The effect of retirement on physical and mental health in China: a nonparametric fuzzy regression discontinuity study

BACKGROUND

With the rapid aging of the domestic population, China has a strong incentive to increase the statutory retirement age. How retirement affects the health of the elderly is crucial to this policymaking. The health consequences of retirement have been debated greatly. This study aims to investigate the effects of retirement on physical and mental health among Chinese elderly people.

METHODS

The data we use in this study comes from four waves (2011, 2013, 2015, and 2018) of the Harmonized China Health and Retirement Longitudinal Study (Harmonized CHARLS), a prospective cohort. We use the nonparametric fuzzy regression discontinuity design to estimate the effects of retirement on physical and mental health. We test the robustness of our results with respect to different bandwidths, kernel functions, and polynomial orders. We also explore the heterogeneity across gender and education.

RESULTS

Results show that retirement has an insignificant effect on a series of physical and mental health outcomes, with and without adjusting several sociodemographic variables. Heterogeneity exists regarding gender and education. Although stratified analyses indicate that the transition from working to retirement leaves minimal effects on males and females, the effects go in the opposite direction. This finding holds for low-educated and high-educated groups for health outcomes including depression and cognitive function. Most of the results are stable with respect to different bandwidths, kernel functions, and polynomial orders.

CONCLUSIONS

Our results suggest that it is possible to delay the statutory retirement age in China as retirement has insignificant effects on physical and mental health. However, further research is needed to assess the long-term effect of retirement on health.

Exploring influential factors in the self-assessment of life satisfaction among Chinese elderly: a structural equation modeling analysis

The aging problem is becoming more and more prominent globally. Attention to the quality of life and related health improvement among the elderly has become an important issue in modern society. This study utilized a tracking survey conducted in 2017-2018, involving 9,327 Chinese older adults, to examine health influencing factors, and applied structural equation modeling to analyze the influencing factors on the self-assessment of life satisfaction among older adults in different regions (cities, counties, and villages) in China. This study revealed that economic status, psychological status, personal situation, life behaviors, and child care are important influences on older people's self- assessed life satisfaction. There is a positive correlation between economic status, psychological status, child care and the results of the self-assessment of life satisfaction of the elderly. Psychological status and child care have a greater impact on the self-assessment of life satisfaction among the elderly in urban areas compared to villages and towns. The influence of economic status on the self-assessment of life satisfaction of the elderly is lower in urban areas than in rural areas. There is a significant difference in the influence of personal situations on the self-assessment of life satisfaction among the elderly. Additionally, older individuals tend to report higher levels of self-assessment of life satisfaction. Furthermore, female elderly individuals tend to report higher levels of satisfaction compared to males. Findings from this study indicate that improving health self-assessment in older adults requires targeted efforts based on different geographic areas of life and the age stages of older adults, and more attention needs to be paid to men who are just entering old age.

Patterns of physical and mental co-occurring developmental health among Chinese elderly: A multidimensional growth mixture model analysis

Background

This study focuses on the heterogeneity, interaction, and imbalance in the concurrent development of physical and mental health trajectories among Chinese elderly.

Methods

The data used in this study are from four waves of the China Health and Retirement Longitudinal Study (CHRLS) conducted between 2011 and 2018. A multidimensional growth mixture model (MGMM) was employed to analyze the patterns and characteristics of co-occurring physical and mental health development. Additionally, multinomial logistic regression analysis was conducted to systematically investigate the factors that predict the conjoint trajectories of physical and mental health.

Results

The study findings reveal the presence of four distinct latent classes of conjoint trajectories for physical and mental health. These classes are categorized as follows: 'physical and mental health deteriorating', 'physical disease increasing & low mental vulnerability maintaining', 'low physical & mental vulnerability maintaining', and 'high physical disease increased & mental health moderate-stable'. Furthermore, demographic characteristics, socioeconomic status, family-society relations, health behaviors, and institutional factors were found to significantly predict these latent classes.

Conclusion

The study emphasizes the diversity and complexity of physical and mental co-occurring developmental health issues in the elderly population in China. These findings have significant implications for the development of targeted intervention strategies that take into account the unique health changes experienced by older adults. Additionally, they can serve as evidence for the establishment of a comprehensive long-term care system.

The association between satisfaction with life and anxiety symptoms among Chinese elderly: a moderated mediation analysis

BACKGROUND

Previous studies have suggested that certain personal psychological variables (e.g., life satisfaction and cognitive function) and physical variables (e.g., body mass index [BMI]) are significantly associated with individuals' anxiety symptoms. However, relevant research on elderly is lagging and no studies have yet investigated the combined impact of these variables on anxiety. Thus, we conducted the present study to investigate the potential moderator role of BMI and the potential mediator role of cognitive function underlying the relationship between life satisfaction and anxiety symptoms in Chinese elderly based in Hong Kong.

METHODS

Sixty-seven elderly aged 65 years old and above were recruited from the local elderly community centres in this pilot study. Each participant underwent a systematic evaluation using the Satisfaction with Life Scale (SWLS), Hong Kong Version of the Montreal Cognitive Assessment (HK-MoCA), and the Hamilton Anxiety Rating Scale (HAM-A) and were measured for their body weight and height. Regression analysis using the bootstrapping method was employed to test the hypothesized moderated mediation model.

RESULTS

Our findings demonstrated the overall model accounted for 23.05% of the variance in scores of HAM-A (F (8, 57) = 2.134, p = 0.047) in Chinese elderly. There was a significant association between life satisfaction and anxiety symptoms (p = 0.031), indicating that individuals with higher life satisfaction were associated with less anxiety symptoms. Moreover, this relationship was positively moderated by BMI (b = 0.066, 95% CI [0.004, 0.128]), especially in Chinese elderly with BMI at a lower level (b = -0.571, 95% CI [-0.919, -0.224]) and an average level (b = -0.242, 95% CI [-0.460, -0.023]). No significant mediator role was detected for cognitive function (b = -0.006, 95% CI [-0.047, 0.044]) in our model.

CONCLUSIONS

Our findings suggest that increased life satisfaction can reduce anxiety symptoms among Chinese elderly as their BMI decreases (when BMI ranged between "mean - 1SD" and "mean" of the population). The significant interaction between psychological and physical factors underlying anxiety symptoms found in this study, presents a promising opportunity for translation into multi-level psychological and physical interventions for the management of anxiety in ageing patients during clinical practice.

Association Between Dietary Copper Intake and Cognitive Decline: A Perspective Cohort Study in Chinese Elderly

OBJECTIVE

The association between dietary copper (Cu) intake and cognitive decline remains uncertain. We aim to investigate the longitudinal association of dietary Cu with cognitive decline in Chinese elderly.

METHODS

A total of 3,106 Chinese adults aged older than or equal to 55 years from China Health and Nutrition Survey (CHNS) were included. Dietary nutrients information was collected by 24-hours dietary recalls in combination with a food-weighted method. The 5-year change rates in global or composite cognitive scores based on a subset of items from the Telephone Interview for Cognitive Status-modified (TICS-m) was calculated as the last-survey score minus the baseline score, then divided by the follow-up time (unit, years) and multiplied by five.

RESULTS

The median follow-up duration was 5.9 years. There was a nonlinear association of dietary Cu intake with the 5-year change rates in global or composite cognitive scores, with the inflection point at approximately 1.3 mg/day of dietary Cu intake. Accordingly, for the composite cognitive score, compared to the first quantile (<1.28 mg/day), those with dietary Cu in quantiles 2-8 (≥1.28 mg/day) had a significantly slower cognitive decline rate (B, 0.30; 95% CI, 0.13, 0.47). Similar results were found for the global cognitive score. Moreover, the inverse association between dietary Cu and cognitive decline was stronger in those with lower dietary fat intake and lower levels of physical activity (All p-interactions <0.05).

CONCLUSION

There was a nonlinear inverse association of dietary Cu intake with cognitive decline in the elderly, with an inflection point at approximately 1.3 mg/day of dietary Cu intake.

A Body Shape Index and Its Changes in Relation to All-Cause Mortality among the Chinese Elderly: A Retrospective Cohort Study

Although recent evidence has revealed that a body shape index (ABSI) is correlated with the incidence of death among different ethnicities, there remains a paucity of studies investigating the impact of ABSI on mortality within the Chinese elderly. Our objective was to ascertain the link between ABSI, as well as its alterations over time, and all-cause mortality among Chinese aged 65 y and above. A total of 3789 participants were enrolled from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Cox regressions and restricted cubic splines were employed to assess the association of ABSI and relative changes with all-cause mortality. When nonlinearity was detected, a restricted cubic spline regression was subsequently conducted to compute hazard ratios and 95% confidence intervals. The median survival time was 46 months, and 1342 individuals (35.4%) were reported to have died. ABSI contributed independently to rising death rates among Chinese old populations according to univariate and multivariate Cox regressions. Statistically significant associations were also found stratified by age, sex, and lifestyle. A U-shaped association of ABSI changes with all-cause mortality (p = 0.027) was observed, indicating that old adults with stable ABSI during the follow-up period experienced the lowest risk of mortality. After multivariable adjustment, participants with a 10% reduction in ABSI changes had an increased 9.4% risk of death, while participants with a 10% rise in ABSI changes had an increased 1.9% risk. ABSI and its changes are predictors for all-cause mortality among the elderly Chinese population, which emphasizes the clinical importance of monitoring ABSI and keeping it stable over time.

