Association between living arrangements and health risk behaviors among the Hakka older adults in Fujian, China.

BACKGROUND: Behavioral lifestyles are important social determinants of health. The impact of changes in living arrangements on behavioral lifestyles is currently under-explored. This study aims to examine the association between living arrangements and health risk behaviors among the Hakka older adults. METHODS: Data were extracted from China's Health-Related Quality of Life Survey for Older Adults 2018. Living arrangements were divided into five categories: living alone, living with spouse only, living with child, mixed habitation, and others. Five health risk behaviors, including unhealthy dietary patterns, drinking, smoking, irregular sleep practices, and physical inactivity were measured. Logistic regression analysis was used to assess the association between living arrangements and specific health risk behaviors, and generalized linear models were established to test the association between living arrangements and the number of health risk behaviors. RESULTS: A total of 1,262 Hakka older adults were included in this study. Compared to those living alone, those living with spouse only were less likely to have unhealthy dietary patterns (OR = 0.45, P < 0.05) and drinking (OR = 0.50, P < 0.05), those living with the child were less likely to experience unhealthy dietary patterns (OR = 0.35, P < 0.001), drinking (OR = 0.32, P < 0.001), smoking (OR = 0.49, P < 0.05), and physical inactivity (OR = 0.13, P < 0.01). Moreover, those who were living with child (ß = -0.78, P < 0.001) or mixed habitation (ß = -0.33, P < 0.05) tended to engage in fewer health risk behaviors than those living alone. CONCLUSIONS: This study suggests significant differences in health risk behaviors among the Hakka older adults with different living arrangements. Living with the child could reduce the occurrence of health risk behaviors in the Hakka older adults and thus maintain their health status.

Adherence Behaviors and Related Factors Among Elderly Hypertensive Patients in China: Evidence from the China Health and Retirement Longitudinal Study.

Background: Non-adherence or partial adherence is the main reason for poor therapeutic effect of hypertension. This paper aims to assess adherence behaviors and related factors among elderly hypertensive patients in China. Methods: Participants aged ≥60 years, with hypertension, and with complete data in 2018 interviews of the China Health and Retirement Longitudinal Study (CHARLS) were included. The adherence behaviors included medication, blood pressure monitoring and the combined adherence behaviors. Referring to the social-ecological theory, correlates of adherence behaviors were divided into three layers, namely demographic characteristics, health behaviors, living environment and retirement. Univariate and multivariable logistic regression models were performed to identify factors of adherence behaviors. Results: The prevalence of medication adherence (76.58%) was higher than that of blood pressure monitoring adherence (20.08%), and the full adherence rate was 18.53%. Self-rated health status, smoking status, living area, and health education status were detected to be associated with medication adherence and blood pressure monitoring adherence (all p < 0.05). Gender, sleep duration, health examination, and physical exercise were also detected to be associated with blood pressure monitoring adherence (all p < 0.05). Self-rated health status and health education status were detected to be associated with partially and fully adherence, while age, living area, and life satisfaction were detected to be associated with partially adherence, smoking status, sleep duration, health examination, and pension reliance were detected to be associated with fully adherence (all p < 0.05). Conclusion: Our study reveals the poor adherence behaviors of elderly hypertensive patients in China. This is most evident among those who were male, 60-69 years old, living in rural areas, self-reported being healthier, those without health examination and health education. Targeting these vulnerable populations, we suggest to strengthen health education, increase the publicity of basic public health services and enhance the self-management ability of hypertensive patients.

Gender differences in the relationship between loneliness and health-related behavioral risk factors among the Hakka elderly in Fujian, China.

