How to Improve the Cognitive Health of Middle-Aged and Elderly People: Evidence From China Family Panel Studies

Aging wisely: The impact of Internet use on older adults' mental health

This study aims to explore the impact of Internet use on the mental health of older adults and its pathway mechanisms and to provide a theoretical basis and practical guidance for improving the mental health of older adults and better realizing active aging. Using cross-sectional data from the 2020 China Health and Retirement Longitudinal Survey, 6722 older adults over 60 were finally included. We conducted descriptive and correlation analyses of the data; we analyzed the correlation of Internet use on the depression level and cognitive ability of older adults using seemingly unrelated regression; we further explored the mediating role of socialization frequency in the relationship between Internet use and the depression level and cognitive ability of older adults and its differences through mediation analysis. The results showed that the mean age of older adults in this study was (68.52 ± 5.97), the mean Internet use score was (1.12 ± 1.63), the mean depression score was (8.44 ± 6.31), and the mean cognitive score was (12.17 ± 3.27). Internet use had a positive impact on the mental health of older adults, including lowering depression (β = -0.275, P < 0.05) and improving cognition (β = 0.300, P < 0.05). Socialization frequency mediated the relationship between Internet use and depression/cognitive ability (95 % CI = -0.034 to -0.008, 95 % CI = 0.007-0.022). Therefore, it is essential to encourage older adults to use the Internet, actively integrate into the digital society, promote wise aging, share the fruits of technological development, and utilize the Internet to maintain the mental health of older adults.

The impact of Internet use and involvement on residents' attitudes to healthcare in China: A propensity score matching analysis

The recent surge in Internet growth has significantly altered how residents obtain health information and services, underscoring the need to investigate its impact on healthcare perceptions. However, current studies often fail to distinguish between Internet use and involvement, as well as the diverse range of healthcare stakeholders, resulting in incomplete and inconsistent understanding. To address this, this study utilized data from the 2018 China Family Panel Study (CFPS 2018), categorizing attitudes toward healthcare into three dimensions: doctor trust, satisfaction with medical institutions, and perception of systemic healthcare issues. Employing propensity score matching (PSM) to control for thirteen confounding variables, this study examined the Internet's impact on public attitudes toward healthcare among similar demographic, psychological, and health-related variables. Results revealed that both Internet use and involvement affect residents' attitudes toward healthcare to some extent, with involvement having a more pronounced effect. While Internet use increased the perception of systemic healthcare issues, Internet involvement enhanced doctor trust, yet reduced satisfaction with medical institutions and exaggerated the perception of systemic healthcare issues. These findings have significant theoretical and practical implications. They enhance the comprehension of diverse levels and purposes of Internet use, thereby advancing our knowledge of its multi-faced influence on public attitudes toward healthcare. Furthermore, they offer insights for medical institutions to improve service quality, assist Internet media in optimizing information delivery, and illuminate the implications for residents who effectively use the Internet to assess health information.

Preference for primary care in Chinese homebound patients

OBJECTIVE

This study aims to describe the preference for primary healthcare (PHC) and investigate associated factors among homebound residents in both rural and urban areas of China. It provides valuable insights to facilitate the rational allocation of healthcare resources and promote the utilization of PHC.

METHODS

In this nationally representative cross-sectional study, we utilized the most recent data (2020) from the China Family Panel Studies (CFPS). Participants were recruited from 25 provincial-level administrative regions in both rural and urban areas of China. Homebound patients were asked to provide details about their individual characteristics, variables related to family caregiving, and preferences for PHC. Multivariable logistic models were used to analyze potential factors associated with preference for PHC. Estimates of association were reported as odds ratios (OR) and their 95% confidence intervals (CI).

RESULTS

The study found that 58.43% of rural patients reported a preference for PHC, while 42.78% of urban patients favored PHC. Compared to rural participants who did not received inpatient care in the past year, those who received inpatient care in the past year had 67% lower odds of choosing PHC (OR:0.33, 95% CI:0.19-0.59); Compared to rural participants who did not received family caregiving when ill, those who received family caregiving when ill had 59% lower odds of choosing PHC (OR: 0.41, 95% CI:0.21-0.77). Correspondingly, Compared to urban participants who did not received inpatient care in the past year, those who had received inpatient care in the past year had 75% lower odds of choosing PHC (OR: 0.25, 95% CI: 0.10-0.56); Compared to urban participants who did not received family caregiving when ill, those who received family caregiving when ill had 73% lower odds of choosing PHC (OR: 0.27, 95% CI: 0.11-0.63); Compared to urban participants who with agricultural Hukou, those with Non-agricultural Hukou had 61% lower odds of choosing PHC (OR: 0.39, 95% CI:0.18-0.83); Compared to urban participants living in the eastern part of mainland China, those living in the central part of China had 188% higher odds of choosing PHC (OR: 2.88, 95% CI: 1.14-7.29).

