation and Autonomy Questionnaire, the Lubben Social Network Scale-6, Medical Outcomes Study Social Support Survey and Geriatric Depression Scale-15 from May to August 2023 in a community of Beijing, China. Latent profile analysis was used to analyse the latent profiles of social participation in elderly with hearing impairment. Multiple logistic regression was used to explore the predictors of different profiles.

RESULTS

The social participation of older people with hearing impairment in the community can be classified into three potential profiles: Profile 1 - high social participation group (76.05 %), Profile 2 - moderate social participation group (17.34 %), Profile 3 - low social participation group (6.61 %). Age, types of chronic diseases, self-reported health, severity of hearing impairment, social network, social support and depression were predictors of different profiles.

CONCLUSIONS

Nurses should pay attention to the characteristics, depression, social network and support of older people with different hearing impairment to improve social participation in different profiles.

IMPLICATIONS AND RECOMMENDATIONS

This was the first study exploring latent profiles of social participation in older people with hearing impairment. Insights from this study are useful for gerontological nursing to distinguish different profiles and further identify the characteristics of different profiles in older people with hearing impairment by characterizing the level of social participation in the community and better implement interventions according to profiles.

Are adverse childhood experiences associated with trajectories of healthy aging? Evidence from China

Adverse childhood experiences (ACEs) have life-course impact and may be associated with healthy aging. This study aimed to explore the association between ACEs and healthy aging trajectories among middle- and older-aged adults in China. The data were obtained from the China Health and Retirement Longitudinal Study from 2011 to 2018. A total of 8906 respondents were enrolled in the analysis. Through latent growth mixture model, five categories of healthy aging trajectories which defined as 'stable type with high starting point', 'stable type at the middle level', 'stable type with low starting point', 'rapid descending type with high starting point', and 'stable descending type with medium starting point' were identified. Based on multinomial logistic regression, ACEs were significantly associated with healthy aging trajectories (stable type at the middle level/stable type with high starting point: relative risk reduction [RRR] = 1.19; P < 0.01; 95% CI = 1.16-1.23; stable type with low starting point/stable type with high starting point: RRR = 1.35; P < 0.01; 95%CI = 1.21-1.51; rapid descending type with high starting point/stable type with high starting point: RRR = 1.09; P < 0.1; 95% CI = 0.99-1.19; and stable descending type with medium starting point/stable type with high starting point: RRR = 1.30; P < 0.01; 95% CI = 1.23-1.38). When treating ACEs as a categorical variable, the healthy aging trajectory of the rapid descending type with a high starting point was not affected by any ACE groups. Further analysis of the relationship between each ACE and the trajectories of healthy aging reveals that parental disability, household mental illness, domestic violence, physical abuse, unsafe neighbourhood and bullying had significant impacts on almost every developmental trajectory of unhealthy aging. The government should promote the realisation of healthy aging from the perspective of the entire population and life cycle, intervene early in life, avoid the occurrence of ACEs as much as possible, and minimize the harm done by ACEs as much as possible.

Impact of the National Nursing Development Plan on nursing human resources in China: An interrupted time series analysis for 1978-2021

BACKGROUND

Shortages of nurses and unequal distribution of nursing staff have been huge challenges for global health services.

OBJECTIVES

The aim of our study was to evaluate the impact of the National Nursing Development Plan on nursing human resources in China.

METHODS

An interrupted time series design was used in this study. The data for this study were extracted from the National Health Statistics Yearbook from 1978 to 2021. The Ministry of Health issued the National Nursing Development Plan (2005-2010) in July 2005. Subsequently, the strategic plan was issued every 5 years: the National Nursing Development Plan (2011-2015), the National Nursing Development Plan (2016-2020), and the National Nursing Development Plan (2021-2025). This study used five indicators including 1) the number of registered nurses (RNs) in China, 2) the number of RNs per 1000 population in China, 3) the proportion of RNs in health technical personnel in China, 4) the doctor-nurse ratio and 5) the number of nurses working in primary medical institutions to evaluate the changing trend of nursing human resources in China from 1978 to 2021.

