Search Results (151)

The aging of China’s population has created significant challenges for the mental health of older adults. However, limited research has examined how public sports facility availability in living communities supports older adults’ mental health. To explore this association, data were extracted from the 2016 China Longitudinal Aging Social Survey, which involved 7811 respondents. The ordinary least squares model and the instrumental variable approach were employed to test the association between public sports facility availability in Chinese older adults’ living communities and their mental health. The bootstrapping method was used to estimate the mediating effect of physical activity and life satisfaction. The results indicate that public sports facility availability in living communities was significantly correlated with a decrease in depressive symptoms among older people (coefficient = −0.225; p < 0.01), which suggests that a greater availability of public sports facilities in living communities is related to the better mental health of older adults. The results of the mediation analysis show that physical activity and life satisfaction were identified as mediating mechanisms. This study suggests that increasing the availability of public sports facilities in older adults’ living communities can alleviate depression and promote better mental health. Our findings provide valuable policy implications for enhancing public sports infrastructure and promoting healthy aging. Full article

Background: Diabetes is rapidly increasing in developing and industrializing nations, primarily due to type 2 diabetes (T2DM). With the global prevalence of diabetes steadily increasing, estimates suggest that by 2045, nearly 548 million people will be living with the disease worldwide. Alzheimer’s disease (AD), recognized as the primary contributor to dementia in aging populations, exhibits an escalating prevalence that parallels the demographic shifts toward older age groups worldwide. This progressive neurodegenerative disorder has emerged as a critical public health challenge, with epidemiological patterns closely tracking the trajectory of population aging across industrialized and developing nations. This study investigates whether metformin may help reduce the risk of dementia. Previous studies from various countries have explored the association between metformin use and dementia risk; however, the findings have been inconsistent. Therefore, we conducted this study to examine whether the observed protective effect of metformin also applies to the Taiwanese (Han Chinese) population, potentially providing valuable insights into ethnic or regional differences in drug response. Methods: We conducted a retrospective cohort study using data from the Longitudinal Health Insurance Database 2000 (LHID2000), including 2 million individuals from 2000 to 2013. Patients with T2DM aged ≥40 years who initiated metformin between 2000 and 2005 formed the exposed group, while those starting other second-line antidiabetic medications formed the non-exposed group. Propensity score matching was used to control for age, sex, index date, and major comorbidities. Incident dementia (2007–2013) was identified using relevant ICD-9-CM codes. Adjusted hazard ratios were estimated using Cox regression with time-dependent covariates. Results: The metformin-exposed cohort demonstrated a risk reduction for dementia incidence relative to the comparator group (adjusted HR 0.472, 95% CI = 0.328–0.679). This protective association remained robust in sex-stratified analyses and age-stratified subgroups. Temporal analysis further revealed a duration-dependent risk attenuation, with extended therapeutic exposure correlating with progressive dementia risk decrement. Conclusions: Our findings suggest that metformin use may be associated with a lower risk of developing dementia in individuals with type 2 diabetes mellitus. Full article

Background: Sarcopenia and buttock pain are highly prevalent in older adults and exert profound negative effects on quality of life. Little is known about the association between sarcopenia and buttock pain. Methods: This study performed cross-sectional and longitudinal analyses based on prospective cohort study data from the 2015 and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS). A total of 12,884 community-dwelling adults aged ≥45 years were included in the cross-sectional analysis, and 10,511 of these participants, free of buttock pain at baseline, were further investigated to assess incident buttock pain. Sarcopenia status was categorized as non-sarcopenia, possible sarcopenia, and sarcopenia according to the 2019 Asian Working Group for Sarcopenia and the 2021 Chinese consensus criteria. Logistic regression models adjusted for sociodemographic and health-related covariates were performed to estimate associations between sarcopenia status and buttock pain. Results: After adjusting for covariates, possible sarcopenia, but not sarcopenia, was associated with prevalent buttock pain (OR 1.23, 95% CI 1.03–1.48). After 5 years of follow-up, participants with sarcopenia were more likely to develop incident buttock pain (OR 1.37, 95% CI 1.03–1.81). Among sarcopenia components, poor physical performance was linked to prevalent pain (OR 1.25, 95% CI 1.05–1.50) and low handgrip strength predicted incident pain in males (OR 1.31, 95% CI 1.07–1.60). Appendicular muscle mass was not independently associated with either prevalent or incident buttock pain. Conclusions: In middle-aged and older Chinese adults, sarcopenia is an independent risk factor for incident buttock pain. Early screening and interventions of sarcopenia may help to mitigate the burden of buttock pain and its associated disability. Full article

