Effect of family "upward" intergenerational support on the health of rural elderly in China: Evidence from Chinese Longitudinal Healthy Longevity Survey

Active aging and health among older adults in China: a perspective based on downward intergenerational economic support

Introduction

In China, the rapid progression of population aging presents significant challenges to society and the economy, drawing widespread attention to the health conditions of older adults. While aging is often seen as a societal burden, the phenomenon of intergenerational economic support reveals the potential for older adults to continue playing an active role within their families. This study delves into how older parents' financial support to their children can reciprocally influence their own health, exploring the potential non-linear relationships involved.

Methods

This research, utilizing data from the 2018 China Health and Retirement Longitudinal Study, employs instrumental variable techniques and cross-sectional threshold models to examine how financial support provided by older adults to their children affects their health. It particularly highlights the varied impacts of economic support on older adults' health at different levels of support.

Results

The findings indicate that moderate intergenerational economic support significantly enhances the health of older adults, while either minimal or excessive financial support does not demonstrate the same positive effect. Additionally, subjective life expectancy plays a mediating role between intergenerational economic support and the health of older adults, further emphasizing the beneficial impact of economic support.

Discussion

The study underscores the importance of moderate intergenerational economic support in improving the health of older adults amidst aging challenges. Future policies and practices should consider how to encourage and optimize such support to address the challenges of an aging society, enhance the welfare of older adults, and promote healthy aging.

Symptom patterns of comorbid depression and anxiety among older adults in China and their predictors

Comorbid depression and anxiety causes serious psychological and physiological damage for older people. This study aimed to identify heterogeneous classes of comorbid depression and anxiety (CDA) among older people in China and to ascertain predictors of latent class membership. Cross-sectional data of 10,919 cases were extracted from the Chinese Longitudinal Healthy Longevity Survey. Latent profile analysis (LPA) was used to identify symptom patterns of comorbid depression (measured by the 10-item Center for Epidemiologic Studies Depression Scale) and anxiety (measured by the Generalized Anxiety Disorder 7-item Scale). Multinomial logistic regressions following bivariate analyses were used to explore the relationship between the derived classes and individual- and social-level factors. Four patterns of CDA were identified: low symptoms of depression and anxiety (30.52%; n = 3333), mild depression only (53.26%; n = 5815), moderate depression and anxiety (13.82%; n = 1509), and severe depression and anxiety (2.40%; n = 262). Older people who are male, suffer from multimorbidity, and lack a healthy lifestyle are more likely to have problematic symptom profiles. While intimate relationships with partners and children significantly predicted CDA patterns, the effects of sibling relationships, daily life, and emotional support from the community were insignificant. LPA identified four distinct CDA patterns among a representative sample of older Chinese people. While restless sleep, lack of positive emotions, uselessness, and weak concentration are salient across all profiles, "difficult to relax" is prominent in profiles high in anxiety. In addition to individual-level variables, social-level factors, especially intimate relationships with partners and children rather than general links to siblings or the community, have unneglectable impacts on whether and to what extent older Chinese adults suffer from CDA in the cultural context of relationism, patriarchy, and filial piety.

Influence of intergenerational support on the mental health of older people in China

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.

The mediating role of children's intergenerational support in association between grandparenting and cognitive function among middle-aged and older Chinese: findings from the CHARLS cohort study

OBJECTIVES

With the world's population increasing in age, there has been a significant rise in the prevalence of cognitive impairment and dementia among individuals. This study aims to investigate the association between grandparenting and cognitive function among middle-aged and older Chinese using data from 2011 to 2018 China Health and Retirement Longitudinal Study (CHARLS). Additionally, the study seeks to explore the potential mediating effect of intergenerational support from children on this relationship, using data from the CHARLS 2011 database.

METHODS

5254 participants were recruited at the baseline survey in CHARLS 2011. Subsequently, a follow-up survey was conducted over 8 years, from CHARLS 2011 to 2018, with 1472 individuals completing the follow-up survey. The CHARLS included surveys on grandparenting and cognitive assessments. Grandparenting was categorized as yes and no. The assessment of cognitive function involved the evaluation of episodic memory and mental intactness. The present study used cross-sectional and longitudinal analyses to examine the relationship between grandparenting and cognitive function. The bootstrap method assessed the mediating effect of children's intergenerational support.

RESULTS

The results of both cross-sectional and longitudinal studies indicated a positive association between grandparenting and cognitive function in middle-aged and older Chinese (B = 0.138, p < 0.05; B = 0.218, p < 0.05). Children's emotional and economic support played intermediary roles between grandparenting and cognitive function.