RESULTS

Interrupted time series analysis showed that after the implementation of the National Nursing Development Plan (2005-2010), the building of nurses in China was gradually strengthening, and the number of RNs in China increased by 0.198 million per year (95%CI 0.174-0.223; P < 0.001); the number of RNs per 1000 population (Coefficient = 0.139; 95%CI 0.123-0.154; P < 0.001); the proportion of RNs in the total number of health professionals in China has increased from 29.6 % to 44.6 % (Coefficient = 0.010; 95%CI 0.009-0.010; P < 0.001); in China, the doctor-nurse ratio increased by 0.024 (95%CI 0.019-0.029; P < 0.001). In 2021, the number of RNs working in primary medical institutions increased by approximately 0.86 million compared with that in 2005, and the proportion of RNs in the country increased by 1.4 %. The development of nurses is especially tilted to the primary level to meet the health and nursing needs of the primary level.

CONCLUSIONS

The implementation of the National Nursing Development Plan has greatly expanded the scale of nursing human resources in China and significantly optimized the efficiency of allocation. The implementation of the National Nursing Development Plan (2011-2015) and the National Nursing Development Plan (2016-2020) well continued the strategic plan from 2005 to 2010, further expanded the nursing workforce and further optimized the allocation efficiency.

TWEETABLE ABSTRACT

The implementation of the National Nursing Development Plan has greatly expanded the scale of nursing human resources in China and significantly optimized the efficiency of allocation.

Lifestyle behaviours and associated factors among people with type 2 diabetes attending a diabetes clinic in Ningbo, China: A cross-sectional study

The burden of type 2 diabetes (T2DM) in China is significant and growing, and this is reflected in high rates of T2DM in the city of Ningbo, China. Consequent impacts on morbidity, mortality, healthcare expenditure, and health-related quality of life, make this a problem of the utmost importance to address. One way to improve T2DM outcomes is to address lifestyle behaviours that may affect prognosis and complications, such as physical activity levels, dietary habits, smoking status, and alcohol intake. A cross-sectional survey was undertaken to describe the prevalence of being physically active, having a healthy diet, currently smoking, and currently drinking alcohol among people living with T2DM attending a diabetes clinic in Ningbo, China. Regression analysis was used to determine the factors associated with these lifestyle behaviours. We found a high prevalence of a healthy diet (97.8%, 95% CI 96.5-98.7%). Prevalence of being physically active (83.4%, 95% CI 80.6-85.9%), smoking (21.6%, 95% CI 18.8-24.6%), and alcohol drinking (32.9%. 95% CI 29.6-36.2%) appeared in keeping with those of the general population. Marked associations were demonstrated between male sex and smoking (OR 41.1, 95% CI 16.2-139.0), and male sex and alcohol drinking (OR 4.00, 95% CI 2.62-6.20). Correlation between lifestyle factors was demonstrated including between alcohol drinking and smoking, and between physical activity and reduced smoking. General diabetes self-management education programmes that address multiple lifestyle risk factors simultaneously may be beneficial in this population. Specific interventions targeting smoking cessation and reduction in alcohol drinking may be of benefit to men living with T2DM attending a diabetes clinic in Ningbo.

Self-efficacy and well-being in the association between caregiver burden and sleep quality among caregivers of elderly patients having multiple chronic conditions in rural China: a serial multiple mediation analysis

BACKGROUND

Caregivers of elderly patients with multiple chronic conditions have heavy caregiver burden and poor sleep quality, which has an important impact on both caregivers and patients. This study aimed to examine among rural caregivers of elderly patients who have multiple chronic conditions in China, whether self-efficacy and well-being mediate the link between caregiver burden and sleep quality.

METHODS

The study recruited 325 caregivers of elderly patients having multiple chronic conditions in rural China. Several measures including the Caregiver Burden Inventory (CBI), Athens Insomnia Scale (AIS), General Self-Efficacy Scale (GSES) and Index of Well-Being (IWB) were utilized to collect data. Structural equation modeling was employed to study the relationships among caregiver burden, sleep quality, self-efficacy, as well as well-being.

RESULTS

Significant correlations were found between the measured variables (each p < 0.01). Self-efficacy and well-being acted as mediators in the link between caregiver burden and sleep quality, accounting for 10.94% and 15.63% of the total effect, respectively. In addition, self-efficacy and well-being had a serial multiple mediating effect in the association between caregiver burden and sleep quality, with this mediating pathway, explaining 9.93% of the total effect.

