Psychological well-being of the institutionalized and community-residing oldest old in China: The role of children

Studies have shown that institutionalized older adults have worse psychological health than their community-residing counterparts. However, much less is known about this association in developing countries such as China with a rapidly aging population and a short history of institutional care. This article investigates the role of children in differences in psychological well-being between institutionalized and community-residing oldest-old adults in China. Using national data from the 1998, 2000, and 2002 waves of the Chinese Longitudinal Healthy Longevity Survey, results show that the institutionalized have significantly better psychological health-measured by positive affect, loneliness, and quality of life-than those living in the community. Furthermore, we find that the associations are moderated by child-related factors (number of children, proximity, and visits) and strengthened for the three measures of psychological well-being after adjustments for socioeconomic factors, social support, health behaviors, and health status. The results underscore the importance of family dynamics for the psychological health of the institutionalized population in a historically family-care oriented society.     

The association between city-level air pollution and frailty among the elderly population in China

A growing body of research suggests that air pollution negatively affects specific health outcomes, but how long- and short-term exposure to air pollution are associated with frailty is unclear. Using longitudinal data from adults aged 65 and over from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) linked with air quality index data, we model a frailty score according to the city-level of air pollution exposure, adjusting for individual socio-demographic factors and city-level indicators. All models show increased frailty with higher exposure to air pollution in one year prior to the interview, when controlling for short-term fluctuations. Moreover, elderly people living in areas where air pollution increased over the follow-up had larger increases in frailty scores than those where air pollution was relatively constant. The results suggest that air pollution plays a role in healthy ageing.     

Objective and subjective financial status and mortality among older adults in China

The association between financial status and mortality in older adults is well documented. However, it is unclear whether the association may vary by objective and subjective indicators of financial status. To examine this issue, we used the latest four waves (2005, 2008/2009, 2011/2012, and 2014) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) of community-residing adults aged 65 and older (n = 25,954). Financial status was assessed using eight objective, subjective, and culturally-oriented measures to capture various dimensions of financial resources at older ages. Multivariate hazard models were used to examine how different indicators of financial status were associated with subsequent mortality in all older adults and by age, gender, and urban-rural residence. Results showed that higher financial status—either objective or subjective—was associated with lower risks of mortality. Subjective assessments of financial status had stronger associations with mortality than objective assessments. The patterns were generally similar between young-old (aged 65–79) and the oldest-old (aged 80+), between women and men, and between rural and urban areas. Together, the findings offer new evidence to help improve the socioeconomic gradient in mortality among older adults in China.     

老年人小腿围、HCAR与认知障碍的因果中介分析——基于CLHLS2014数据

摘　 要：目的　 探究小腿围与认知障碍的关系及超敏C反应蛋白/白蛋白比值(hypersensitive C-reactive protein/ albumin ratio, HCAR)的中介作用。方法　筛选 2014 年CLHLS数据库中的 1 784 例老年人数据。通过中文版简易精神 状态量表(Chinese version of the brief mental state examination, cMMSE)评估认知功能。使用R软件进行数据处理和分 析,Bootstrap抽样法验证中介效应。结果　校正多种协变量后,小腿围与认知障碍呈显著负相关(OR= 0.951,95% CI： 0.933~0.970),HCAR在其中起到中介作用(中介效应比例为 0.022,95%CI：0.002~0.060)。结论　小腿围与认知障碍之 间存在负关联,HCAR起中介作用。该发现对预防和干预认知障碍有重要意义。     

医养结合背景下城乡社区老年健康管理服务供给及效果研究——来自“中国老年健康影响因素跟踪调查”的证据

本文利用“中国老年健康影响因素追踪调查(CLHLS)”十年的数据,实证考察了医养结合背景下,城乡社区老年健康管理服务供给及效果。结果发现,尽管我国社区健康管理服务的供给水平不断提升,但总体水平较低,城乡差异仍然突出,特别是“精神慰藉”等心理健康服务仍然不足;提高社区健康管理服务有助于降低城乡老人发生大病、认知受损及负面情绪等风险,同时也有助于提高老年人特别是农村老人的生活满意度。因此,要特别注重提高服务供给的城乡均等化水平,同时也要有针对性地增加与促进老年精神及认知健康相关服务内容。     