Sleep duration trajectories and all-cause mortality among Chinese elderly: A community-based cohort study

BACKGROUND

China is among the largest and fastest aging countries. The elderly population is more vulnerable, with higher proportion of inappropriate sleep duration and risk of mortality, compared with young and middle-aged adults. Single-measured sleep duration has been associated with mortality, but the health effects of long-term sleep duration trajectories remain unknown. This study aimed to explore the prospective associations between sleep duration trajectories and all-cause mortality among Chinese elderly.

METHODS

Participants (n = 3,895; median age: 82 years; females: 53.3%) who reported sleep duration in all three surveys (2005, 2008, and 2011) from the community-based Chinese Longitudinal Healthy Longevity Survey (CLHLS) were followed up until 2019 (about 8 years). We identified sleep duration trajectories by latent class mixed model and explored their association with all-cause mortality using Cox hazard proportional regression and Laplace regression models. Further, stratified analysis by demographic characteristics and lifestyles and sensitivity analysis by lag effect, health-related factors, and inverse probability weighting were used to verify the robustness of the association. In addition, we explored the threshold effect of baseline sleep duration on the risk of all-cause mortality.

RESULTS

We documented 1,881 all-cause deaths during 16,689 person-years of follow-up. Five sleep duration trajectories were identified: moderately increased trajectory (28.1%), rapidly increased trajectory (7.2%), persistent sleep trajectory of 7 h (33.7%), moderately decreased trajectory (21.3%), and rapidly decreased trajectory (9.7%). Compared with the persistent sleep trajectory of 7 h, the multivariable-adjusted HRs (95%CI) for moderately increased trajectory, rapidly increased trajectory, moderately decreased trajectory, and rapidly decreased trajectory were 1.21 (1.08, 1.36), 1.21 (1.01, 1.44), 0.95 (0.82, 1.10), and 0.93 (0.78, 1.11), respectively; and the corresponding difference in median survival time (95%CI) were -0.53 (-1.01, -0.05), -0.43 (0.16, -1.02), 0.26 (-0.34, 0.86), and 0.25 (-0.51, 1.02), respectively. Stratified and sensitivity analyses showed consistent results. Threshold analysis indicated a sharply increased risk of mortality in participants whose sleep exceeds 9 h (HR = 1.20, 95%CI: 1.11, 1.30).

CONCLUSION

Compared with the persistent sleep trajectory of 7 h, moderately and rapidly increased sleep duration trajectories were associated with higher subsequent mortality in Chinese elderly. Those who report sleep exceeding 9 h may be at high risk for all-cause mortality.

Association of cooking fuel use with risk of cancer and all-cause mortality among Chinese elderly people: a prospective cohort study

When cooking with biomass and fossil fuels, their incomplete burning can lead to air pollution, which can trigger pernicious effects on people's health, especially among the elderly, who are more vulnerable to toxic and harmful environmental damage. This study explored the association between different cooking fuel types and the risk of cancer and all-cause mortality among seniors constructing Cox regression models. Data were obtained by linking waves of 6, 7, and 8 of the Chinese Longitudinal Healthy Longevity Survey, which included a total of 7269 participants who were 65 years old and over. Cooking fuels were categorized as either biomass, fossil, or clean fuels. And the effects of switching cooking fuels on death risk were also investigated using Cox regression models. The results indicate that, compared with the users of clean fuels, individuals using biomass or fossil fuels were at a greater death risk for cancer [HR (95% CI): biomass, 1.13 (1.05-1.20); fossil, 1.16 (1.06-1.25)] and all causes [HR (95% CI): biomass, 1.29 (1.16-1.42); fossil, 1.32 (1.22-1.50)]. Furthermore, compared with sustained users of biomass fuels, individuals converting from biomass to clean fuels significantly reduced death risk for cancer [HR (95% CI): 0.81 (0.72-0.95)] and all causes [HR (95% CI): 0.76 (0.64-0.93)]. Similarly, all-cause death risk [HR (95% CI): 0.77 (0.62-0.93)] was noticeably reduced among these participants converting from fossil to clean fuels than persistent users of fossil fuels. Subgroup analyses revealed that males had a greater cancer and all-cause death risk when exposed to unclean fuels. These findings can inform the development of policies and the implementation of measures related to cooking fuel use to promote the health of older people and reduce the burden of disease on society.

Association of social participation and psychological resilience with adverse cognitive outcomes among older Chinese adults: A national longitudinal study

BACKGROUND

Limited epidemiological evidence exists regarding the association of social participation and psychological resilience with cognitive health. This study aimed to comprehensively investigate the effects of social participation and psychological resilience on adverse cognitive outcomes among older adults in China.

METHODS

We used two waves (2011 and 2014) of data from the Chinese Longitudinal Survey of Health and Longevity (CLHLS), and 9765 respondents were eligible for the subsequent screening for the present prospective analysis. The Cox proportional hazards model was utilized to examine the association of social participation and psychological resilience with cognitive impairment, cognitive decline and greater cognitive decline. The restricted cubic spline plots were applied to clarify the dose-response relationships between them.

RESULTS

Compared to those with low social participation, participants with high social participation had a lower hazard ratio (HR) of 0.72 (95 % confidence interval [CI]: 0.59-0.89) for cognitive impairment, 0.85 (95 % CI: 0.76-0.94) for cognitive decline and 0.78 (95 % CI: 0.67-0.90) for greater cognitive decline. Participants with high psychological resilience had an HR of 0.77 (95 % CI: 0.63-0.95) for cognitive impairment 0.85 (95 % CI: 0.76-0.94) for cognitive decline and 0.85 (95 % CI: 0.73-0.98) for greater cognitive decline compared with those with low psychological resilience. Similar effects were observed for social participation score and psychological resilience score. The dose-response analysis also showed that the risk of adverse cognitive outcomes decreased gradually with increasing social participation scores and psychological resilience scores. Additionally, the multiplicative interaction between social participation and psychological resilience was not significant.

LIMITATION

All information was collected by self-report, which may lead to biases in the process of information collection.

CONCLUSION

In this study, social participation and psychological resilience were independently associated with a lower risk of adverse cognitive outcomes, and therefore both need to be considered as broader measures to preserve cognitive health among older Chinese adults.

Calf circumference change and all-cause mortality among community-dwelling Chinese older people

BACKGROUND

Previous studies have described an association between single time point calf circumference (CC) and mortality. Evidence of associations between CC change and mortality is lacking. We aimed to determine the relationship between the CC change over time and all-cause mortality.

METHODS

We conducted a retrospective cohort study of 906 participants in the 2014-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Restricted cubic splines were used to analyze associations between the relative CC change (exposure) and all-cause mortality (primary outcome). When there was evidence of non-linearity, a piecewise Cox regression model was next fitted, adjusting for sociodemographic characteristics, health behaviours, health status and baseline CC.

RESULTS

The mean (SD) age was 83.8 (12.2) years old, and 50.2% (455/906) of participants were male. We observed a U-shaped association between the relative CC change (%) and all-cause mortality (P for non-linearity <0.001). Participants with stable CC over time had the lowest risk of death. After adjusting for covariates, when CC decreased over time, the hazard ratio per 10% higher in CC change was 1.32 (1.01-1.69). When CC increased over time, the hazard ratio per 10% higher in CC change was 1.35 (1.10-1.66).

CONCLUSION

Stable CC over time was associated with the lowest mortality risk. Our findings indicate the practical significance of monitoring CC change in older adult.

Associations between trajectories of cardiovascular risk factor change and cognitive impairment in Chinese elderly: A nationwide cohort study

Objectives

This study aimed to investigate the relationship between long-term trajectories of changes in cardiovascular risk factors (CVRFs) and the risk of cognitive impairment among Chinese adults over 60 years old.

Methods

Data were obtained from the Chinese Longitudinal Healthy Longevity Survey 2005-2018. Cognitive function was evaluated longitudinally through the Chinese version of the Mini-Mental State Examination (C-MMSE), and cognitive impairment (C-MMSE ≤23) was used as the main outcome variable. The cardiovascular risk factors, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), and body mass index (BMI), were continuously measured in the follow-up duration. The patterns of trajectories of changes in CVRFs were derived from the latent growth mixture model (LGMM). The Cox regression model was used to evaluate the cognitive impairment hazard ratio (HR) across different CVRF trajectories.

Results

A total of 5,164 participants aged ≥60 years with normal cognitive function at baseline were included in the study. After a median follow-up of 8 years, 2,071 participants (40.1%) developed cognitive impairment (C-MMSE ≤ 23). The four-class trajectories of SBP and BMI were obtained by means of LGMM, and the trajectories of DBP, MAP, and PP were grouped into a three-class subgroup. In the final adjusted Cox model, the lowered SBP [adjusted HR (aHR): 1.59; 95% CI: 1.17-2.16], lowered PP (aHR: 2.64; 95% CI: 1.66-4.19), and progressively obese (aHR: 1.28; 95% CI: 1.02-1.62) and stable slim (aHR: 1.13; 95% CI: 1.02-1.25) were associated with the higher risk of cognitive impairment. Low stable DBP (aHR: 0.80; 95% CI: 0.66-0.96) and elevated PP (aHR: 0.76; 95% CI: 0.63-0.92) decreased the risk for cognitive impairment among participants.