CONCLUSION

Policymakers should focus on tailoring PHC to vulnerable populations and prioritizing family-based public health strategies for enhancing homebound patients' perceptions of PHC. Furthermore, further study is needed on whether the Hukou registration system affects the barriers that homebound patients experience in choosing healthcare providers.

Effect of extracurricular tutoring on adolescent students cognitive ability: A propensity score matching analysis

In recent years, there has been a substantial increase in the number of adolescent students attending extracurricular tutoring. However, extracurricular tutoring, being a distinct form of education, may have varying effects on cognitive capabilities compared to conventional education. Accordingly, the purpose of this paper is to conduct a thorough examination of the effects of extracurricular tutoring on cognitive abilities among adolescent students. The study utilized national data from the China Family Panel Study 2018 to explore the relationship between involvement in extracurricular tutoring among students and cognitive abilities. The study included 2567 valid respondents. A binary logistic regression model was built to determine the factors associated with tutoring involvement while controlling for 19 individual, family, and school factors. Furthermore, a propensity score-matched analysis was conducted in order to mitigate potential bias by using confounding variables identified in the previous step. The study results show that participation in extracurricular tutoring can significantly increase the level of cognitive ability of adolescent students, with adjustments made for age, gender, ethnicity, number of family members, net family income per capita, education and training expenditure in the past years, change of residence for enrollment, change of domicile address for enrollment, locality of the current school, class size, hold a position as a class cadre, average daily study time on weekdays, average study time per day during weekends. The findings imply that the government should provide tutorial subsidies to disadvantaged groups of adolescent students, allocate educational resources equitably, and invest more in education resources in less developed regions to foster fair and healthy development of education and improve the cognitive abilities of young students in the long-term.

Conflict with children, psychological depression, and problematic internet use among Chinese older adults: The moderating effect of sociability and living situation

Introduction

Problematic internet use among the elderly is an emerging area as previous studies focused more among the young people. Only a few studies focused on problematic internet use at the level of individual characteristics of older adults or on mitigating factors at the level of the older adult's family, ignoring family-level disruptive factors.

Objective

The purpose of study is to investigate the relationship between conflict with children and problematic internet use among the elderly, as well as the mediating mechanisms and boundary conditions of the relationship.

Methods

The valid sample of study composed of 428 older adults from 39 different villages and communities in central China. Data analyses were conducted by SPSS, MPLUS, and SmartPLS software. To test our hypotheses, we implement several quantitative methods, including confirmatory factor analysis (CFA), correlations analysis, and ordinary least squares (OLS) regression. Also, we employed partial least square structural equation modeling (PLS-SEM) for robustness testing.

Results

The results indicated that conflict with children was positively associated with problematic internet use of old people; psychological depression mediated the relationship between conflict with children and old adults' problematic internet use; sociability moderated the effect of conflict with children on psychological depression; and living situation moderated the effect of psychological depression on problematic internet use among the elderly.

Conclusion

The current research improved the understanding of the mechanisms that produce problematic internet use among the elderly and helped prevent or reduce problematic internet use in older adults in terms of family support systems and individual ability characteristics.

Digital exclusion and functional dependence in older people: Findings from five longitudinal cohort studies

Background

Older people are more likely to be excluded from the digital world, and this has been linked to poor health outcomes. The extent and direction of the influence of digital exclusion on functional dependency is, however, not well understood. We aimed to investigate the association between digital exclusion and functional dependency among older adults from high-income countries (HICs) and low- and middle-income countries (LMICs).

Methods

In this multicohort study, we pooled individual-level data from five longitudinal cohort studies that included nationally representative samples of older adults across 23 countries, including the Health and Retirement Study (HRS), the English Longitudinal Study of Aging (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Aging Study (MHAS). The digital exclusion was recorded as an absence from internet use by self-reported. We assessed basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and we used interval-of-need methods to categorize the functional dependency. We applied generalized estimating equations models fitting Poisson model to investigate the association of digital exclusion with difficulties in BADL or IADL and functional dependency, adjusting for the causal-directed-acyclic-graph (DAG) minimal sufficient adjustment set (MSAS), including gender, age level, labour force status, education, household wealth level, marital status, and co-residence with children.