Objective: The purpose of this study was to investigate the association of built environment and intrapersonal factors with leisure-time physical activity (LTPA), and the possible moderating effect of intrapersonal factors on the association between the built environment and LTPA. Methods: A total of 514 older people in the village of Fuwen were included in this study. Data on LTPA, intrapersonal factors (social, fitness, medical, benefits/challenges, recognition), and the built environment (traffic safety, street connectivity, walking facilities, access to services, crime safety, aesthetics, residential density, land use mix diversity) were collected. Multivariate linear regression analysis with the “enter” method was conducted to analyze the association of perceived scores of built environment and intrapersonal factors with LTPA. Results: Among the intrapersonal factors, fitness was positively related to LTPA (p = 0.012). Among the built environment factors, traffic safety (p = 0.02) and crime safety (p = 0.047) were positively related to LTPA, while walking facilities was negatively associated with LTPA (p = 0.007). Additionally, fitness had a significant moderating effect on the association between walking facilities and LTPA (p = 0.025). Conclusions: Older people with higher fitness requirements and better perceived traffic safety and crime safety tend to engage in greater levels of LTPA. The findings provide valuable insights for policymakers, particularly in designing ecologically livable villages that promote physical activity among older populations. Full article

Background: It is unclear how marital status moderates the association between multidomain leisure activities and the progression of cognitive decline in community-dwelling older adults. Methods: Data from the Chinese Longitudinal Healthy Longevity Survey with up to 10 years of follow-up were used. The study included participants aged ≥65 years without cognitive impairment at baseline. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Linear mixed-effect models were used to evaluate the modifying effect of marriage on leisure activities (multiple types, frequency, and single type) and cognitive decline. Results: A total of 5286 participants (aged 79.01 ± 9.54 years, 50.0% women, and 61.4% rural residents) were enrolled. The results indicated that marital status moderates the relationship between leisure activities and cognitive decline. In the unmarried group, multi-type and high-frequency leisure activities were more strongly associated with slower cognitive decline. Specific activities such as gardening, reading, performing household chores, and playing cards were found to significantly contribute to cognitive protection exclusively within the unmarried group, with no such effect observed in the married group. Conclusions: Marital status affects the relationship between participation in multiple leisure activities and cognitive decline in cognitively intact elderly people. For unmarried older adults, regular participation in leisure activities may be an effective intervention. Full article

Objective: This study systematically reviews health economic evaluations of influenza vaccines in China and synthesizes the evidence on different vaccine categories. Methods: We searched databases, including the China Hospital Knowledge Database, Wanfang, PubMed, Web of Science, and Embase, for studies on the health economics of influenza vaccines in China from 2015 to 2024. Studies were selected based on predefined criteria, and relevant data were extracted for analysis. The research utilized a parameter, ICER/threshold, defined as the ICER divided by the GDP per capita, to compare the results of cost-effectiveness analysis (CEA) studies. Results: A total of 1743 articles were identified, of which 25 met the inclusion criteria for full-text review. These included 19 Chinese studies and 6 English studies. Study populations were predominantly older adults (52.0%), followed by children, adolescents, people with chronic disease, and pregnant women. Vaccination strategies included trivalent inactivated influenza vaccine (TIV), quadrivalent inactivated influenza vaccine (QIV), trivalent live-attenuated influenza vaccine (LAIV), and non-vaccination groups. For TIV, 94.7% reported positive cost-effectiveness or cost-benefit results, with 21.1% identifying it as the most dominant strategy. For QIV, six studies compared it with a non-vaccinated group, and five (83.3%) reported favorable economic results. The study on LAIV showed cost-effectiveness compared to no vaccination, but not compared to QIV. The ICER threshold for TIV is the most favorable, and the population that exhibits the highest cost-effectiveness and benefit from vaccination is those people with underlying health conditions. Conclusions: TIV vaccination is often cost-effective, especially for people with chronic diseases, children, and older adults. Prioritizing TIV vaccination for those people with chronic diseases is recommended. Full article