Conclusion

Lowered SBP, lowered PP, progressive obesity, and stable slim increased the risk for cognitive impairment in the Chinese elderly. Low stable DBP and elevated PP were protective against cognitive impairment, but more DBP lowering and ≥25 mmHg growth in PP contributed to a higher risk of cognitive impairment. The findings have important implications for preventing cognitive impairment in elder adults based on the long-term trajectories of changes in CVRFs.

Greater habitual resveratrol intakes were associated with lower risk of hip fracture- a 1:1 matched case-control study in Chinese elderly

The aim of the study was to testify the association of dietary resveratrol (RSV) intakes with hip fracture risk in Chinese elderly. This was a 1:1 age- and gender- matched case-control study. Eligible cases were newly diagnosed patients of hip fracture. Dietary assessment was made by a 79-item validated food frequency questionnaire. Habitual RSV intakes were estimated as the sum of trans- and cis- isomers of resveratrol and piceid according to the available database. Multivariable conditional logistic regression was applied to examine the relationship of dietary RSV and RSV-rich foods with hip fracture risk. A total of 1,070 pairs of hip fracture incident cases and controls were recruited and 1,065 were included for analysis. Compared with the lowest group, total RSV in the highest quartile group had significantly reduced hip fracture risk by 66.3% (OR: 0.337, 0.222 ~ 0.571, p_trend  < 0.001). Similar findings were observed for cis- and trans-RSV, cis- and trans-Piceid, as well as RSV-rich foods (grapes, apples and nuts) respectively. Subgroup analysis suggested more evident findings among female and less obese participants. Our findings demonstrated that higher habitual RSV intakes and RSV-rich foods, even in a relatively low amount, were associated with reduced risk of hip fracture in Chinese elderly.

Multiple chronic conditions among older adults in China: differences in socio-demographic characteristics

Objective

There are relatively few studies on multiple chronic conditions (MCC) among older adults in China. This study sought to assess the potential differences in the risk of MCC among different elderly populations, and thus to identify the most vulnerable populations at higher risk of developing the MCC.

Methods

A sample of 5320 adults aged 60 years or above from the China's Health-Related Quality of Life Survey for Older Adults 2018 (CHRQLS-OA 2018) were included in this study. Descriptive statistics frequencies and proportions were used to summarize the sample characteristics, and logistic regression models were conducted to identify the differences in the risk of having MCC among different populations.

Results

Overall, 52.6% of respondents had been clearly diagnosed with at least one chronic disease with 25.3% having MCC. The males ((adjusted odds ratio [AOR] = 0.84; 95% confidence interval [CI] = 0.73-0.98) were less likely to have MCC. This was also true among female elderly with a non-agricultural hukou (AOR = 0.75; 95% CI = 0.57-0.99). The elderly with a non-agricultural hukou aged 60-64 (AOR = 0.55; 95% CI = 0.34-0.88) had a lower risk of having MCC. Those whose average annual household income per capita were 15,000-30,000 RMB (AOR = 1.42; 95% CI = 1.03-1.96) were more likely to suffer from MCC. The odds ratios of having MCC were smaller as the personal savings increases in total samples (all P < 0.05).

Conclusions

The findings suggest that different policies or approaches should target these specific populations who are most in need and are most likely to suffer from MCC.

Assessing the income-related inequality in obesity among the elderly in China: A decomposition analysis

Background

Obesity among the elderly imposes a significant health and economic burden. The purpose of this study was to measure the obesity prevalence and income-related inequality among older adults in China and to explore the determinants of the inequity.

Methods

Data were obtained from 4,541 older adults (60 years and older) participating in the China Family Panel Study, 2018. Obesity was defined as body mass index (BMI) ≥28 kg/m². Normalized concentration index and concentration curve were calculated to measure the income-related inequality. Decomposition analysis was used to measure the contribution of each factor to the overall unfairness.

Results

The prevalence of obesity among the respondents was 7.99%. The 95% confidence interval for the overall prevalence was 7.20-8.78%. The normalized concentration index of obesity in the elderly was 0.075 (95% confidence interval: 0.047-0.103), indicating that obesity was more concentrated among the rich (p < 0.05). Socioeconomic factors contributed the most to the overall inequality (68.73%). Health behavior factors explained 16.38% of the observed income-related inequality in obesity among the elderly in China.

Conclusions

In 2018, obesity was more concentrated among the elderly with higher incomes in China. The pro-poor income-related inequality was mainly due to the higher socioeconomic status of higher-income older adults. Health behaviors and psychosocial factors could also exacerbate the inequality. To prevent the heavy burden of obesity on the health and finances of older adults, more attention should be paid to those who are financially better off, especially those who smoke and are physically inactive, while extroverted older adults also need to be focused on. For developing countries, concern needs to be given to the obesity of the wealthy elderly as a result of economic development.

Sex-specific longitudinal association between baseline physical activity level and cognitive decline in Chinese over 45 years old: Evidence from the China health and retirement longitudinal study

OBJECTIVES

To examine whether sex-specific associations between baseline PA level and follow up cognitive performance in Chinese subjects exist from the China Health and Retirement Longitudinal study (CHARLS).

METHOD

A total of 3395 adults aged 45 or old from the CHARLS were used for analysis. The combined scores of measurements of mental status and verbal episodic memory were utilized for assessing cognitive function at baseline in 2011 and the follow-up survey in 2015. Baseline PA level was quantified as the total PA score. Multiple linear regression and logistic regression models were used to examine the association between baseline PA status and global cognitive function and cognitive domains.

RESULTS

In the female subjects (n = 1748), compared with individuals of PA level in the lower tertile, those grouped into the upper tertile had the lowest risk of global cognitive decline [odds ratio (OR) =0.273, 95% confidence interval (CI) =0.077-0.960; p = 0.043] and verbal episodic memory decline [OR)=0.257, 95% CI =0.066-1.003; p = 0.051] from 2011 to 2015. However, no significant associations were observed in the male subjects (n = 1647).

CONCLUSION

In the female subjects, higher PA level was associated with reduced risk of cognitive decline within 4 years, this might be associated with reduced decline of verbal episodic memory. Our findings confirmed that female sex would positively affect the association between PA levels and cognitive decline.

Prevalence, awareness and control of type 2 diabetes mellitus and risk factors in Chinese elderly population

Background

Type 2 diabetes mellitus is an expanding global public health issue, especially in developing countries. This study aimed to investigate the prevalence, awareness and control rate of type 2 diabetes mellitus, and assess its risk factors in elderly Chinese individuals.

Methods

The health screening data of 376,702 individuals aged ≥ 65 years in Wuhan, China, were collected to analyse the prevalence, awareness, and control rates of diabetes. Indices, including fasting plasma glucose and other biochemical indicators, were measured for all participants using standard methods at the central laboratory. Multilevel logistic regression analysis was performed to assess the key determinants of the prevalence, awareness, and control rates of diabetes.

Results

The prevalence, awareness, and control rates of diabetes in the Chinese individuals aged ≥ 65 years were 18.80%, 77.14%, and 41.33%, respectively. There were statistically significant differences in the prevalence, awareness, and control rates by gender. Factors associated with diabetes prevalence were age, body mass index (BMI), and central obesity; while those associated with awareness and control were gender, education level, marital status, physical activity, alcohol consumption, BMI, and central obesity.

Conclusions

Diabetes is an important public health problem in the elderly in China. The awareness and control rates have improved, but overall remained poor. Therefore, effective measures to raise awareness and control the rates of diabetes should be undertaken to circumvent the growing disease burden in elderly Chinese people.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13759-9.

Association of food groups with the risk of cognitive impairment in Chinese older adults

OBJECTIVE

To investigate the impact of 10 common foods (including staple foods, fruits, vegetables, sugar, meat, fish, eggs, beans, salt-preserved vegetables, and garlic) on cognitive function in Chinese older adults.

METHODS

Cross-sectional data on demographic characteristics, lifestyle, and dietary habits were taken from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Cognition was assessed using the Mini-Mental State Examination (MMSE). Food consumption was measured by participants reporting the frequency of their food consumption. Association between food groups and cognitive function was evaluated using mixed-effect regression model analysis.

RESULTS

Compared with those who rarely or never consumed vegetables, meat, fruits, beans, and garlic, older adults who consumed these foods almost daily were 56%, 30%, 23%, 34%, and 29% less likely to have cognitive impairment, respectively. No associations between staple foods, sugar, fish, and eggs consumption and cognitive impairment were found. Low-frequency consumption of salt-preserved vegetables may be associated with cognitive function. Regular vegetables consumption had the greatest associated risk reduction of all food types. Interactions indicated that the co-ingestion of vegetables and beans or sugar, meat and beans may have antagonistic effect, while the co-ingestion of salt-preserved vegetables and garlic may have synergistic effect. Subgroup analyses showed that sex and age were the significant effect modifiers for meat and fish, respectively.

CONCLUSIONS

Cognitive function of Chinese older adults may be related to food groups. Future research should measure food types and consumption level with greater granularity.