Projecting Long-Term Care Costs for Home and Community-Based Services in China from 2005 to 2050

ObjectivesThe aim of this study was to estimate and project the trend in long-term care (LTC) costs for home and community-based services as a percentage of gross domestic product in China between 2005 and 2050.DesignLongitudinal.Setting and ParticipantsWe used 61,249 observations from 37,702 adults age ≥65 years from waves 2005, 2008, 2011, 2014, and 2018 of the Chinese Longitudinal Healthy Longevity Surveys.MethodsLTC costs for home and community-based services consisted of the monetary value of time spent on LTC and the direct LTC cost. We used the age-sex-residence-specific weights provided by the Chinese Longitudinal Healthy Longevity Surveys to estimate the LTC costs from 2005 to 2018. We used a component-based model to project LTC costs, in which the 2-part model was used to estimate the average LTC costs and the multi-state Markov model approach was used to project the future population by age, sex, and disability state.ResultsThe percentage of older adults with disabilities was projected to increase from 6.1% in 2005 to 7.5% in 2020 and 9.6% in 2050. The total LTC cost for home and community-based services were projected to increase from 0.3% of gross domestic product in 2005 to 0.7% in 2020 and to 6.4% in 2050.Conclusions and ImplicationsPolicymakers in China should take urgent actions to delay the onset of disabilities among older adults, which would curb the increasing LTC costs and maintain the sustainability of the LTC policies.     

The Effects of “Diet–Smoking–Gender” Three-Way Interactions on Cognitive Impairment among Chinese Older Adults

Investigations on gender variations in the risk factors of cognitive impairment are required to promote future precision medicine among older adults, as well as to contribute to a better understanding of the “male–female health-survival paradox”. With this study, we aimed to investigate the effects of “diet–smoking–gender” three-way interactions on cognitive impairments among Chinese older adults. We conducted a 16-year prospective cohort study among 15,953, 15,555, 16,849, 9716, 7116, and 13,165 older adults from the 2002, 2005, 2008–2009, 2011–2012, 2014, and 2017–2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), respectively. Cognitive impairment was measured by the Mini-Mental State Examination (MMSE). The dietary diversity score (DDS) was calculated using the CLHLS food frequency questionnaire. Generalized estimating equations (GEE) were used to assess the “diet–smoking–gender” three-way interaction effects on cognitive impairment across the six waves of CLHLS. We found that higher dietary diversity was associated with lower probability of cognitive impairment among older adults (OR = 0.92; 95%CI = 0.90, 0.98). However, smoking behavior may negatively influence the protective effect of higher dietary diversity on cognitive function among females (OR = 1.26; 95%CI = 1.07, 1.49). Our findings imply that we should take gender differences and lifestyle behaviors into consideration in implementing dietary interventions to improve cognitive function among older adults.     

体重指数、腰围和高龄老年人死亡风险的关联

目的 分析体重指数、腰围与高龄老年人死亡风险的关联,为完善高龄老人的体重管理提供科学依据。方法 采用中国老年人健康长寿影响因素调查（Chinese Longitudinal Healthy Longevity Survey, CLHLS）2011—2018队列数据库4 508例样本,暴露变量为体重指数（body mass index, BMI）和腰围（waist circumference, WC）,结局为死亡。采用Cox比例风险回归模型分析体重指数、腰围和高龄老年人死亡风险的关联。结果 中位随访时间为3.08年,死亡3 416人。按照BMI分类,体重过轻对高龄老年人死亡风险最大（HR=1.31,95%CI:1.19～1.43）,超重是老年人死亡风险的保护因素（HR=0.85,95%CI:0.74～0.98）。按照WC分类,中心型肥胖是老年人死亡风险保护因素(HR=0.84,95%CI:0.76～0.93)。BMI和WC构建的综合体重表型结果显示,BMI超重合并腰围肥胖是老年人死亡风险的保护因素（HR=0.82,95%CI:0.69～0.97）,而BMI过轻合并腰围肥胖是老年人死亡风险...     

中国老年人健康状况及影响因素分析——基于第8轮CLHLS数据

目的 探索中国老年人的健康状况影响因素,为政府部门制定老年人健康相关政策提供建议和理论依据。