Living Long and Well: Cross-Temporal Meta-Analytic Evidence on Elderly Chinese Health-Related Quality of Life

Round 1

Reviewer 1 Report

Dear Authors!

Your research is focused on sustainable topic: human well-being and quality of life. The research focus on elderly Chinese health-related quality of life makes is applicable and prospective.

For the research authors used complex and original method of cross-temporally meta-analyzed 45 research reports (N = 18 36,352) that utilized the health-related quality of life (HRQoL) scale (SF-36) from 2000 to 2020. The research implemented on prospective topic with complex methodology, but it could be improved in the followings:

1.      Please short and concrete the title, it is too long for the scientific paper.

2.      All figures should be signed with Source (Is it authors or etc.?).

3.      Please remove the citation ([15]) from the Conclusion and change it to the explanation or the link to authors Figure/Table.

The literacy review is actual and complex with more than 47 publications and for its improving I suggest You to add more actual publication about the research topic like:

1.       Li, C., Wu, J., & Huang, Y. (2023). Spatial–Temporal Patterns and Coupling Characteristics of Rural Elderly Care Institutions in China: Sustainable Human Settlements Perspective. Sustainability, 15(4), 3286.

I wish you to improve your manuscript successfully!

Best regards,

Your Reviewer

Author Response

To Reviewer 1

1. On the length of the title, we thank the reviewer for this comment. We have modified the title to be short and reflective of our study.
2. On the sources of Figures, we thank the reviewer for this comment. We have indicated the sources of all the Figures in the study.
3. On removing the citation number 15 from the study’s conclusion, we thank the reviewer for this suggestion. However, we would like to note that, the idea of inconclusive results is what motivated this study and that has been thoroughly articulated already in the introduction. We reiterate this motivation as we conclude the paper. If the reviewer suggests the citation be deleted, we have no problem, but we do not think any explanation in whatever form (texts, table or figure) is needed. That has been done in the introduction. The citation is there to help readers who do not have the time to go through the whole paper by pointing them to a pivotal reference for our research. So, in keeping with the reviewer, we have deleted the reference but maintain no explanation is needed.
4. On adding additional reference, we thank the reviewer for reference suggestion. We have updated our reference lists to include this work on institutional care for the rural elderly.

Thank you for your time and valuable comments.

Reviewer 2 Report

I would like to increase the value of the research with some suggestions.

1. The author suggests that the expectations or values ​​of this study be specifically described in the preface. I think the need for a meta-analysis has been appropriately raised, but the research value of this study is not well recognized. This is because readers have already been able to predict the analysis results with common sense through the research topic presented by the researcher, and did not exceed that level. Therefore, in order to increase the value of this study, it is necessary to analyze the results using more specific and appropriate evidence in the section 4. Consideration and to make suggestions for future research.

- For example, it seems that more references and logical reinforcement are needed for the use of ICT as an alternative presented as a result of the study in 4.1. Indeed, not only do older people find it difficult to use tools related to ICT technology, but it can be even more difficult to benefit from these devices, especially alone, after their children have left. In addition to this, regional differences must also be considered. This is because the more provincial it is, the more likely it is that the infrastructure that can use it is not properly set up.

-In the case discussed in 4.3, it is necessary to comment on the direction of future research along with alternatives to the researcher's analysis. It seems that researchers cannot be satisfied with simply raising the problem of a care system that provides only basic living services without family care based on the results.

 2. The analysis method related to CTMA described in the second half of the introduction is '2. After moving to 'Materials and Methods', it seems appropriate to describe the analysis method separately. In addition, for the description of the software mentioned in the last part of '2.3 Document selection and coding', it is recommended that the analysis methods used within the framework of the analysis method in No. 2 be separately mentioned in more detail.

3.  In the concluding section, please additionally mention the limitations of this study and suggestions for future research.

Author Response

To Reviewer 2

1. On giving research recommendation, we thank the reviewer for this suggestion. Recommendations for future research has been put forward based on the patterns in our results.

1. On strengthening analytical methods, we thank the reviewer for this comment. We have added the mathematical formular for the calculation of the weighted scores.

3. On adding study limitations and suggestion for further studies, we thank the reviewer for this comment. A study limitation section (5) has been added.

Thank you for your time and valuable comments.

Reviewer 3 Report

This paper focuses on the effects of government policy and program interventions on changes in how well the el1derly live over the years. Accordingly, the author cross-temporally meta-analyzed 45 research reports (N = 18 36,352) that utilized the health-related quality of life (HRQoL) scale (SF-36) from 2000 to 2020. They found that: (1) bodily pain, general health, vitality and mental health of the elderly deteriorated over 20 time; however, their physical and emotional roles as well as social functioning improved with time; (2) the rising dependency ratio impoverishes the HRQoL of the elderly; (3 the HRQoL indicators of the elderly revealed positive gains under the home-based care model; whilst they showed a downward trend under the institutional pension model; (4) the HRQoL indicators of the elderly in economically developed areas produced mixed results, but they all worsen with years in economically underdeveloped areas. The authors conclude that more investment efforts from government and private entities are needed to reduce dependency ratio, and to improve the lives of the elderly under institutional care and/ or in economically underdeveloped areas.

This is an interesting paper from a societal and scientifical point of view.

I have the followingminor points to make the paper stronger:

Introduction:

The authors state: “The people of China, like their counterparts in the West, now live longer.”

Please provide some stats for China and other parts of the world.

Section 2.3 Document selection and coding:

“The 45 selected documents were carefully coded. For studies that utilized sub data rather than the total, the results of such sub-studies were weighted and synthesized.” Explain if you used intercoder reliability, and if not why you didn’t.

Conclusion: Repeat you research questions and answer them one by one.

Try to give an explanation, even if this is tentative, for your results.

Add a Limitations section.

Author Response

To Reviewer 3

1. On supplying a comparative statistic for China and Western countries, we thank the reviewer for this suggestion. However, we are of the opinion that such presentation of statistics derails the focus of the study. In fact, from line 42 to 47, the point is made that China has the highest number (200.56million), not proportion, of people who are 65 and above in the world. The argument establishes further that almost a quarter (18.9%) of Chinese population are over 60 years compared to almost 14% in 2010. If all these numbers do not put the assertion “The people of China, like their counterparts in the West, now live longer” into perspective, then we opt to revise the sentence to “The people of China now live longer” to avoid comparative analysis because we find that to be out of scope of this paper. 18.9 is higher than 13.9 and that should support our revised statement.

2. On repeating our questions and answering them one by one, we thank the reviewer for this recommendation. We repeated our questions and answered them as per our results. Please check the conclusion.

3. On giving explanation for our results even tentatively, we thank the reviewer for this suggestion. We have provided tentative explanations as to why we see the trend we see in elderly HRQoL and offered recommendations for future research.

4. On adding limitation section, we thank the reviewer for this suggestion. A study limitation section (5) has been added.

Thank you for your time and valuable comments.