Preoperative malnutrition as an independent risk factor for the postoperative mortality in elderly Chinese individuals undergoing hip surgery: a single-center observational study

Objective:

Malnutrition is prevalent in elderly with hip fracture and higher than in community-dwelling older adults. Scarce studies have examined the association between preoperative malnutrition and postoperative mortality in elderly Chinese individuals with hip fracture. This study was designed to explore the effect of preoperative malnutrition on the postoperative long-term mortality in elderly Chinese individuals undergoing hip surgery.

Methods:

As a single-center observational study, this study included 263 consecutive patients above 70 years old with hip fracture and elective surgery. Preoperative nutritional status was evaluated by prognostic nutritional index (PNI). Patients were divided into one group with malnutrition (26 patients with PNI ⩽ 38) and the other group without malnutrition (169 patients with PNI > 38), respectively.

Results:

The overall malnutrition rate was 13.3% (26 patients). The postoperative long-term mortality rates of patients with and without malnutrition had statistically significant difference [10 patients (38.5%) and 32 patients (18.9%), p < 0.05]. Cox regression analysis showed that malnutrition (hazard ratio: 0.269, 95% confidence interval: 0.085–0.859, p < 0.05) and partial pressure of carbon dioxide (hazard ratio: 0.873, 95% confidence interval: 0.790–0.964, p < 0.05) were independent risk factors for the postoperative long-term mortality.

Conclusion:

This study demonstrated that preoperative malnutrition was an independent risk factor for the postoperative long-term mortality and resulted in a more than 2.5-fold increase of the postoperative long-term mortality in elderly Chinese individuals undergoing hip surgery.

Classifying and characterizing the development of self-reported overall quality of life among the Chinese elderly: a twelve-year longitudinal study

Background

To promote healthy aging, the information about the development of quality of life (QoL) is of great importance. However, the explorations of the heterogeneity in the change of QoL under the Chinese context were limited. This study aimed to identify potential different development patterns of QoL and the influential factors using a longitudinal, nationally representative sample of the Chinese elderly.

Methods

We adopted a five-wave longitudinal dataset from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), and a total of 1645 elderly were obtained. The sample had a mean age of 72.7 years (SD = 6.64) and was 47.2% male. Overall QoL was measured through self-report during the longitudinal process. We utilized the conditional growth mixture model (GMM) with time-invariant covariates (TICs) to explore various development patterns and associated factors.

Results

Three distinct trajectories of self-reported overall QoL were identified: the High-level Steady Group (17.08%), the Mid-level Steady Group (63.10%), and the Low-level Growth Group (19.82%). Results also indicated that several factors predicted distinct trajectories of self-reported overall QoL. Those elderly who received enough financial resources, had adequate nutrition, did not exhibit any disability, engaged in leisure activities, and did less physical labor or housework at the baseline were more likely to report a higher level of overall QoL over time.

Conclusions

There existed three development patterns of self-reported overall QoL in elders, and the findings provided valuable implications for the maintenance and improvement of QoL among the Chinese elderly. Future studies could examine the influence of other confounding factors.

Cooking with biomass fuels and mortality among Chinese elderly people: A prospective cohort study

This study used data from the Chinese Longitudinal Healthy Longevity Survey (n = 9765, age 65+) to investigate the impact of biomass fuels on the mortality of the Chinese elderly population. The association between biomass fuels and mortality was examined using a Cox proportional hazards model. We evaluated the difference in risk of death between those who switched fuel types from biomass to clean fuels and from clean to biomass fuels versus those who did not during the follow-up period. Participants who used biomass fuels had a higher risk of death than participants who used clean fuels (HR = 1.09, 95% CI: 1.01-1.17). For participants who switched cooking fuel types during the follow-up period, switching from biomass to clean fuels significantly reduced the risk of death (HR = 0.78, 95% CI: 0.67-0.91), while no evidence of an association between switching from clean to biomass fuels and risk of death was found (p > 0.05). Interactions and subgroup analyses indicated that effect estimates were greater for women and non-smokers. Biomass fuels may be associated with a higher risk of death among Chinese elderly. Research measuring personal exposure levels to indoor air pollution caused by biomass fuels combustion is required to confirm our results.

The Relationship of Malnutrition With Cognitive Function in the Older Chinese Population: Evidence From the Chinese Longitudinal Healthy Longevity Survey Study

Background and Objective: Few studies have explored the relationship between malnutrition measured by the Geriatric Nutritional Risk Index (GNRI) and cognitive performance. This study aimed to investigate the association of malnutrition with cognitive function in the Chinese population.

Methods: It was a prospective longitudinal study and used three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2011–2012, 2014, and 2017–2018. Participants aged 60 years or older without mental illness and cerebrovascular diseases were eligible. The GNRI was used to assess nutritional status as follows: normal nutrition (a GNRI > 98), mild malnutrition (92 ≤ a GNRI ≤ 98), and moderate-to-severe malnutrition (a GNRI < 92). Cognitive performance was evaluated by the Mini-Mental State Examination (MMSE) scores. The relationship between the GNRI and cognitive function was analyzed using a linear mixed-effects model.

Results: A total of 1,632 subjects were analyzed, including 741 males and 891 females. Of these, 65.0, 19.4, and 15.6% of subjects were at normal nutritional status, mild, and moderate-to-severe malnutrition, respectively. After adjusting for potential confounders, participants under mild and moderate-to-severe malnutrition status have a lower MMSE score [β (95% CI): –0.95 (–1.60, –0.25) and –1.39 (–2.21, –0.57), respectively], compared with those having normal nutrition. Also, there was a linear trend in the association of malnutrition risk with cognitive function in the total population [β (95% CI): –0.74 (–1.13, –0.35)]. However, a significant association of malnutrition with cognitive function was observed only among illiterate females aged above 90 years.

Conclusion: This study suggested that there was a significant relationship between the GNRI and cognitive function in the Chinese elderly. Furthermore, subjects with more serious malnutrition have a worse cognitive function, especially in the oldest illiterate females. Clinicians should put more emphasis on assessing the nutritional and cognitive status of the elderly to timely intervene and prevent cognitive impairment.

Gender Differences in the Score and Influencing Factors of Social Participation among Chinese Elderly

This study measured the social participation score of the Chinese elderly, described its decayed trajectory based on birth cohort, and analyzed the gender differences of factors that affected the social participation of the elderly based on MIMIC model by groups. Results showed that age, economic status, and living status were the influencing factors with significant gender differences on social participation level of Chinese elderly. At any age, the social participation of Chinese elderly women was lower than that of elderly men, and this gap widened with age. Social participation of older women was more vulnerable to economic conditions. Living with children had a significant negative impact on the social participation of elderly women. There was no significant gender difference in the influence of marital status and educational level on the social participation of the elderly.

A 1:1 matched case-control study on dietary protein intakes and hip fracture risk in Chinese elderly men and women

The role of protein intake in bone has been controversial. Our case-control study among Chinese elderly concluded that a higher consumption of protein, even substituted for fat, is associated with lowered hip fracture risk. Differences in protein sources, amino acids composition, gender, and calcium sufficiency may explain the inconsistency.

PURPOSE

The aim of the study was to investigate the association of dietary protein intakes with hip fracture risk among Chinese elderly.

METHODS

This was a 1:1 age and sex matched cross-sectional study of case-control design among 1070 pairs of elderly Chinese people aged 55 to 80 years. Patients who were newly diagnosed (within 2-week) hip fracture by X-ray were recruited from four hospitals in Guangdong Province of China. Dietary intakes were evaluated by a validated food frequency questionnaire for total protein, protein from different sources, amino acids profiles, and estimated renal acid load in diet.

RESULTS

Daily average intakes of total protein were 58.1±27.0 (women) and 65.7±31.8 (men) g/d for cases, and 66.8±21.5 (women) and 72.1±24.4 (men) for controls (p<0.001). Multivariable regression indicated that, compared with the lowest quartile, the highest quartile of consumption of energy adjusted total protein [OR: 0.360 (0.206~0.630) for women and 0.381 (0.153~0.949) for men] and animal protein [0.326 (0.183, 0.560) for women and 0.335 (0.136~0.828) for men] was significantly associated with the lowered risk of hip fracture in a dose-response manner (all p for trend <0.05). A significant hip fracture risk reduction was observed in women with higher intakes of sulfur amino acids [OR: 0.464 (0.286~0.753)] and aromatic amino acids [0.537 (0.326~0.884)] but not in men. Subgroup analysis suggested that these associations were more evident in elderly with lower body mass index and dietary calcium intake less than 400 mg/d.

CONCLUSIONS

A higher level of protein intake, even substituted for fat, is associated with lowered hip fracture risk.

Zinc Nutritional Status and Risk Factors of Elderly in the China Adult Chronic Disease and Nutrition Surveillance 2015

OBJECTIVES

To analyze the serum zinc nutrition status of the Chinese elderly, and to assess the risk factor for zinc deficiency.

METHODS

3727 elderly people over 60 years old were randomly selected from 302 monitoring points in 31 provinces of China Adult Chronic Disease and Nutrition Surveillance (CACDNS) 2015. Blood samples were selected from the biological sample bank of CACDNS 2015 and the basic information were collected by questionnaires. The criteria of serum zinc deficiency recommended by the International Zinc Nutrition Consulting Group (IZiNCG) were adopted, and the related factors were also analyzed.

