Depression in Community-Dwelling Older Adults Living Alone in China: Association of Social Support Network and Functional Ability

The effect of long-term care insurance on women's health outcomes in China: evidence from a disability inclusion action

BACKGROUND

Long-term care insurance (LTCI) in China provides financial and care security for persons with disabilities and includes caregivers in the paid labour workforce. However, it is unclear how the LTCI affects health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers.

METHODS

Using the China Health and Retirement Longitudinal Study data and staggered difference-in-differences method, we evaluated the effect of LTCI on health outcomes in women with different roles, including female recipients, female caregivers, and female non-recipients and female non-caregivers, and discussed the heterogeneity of the effect on women's health outcomes.

RESULTS

LTCI statistically significant increased self-rated health and reduced depression in women and improved the health in women with different roles by increasing self-rated health in female recipients, reducing chronic diseases in female caregivers, and reducing depression in female non-recipients and female non-caregivers. There was a more pronounced improvement in health outcomes among women in the west and northeast and women in rural village.

CONCLUSIONS

After the implementation of LTCI, health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers were improved. LTCI' improvement on women's health outcomes was heterogeneous geographically and socially. Our findings highlight the importance of delivering differentiated health interventions for women with different roles in the implementation process of LTCI and minimizing women's health inequalities in geography and society.

Effect of long-term care insurance policy on depression in non-disabled people: evidence from China

BACKGROUND

Policy effect might be multidimensional and spill over to non-recipients. It is unclear how the implementation of Long-Term Care Insurance (LTCI) policy affects depression in non-disabled people and how this effect differs in different non-disabled groups.

METHODS

Using time-varying differences-in-differences method and nationally representative health survey data in wave 2011, wave 2013, wave 2015 and wave 2018 from the China Health and Retirement Longitudinal Study, we assessed the effect of LTCI policy on depression in non-disabled people aged 45 years and older, and discussed the heterogeneity of effect across different population characteristics: retirement, financial support and social participation status.

RESULTS

We found LTCI policy statistically significant reduced depression by 0.76 units in non-disabled people compared to non-pilot cities. Depression in non-disabled people who unretired, with financial support and without social participation was reduced by 0.8267, 0.7079 and 1.2161 units, respectively.

CONCLUSIONS

Depression in non-disabled people was statistically significant reduced because of LTCI policy in China, and non-disabled people who unretired, with financial support and without social participation benefited more from LTCI policy. Our findings highlight the depression-reducing effect of LTCI policy in non-recipients and suggest that non-disabled people who unretired, with financial support and without social participation should be concerned during LTCI policy progress.

Multiple geriatric syndromes in community-dwelling older adults in China

This study aims to assess the prevalence of geriatric syndromes and identify factors associated with multiple geriatric syndromes in community-dwelling older adults in China. We utilized a convenience sampling method to recruit older adults and from one rural and one urban community in Chengdu, China, from October 2022 to March 2023. A total of 706 older adults aged 60 years or older were included. Ten geriatric syndromes were investigated including two mental disorders: depressive symptoms, cognitive impairment; and eight somatic disorders: pain, falls, sleep disturbance, constipation, polypharmacy, multimorbidity, malnutrition and frailty. Multiple geriatric syndromes were defined as an individual having two or more geriatric syndromes. The data obtained were analysed using descriptive statistics. The independent risk factors for multiple geriatric syndromes were assessed using a logistic regression model. This study found that 90.5% of the participants had at least one geriatric syndrome, with 72.8% experiencing multiple geriatric syndromes. The top four geriatric syndromes in our study were polypharmacy (58.5%), malnutrition/at risk of malnutrition (43.1%), multimorbidity (42.1%), and frailty/prefrailty (34.3%). Of the older adults, 368(52.1%) had only somatic disorders, 18(2.5%) had only mental disorders and 253 (35.8%) had somatic-mental disorders. According to the logistic regression analysis, residence, age, marriage, BMI, and self-related health were significantly associated with multiple geriatric syndromes among older adults. This study highlights that multiple geriatric syndromes are prevalent among community-dwelling older adults in China, and underscores the significance of certain demographic factors in their occurrence. Future longitudinal studies are needed to establish the temporal relationship between multiple geriatric syndromes and these demographic factors, as well as to explore causal relationships and effective prevention strategies for geriatric syndrome.