With the increasingly severe situation of population aging in China, how to improve the well-being of older adults is an important topic of social discussion. However, the situation of older adults in urban and rural China greatly differs. Current research has focused on older people in urban areas, with insufficient attention paid to the urban-rural differences in older groups. At the same time, volunteering is considered to be a significant strategy to improve the lives of older adults, and the young-old are the main participants in volunteer activities, but the impact and influence mechanism of volunteering on life satisfaction among urban and rural young-old have yet to be clarified. Therefore, the goal of this study is to analyze the influence of volunteering on the lives of the young-old in a more comprehensive way, mainly exploring three questions: (1) The impact of volunteering on life satisfaction of the young-old. (2) The influence mechanism of volunteering on their life satisfaction. (3) The urban-rural differences in the impact and influence mechanism. To answer the above questions, this study was conducted from the perspective of urban-rural differences, based on Activity Theory and Social Capital Theory, and adopted quantitative research methods, including multiple linear regression and structural equation models. Secondary data, which comes from the Chinese Social Survey in 2021, was used in this study, and we chose the Chinese older adults aged 55–70 years old as the object of study. The results show that volunteering positively correlates with life satisfaction, while social trust is a significant positive mediating mechanism. Furthermore, the rural young-old benefit more from volunteering. The findings imply that it is of great significance to appropriately encourage the young-old to participate in volunteer activities, formulate targeted policies for different older people based on urban-rural differences, and gradually break the obstacles of the urban-rural dual system comprehensively. Full article

Background: Sarcopenia associated with aging severely affects the quality of life of the elderly; diets have been shown to elicit an inflammatory response in the body, and diets that promote inflammation may lead to damage to muscles. The Dietary Inflammatory Index (DII) has been developed to quantify the inflammatory potential of individual diets. Therefore, this study aimed to investigate the association between the DII, sarcopenia and its components in elderly Chinese people. Methods: In this study, data were obtained from the China Nutrition Improvement Strategies and Applications for the Elderly Research Programme. An assessment of sarcopenia was carried out according to the Asian Working Group on Sarcopenia’s (AWGS2019) criteria. The DII was calculated using food intake data obtained using the FFQ method, and then the quartile method was used to categorize the subjects into four groups. Multifactor logistic regression was conducted to examine the associations between DII, sarcopenia and its components. Results: This study included 993 subjects over the age of 65, and the prevalence of sarcopenia was 20.2%. The mean DII score of the study population was 0.99 ± 0.1. After adjusting for the confounders age, gender, marital status, and educational level, the risk of sarcopenia was 1.66 times higher in group Q4 than in group Q1 (p-trend < 0.05). However, this relationship is not statistically significant when other more confounding factors are added. Nevertheless, when further analyzing the relationship between DII and sarcopenia components, it was found that after adjusting the model, a higher DII was associated with a risk of muscle strength loss (OR = 1.65, p-trend < 0.05). Conclusions: Higher DII scores increase the risk of muscle strength loss in older adults. By guiding older adults to adopt a more anti-inflammatory diet, muscle health can be improved in terms of increased muscle strength. Further cohort or interventional studies are necessary to validate our findings. Full article

China’s rapidly aging population necessitates a sustainable social care system. Although the majority of Chinese disabled older adults live in their communities, the utilization rate of home- and community-based care (HCBC) services has been low. Moreover, family members still take the main responsibility for the care of disabled older persons and generally suffer from the stress of caregiving. To increase the use of HCBC services by disabled elderly families, this study examined which individual characteristics of both elderly individuals and their primary family caregivers were related to HCBC service use among disabled urban elderly individuals in a regional sample from the 2018 to 2019 Beijing Precise Assistance Need Survey (n = 34,153). Logistic regression was used as the baseline model, and a simultaneous equation model was established to address the jointly dependent variables. The results show that the degree of disability of disabled older adults has no significant effect on their service use, whereas their worse health status played a significant role in predicting respite care service use. Working status, a longer period of caregiving, and poor health of caregivers all significantly predict a greater likelihood of service use by elderly individuals. Caregivers with burdened feelings predicted a decrease in the likelihood of elderly individuals using services. Our findings show that primary family caregivers have an important influence on disabled elderly people’s use of HCBC services, but service use is more likely to compensate for the lack of care and expertise provided by family caregivers than to reduce caregivers’ caregiving burden. Full article