RESULTS

The median serum zinc concentration of Chinese elderly was 99.2 (84.3~118.7) μg/dL. The overall adjusted prevalence of zinc deficiency was 8.68%, with a 95% confidence interval (CI) of 7.74% and 9.61%. Significant differences were found in different sex, age groups, Body Mass Index (BMI), residence region, race and education level in terms of serum zinc status in the elderly (p < 0.05). Participants who are males, aged above 70y, with BMIs of less than 18.5 kg/m2, living in rural areas, minority, and with the lowest income had a higher prevalence of zinc deficiency in the subgroups under different classifications. The risk of zinc deficiency in the elderly over 70y was 1.44 higher than those aged 60-69y (OR = 1.44, 95%CI 1.14-1.82), and the minority elderly has a 1.39 higher risk than Han nationality (OR = 1.39, 95%CI 1.01-1.91), while overweight/obesity and female elderly were at lower risk (OR < 1, p < 0.05).

CONCLUSIONS

The overall prevalence of zinc deficiency in the elderly was highest in all adults in the CACDNS. It is recommended that the male elderly, over 70 years, and the minority elderly should pay more attention to the zinc nutrition status of their own.

Taller adult height is associated with better performance of cognitive trajectories in Chinese over 45 years old: Evidence from the China Health and Retirement Longitudinal Study

AIM

The association between adult height and follow-up cognition requires an update in China. We aimed to examine the association between baseline height and follow-up cognitive trajectories in Chinese subjects from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

A total of 6508 adults aged 45 years or older from the CHARLS were included for analysis. Latent class growth modeling was used to determine cognitive trajectories of 2011, 2013 and 2015. Multivariable linear regression and logistic regression models were used to examine the association between baseline adult height and cognitive performance and trajectories, respectively.

RESULTS

At baseline, an increment of 1 SD (8.3 cm) of height was associated with a higher global cognitive score (β = 0.492, 95% CI, 0.348-0.636), verbal episodic memory (β = 0.155, 95% CI, 0.086-0.224) and mental status (β = 0.337, 95% CI, 0.225-0.449). These associations were still observed even when stratified by sex. Prospectively, for females, the third quartile of height level (i.e., 155 to 158 cm) was associated with a better global cognitive function trajectory (OR = 1.627, P = 0.001, P for trend = 0.009) and mental status trajectory (OR = 1.456, P = 0.012, P for trend = 0.047); and the tallest height level (i.e., 159 cm or taller) was related to a better verbal episodic memory trajectory (OR = 1.574, P = 0.017). For males, no associations were observed.

CONCLUSION

Increased stature might be associated with better cognitive trajectories for subjects in China. Geriatr Gerontol Int 2021; 21: 732-740.

Daytime Napping and Nighttime Sleep Duration with Incident Diabetes Mellitus: A Cohort Study in Chinese Older Adults

Background: We aimed to examine the longitudinal associations between daytime napping and nighttime sleep duration with the risk of diabetes mellitus (DM) among Chinese elderly using data from the China Health and Retirement Longitudinal Study (CHARLS). Methods: A cohort study was conducted among 2620 participants aged 60 years or above. Information on daytime napping and nighttime sleep duration was self-reported during the 2011 baseline survey. DM status during the 2015 follow-up survey was confirmed according to the American Diabetes Association criteria. Results: Individuals with long daytime napping (>1 h/day) had increased risk of developing DM than non-nappers (adjusted RR = 1.52, 95%CI: 1.10, 2.10). In addition, we observed a U-shaped association between nighttime sleep duration and incident DM risk. We further found that nappers with <4 h of nighttime sleep, and those with >1 h of daytime napping and >6 h nighttime sleep had approximately two-fold elevated risk of DM, compared to non-nappers with 6–8 h of nighttime sleep. Conclusion: Long daytime napping and extreme nighttime sleep duration were associated with increased DM risk among Chinese elderly. There was a joint effect of long daytime napping and nighttime sleep duration on the risk of DM.

Early prevention of cognitive impairment in the community population: The Beijing Aging Brain Rejuvenation Initiative

Facing considerable challenges associated with aging and dementia, China urgently needs an evidence-based health-care system for prevention and management of dementia. The Beijing Aging Brain Rejuvenation Initiative (BABRI) is a community-based cohort study initiated in 2008 that focuses on asymptomatic stages of dementia, aims to develop community-based prevention strategies for cognitive impairment, and provides a platform for scientific research and clinical trials. Thus far, BABRI has recruited 10,255 participants (aged 50 and over, 60.3% female), 2021 of whom have been followed up at least once at a 2- or 3-year interval. This article presents aims and study design of BABRI; summarizes preliminary behavioral and neuroimaging findings on mild cognitive impairment (MCI) and results of clinical trials on MCI; and discusses issues concerning early prevention in community, MCI diagnosis methods, and applications of database of aging and dementia. BABRI is proposed to build a systematic framework on brain health in old age.

Association of the Time to First Cigarette and the Prevalence of Chronic Respiratory Diseases in Chinese Elderly Population

BACKGROUND

Increasing number of studies has suggested the time to first cigarette after waking (TTFC) have significant positive effect on respiratory diseases. However, few of them are focused on Chinese population. This study aims to estimate the impact of TTFC on the prevalence of chronic respiratory diseases (CRD) in Chinese elderly and explore the association in different sub-populations.

METHODS

Cross-sectional data of demographic characteristics, living environment, smoking-related variables, and CRD were drawn from the Chinese Longitudinal Healthy Longevity Survey in 2018. Multivariate stepwise logistic regression analyses were conducted to examine the association of the TTFC with the prevalence of CRD.

RESULTS

This study includes 13208 subjects aged 52 years and older, with a mean age of 85.3 years. Of them, 3779 participants are ex- or current smokers (44.9% had the TTFC ≤30 minutes, 55.1% >30 minutes) and 1503 have suffered from CRD. Compared with non-smokers, participants with TTFC ≤30 minutes seemed to have higher prevalence of CRD (OR 1.97; 95% CI, 1.65-2.35) than those with TTFC >30 minutes (OR 1.70; 95% CI, 1.44-2.00), although the difference was statistically insignificant (P_interaction=0.12). Compared with TTFC >30 minutes, TTFC ≤30 minutes could drive a higher prevalence of CRD among female participants, those aged 90 years and older, urban residents, and those ex-smokers (P_interaction<0.05).

CONCLUSIONS

Shorter TTFC relates to higher prevalences of CRD in Chinese older females, those aged 90 years and older, urban residents, and ex-smokers. Delaying TTFC might particially reduce its detrimental impact on respiratory disease in these specific subpopulations.

Drinking habits and water sources with the incidence of cognitive impairment in Chinese elderly population: The Chinese Longitudinal Healthy Longevity Survey

BACKGROUND

Little was known on whether drinking habits and water sources affected cognitive function. This study aimed to examine the associations of drinking habits and water sources with the incidence of cognitive impairment in the Chinese elderly population.

METHODS

Data were drawn from the Chinese Longitudinal Healthy Longevity Survey. All participants aged ≥ 60 years at baseline were potential eligible. Cognitive function was measured using the Chinese version of the Mini-Mental State Examination (CMMSE). Participants with the CMMSE score ≤ 24 were identified as cognitive impairment. Drinking habits included preferring to drink boiled water or un-boiled water. Water sources included well, surface water, spring, and tap water.

RESULTS

This study included 18034 participants. Participants drinking un- boiled water were more likely to develop cognitive impairment than those drinking boiled water (P< 0.001; HR: 1.269; and 95% CI: 1.128-1.427). Compared to drinking from a well, drinking from tap water at childhood, around aged 60 years, and present was associated with a lower incidence of cognitive impairment (all P< 0.001; HR: 0.672, 0.735, and 0.765; and 95% CI: 0.540-0.836, 0.686-0.788, and 0.723-0.810, respectively).

LIMITATIONS

The underline mechanisms behind the associations of drinking habits and water sources with the incidence of cognitive impairment were not fully explained.

CONCLUSIONS

Participants drinking un- boiled water were more likely to develop cognitive impairment. Meanwhile, compared to drinking from a well, drinking from tap water was associated with a lower incidence of cognitive impairment.

Trends and Associated Factors of Dietary Knowledge among Chinese Older Residents: Results from the China Health and Nutrition Survey 2004-2015

Promoting a healthy diet of the elderly is an important task in the current "Healthy China Action". This study aimed to describe the changing trends of the dietary knowledge elderly Chinese during 2004-2015 and to examine the associated factors of dietary knowledge. Elderly people aged ≥60 years were included as study subjects from the China Health and Nutrition Survey 2004-2015. A total of 15,607 samples were involved in the analysis. The correct rate of dietary knowledge items followed upward trends over time, except for two items regarding physical activity intensity (Question 11, Cochran-Armitage χ² = 20.05, p < 0.001) and healthy weight (Question 12, Cochran-Armitage χ² = 43.93, p < 0.001). Four of the twelve dietary knowledge items consistently followed the lowest correct rate between 2006 and 2015, regarding physical activity intensity (Question 11, 24.5%-25.8%), staple food consumption (Question 5, 36.6%-41.5%), animal product consumption (Question 6, 45.8%-59.5%), and fatty meat and animal fat consumption (Question 7, 63.6%-64.9%). Participants who had a lower educational level or lived in rural areas or western regions, did not know about the Chinese Food Pagoda (CFP) or Dietary Guidelines for Chinese Residents (DGCR), and did not proactively look for nutrition knowledge were less likely to have adequate dietary knowledge literacy. Targeted interventions should be developed to promote dietary knowledge level of the elderly.