CONCLUSION

The results emphasized the significance of policymakers considering the consequences of intergenerational care and family support when formulating and executing social service policies targeted at the middle-aged and older population in China.

Marital transitions and frailty among middle-aged and older adults in China: The roles of social support

Background

This study explored the association of marital transitions and frailty among Chinese middle-aged and older people and whether this association differs by social support.

Methods

We used a sample of 12,388 adults aged ≥45 years who participated in the China Health and Retirement Longitudinal Study (CHARLS) between 2015 and 2018. Between-wave changes in marital status ("married at both times", "unmarried to married", "married to unmarried", "unmarried at both times") were used to explore the changes in frailty measured by the frailty index (FI), which was constructed from 55 health variables. Social support was evaluated based on social engagement and intergenerational support. The associations among marital transitions, social support and frailty were analyzed using generalized estimating equations (GEEs).

Results

The mean FI of 12,388 participants was 0.23 (SD = 0.13). Participants who were married to unmarried (β = 0.014, B = 0.005, P = 0.012) and unmarried at both times (β = 0.022, B = 0.003, P < 0.001) had significant a positive impact on FI compared with participants who were married at both times. Social engagement, financial support by children and providing care to grandchildren had an interactive effect with marital transitions in influencing FI.

Conclusions

Being unmarried may increase frailty among Chinese middle-aged and older adults. Financial support by children may mitigate the adverse effects of being unmarried on frailty.

A study on the impact of the number of family generations on intergenerational support for centenarians: a study in a Chinese 'longevity city'

BACKGROUND

As a natural source of support for the elderly, the family is an important channel for achieving a sense of security, happiness, and worthiness in old age. In this study, we analysed the characteristics of intergenerational support in families of centenarians and explored the impact of the number of family generations on intergenerational support.

METHODS

We conducted a cross-sectional survey between April 2020 and January 2021 among 62 elderly people aged 99+ in Rugao, China, one of six 'longevity cities' in the world. Assisted by the researchers, centenarians completed questionnaires with details pertaining to general demographics, intergenerational support, and other aspects. We used a logistic regression model to analyse the influence of the number of family generations on intergenerational support that the centenarians received with respect to economic, living, and emotional aspects.

RESULTS

Centenarians were primarily recipients of care in their families, and received intergenerational support mainly for their declined physical functions and limited self-care ability. The study results revealed that the greater the number of generations comprising the family, the greater was the intergenerational life care and emotional comfort provided for centenarians by the family.

CONCLUSIONS

In this study, we found a positive effect of the number of family generations on intergenerational support for centenarians. The government and society should promote the tradition of respecting, caring for, and honouring the elderly while paying close attention to the dynamic changes in the family structure of centenarians in promoting high-quality and sustainable development of the people, economy, and society.

Evolutionary game analysis of rural public-private partnership older adult care project in the context of population aging in China

Introduction

Public-private partnership (PPP) older adult care project is an effective means to solve the dilemma of the aging population in China's rural areas, but there are some problems in the operation process, such as a low participation rate and poor service quality, resulting in the needs of rural older adult groups not being met.

Methods

To alleviate the pressure of the aging population in rural areas, this study establishes an evolutionary game model for the PPP older adult care project, then defines the interests of local government, the private sector, and rural older adult residents, based on which it discusses the strategic choices of the three parties in the evolutionary process, and finally analyzes the influencing factors of the strategic choices of the game parties through simulation.

Results

The results suggest that whether the private sector chooses to actively participate in the project will be influenced by the willingness of local government and rural older adult residents to participate in the project. Local government could play the role of supervisor through reward and punishment mechanisms. Whether older rural residents choose to participate in the project depends on the number of benefits they would receive.

Discussion

Based on these findings, local governments should clarify the responsibilities of relevant stakeholders, adopt a regulatory strategy combining subsidies and penalties, improve the participation efficiency of rural older adult residents, promote the effective operation of PPP older adult care projects, and improve the quality of rural older adult care services in the new era.

Perspectives on Aging and Quality of Life

The aging of the world's population and the health problems accompanying it are becoming increasingly severe. Healthcare policies in developed countries focus on how to prevent and treat diseases associated with aging and how to maintain quality of life. Typical age-related diseases include deafness, cataracts, osteoarthritis, chronic obstructive pulmonary disease, diabetes mellitus, and dementia. Although the mechanisms by which these diseases develop differ, they are all caused by the accumulation of molecular and cellular damage over time. In addition, age-related diseases can cause a decline in physical and mental functions and the ability to perform activities of daily living, as well as the loss of roles in society and a sense of fulfillment in life. Therefore, there is a need for treatment and measures to accurately grasp and maintain quality of life. This review aims to introduce areas and representative papers expected to be contributed to the special issue of "Aging and Quality of Life".