Effectiveness of a multicomponent activity and horticultural intervention for the hospitalized older adults: A randomized controlled trial: Effectiveness of Intervention for the Hospitalized Older Adults

This study evaluated the effectiveness of different intervention programs in improving function among hospitalized older individuals using the Comprehensive Geriatric Assessment (CGA). A randomized controlled trial consisted of three groups: routine care, horticulture, and multicomponent activities (n = 32 each). Horticultural and multicomponent activity interventions showed beneficial effects on the CGA in hospitalized older individuals, particularly regarding cognitive function and quality-of-life. Additionally, horticultural activities significantly contributed to the perception of older adults' health status. We recommend to select older patients in geriatric wards with long-term hospitalization and adjust the frequency of activities or choose a single intervention program to provide long-term and effective intervention effects.

Living alone and the risk of depressive symptoms: a cross-sectional and cohort analysis based on the China Health and Retirement Longitudinal Study

BACKGROUND

There were a few studies that examined the longitudinal association between living alone and depressive symptoms, and the vast majority of them were conducted in patients with certain diseases, such as heart failure, cancer, and glaucoma. This study aimed to examine the association between living alone and depressive symptoms in a large representative older Chinese population.

METHODS

The China Health and Retirement Longitudinal Study (CHARLS) data from 2015 to 2018 were used. Living alone was defined as participants who did not live with others ever or more than 11 months in the past year at baseline. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression Scale (CES-D10). The multivariate logistic regression was used to estimate the relationship between living alone and depressive symptoms.

RESULTS

There were 5,311 and 2,696 participants ≥ 60 years old included in the cross-sectional and cohort analysis, respectively. The risk of depressive symptoms in participants who lived alone was significantly higher than those who lived with others in both cross-sectional (OR:1.33; 95%CI:1.14,1.54) and cohort analysis (OR:1.23; 95%CI:0.97,1.55). There was a significant interaction between financial support and living alone (Pinteraction = 0.008) on the risk of depressive symptoms. Stratified analyses showed that, compared to those who lived with others, the risk of depressive symptoms in participants who lived alone increased by 83% (OR:1.83; 95%CI:1.26,2.65) in participants receiving lower financial support. However, we did not find statistically significant associations in participants with medium (OR:1.10; 95%CI: 0.74,1.63) and higher financial support (OR: 0.87; 95%CI: 0.53,1.41).

CONCLUSION

Living alone was associated with a higher risk of depressive symptoms in the Chinese older population, and this association was moderated by the receipt of financial support. Living alone may be an effective and easy predictor for early identification of high-risk populations of depression in the older population.

Effects of adverse life events on mental health in single older adults in Japan

BACKGROUND

This study tested a hypothesised model of the effects of adverse life events on the mental health of middle-aged and older adults living alone, as mediated by thought suppression and help-seeking behaviours, considering gender differences.

METHODS

A questionnaire survey was conducted on a sample of 1202 (622 men; 580 women) individuals from 247445 residents aged 50-79 in District A of Tokyo. The questionnaire items covered parameters on adverse life events, help-seeking behaviour, thought suppression, and mental health status.

RESULTS

Multiple group structural equation-modelling analysis revealed that the seriousness of adverse life events, help-seeking behaviours, and mental health scores were higher in women than in men. No significant gender differences were observed in thought suppression. The findings support all three proposed hypotheses: severe adverse life events will: (a) give rise to help-seeking behaviours, which will have a positive effect on mental health; (b) intensify thought suppression, which will harm mental health; and (c) inhibit help-seeking behaviour, especially in single middle-aged and older adult men.

CONCLUSION

There is a need to develop interventional programs based on the theory of replacement thinking to encourage help-seeking behaviours in middle-aged and older adults.

Perspectives on the popularization of smart senior care to meet the demands of older adults living alone in communities of Southwest China: A qualitative study

Background

Older adults who live alone face challenges in daily life and in maintaining their health status quo. Currently, however, their growing demands cannot be satisfied with high quality; therefore, these demands expressed by elders may be settled in the form of smart senior care. Hence, the improvement in smart senior care may produce more positive meanings in promoting the health and sense of happiness among this elderly population. This study aimed to explore the perceptions of demands and satisfaction with regard to the provision of senior care services to the community-dwelling older adults who live alone in Southwest China, thus providing a reference for the popularization of smart senior care.