Mental health and related influencing factors among rural elderly in 14 poverty state counties of Chongqing, Southwest China: a cross-sectional study

BACKGROUND

China has the largest elderly population in the world; little attention has been paid to the mental health of elderly in areas of extreme poverty. This is the first study to investigate the mental health of the rural elderly in poverty state counties in Chongqing and was part of the Chongqing 2018 health literacy promotion project.

METHODS

In 2019, a cross-sectional study was conducted to investigate the mental health status of the rural elderly in fourteen poverty state counties of Chongqing, in which a total of 1400 elderly aged ≥ 65 years were interviewed, where mental health status was measured by the ten-item Kessler10 (K10) scale. Ordered multivariate logistic regression was performed to evaluate the influencing factors related to mental health of the elderly in these areas.

RESULTS

The average score of K10 in 14 poverty state counties was 17.40 ± 6.31, 47.6% was labeled as good, 30.2% was moderate, 17.0% was poor, and lastly 5.1% was bad, and the mental health status of the elderly in the northeastern wing of Chongqing was better than the one in the southeastern wing of Chongqing. A worse self-rated health was the risk factor for mental health both in the northeastern and southeastern wings of Chongqing (all P < 0.001). Lower education level (OR (95% CI) = 1.45 (1.12-1.87), P = 0.004) was a risk factor in the northeastern wing, whereas older age (OR (95% CI) = 1.33 (1.13-1.56), P = 0.001) was a risk factors in the southeastern wing.

CONCLUSIONS

The results showed that mental health of the elderly in poverty state counties was poor, especially in the southeastern wing of Chongqing. Particular attention needs to be paid to the males who were less educated, older, and single; female with lower annual per capital income; and especially the elderly with poor self-rated health.

Do Older Adults with Parent(s) Alive Experience Higher Psychological Pain and Suicidal Ideation? A Cross-Sectional Study in China

Elderly mental health promotion is an important task in the current "Healthy China Action". This study aims to (a) clarify the psychological pain and suicidal ideation of the Chinese elderly with different parental states, (b) examine the associated factors of psychological pain and suicidal ideation, and (c) examine the relationship between psychological pain and suicidal ideation. A sample of 4622 adults aged 60 years and older were included in this study, from the China's Health-related Quality of Life Survey for Older Adults 2018. Participants with both parents alive demonstrated the heaviest psychological pain, and those with one parent alive observed significantly lowest psychological pain and suicidal ideation. Participants who were single, divorced, or widowed, live in rural areas, had higher education level, had lower family income, suffered from two or more chronic diseases, and had no self-care ability were more likely to experience psychological pain and suicidal ideation. In addition, higher psychological pain significantly associated with the occurrence of suicidal ideation. In China, much more attention should be paid to the mental health condition of the elderly, especially for those with both parents alive. Moreover, the associated factors above should be considered to develop targeted health interventions.

Trajectories of depression symptoms in Chinese elderly during widowhood: a secondary analysis

Objectives: This study aims to identify heterogeneous depressive symptom trajectories among the widowed elderly in China, to explore predictive variables of latent class membership, and to detect between-classes differences in life satisfaction across time.Method: Data of 198 individuals widowed between 2011 and 2013 were drawn from The China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey. Latent class growth analysis was employed to identify depressive symptom trajectories across 2011, 2013, and 2015, and a three-step auxiliary approach was applied to detect predictive variables of latent class membership. Mixed Analysis of Variances was followed to make between-class comparisons on life satisfaction across time.Results: Four grieving trajectories were identified: resilient (54.6%), chronic grief (23.7%), depressed-improved (11.6%), and chronic depression (10.1%). Older age, living exclusively with spouse before widowhood, and agricultural Hukou were significant predictors of depressed-improved, chronic grief, and chronic depression patterns, respectively. Life satisfaction in all groups except for the resilient one remained stable across time, and that of the chronic depression group was significantly lower than those of all the remaining groups.Conclusion: Consistent depressive symptom trajectories during late-life widowhood exist across nations while the specific culture, values, and resources in the Chinese context may have contributed to a particularly high proportion of the chronic grief trajectory. More efforts should be made to identify patterns with predictors before support are provided, and interventions need to be tailored to target specific needs in each subgroup of the elderly during their transitions to widowhood.

Prevalence of Dysphagia in China: An Epidemiological Survey of 5943 Participants

OBJECTIVE

To determine the prevalence of dysphagia among an older population and patients with stroke, head and neck cancers (HNCs) or neurodegenerative diseases (NDDs) in China, to identify the factors associated with this condition, and to explore the relationship between dysphagia and nutritional status.

METHODS

This study included participants 65 years and older living in the community or in nursing homes and patients who had sustained a stroke, HNC, or NDD also recruited in hospitals from 14 provinces of China. The presence of dysphagia was determined by use of a questionnaire, water swallowing test, and/or a videofluoroscopic swallowing study. Logistic regression analysis was used to assess the possible associated risk factors. Body mass index was assessed as an indicator of malnutrition.

RESULTS

A total of 5943 persons met the inclusion criteria and 2341 (39.4%) were identified with dysphagia, including the following: 51.14% of patients with stroke, 34.4% in HNCs, 48.3% in NDDs, and 19.2% of otherwise healthy older adults. The elderly with comorbidity (OR = 2.90, p < 0.01) and stroke patients (OR = 2.27, p < 0.01) were significantly more likely to exhibit signs of dysphagia. Dysphagic participants were at significantly greater risk of malnutrition (OR = 1.91, p < 0.01) compared to those without dysphagia.

CONCLUSION

Dysphagia is prevalent in China among older individuals and people who have suffered a stroke, HNCs, or NDDs. The prevalence of dysphagia increases steadily with increasing age and presence of comorbid disease. People with dysphagia are more likely to suffer from malnutrition.

[Impact of physical fitness on activities of daily life among the Chinese elderly]

Objective: To investigate the prevalence of impairment on daily life and to determine the correlation between physical fitness and activities of daily life among the Chinese elderly. Methods: Data were extracted from the 2015 China Health and Retirement Longitudinal Study database. Chi-square tests were performed to explore the prevalence of impairment of activities of daily life among the elderly with different characteristics. Binary logistic regression method was used to identify the relationship between physical fitness and activities of daily life. Results: The overall prevalence on the impairment of basic activities in daily life was 6.6% (297/4 355) and the prevalence of impairment of instrumental activities on daily life was 26.0% (1 167/4 485), among the Chinese elderly. Factors as BMI, muscle strength, ability of balance and the ability of activities were all closely related to activities of daily living, but differences between blood pressure and ADL presented no statistical significance. Conclusion: Physical fitness could affect the activities of daily life at different levels. Elderly with higher or lower BMI, poorer muscle strength, ability on balance and activities were at a greater possibility to suffer from the impairment of ADL.

The Relationship between the Number of Daily Health-Related Behavioral Risk Factors and Sleep Health of the Elderly in China

This study examined the cross-sectional association among a number of daily health-related behavioral risk factors and sleep among Chinese elderly. A sample of 4993 adults, aged 60 years and older, from the China’s Health-Related Quality of Life Survey for Older Adults 2018 was included in this study. Five daily health-related behaviors, which included smoking, drinking, unhealthy eating habits, insufficient leisure activities, and physical inactivity were measured. Sleep disturbances and sleep quality were used to represent the respondents’ sleep status. Multiple logistic regression models and multiple linear regression models were established. The odds ratios (ORs) of sleep disturbances for those with one to five health-related risk behaviors were 1.41 (95% CI = 1.11 to 1.78), 2.09 (95% CI = 1.66 to 2.63), 2.54 (95% CI = 1.99 to 3.25), 2.12 (95% CI = 1.60 to 2.80), and 2.49 (95% CI = 1.70 to 3.65), respectively. Individuals with one health-related risk behavior (B = 0.14, 95% CI = −0.23 to −0.06), two health-related risk behaviors (B = 0.21, 95% CI = −0.30 to −0.13), three health-related risk behaviors (B = 0.46, 95% CI = −0.55 to −0.37), four health-related risk behaviors (B = 0.50, 95% CI = −0.62 to −0.39), and five health-related risk behaviors (B = 0.83, 95% CI = −1.00 to −0.66) showed lower scores of self-perceived sleep quality. Having multiple health-risk behaviors was positively correlated with a higher risk of sleep disturbances among Chinese elderly. Moreover, elderly individuals with multiple health-related risk behaviors were significantly associated with poorer sleep quality.

Characteristics of decline in cognition and locomotion among the elderly in seven provinces of China

BACKGROUND

Decline in cognition and in locomotion is associated with aging. However, the relationship between them and the current occurrence of them in Chinese elderly people was weak.

METHODS

To investigate the details of these two functions in Chinese elderly people and to try to find some early recognition and intervention clues, data of MMSE test and usual gait speed from 4487 elderly people from seven provinces in China were analysed.

RESULTS

The prevalence of mild cognitive impairment (MCI) and dementia in persons aged 60 and over was 17.83% and 4.08%, respectively. Among 11 items of MMSE, calculation, three-word recall, drawing two pentagons, and temporal orientation were the most commonly impaired items in persons with MCI or dementia. The gait speed of old persons with dementia was significantly slower than that of persons with MCI or NCI. Meanwhile, old persons with gait speed >1.39 m/s fast gait speed also had high MMSE scores and no dementia was detected by MMSE.