Objective: This research investigated the prospective association of serum homocysteine with lumbar bone mineral density (BMD) and the risk of osteoporosis in the Chinese population. Methods: In this cohort, 2551 Chinese individuals aged ≥50 years underwent annual health examinations. Among them, 2551, 1549, and 926 completed two, three, and more than three examinations, respectively. We used generalized estimating equations to analyze the connection between serum homocysteine and lumbar BMD. Additionally, we assessed the connection between serum homocysteine and the incidence of osteoporosis using Cox proportional hazard models. Subgroup analyses based on covariates were performed to identify important at-risk populations. Results: Participants with higher homocysteine levels showed decreased lumbar BMD compared to those with lower homocysteine levels (p-trend < 0.05). Specifically, lumbar BMD decreased by −0.002 (−0.003, −0.001) g/cm² for every standard deviation increase in log-transformed serum homocysteine. Compared to the lowest quartile of homocysteine levels, lumbar BMD decreased by −0.006 (−0.010, −0.002) g/cm² in the highest quartile in men. In smokers, lumbar BMD decreased by −0.007 (−0.012, −0.003) g/cm² in the highest quartile. During the follow-up period, 175 incidences of osteoporosis were recorded. Serum homocysteine was linked to an increased risk of osteoporosis (p-trend < 0.05). Furthermore, for every standard deviation rise in log-transformed homocysteine, the HR for osteoporosis was 1.33 (95% CI, 1.12–1.58). Conclusions: Elevated homocysteine levels may be responsible for reduced lumbar BMD in middle-aged and older Chinese people, especially men and smokers. In addition, elevated homocysteine levels may be a risk factor for the development of osteoporosis. Full article

Local governments excessively pursued an economic growth-oriented incentive system while neglecting air pollution control for a long time in China. The impacts of environmental assessment and public appeal could potentially promote environmental governance, thus reducing air pollution. Based on panel data of 30 Chinese provinces from 2003 to 2021, we obtain results using the OLS and GLS methods indicating that environmental assessment and public appeal significantly impact both local environmental governance investments and environmental legislation, with environmental legislation having a more significant effect. Compared to environmental letters and visits, environmental proposals from NPC (National People’s Congress) deputies and CPPCC (Chinese People’s Political Consultative Conference) members, as well as public online environmental concerns, have more significant positive impacts on environmental governance. Environmental governance can indeed reduce air pollution and is also affected by the personal characteristics of the officials. Officials who are in their second term or have transferred from other provinces are more willing to implement environmental governance. Older officials and those with higher education are also inclined towards environmental governance. Compared to provincial governors, the results are more significant for CCP (China’s Communist Party) secretaries. We also further perform a series of robustness tests and find that the effect still exists. The presented results provide valuable insights for the optimization of the roles of environmental assessment and public participation, contributing to reforming the environmental governance system in China. Full article

Background: Numerous studies have established a link between adverse childhood experiences (ACEs) and the development of depression in later life. However, the interactive relationships between ACEs, depression, and chronic diseases are still not well understood. In this study, the aim was to investigate the impact of ACEs on depressive trajectories among middle-aged and elderly individuals in China, as well as to examine the mediating roles of chronic diseases in this association. Methods: Data were drawn from 6921 participants aged 45 and older, using the China Health and Retirement Longitudinal Study (CHARLS) data from 2011, 2013, 2015, and 2018, combined with the 2014 life history survey. Depressive symptom scores were assessed using the widely recognized CES-D-10 scale. The trajectories of depressive symptoms were identified via group-based trajectory modeling (GBTM). The association between ACEs and depressive trajectories was analyzed using multinomial logistic regression, and the KHB method was employed to test the mediating effects of different chronic diseases. Results: The age of the 6921 participants was 57.2 ± 8.0 years, with females comprising 53.9% and males 46.1%. We found that approximately 70% of Chinese middle-aged and older adults had experienced at least one ACE, and 4.8% had experienced four or more ACEs. The following four distinct trajectories of depressive symptoms were identified: continuing-low (N = 1897, 27.4%), continuing-low-to-middle (N = 2937, 42.4%), continuing-middle-to-high (N = 1649, 23.8%), and continuing-high (N = 438, 6.3%). Compared to individuals without ACEs, those with four or more ACEs had a significantly higher likelihood of following the continuing-low-to-middle trajectory (OR = 2.407, 95%CI: 1.633–3.550), the continuing-middle-to-high trajectory (OR = 7.458, 95%CI: 4.999–11.127), and the continuing-high trajectory (OR = 20.219, 95%CI: 12.115–33.744), rather than the continuing-low trajectory. Exposure to a greater number of ACEs was associated with an increased risk of following an adverse trajectory of depressive symptoms. Multiple chronic diseases significantly mediated the relationship between ACEs and depressive trajectories, with arthritis or rheumatism exerting the largest mediating effect, followed by digestive and respiratory diseases. Conclusions: These findings indicated that ACEs were associated with a higher risk of worse depressive symptom trajectories, with different chronic diseases mediating this relationship. Therefore, developing public measures to prevent ACEs can reduce the risk of chronic diseases and depression in middle-aged and elderly people. Additionally, strengthening the prevention and management of chronic diseases in individuals exposed to ACEs may further reduce their subsequent risk of depression. Full article