CONCLUSIONS

Caregivers of elderly patients having multiple chronic conditions in rural China experienced poor sleep quality due to the caregiver burden. Self-efficacy and well-being had serial mediating roles on the relationship between caregiver burden and sleep quality. Effective interventions should be developed to improve self-efficacy and well-being of caregivers, reduce their caregiver burden and, eventually, improve their sleep quality.

Community-based social healthcare practices in China for healthy aging: a social prescription perspective analysis

Background

The global population is aging, and the number of people suffering from chronic diseases is increasing. In response to these trends, community-enhanced social healthcare practices are a novel paradigm of social prescribing that aims to improve both the community's and the individual's level of health by combining community involvement, organizational change, and individual-level practice.

Objective

The study examined the state of community-based social healthcare practices using the lens of social prescription in China with an eye on promoting healthy aging there.

Method

Thematic analysis approach was used in this investigation. A social prescription lens was used to conduct an open-ended theme study of China's community-based social healthcare practices for healthy aging. The research was conducted in Yiwu in Zhejiang Province, P. R. China. A sample of 24 "comprehensive evaluation team members (CETM)" was chosen using a purposive selection strategy.

Results

In the context of the social prescription, we analyzed social healthcare practices for healthy aging at the community level. All the comprehensive evaluation team members described community social healthcare practices under the paradigm of social prescription. After analyzing the community social healthcare practices under the paradigm of social prescription, six main themes (E-Social Prescription, Nature-based Social Prescription, Healthy Living Social Prescription, Culture-based Social Prescription, Health Screening Social Prescription, and Health Education Social Prescription) emerged for healthy aging at the community level.

Conclusion

Social prescribing links individuals to non-clinical services and activities, typically provided by the nonprofit and community sectors. Community-based social healthcare practices under social prescription can be an efficient and cost-effective way to assist patients with chronic diseases in managing their illnesses and enhancing their overall health and wellbeing.

Association Between Daily Internet Use and Incidence of Chronic Diseases Among Older Adults: Prospective Cohort Study

BACKGROUND

Chronic disease incidence among the elderly is increasing, which is correlated with the acceleration of population aging. Evolving internet technologies may help prevent and provide interventions for chronic diseases in an accelerating aging process. However, the impact of daily internet use on the incidence of chronic diseases is not well understood.

OBJECTIVE

This study aims to investigate whether daily internet use by middle-aged and older adults may inhibit or promote the occurrence of chronic diseases.

METHODS

We included participants from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal survey of Chinese residents aged ≥45 years. We assessed 8-year data from wave 1 (June 2011-March 2012) to wave 4 (July-September 2018) in CHARLS. Data from wave 4 were used for a cross-sectional study, and data from all 4 waves were used for a longitudinal study. Self-reported data were used to track variables, including internet use, use frequency, and the incidence of different chronic diseases. Cox proportional hazards modeling was applied in the longitudinal study to examine the relationship between daily internet use and chronic diseases among middle-aged and older adults, while adjusting for sociodemographic characteristics and health behaviors. In addition, longitudinal data were used to analyze internet usage trends, and cross-sectional data were used to analyze the factors influencing internet use.

RESULTS

Among the 20,113 participants included in the longitudinal analyses, internet use increased significantly, from 2% to 12.3%, between 2011 and 2018. The adjusted model found statistically significant relationships between daily internet use and a lower incidence of the following chronic diseases: hypertension (hazard ratio [HR] 0.78, 95% CI 0.65-0.95, P=.01), chronic lung disease (HR 0.74, 95% CI 0.57-0.97, P=.03), stroke (HR 0.69, 95% CI 0.50-0.94, P=.02), digestive disease (HR 0.73, 95% CI 0.58-0.91, P=.005), memory-related disorders (HR 0.58, 95% CI 0.37-0.91, P=.02), arthritis or rheumatism (HR 0.60, 95% CI 0.48-0.76, P<.001), asthma (HR 0.52, 95% CI 0.33-0.84, P=.007), depression (HR 0.80, 95% CI 0.71-0.89, P<.001), and vision impairment (HR 0.83, 95% CI 0.74-0.93, P=.004). Moreover, our study also showed that with increasing frequency of internet use, the risk of some chronic diseases decreases.