CONCLUSION

The prevalence of dementia observed in this population was similar to that reported 20 years ago. Loss of temporal orientation and drawing two pentagons may supply more information for early recognition of cognitive impairment. Maintaining locomotion in a proper way may help old persons to prevent cognitive function decline.

Prevalence of kidney damage in Chinese elderly: a large-scale population-based study

Background

In China, both population aging and kidney damage has become emerging public health challenges. Despite the number of elders is huge, data on kidney damage in this population are scarce. The present study aimed to describe the prevalence of kidney damage among older adults in Wuhan, China.

Methods

To describe the prevalence of kidney damage among Chinese elderly, the health screening data of 350,881 adults older than 65 years in Wuhan, China were collected and analyzed. Kidney damage was defined as eGFR less than 60 mL/min per 1·73 m² or the presence of proteinuria. Decreased renal function was defined as an eGFR < 60 mL/min/1.73 m². Proteinuria was defined as urine protein ≥1+ and without urine WBC or nitrite positive. The associated risk factors of eGFR decline and kidney damage were analyzed by multivariate logistic regression.

Results

The age-standardized prevalence of kidney damage, decreased renal function and proteinuria was 17.2, 13.5 and 5.3%. Among the patients, up to 74.4% was stage 3. The prevalence of kidney damage and eGFR decline were higher in suburbs than in urban (18.3% vs 16.0 and 14.6% vs 12.4%). Factors independently associated with kidney damage were age, female, BMI, abdominal circumference, hypertension, diabetes, stroke and coronary heart disease.

Conclusions

Kidney damage has become an important public health problem in Chinese elderly. More attention should be paid to elderly lived in suburbs or rural area in our further work.

Changes in Cognitive Function and Risk Factors for Cognitive Impairment of the Elderly in China: 2005-2014

Background: The cognitive function of the elderly has become a focus of public health research. Little is known about the changes of cognitive function and the risk factors for cognitive impairment in the Chinese elderly; thus, the purposes of this study are as follows: (1) to describe changes in cognitive function in the Chinese elderly from 2005–2014 and (2) to explore risk factors for cognitive impairment of the Chinese elderly. Design and setting: A total of 2603 participants aged 64 years and above participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and were followed up from 2005 to 2014. Cognitive function and cognitive impairment were assessed using the Chinese version of the Mini-Mental State Examination (MMSE). Binary logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence intervals (CI) of cognitive impairment. Results: Results revealed that the cognitive function of the Chinese elderly shows diversified changes: deterioration (55.09%), unchanged (17.21%) and improvement (27.70%). In addition, there are significant demographic differences in gender, age, education, marriage and other aspects when it comes to the changes of cognitive function in Chinese elderly. In the binary logistic regression analysis, female, increased age, lower education level, no spouse, less income, worse PWB (psychological well-being), less fresh fruit and vegetable intake, more activities of daily living (ADL) limitations, lower social engagement were significantly associated with higher odds for cognitive impairment. Conclusions: Various interventions should be implemented to maintain cognitive function in Chinese elderly.

Prevalence, Influence Factors and Cognitive Characteristics of Mild Cognitive Impairment in Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) is considered as an independent risk factor for mild cognitive impairment (MCI). This study was performed to investigate the prevalence, influencing factors and cognitive characteristics of MCI in elderly patients with T2DM in China.

Methods: In the cross-sectional study, we performed cluster random sampling of 3,246 people age 60 years and older across the country. All participants were interviewed and screened for T2DM and MCI. A total of 341 subjects were diagnosed of MCI according to the criteria of Petersen, and a total of 256 subjects were diagnosed of T2DM by using the American Diabetes Association criteria Among the 256 T2DM people, 56 were also diagnosed with MCI. Logistic regression analyses were performed to evaluate risk and protective factor for MCI with T2DM. We also assessed their cognitive function by using the Mini-mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit span, Associative Learning Test (ALT), Visual Identification Test (VIT), Verbal Fluency (VF), Wechsler Adult Intelligence Scale (WAIS)-III Block Design, WAIS-III picture completion and Auditory Verbal Learning Test (AVLT).

Results: Among the 256 T2DM patients, 56 were diagnosed with MCI, and the prevalence of MCI in T2DM was 21.8%. Multivariate logistic regression analyses showed that depression (p = 0.002, OR = 6.220, 95% CI: 2.005–19.290) was a risk factor for MCI among T2DM patients, while education (p < 0.001, OR = 0.869, 95% CI: 0.805–0.983) was a protective one. All the scores of neuropsychological tests (except for MMSE) in T2DM patients with MCI were lower than those without MCI (p < 0.05), but there was no statistical difference (p > 0.05) in neuropsychological tests between T2DM-MCI group and No-T2DM-MCI group. Linear regression analysis showed that the drug treatment of diabetes was positively correlated (t = 2.263, p = 0.025) with the total score of auditory word tests.

Conclusions: The present study suggests a high prevalence of MCI among Chinese T2DM patients. Depression is a risk factor for MCI, while education is a protective one. T2DM patients with MCI often show comprehensive cognitive impairment, and the drug treatment of diabetes might help to improve cognitive function.

The Evolutionary Trends of Health Behaviors in Chinese Elderly and the Influencing Factors of These Trends: 2005⁻2014

As China is now facing the severe challenge of rapid population ageing, the health behaviors in Chinese elderly people are of great significance for realizing the goal of “Healthy Ageing” and the construction of a “Healthy China”. Little is known about the evolutionary trends of health behaviors in the Chinese elderly and about the factors influencing these trends; thus, the purposes of this paper are: (1) To describe the classes and evolutionary trends of health behaviors in the Chinese elderly; and (2) to explore the factors that influence the changes in the health behaviors in the elderly in China. Latent class analysis (LCA) is applied in this study to analyze the classes of health behaviors in the Chinese elderly. Growth mixture modelling (GMM) is employed to describe the evolutionary trends of the health behaviors in elderly people in China. In addition, the Bivariate analysis model is adopted to identify the influencing factors of the evolution of health behaviors. The data were derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2005 to 2014. The results reveal that the health behaviors in the Chinese elderly can be grouped into five classes: Negative, relatively negative, fair, relatively positive, and positive. Approximately 77.2% of the health behaviors in the Chinese elderly have the characteristics of “modified”, with a positive tendency. Moreover, approximately 22.8% of the health behaviors in Chinese elderly people have the characteristics of “non-modified”, with a negative tendency or remaining unchanged. The evolution of the health behaviors in the elderly in China is more affected by economic factors such as timely medical treatment during childhood, pension, occupations before the age of 60 and family income, as well as by self-rated health (SRH) and demographic characteristics such as household registration, age, and education level. Hence, various possible interventions should be made to improve the health behaviors in elderly people.

[Attaching importance to health of elderly population and promoting national healthy ageing actively in China]

China has entered an aging society since 1999. By the end of 2017, the number of persons aged ≥60 years had increased to 240.90 million. At present, the average life expectancy of China's population is 76.4 years, and the healthy life expectancy is around 68.7 years, which means that the elderly will be accompanied by disease for about 8 years. The main health problems of the elderly in China include increased prevalence of chronic diseases, increased prevalence of disability, insufficient attention to older persons' mental health and area specific differences in the health level of the elderly. The disease status of the elderly cannot be ignored. Strengthening the medical services in western and rural areas, emphasizing the psychological and mental concern for the elderly, formulating unified health evaluation criteria, promoting a new model of medical and nursing care combination, establishing an elderly security system with equal responsibilities and rights, jointly managing under the cooperation of whole society and multi-dimensions to protect the health of the elderly are essential to the construction of an active ageing society in China and the realization of the strategic goal of healthy China.

Association of the oral microbiome with the progression of impaired fasting glucose in a Chinese elderly population

Objective: The oral microbiota is associated with the risk of type 2 diabetes (T2D), but the relationship between the oral microbiota and disease progression in the elderly population remains to be determined.

Design: In our study, we recruited 150 elderly Chinese residents and divided them into three groups according to their fasting glucose (FG) level: normal (N), high (H), and very high (VH). Their biochemical indexes were analyzed using blood samples. Saliva samples were collected and the oral microbiome was profiled by high-throughput sequencing of the V3-V4 area of the 16S rRNA gene.

Result: Our results revealed that the VH group showed deterioration of the metabolic phenotype and dysbiosis of the oral microbiota simultaneously when compared to the other two groups. Furthermore, potential disease-associated bacterial genera including Leptotrichia, Staphylococcus, Catonella, and Bulleidia were significantly enriched in the VH group.

Conclusions: These results suggest that dysbiosis of the oral microbiota may be a typical feature of hyperglycemia and might also contribute to disease aggravation in the progression of hyperglycemias.