Introduction: To explore gender differences in the relationship between loneliness and health-related behavioral risk factors (BRFs) among the Hakka elderly. Methods: Loneliness was measured by the UCLA Loneliness Scale Short-form (ULS-8). Seven BRFs were examined. Mann-Whitney U, Kruskal-Wallis, and post hoc tests were conducted to compare the differences in ULS-8 scores among the Hakka elderly with different BRFs. Generalized linear regression models were employed to examine the associations of specific BRF and its number with the ULS-8 scores among the Hakka elderly in male, female, and total samples. Results: Physical inactivity (B = 1.96, p < 0.001), insufficient leisure activities participation (B = 1.44, p < 0.001), unhealthy dietary behavior (B = 1.02, p < 0.001), and irregular sleep (B = 2.45, p < 0.001) were positively correlated with the ULS-8 scores, whereas drinking (B = -0.71, p < 0.01) was negatively associated with the ULS-8 scores in the total sample. In males, insufficient leisure activities participation (B = 2.35, p < 0.001), unhealthy dietary behavior (B = 1.39, p < 0.001), and irregular sleep (B = 2.07, p < 0.001) were positively associated with the ULS-8 scores. In females, physical inactivity (B = 2.69, p < 0.001) and irregular sleep (B = 2.91, p < 0.001) was positively correlated with the scores of ULS-8, while drinking (B = -0.98, p < 0.05) was negatively associated with the ULS-8 scores. More BRFs were significantly related to greater loneliness (p < 0.001). Conclusion: There are gender differences in the relationship between loneliness and BRFs among the Hakka elderly, and individuals with more BRFs were more likely to feel loneliness. Therefore, the co-occurrence of multiple BRFs requires more attention, and integrated behavioral intervention strategies should be adopted to reduce the loneliness of the elderly.

Socio-Demographic Factors Associated with Rural Residents' Dietary Diversity and Dietary Pattern: A Cross-Sectional Study in Pingnan, China.

There is limited evidence regarding the factors correlated with dietary diversity (DD) and dietary pattern (DP) in rural residents of China. This study aims to identify the DD and DP of rural residents and their association with socio-demographic factors. A cross-sectional survey was conducted in Pingnan, China. The Food Frequency Questionnaire (FFQ) was applied to evaluate dietary intake. Latent class analysis (LCA) was used to identify patterns of six food varieties, including vegetables-fruits, red meat, aquatic products, eggs, milk, and beans-nuts. Generalized linear models and multiple logistic regression models were used to determine factors associated with the DD and DP. Three DPs were detected by LCA, namely "healthy" DP (47.94%), "traditional" DP (33.94%), and "meat/animal protein" DP (18.11%). Females exhibited lower DD (ß = -0.23, p = 0.003) and were more likely to adhere to "traditional" DP (OR = 1.46, p = 0.039) and "meat/animal protein" DP (OR = 2.02, p < 0.001). Higher educational levels and annual household income (AHI) were positively associated with higher DD (p < 0.05) and less likely to have "traditional" DP and "meat/animal protein" DP (p < 0.05). Non-obese people exhibited higher DD (ß = 0.15, p = 0.020) and were less likely to have "meat/animal protein" DP (OR = 0.59, p = 0.001). Our study reveals that females, those with lower educational levels and AHI, and obese people are more likely to have a lower DD and are more likely to adhere to "traditional" DP and "meat/animal protein" DP. The local, regional, and even national performance of specific diet-related health promotion measures and interventions must target these vulnerable populations to improve a healthier DD and DP.

Loneliness Status and Related Factors among the Hakka Elderly in Fujian, China: Based on the Health Ecological Model.

There are few studies estimating the loneliness of the Hakka elderly in China. This study aims to examine the loneliness status and related factors among the Hakka elderly in Fujian, China. The short-form UCLA Loneliness Scale (ULS-8) was used to assess the loneliness of the Hakka elderly. Factors associated with loneliness were classified as individual indicators, behavioral indicators, interpersonal indicators, and social indicators according to the health ecological model (HEM). Hierarchical linear regression models were established to identify the main factors that were most predictive of loneliness. A sample of 1,262 Hakka elderly people was included in this study. Females (ß = 0.631, P=0.012), those with ≥2 chronic diseases (ß = 1.340, P < 0.001), those who were currently living in rural areas (ß = 4.863, P < 0.001) or suburban areas (ß = 2.027, P < 0.001), those with parents both died (ß = 0.886, P=0.001), and those with the Urban Employees Basic Medical Insurance (UEBMI; ß = 0.852, P=0.030) obtained a higher score of ULS-8. Those exercised regularly (ß = -2.494, P < 0.001), those had leisure activities (ß = -1.937, P < 0.001), those ate healthy (ß = -1.270, P < 0.001), and those with better self-rated financial status and higher education level received a lower score of ULS-8. There are differences in loneliness among different Hakka elderly population subgroups, and healthy behaviors and lifestyles may reduce the loneliness of the Hakka elderly. Relevant interventions should be implemented in a targeted manner, focusing on susceptible populations. This is most evident among those who were female, living in rural areas, with parents both died, with lower education, and with multiple chronic diseases.