CONCLUSIONS

This study found that middle-aged and older adults who use the internet have a reduced risk of developing chronic diseases versus those who do not use the internet. The increasing prevalence of daily internet use among middle-aged and older adults may stimulate contemplation of the potential role of internet platforms in future research on chronic disease prevention.

Research hotspots and new trends in the impact of resistance training on aging, bibliometric and visual analysis based on CiteSpace and VOSviewer

Purpose

Resistance training (RT) can intervene in aging, which can effectively improve trainees' life. However, unhealthy living habits such as irregular life, obesity and hyperlipidemia, and chronic diseases lead to a significant decline in the energy level of the population, seriously affecting the health of the population. Our research identifies the research hotspots of RT to intervene in aging from the perspective of bibliometrics, predicts research frontiers and development trends, and provides more perspectives for research on aging populations.

Methods

In this study, we used CiteSpace and VOSviewer visualization software to draw the scientific knowledge map of countries/regions, institutions, authors, co-occurrence keywords, and co-cited references of published articles, and explore the Web of Science core collection database all about the RT intervention aging research status, hotspots, frontiers, and development trends of articles on aging.

Results

Among the 760 articles that meet the inclusion criteria, the number of articles published and the frequency of citations have increased steadily in the past 5 years. Judging from the countries/regions, institutions, scholars, and journals that published articles, the ones with the largest numbers are the USA, Univ Estadual Londrina, Cyrino ES, and Exp Gerontol. The ones with the highest influence are England, Univ Arkansas Med Sci, Frontera WR, and Biochem Biophys Rep Co. The top five co-occurrence keywords of include exercise, strength, resistance training, skeletal muscle, and muscle strength. The research frontier is physical function.

Conclusion

In the field of RT intervention aging research, relevant scholars deserve further in-depth research and exploration. The United States, Brazil, Canada, and other economically developed countries/regions, institutions, and authors have greater influence and productivity. These quantitative research results can provide references for relevant scholars' follow-up research and government departments to formulate and modify health policies or measures.

Individual and environmental factors associated with successful aging among Korean older adults: Multilevel analysis of cross-sectional nationwide survey data

PURPOSE

The importance of environmental influences on successful aging has recently been emphasized. However, existing studies that investigated environmental factors related to successful aging in older adults did not apply multi-level analysis while simultaneously examining individual and environmental factors related to successful aging. Therefore, this study aimed to determine the level of successful aging in older adults and the individual and environmental factors related to successful aging.

MATERIALS AND METHODS

Data from a nationwide survey were used. The study comprised a cross-sectional sample of 73,942 community-dwelling adults aged ≥65 years with individual-level data drawn from the 2019 Korea Community Health Survey. Community-level data of 255 local administrative districts (cities or counties) were extracted from the Community Health Determinant Database from 2017 to 2019. These data were merged and used in multi-level logistic regression analyses.

RESULTS

Generally, 27.1% of the participants achieved successful aging. Individual factors including sex, age, marital status, education level, job, monthly household income, smoking, physical activity, and body mass index were significantly associated with successful aging. Four environmental factors, urban residential area, social network, satisfaction with living environment, and air quality, were positively associated with successful aging at the community level; among them, high satisfaction with living environment (OR = 6.06, 95% CI: 2.43-15.12) was the most strongly associated factor with successful aging.

CONCLUSIONS

The findings suggest that environmental factors are essential for successful aging among older adults in addition to individual factors. Therefore, multiple strategies considering individual and environmental factors are needed to improve successful aging.

Trends in the availability of community-based home visiting services for oldest-old in China, 2005-2018

OBJECTIVES

This study aims to examine trends in neighbourhood availability of community-based home visiting services (CHVS) (ie, coverage by local primary healthcare providers) over time and disparities in service availability according to individual characteristics using nationwide data of oldest-old individuals (age >80) in China.

DESIGN

Repeated, cross-sectional study.

SETTING

This study derived nationally representative data from the 2005-2018 Chinese Longitudinal Health Longevity Survey.

PARTICIPANTS

A final analytical sample of 38 032 oldest-old individuals.

PRIMARY OUTCOME MEASURES

Availability of CHVS was defined as having home visiting services in one's neighbourhood. Cochran-Armitage tests were used to test linear trends in the proportions of oldest-old with service availability. Weighted logistic regression models were used to examine variations in service availability across individual characteristics.