Background: The demand for long-term care is increasing as the elderly population continues to grow, prompting a critical examination of care modalities. Methods: This study employs data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) to assess the relationship between informal and formal care for older people with disabilities in Beijing. The analysis employs the Probit model and incorporates the application of instrumental variable techniques and propensity score matching to ensure robustness in the results. Results: The findings highlight the important role of informal care. Conclusions: Policymakers should incorporate support policies for informal care into the overall design of the system, provide support to informal caregivers, and reduce their burden. Our research conclusions provide empirical reference for cities with similar characteristics to Beijing. Full article

Background: Influenza poses a substantial health burden, especially among older adults in China. While vaccination is one of the most effective preventions, influenza vaccine uptake rates among Chinese older adults remain low. This study examines the individual and combined effects of behavioral interventions based on the Information–Motivation–Behavioral Skills (IMB) model and economic incentives in promoting influenza vaccine uptake among older adults living in China. Methods: The study will recruit 640 older adults living in eight communities that have not been covered by the free influenza vaccination policy. These eight communities (as clusters), stratified by urban and rural, will be randomized to four parallel arms, including a usual care arm, an IMB-based behavioral intervention arm, a conditional economic incentive arm, and a combined behavioral-economic arm. The interventions will start from the beginning of the flu season and last for about one month. Specifically, the IMB-based behavioral intervention encompasses health education brochures, healthcare provider-led lectures, interactive quizzes, and personalized consultations. The exact number of economic incentives is conditional on the timing of vaccination (a higher amount for early immunization) and the number of people within a household to be vaccinated at the same appointment (a higher amount for more people). The primary outcome is the influenza vaccination rate. Data will be gathered through vaccination records and questionnaires covering IMB-based vaccination cognitions. Mixed-effects models will be used to analyze the outcome of vaccination rate, reporting difference-in-differences estimates with 95% confidence intervals. Conclusions: The results of this study have the potential to inform influenza vaccination program scaleup among older adults who are not yet covered by the free influenza vaccination policy. Ethics and dissemination: Ethics approval has been granted by the ethics commission of Peking University Health Science Centre (IRB00001052-24090). Participants will be required to sign a written consent form. Findings will be reported in conferences and peer-reviewed publications in accordance with the recommendations of the Consolidated Standards of Reporting Trials. Registration number: This study was registered at the Chinese Clinical Trial Registry (ChiCTR2400090229). Full article

Background: The Supportive and Palliative Care Indicators Tool (SPICT) was developed for identifying, in a timely manner, patients who may benefit from supportive and palliative care for better treatment review, care-plan discussion, and end-of-life care. Although the SPICT has been validated in different languages and for patients living in different settings, it has not been validated for patients receiving home-based medical care (HBMC), or in the context of using traditional Chinese characters. Objectives: The present study aimed to validate the Taiwanese version of the SPICT (SPICT-TW) and to measure its ability to predict six-month mortality in patients who received HBMC in Taiwan. Methods: Seven HBMC agents (five clinics and two hospitals) participated in this validation study. We recruited 129 patients aged ≥ 50 years who had been consistently receiving HBMC for >two months. Results: The results revealed that the SPICT-TW demonstrated similar reliability and validity compared to other language versions of the SPICT. It may be an appropriate tool for healthcare professionals to detect, in a timely manner, the needs for palliative care in older people who receive home healthcare. Furthermore, we found that a combination of four general indicators and one clinical indicator in the SPCIT-TW has the best prediction ability at predicting six-month mortality in these HBMC recipients. This multi-center study validated the SPICT-TW among HBMC recipients in Taiwan. Conclusions: The SPICT-TW demonstrated high reliability and validity through the Kuder–Richardson 20, an intraclass correlation coefficient, Cohen’s kappa, and receiver operating characteristic analysis, supporting its potential as a practical tool for identifying older adults at risk of dying within six months who have not yet received palliative care but may benefit from it. Full article