Prevalence and correlates of elder neglect in the community-dwelling Chinese population: New evidence from the CLHLS study

Background

This study aimed to explore the prevalence of elder neglect (EN) and its associated factors among community-based Chinese older adults.

Methods

We used data from the 2018 phase of a nationwide cross-sectional study, the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which recruited 15,854 older adults to complete the study interviews that incorporated six dimensions of EN, namely, life neglect, social isolation, medical neglect, poor living situation, family neglect, and social neglect. Multivariate logistic regression was used to explore factors associated with EN.

Results

We included demographic factors, chronic diseases, cognitive function, and daily activity function in our comprehensive analysis and showed that they had different effects on the six EN dimensions. Different demographic factors such as gender, age, marriage, education, occupation, residence, and household income were included in the comprehensive analysis, and the results showed that these factors had different effects on the six dimensions of EN. Next, we found that older adults with chronic diseases are prone to life neglect, medical neglect, and residential environment neglect. Older adults with better cognitive abilities were less likely to be neglected, and a decline in daily activity capacity has been linked to EN in older adults.

Conclusion

Future studies are needed to identify the health effects of these associated factors, develop prevention strategies for EN, and improve the quality of life of older adults living in communities.

Self-Rated Health and Life Satisfaction among Elderly Migrants in China: A Moderated Mediation Model of Resilience and Upward Intergenerational Support

OBJECTIVE

This study aimed to test whether resilience mediates the association between self-rated health and life satisfaction and the moderated effect of upward intergenerational support among elderly migrants in China.

METHOD

We used self-reported data collected from 654 elderly migrants in Nanjing. The regression analysis using bootstrapping methods was conducted to explore the mediating and moderating effects.

RESULTS

Resilience mediated the relationship between self-rated health and life satisfaction among elderly migrants in China. The moderated mediation analysis indicated that the upward intergenerational support moderated the path between self-rated health and resilience. Specifically, compared with those with a low level of emotional support, the self-rated health of elderly migrants with a high level of emotional support has a stronger effect on resilience. Moreover, the self-rated health of elderly migrants with a low level of financial support has a stronger effect on resilience than those with a higher level of financial support.

CONCLUSION

Resilience could partially mediate the effect of self-rated health on life satisfaction among elderly migrants in China, and upward intergenerational support moderated the indirect relationship between self-rated health and life satisfaction via resilience.

Internet use and health status among older adults: The mediating role of social participation

Background

The acceleration of population aging and the arrival of the informatization make more and more older adults use the Internet, and its use is having an impact on their health. However, the relationship between internet use and the health of older adults and the mechanism of the effect of internet use on the health are not very clear.

Methods

Multiple linear regression models to explore the correlation between internet use and health status in the 3,141 individuals aged ≥60 years were used. Propensity score matching (PSM) method was used to test the robustness of the regression results. In addition, sequential recursive models was used to examine the mediating effect of social participation on the relationship between internet use and health status.

Results and discussion

We found a significant positive relationship between internet use and health status, and social participation mediated the relationship between internet use and health status. In addition, the effect of internet use on health status was different among older adults in rural and urban areas.

Conclusions

The development and application of internet products adapted to the development of an aging society should be accelerated to meet their needs for continued socialization. The forms and activities of social participation for the elderly groups should be enriched and public service internet usage training seminars should be conducted to improve internet skills.

How Does Internet Use Improve Mental Health among Middle-Aged and Elderly People in Rural Areas in China? A Quasi-Natural Experiment Based on the China Health and Retirement Longitudinal Study (CHARLS)

One of the most significant public health issues in rural China is how to improve the mental health of middle-aged and older individuals. Using 2013, 2015, and 2018 CHARLS panel data, this paper properly examined the effects of Internet use on the mental health of middle-aged and elderly people in rural China based on the difference-in-differences method. The findings are as follows: (1) Internet use effectively improves the mental health status of middle-aged and elderly people in rural China; (2) compared to the middle-aged group, Internet use has a more obvious effect on the mental health of the elderly; (3) further analysis showed that reading news, watching videos, and playing games online could significantly improve the mental health status of middle-aged and elderly people in rural China, while chatting online and other Internet activities cannot significantly improve mental health status; and (4) playing games, watching videos, and reading news have different effects on the mental health of middle-aged and elderly people in rural China. The results indicate that playing games have a better effect on depression levels than watching videos. In contrast, watching news had the lowest effect on depression levels among middle-aged and elderly people in rural China. The results of this study also show the latest evidence that Internet use can help China's rural middle-aged and elderly populations to reduce social isolation, establish new social connections, gain social support, and, ultimately, achieve active ageing. Therefore, promoting multiple forms of interaction is an effective path to prevent loneliness, which has become the new policy direction of the government to create an age-friendly Internet environment using various measures in the future to eliminate the barriers to Internet access affecting the middle-aged and elderly in rural China.