The Relationship between Socioeconomic Status, Mental Health, and Need for Long-Term Services and Supports among the Chinese Elderly in Shandong Province-A Cross-Sectional Study

This study aims to clarify the association between socioeconomic status (SES), mental health, and the need for long-term services and support (NLTSS) of the Chinese elderly, and further, to provide evidence-based suggestions for the development of the long-term services and support (LTSS) system in China. A cross-sectional survey using a multi-stage random sampling method was conducted in Shandong Province, China, in 2017. Data were collected from seniors aged over 60 years old through questionnaires by face-to face interviews. A total of 7070 subjects were included in the final database (40.3% male and 59.7% female). A chi-square test analysis and structural equation modeling (SEM) were employed to explore the relationship between SES, mental health, and NLTSS for both male and female elderly people. The SEM analysis showed that mental health was significantly and negatively associated with NLTSS for both male elderly and female elderly, and it was slightly stronger among the male elderly. A significant and negative relationship was observed between SES and NLTSS for both genders, and the association was stronger among the female elderly. SES exerted a positive effect on mental health for both male and female elderly people, and a slightly stronger effect was found among the male elderly. Advice for the development of a LTSS system in China was given based on the above results.

Study on Lifestyle Evaluation Systems for the Health of Chinese Elderly

Background/Objective: China is now faced with a serious population aging challenge, and the health of the Chinese elderly is becoming an imminent concern. Consequently, it is critical to establish a lifestyle evaluation system for promoting the health of the Chinese elderly. Methods: Interviews with experts and questionnaire surveys were conducted. Factor analysis, analytic hierarchy process, and statistical analyses were also adopted in this study. Results: Besides evaluation metrics and standards, a two-level category system including 50 indices and associated weights from three level 1 categories (physical and mental health and social wellbeing) and thirteen level 2 categories were obtained. Discussion and Conclusions: Based on the confirmatory factor analysis and Cronbach's test, such an evaluation system excels in effectiveness and reliability, and is ready to be popularized in Chinese society. We expect that the Chinese elderly will benefit from our system and that it will lead to a healthy lifestyle accordingly.

Perceived Discrimination and Life Satisfaction of Elderly Chinese People: The Chain Mediating Effects of National Identity and Sense of Community

In China, aging is becoming an increasingly serious issue, and the Chinese government are paying more attention to the life satisfaction of the elderly. Nevertheless, in their daily lives, the elderly are often discriminated against, which may have a negative impact on their life satisfaction. To enable a better understanding of these relationships, we discuss the factors affecting the macro-system (national identity) and micro-system (sense of community) of the elderly. Three hundred and ninety-one elderly people (60–101 years old; 121 males, 270 females) from three communities in the Anhui and Shandong provinces of China participated in our study. Each participant completed the appropriate questionnaires, including: perceived discrimination measure, national identity questionnaire, sense of community questionnaire, and life satisfaction questionnaire. The results of structural equation modeling revealed that perceived discrimination negatively influenced life satisfaction through national identity and community. Perceived discrimination was found to negatively predict national identity, suggesting that perceived discrimination brings a negative influence to national identity within Chinese culture. The relationship between perceived discrimination and life satisfaction was partially mediated by the chain of national identity and sense of community. The size of the total mediation effect was 32.17%. The relationship between perceived discrimination and life satisfaction, when mediated by national identity or sense of community, was not significant. This suggests that the application of the rejection-identification model to the elderly in China may produce different results. The limitations and the implications of our study were considered in discussion.

Association of postlunch napping duration and night-time sleep duration with cognitive impairment in Chinese elderly: a cross-sectional study

OBJECTIVE

To analyse the independent and combined associations of postlunch napping duration and night-time sleep duration with risk of cognitive impairment among Chinese elderly.

DESIGN

A cross-sectional study.

SETTING

We analysed the data from Zhejiang Ageing and Health Cohort, a population-based survey of seven counties located in Zhejiang province in eastern China.

PARTICIPANTS

10 740 participants aged 60 years or older were included in final analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

Cognitive impairment was assessed through Mini-Mental State Examination. Data on sleep-related characteristics was collected in the behavioural habits section within the questionnaire.

RESULTS

Relative to participants with 1-30 min of postlunch napping, those who did not nap and who napped longer had significantly higher risks for cognitive impairment. OR of cognitive impairment were 1.41 (95% CI 1.14 to 1.75) for participants with longer night-time sleep duration (≥9 hours), compared with those sleeping 7-8.9 hours. In addition, combined effects were further identified. Participants with both longer night-time sleep duration (≥9 hours) and longer postlunch napping duration (>60 min) (OR=2.01, 95% CI 1.30 to 3.13), as well as those with both longer night-time sleep duration (≥9 hours) and appropriate postlunch napping duration (1-30 min) (OR=2.01, 95% CI 1.20 to 3.38), showed significantly higher risk of cognitive impairment than those with sleeping 7-8 hours and napping 1-30 min. Meanwhile, a 34% increase in odds of cognitive impairment was observed in participants with both shorter night-time sleep duration (5-6.9 hours) and no napping.

CONCLUSION

Both postlunch napping duration and night-time sleep duration were independently and jointly associated with cognitive impairment, which needs verification in prospective studies.

Efficacy and safety of levosimendan in Chinese elderly patients with Takotsubo syndrome

Background

Takotsubo syndrome has a low global incidence, but it is observed more and more in clinical practice. Only case reports and series have been published, while prospective studies are still necessary. This study aimed to explore the efficacy and safety of levosimendan in elderly with Takotsubo syndrome.

Methods

This study followed a prospective, randomized and double-blinded design. All 200 consecutive patients (>65 years) with Takotsubo syndrome were randomly assigned into a levosimendan group (n=100) and a control group (n=100). The control group underwent regular treatment, and the levosimendan group was additionally administrated with levosimendan.

Results

Age of all patients was 71 [66-85] years, and there were 138 females (69%). Baseline characteristics between the two groups had no significant difference before treatment (P>0.05 for all). In the levosimendan group on the 30 and 180 days after treatment, left ventricular ejection fraction was significantly higher, and New York Heart Association class and N-terminal pro-brain natriuretic peptide levels were significantly lower, than those in the control group (P<0.05 for all). Systolic blood pressure, diastolic blood pressure, heart rate and serum creatinine levels had no significant difference between the two groups (P>0.05 for all).

Conclusions

Levosimendan showed reliable efficacy and safety in Chinese elderly patients with Takotsubo syndrome, supporting the idea that levosimendan has the potential to be an essential drug applied for patients with Takotsubo syndrome.

Dietary sugar intake does not pose any risk of bone loss and non-traumatic fracture and is associated with a decrease in all-cause mortality among Chinese elderly: Finding from an 11-year longitudinal study of Mr. and Ms. OS Hong Kong

BACKGROUND

The association of dietary sugar intake and skeletal health remains uncertain in the elderly. We aimed to investigate the association of sugar intake with the bone health and mortality of Chinese elderly.

METHODS

An analysis was conducted through an 11-year longitudinal study (Mr. and Ms. OS Hong Kong). Four thousand Chinese elderly aged 65 and older were recruited from the local community between 2001 and 2003. Sugar intake was assessed at baseline by a validated 329-item Food Frequency Questionnaire and a local sugar database. The bone mineral density (BMD) was examined at baseline and the fourth year follow-up by a dual-energy X-ray absorptiometry. Data on the incidence of non-traumatic fractures (total, hip and osteoporotic sites) and all-cause mortality were collected. The multivariable logistic and Cox regression models were used to test the associations of sugar intake with bone health and all-cause mortality.

RESULTS

No significant association was observed between sugar intakes and BMD changes in the fourth year's follow-up. During a total 34,483 person years' follow-up, we documented 433 non-traumatic fractures and 769 deaths. Although lack of significant association with the incidence of non-traumatic fractures, high added sugar intakes were significantly associated with a low risk of all-cause mortality among the elderly with a hazard ratio of 0.750 (95% CI: 0.590-0.954, P for trend = 0.007) in the highest quintile compared with that in the lowest quintile.

CONCLUSION

The amount of sugar consumed by the Chinese elderly did not pose any risk of bone loss and fracture. Moreover, high sugar intake of the elderly was associated with a low rate of all-cause mortality.

Association between a frailty index based on common laboratory tests and QTc prolongation in older adults: the Rugao Longevity and Ageing Study

BACKGROUND

Risk factors for heart rate-corrected QT interval (QTc) proglongation should be explored to stratify high-risk individuals to aid the prevention of incident cardiovascular events and mortality. The diversity of risk factors for QTc prolongation suggests that use of the frailty index (FI), indicating general health deficits, may be an effective approach, especially in the elderly, to identify the risk of QTc prolongation.

METHODS

We used the data of 1,780 individuals aged 70-87 years from the Rugao Longevity and Ageing Study (RuLAS), a community-based longitudinal study. The FI was constructed using 20 routine laboratory tests, plus the body mass index and measures of systolic and diastolic blood pressures (FI-Lab).

RESULTS

The mean FI-Lab value was 0.24±0.09. The mean heart rate-corrected QT interval (QTc) was 407±38 ms. The prevalence of QTc prolongation was 5.2% in elderly community populations aged 70-87 years. A higher FI-Lab value was associated with a higher risk for QTc prolongation. Each 10% increase in the FI-Lab value increased the odds ratio (OR) by 33% (OR: 1.33; 95% CI: 1.07-1.64). Compared with the lowest quartile, the top quartile FI-Lab score was associated with a 2.50-fold QTc prolongation risk in elderly individuals (95% CI: 1.21-5.19).

CONCLUSION

An FI based on routine laboratory data can identify older adults at increased risk for QTc prolongation. The FI approach may therefore be useful for the risk stratification of QTc prolongation.