RESULTS

Of 38 032 oldest-old individuals, availability of CHVS decreased from 9.7% in 2005 to 7.8% in 2008/2009, followed by continual increases to 33.7% in 2017/2018. These changes were similar between rural and urban oldest-old. After accounting for individual characteristics, in 2017/2018, compared with their counterparts, urban residents who had white-collar jobs before retirement and those residing in Western and Northeast China were less likely to have service availability. Oldest-old with disabilities, those living alone and those with low incomes did not report having greater availability of CHVS in either 2005 or 2017/2018.

CONCLUSIONS

Despite the increasing service availability over the past 13 years, persistent geographical disparities in the availability of CHVS remain. As of 2017/2018, only one in three oldest-old in China reported having service availability, which raises concerns regarding continuity of care across different settings of services for those most in need, especially those living alone or with disabilities. National policies and targeting efforts are necessary to improve the availability of CHVS and reduce inequity in service availability for optimal long-term care to the oldest-old population in China.

Evaluation of the optimal cutoff number of types of social participation activities in older people

INTRODUCTION

Social participation activities have a close association with health aging. However, the clinical significance of numbers of social participation activities and its cutoff value has not been defined.

METHODS

We recruited 516 people aged ≥55 years. Twelve social participation behaviors modified according to Taiwanese culture were investigated, and the adequacy of cutoff number was determined by the area under the receiver operating characteristic curve (AUC) according to the results of cluster analysis of individual activities and scores of the Brief Symptom Rating Scale-5 (BSRS-5) and the Chinese Happiness Inventory (CHI). Demographic, BSRS-5 and CHI data were then compared according to the candidate cutoff numbers.

RESULTS

The distribution of the numbers of social activities suggested that the highest partition of numbers of social activities was 3 in women and 4 in men. The AUC regarding the cluster of activity types was 0.917, with the highest Youden's J value located between 3 and 4. The AUC regarding the cluster of activity types and scores of the BSRS-5 and the CHI was 0.929, with similar cutoffs. If 3 and 4 were used as cutoffs, the between-group differences of both the CHI and the BSRS-5 were significant. More types of social activities had a different engaging frequency with the 3 and 4 cutoffs.

CONCLUSION

Our findings found an adequate cutoff with better differential power in the psychopathology and happiness of older people that provided a basis for application in intervention and policy formation.

Associations between Sedentary Duration and Cognitive Function in Older Adults: A Longitudinal Study with 2-Year Follow-Up

OBJECTIVES

This study aimed to investigate the association between different forms of sedentary behavior and cognitive function in Chinese community-dwelling older adults.

DESIGN

A longitudinal study with a 2-year follow-up.

SETTING AND PARTICIPANTS

Data from 5356 participants at baseline and 956 participants at the follow-up of the Anhui Healthy Longevity Survey (AHLS) were analysed.

MEASUREMENTS

Cognitive function was evaluated by the Mini-Mental State Examination (MMSE), and mild cognitive impairment (MCI) was classified according to education-specific criteria. Self-report questionnaires were used to assess the sedentary behavior of the participants.

RESULTS

The participants who reported longer screen-watching sedentary duration had higher MMSE scores (1-2 hours: β=0.758, 95% CI: 0.450, 1.066; > 2 hours: β=1.240, 95% CI: 0.917, 1.562) and lower likelihoods of MCI (1-2 hours: OR= 0.787, 95% CI: 0.677, 0.914; >2 hours: OR=0.617, 95% CI: 0.524, 0.726). The participants who had played cards (or mahjong) sedentary had higher MMSE scores (β= 1.132, 95% CI: 0.788, 1.476) and lower likelihoods of MCI (OR=0.572, 95% CI: 0.476, 0.687). However, the participants who reported longer other forms of sedentary duration had lower MMSE scores (1-2 hours: β=-0.409, 95% CI: -0.735, -0.082; > 2 hours: β=-1.391, 95% CI: -1.696, -1.087) and higher likelihoods of MCI (1-2 hours: OR=1.271, 95% CI: 1.081, 1.496; > 2 hours: OR=1.632, 95% CI: 1.409, 1.889). No significant association was detected between sedentary duration and MCI incidence.

CONCLUSION

Variations in the impact of diverse sedentary behaviors on the cognitive function were detected in Chinese older adults. However, such associations were cross-sectional and longitudinal associations were not found in the current study.