Methods

This study adopted a qualitative descriptive approach on demands and the popularization of smart senior care. Semi-structured and in-depth individual interviews were conducted with 15 community-dwelling older adults who lived alone in Southwest China between March and May 2021. Thematic analysis was applied to analyze the data.

Results

Through data analysis, three major themes and subcategories were generated: "necessities" (contradiction: more meticulous daily life care and higher psychological needs vs. the current lower satisfaction status quo; conflict: higher demands for medical and emergency care against less access at present), "feasibility" (objectively feasible: the popularization of smart devices and applications; subjectively feasible: interests in obtaining health information), and "existing obstacles" (insufficient publicity; technophobia; patterned living habits; and concerns).

Conclusions

Smart senior care may resolve the contradiction that prevails between the shortage of medical resources and the increasing demands for eldercare. Despite several obstacles that stand in the way of the popularization of smart senior care, the necessities and feasibility lay the preliminary foundation for its development and popularization. Decision-makers, communities, developers, and providers should cooperate to make smart senior care more popular and available to seniors living alone, facilitating independence while realizing aging in place by promoting healthy aging.

Validation and Comparison of Three Short Depression Screening Tools Among Chinese Community-Dwelling Older Adults

The current study validated and compared three short Geriatric Depression Scales (GDS), including the GDS-5, D'Ath GDS-4, and van Marwijk GDS-4, among 917 Chinese community-dwelling older adults. The GDS-5, D'Ath GDS-4, and van Marwijk GDS-4 presented satisfactory accuracy against the GDS-15 (area under the curve [AUC] = 0.872 to 0.952), and the GDS-5 and D'Ath GDS-4 had better accuracy than the van Marwijk GDS-4. Satisfactory accuracy (AUC = 0.842 to 0.979) for the three scales was also observed across subgroups by age, sex, education, cognitive function, and multimorbidity. The GDS-5 but not D'Ath GDS-4 and van Marwijk GDS-4 retained a 2-point optimal cutoff for depressive symptoms across subgroups. The GDS-5 (average inter-item correlation coefficient [AIIC] = 0.233) and the D'Ath GDS-4 (AIIC = 0.171) but not van Marwijk GDS-4 (AIIC = 0.128) had acceptable internal consistency. Three scales had stable test-retest reliability within a 1- to 2-week interval (intraclass correlation coefficient = 0.670 to 0.885). The GDS-5 is an accurate and reliable depression screening tool with an invariable optimal cutoff among Chinese community-dwelling older adults. The variable optimal cutoffs for the D'Ath GDS-4 and van Marwijk GDS-4 across subgroups may limit their applicability in this population. [Research in Gerontological Nursing, xx(x), xx-xx.].

Effectiveness of Social Support for Community-Dwelling Elderly with Depression: A Systematic Review and Meta-Analysis

Depression in the elderly is an important health factor that requires intervention in the form of social support resources. The purpose of this study was to conduct a systematic review, while synthesizing available evidence on what kind of social support, such as social participation and social connection/network, is effective for depression in the elderly. We performed a quality assessment of the included studies using the revised Risk of Bias for Non-randomized Studies tool and a meta-analysis of studies published up to 14 May 2021. Of the 3449 studies, 52 were relevant to this study. The various types of social resource applications reported in these were classified into three types: social support, social participation, and social connection/network. The social support group had significantly lower depression compared to the control group (0.72 [0.65, 0.81], p < 0.00001, I2 = 92%). There was a significant decrease in depression in the social participation group compared to the control group (0.67 [0.56, 0.80], p < 0.00001, I2 = 93%) (2.77 [1.30, 5.91], p = 0.008, I2 = 97%) (0.67 [0.56, 0.80], p < 0.00001, I2 = 93%). Finally, the social connection/network group showed decreased depression compared to the control group (2.40 [1.89, 3.05], p < 0.00001, I2 = 24%) (0.83 [0.76, 0.90], p < 0.00001, I2 = 94%). The results of this systematic review confirmed the effects of various social support interventions in reducing depression among the elderly living in the community.

The relationship between living arrangements and depression among older adults in Shandong, China: The mediating role of social support

BACKGROUND

Living arrangements and social support have an impact on depression among older adults. However, the underlying mechanism between those variables remains unknown. This study aims to investigate the mediating role of social support in the relationship between living arrangements and depression among older adults.