Effect and mechanism of reading habits on physical and mental health among the elderly: Evidence from China

Responding to an aging society worldwide and ensuring the physical and mental health of the elderly are important problems that need to be addressed. Thus, this study aimed to improve the quality of providing the spiritual and cultural needs of the elderly and study the internal transmission of reading habits and its effect on the physical and mental health of the elderly. Using the data from China's comprehensive social survey in 2018, this study applied the Probit model and ordinary least squares method to comprehensively estimate the influence of reading habits of the elderly on their physical and mental health. Stepwise regression and bootstrap method were combined to explore the influencing mechanism, and an instrumental variable method was used to solve endogeneity problems. Results indicate that the reading habits of the elderly have a significantly positive effect on their own physical and mental health. Social activity is the positive conduction path, whereas social justice perception and learning willingness are the negative conduction path. Among low-income families, agricultural workers, and the elderly whose household registration is in rural areas, the benefits of reading to the body and mind are more significant. After dealing with endogeneity problems and a series of robustness tests, the conclusion of this paper still holds. Finally, reference policy suggestions are proposed for the follow-up active aging policy, such as promoting reading for all, organizing various social activities, formulating active pension policies for the elderly, and allocating more public resources for vulnerable elderly groups.

Effect of Receiving Financial Support from Adult Children on Depression among Older Persons and the Mediating Role of Social Participation

Older persons are vulnerable to depression SFduring the ageing process. Financial resources and social participation are expected to have an impact on depressive symptoms. This study investigated the relationship between financial support from children and depression among Chinese older persons, as well as the mediating effect of social participation in this relationship. Data from 7163 participants aged 60 and above were extracted from wave 2015 and 2018 of the China Health and Retirement Longitudinal Survey (CHARLS). A multivariate regression analysis was performed on both cross-sectional data and two-wave longitudinal data to test our hypotheses. The results revealed that financial support from children was negatively associated with depressive symptoms in both the short-term and the long-term. In addition, this relationship was partially mediated by social participation in the short-term association and fully mediated by social participation in the long-term, where financial support was positively related to social participation, and social participation was negatively associated with depressive symptoms. This study offers an in-depth insight into the relationship between financial support from children and depression among Chinese older persons. Policies and initiatives to stimulate social participation should be promoted to improve older persons' mental health.

Association of Received Intergenerational Support with Subjective Well-Being among Elderly: The Mediating Role of Optimism and Sex Differences

Even though an extensive body of previous research has examined the association between received intergenerational support and the well-being outcomes of older adults in a wide variety of contexts, few studies have been conducted to explore the impacts of intergenerational support on elders’ subjective well-being, especially the intermediary mechanisms in this process. The purpose of this study is to fill this gap by exploring the mediating role of optimism in the association between received intergenerational support and subjective well-being among the elderly in China, as well as the sex differences that exist between males and females. The findings show that the intergenerational support received from adult children is positively related to subjective well-being and that this relationship is partly mediated by optimism. Meanwhile, no significant sex difference was found in the interrelations between intergenerational support, optimism, and subjective well-being.

Filial piety matters: A study of intergenerational supports and parental health

Eldercare has become a major challenge in China. As intergenerational support from children remains the primary source of caregiving, this paper investigates the impact of such support on parents' health outcomes. Exploiting data from the China Health and Retirement Longitudinal Study (CHARLS), we adopt the Heckman selection model and ordered probit model with instrumental variables, the firstborn son and firstborn daughter, to control for the potential endogeneity existing between intergenerational support and parents’ health outcomes. Our results suggest that intergenerational support, including emotional and financial support, is effective in improving parental health status, including physical and psychological well-being and performance of activities of daily living (ADL) and instrumental activities of daily living (IADL). Emotional support also improves parental cognition. Children have trade-offs between emotional and financial support. Our findings provide insight into more efficient healthcare for the elderly.

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Intergenerational support is effective in improving parental physical and psychological well-being.

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Both emotional and financial supports matter for parental health and performance of activities of daily living.

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Emotional support improves parental cognitive ability.

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Children have trade-offs between emotional and financial support.