Findings

We included 108,621 participants recruited between 2010 and 2018 with a median follow-up of 3 phrases. Digital exclusion in older adults varied across countries, ranging from 23.8% in Denmark (SHARE) to 96.9% in China (CHARLS). According to the crude model, digital exclusion was significantly associated with functional dependency. In the MSAS-adjusted model, those associations remained statistically significant: HRS (incidence rate ratio [IRR] = 1.40, 95% confidence interval [CI] 1.34-1.48 for BADL; 1.71 [1.61-1.82] for IADL), ELSA (1.31 [1.22-1.40] in BADL and 1.37 [1.28-1.46] in IADL), SHARE (1.69 [1.61-1.78] in BADL and 1.70 [1.63-1.78] in IADL), CHARLS (2.15 [1.73-2.67] in BADL and 2.59 [2.06-3.25] in IADL), and MHAS (1.15 [1.09-1.21] in BADL and 1.17 [1.09-1.25] in IADL). In the subgroup analyses, the associations were more pronounced in the oldest-old (aged ≥ 80 years old).

Interpretation

There is a substantial proportion of older adults who are excluded from the Internet, especially those in LMIC. Older people excluded from the Internet regardless of whether they live in HICs or LMICs are more likely to develop functional dependency. It should be made a priority to remove barriers to Internet access in order to assist older people in maintaining their independence and, consequently, to reduce the care burden associated with the ageing population worldwide.

Funding

The National Natural Science Foundation of China (No. 71904004).

Hierarchical Linear Model of Internet Addiction and Associated Risk Factors in Chinese Adolescents: A Longitudinal Study

The risk effects of internet addiction have been documented in the literature; however, few longitudinal studies have considered the heterogeneity of the subjects. A hierarchical linear model was used here to explore the relationship between adolescents' internet addiction and associated risk factors (depression, anxiety, gender, and obesity) from the perspective of longitudinal analysis. A total of 1033 adolescents were investigated and followed up with every three months with the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Internet Addiction Test (IAT). The hierarchical linear model of internet addiction had only two levels. The first level of the model was the time variable (three time points) and the second level of the model was the individual adolescent (1033 adolescents). The results showed that (1) depression and anxiety, as associated risk factors, were significant positive predictors of adolescents' internet addiction considering the developmental trajectory courses of adolescent internet addiction, as well as the individual differences over time; (2) there were gender differences in the adolescents' internet addictions-specifically, the initial level of internet addiction among boys was significantly higher than that of girls, but the rate of decline was significantly faster than that of girls; and (3) there was no significant difference in obesity. The results demonstrated the importance of considering depression, anxiety, and gender in any intervention efforts to reduce adolescents' internet addictions, and we should pay attention to the cultivation of positive coping strategies for Chinese adolescents. The limitations of the study were also discussed.

The relationship between real-life social support and Internet addiction among the elderly in China

Internet addiction among the elderly is a novel issue in many countries. However, extant research about excessive use of the Internet is focusing on adolescents and younger adults. There are few studies to explore the topic of the elderly's Internet addiction. The purpose of this study is to investigate the relationship between real-life social support and Internet addiction among older adults during the COVID-19 pandemic. This article adopted a self-reported questionnaire via internet links to collect data. A total of 303 valid samples about Internet addiction for the elderly were obtained in China. The results suggested that real-life social support is significantly and negatively related to Internet addiction among the aged. Moreover, the findings revealed that real-life social support could mitigate Internet addiction by increasing the levels of hopefulness and decreasing the feeling of loneliness. We expect that this study can enrich the understanding of the problematic Internet usage within older populations. Finally, the contributions, practical significance, and limitations of this study were discussed.

The impact of interaction with children on internet addiction in older adults: A moderated mediation model

Internet addiction among older adults is a new problem in many countries. However, previous studies on excessive Internet use have focused more on young people, and only few studies have focused on Internet addiction in older adults. There is a need to continue to expand research on Internet addiction in older adults. This paper aimed to fill the gap in exiting literature. We adopted a self-reported questionnaire to assess the elderly’s interaction with children, loneliness, life satisfaction and Internet addiction among old adults. A total of 241 old people were obtained from data collection in China via online survey with the help of a professional research company. We used OLS regression analysis and bootstrap method to test the hypothesis. The results of the empirical analysis indicated that (1) interaction with children was significantly negatively associated with the Internet addiction of old people; (2) loneliness mediated the relationship between interaction with children and old adults’ Internet addiction; and (3) life satisfaction moderated the effect of interaction with children, and the indirect effect between interaction with children and old adults’ addiction via loneliness was stronger for those with low life satisfaction. Finally, we discussed the theoretical significance, practical implications, limitation of this research. Interventions to improve family function systems especially for older people with low life satisfaction can help prevent the development of Internet addiction.