MATERIALS AND METHODS

Multi-stage stratified sampling method was used to select 3,859 older adults from Taian City, Shandong Province, China, for cross-sectional investigation. Living arrangements were measured by a question. Social support and depression were measured using the Multidimensional Scale of Perceived Social Support and Patient Health Questionnaire-9. Multiple linear regression models were used to assess the relationship between living arrangements and depression and the possible influence of social support on the relationship between living arrangements and depression.

RESULTS

Statistics showed that 15.08% of older adults lived alone. After controlling for covariates, living arrangements (ß = 0.45, t = 2.87, P < 0.01) and social support (ß =-0.08, t =-16.93, P < 0.001) were significantly associated with depression. The linear regression model showed that social support mediated the relationship between living arrangements and depression, and the mediating effect accounted for 18.20% of the total effect.

CONCLUSION

This study revealed that living arrangements played an essential role in indirectly predicting depression in older adults through social support. This provided evidence for how to reduce depression in older adults.

Effectiveness of horticultural therapy on physical functioning and psychological health outcomes for older adults: A systematic review and meta-analysis

AIMS AND OBJECTIVES

To systematically determine the effectiveness of horticultural therapy (HT) on the physical functioning and psychological health of older people.

BACKGROUND

With advancing age and increased chronic diseases, older adults are vulnerable to physical deterioration and psychological problems. There is evidence that horticultural therapy (HT) has positive effect among older adults. However, less attention has been devoted to systematically evaluating the physical functioning and psychological health effects of HT in older adults.

DESIGN

Systematic review and meta-analysis were conducted based on the checklist for PRISMA.

METHODS

The searches were conducted in PubMed, EMBASE, CINAHL, PsycINFO, Cochrane, China Network Knowledge Infrastructure, Wan Fang, and China Science and Technology Journal Database, from their inception until June 2021. Randomised controlled trials published in either English or Chinese were reviewed. The Review Manager 5.4 software was used for meta-analyses. The quality of included studies was evaluated using the Cochrane risk of bias tool by two independent researchers.

RESULTS

Ten studies involving 884 participants were included. Compared with the control group, HT can significantly improve upper body flexibility and aerobic endurance in older adults with cancer. Besides, HT was found to be more effective for promoting emotional functioning and well-being, subjective social functioning, and quality of life among the elderly. The attendance rate for HT was 66%-100%, and no negative events were found.

CONCLUSION

Horticultural therapy has potentially positive effects on the physical functioning and psychological health of older adults. However, more rigorous randomised controlled trials with larger populations are required to confirm the findings.

RELEVANCE TO CLINICAL PRACTICE

As a safe and promising nonpharmacological intervention, healthcare professionals may consider the HT intervention when caring for older adults with cancer, dementia and frailty.

A New Social Network Scale for Detecting Depressive Symptoms in Older Japanese Adults

Social engagement and networking deter depression among older adults. During the COVID-19 pandemic, older adults are especially at risk of isolation from face-to-face and non-face-to-face interactions. We developed the National Center for Geriatrics and Gerontology Social Network Scale (NCGG-SNS) to assess frequency of, and satisfaction with, social interactions. The NCGG-SNS consists of four domains: face-to-face/non-face-to-face interactions with family/friends. Each domain score is obtained by multiplying frequency ratings by satisfaction ratings for each item; all scores were summed to obtain a total NCGG-SNS score (range: 0–64). Additionally, face-to-face and non-face-to-face subscores were calculated. Higher scores indicated satisfactory social networking. A cohort of 2445 older Japanese adults completed the NCGG-SNS and the Geriatrics Depression Scale-Short form. Receiver Operating Characteristic (ROC) analysis and logistic regression determined predictive validity for depressive symptoms. Depressive symptoms were reported by 284 participants (11.6%). The optimal NCGG-SNS cut-off value to identify depressive symptoms was 26.5 points. In logistic regression analysis adjusted for potential confounders, lower NCGG-SNS values were significantly associated with greater prevalence of depressive symptoms. Face-to-face and non-face-to-face subscores were associated with depressive symptoms. The NCGG-SNS is a valid and useful indicator of multidimensional social networking enabling identification of depressive symptoms in older adults.