Longitudinal health behaviour patterns among adults aged ≥50 years in China and their associations with trajectories of depressive symptoms.

OBJECTIVES: Against the background of the growing recognition of the need for a holistic perspective on health behaviour, we aim to identify longitudinal patterns of multiple health behaviours, and to assess associations of such patterns with depressive symptoms among older people in China. METHODS: Using three waves of China Health and Retirement Longitudinal Study data (n = 8439), we performed latent class growth analyses (LCGAs) to identify longitudinal patterns of multiple health behaviours. Random-effects models were estimated to assess associations between health behaviour patterns and depressive symptoms. RESULTS: The best fitting LCGA model had seven classes: (1) connected active non-smokers (average posterior probability: 21.8%), (2) isolated active non-smokers (24.7%), (3) isolated inactive non-smokers (17.0%), (4) isolated active smokers (14.5%), (5) connected active smokers (12.2%), (6) increasingly connected and active non-smokers (5.4%), and (7) moderately connected inactive smokers (4.4%). Depressive symptoms were highest in the four classes with lower probabilities of social participation across waves. No evidence was found of change over time in depressive symptomatology gaps between people with different health behaviour trajectories. CONCLUSION: Health behaviour patterns characterized by consistently low social participation were associated with raised depressive symptomatology, suggesting that focusing on social participation may benefit later-life mental health promotion strategies.

Associations of Social Cohesion and Socioeconomic Status with Health Behaviours among Middle-Aged and Older Chinese People.

Background: An understanding of factors associated with health behaviours is critical for the design of appropriate health promotion programmes. Important influences of social cohesion, education, and income on people's health behaviours have been recognised in Western countries. However, little is known about these influences in the older Chinese population. Objective: To investigate associations of social cohesion and socioeconomic status (SES) with health behaviours among middle-aged and older adults in China. Methods: We used data from the World Health Organization's Study on Global AGEing and Adult Health. Logistic regression and multivariate linear regression were performed. Results: Participants who reported greater social cohesion were more likely to have adequate vegetable and fruit (VF) consumption, be socially active, and less likely to smoke daily, but were not physically more active; participants with lower education levels were less likely to have adequate VF consumption and be socially active, and more likely to smoke daily; higher incomes were associated with decreased odds of daily smoking, increased odds of adequate VF consumption, increased likelihood to be socially active, but also less likelihood to have sufficient physical activity (PA). Associations of social cohesion and SES with health behaviours (smoking, PA, and VF consumption) differed between men and women. Discussion: Our findings are an essential step toward a fuller understanding of the roles of social cohesion and SES in protecting healthy behaviours among older adults.

The longitudinal relationship between income and social participation among Chinese older people.

The vital role of active social participation in older people's lives is widely acknowledged. The maintenance of adequate levels of social participation is an essential element of successful aging. Low income may inhibit older people from engaging in social activities. Given its recent rapid economic growth, China provides a unique setting for the study of changes in income and social participation among older people over time. In this study, the longitudinal relationship between income and social participation among Chinese older people was investigated using a nationally representative dataset from three waves of the China Health and Retirement Longitudinal Study (CHARLS). At baseline, a total of 3863 participants with a mean age of 60.4 years (range: 50-89) were included in our study; 49.9% of the participants were female, and 64.4% lived in rural areas. Generalized estimating equations were used to analyze the longitudinal relationship between income and social participation, with and without adjustment for background variables (age, gender, marital status, educational level, empty-nest status, area of residence, and multimorbidity). The results of unadjusted and adjusted analyses clearly showed a longitudinal association between income and social participation. People from the highest income group were almost two times more likely to participate in social activities than were those from the lowest income group. People with a higher educational level are also more likely to participate in social activities compared to people with a lower educational level. Being married and living with children decreased the odds of social participation. Social participation is also less likely among older aged and those living in rural areas. Our findings indicate that higher income levels are associated positively with social participation over time among older people in China.

Social participation is an important health behaviour for health and quality of life among chronically ill older Chinese people.

BACKGROUND: Health behaviours (physical activity, maintenance of a healthy diet and not smoking) are known to be beneficial to the health and well-being of chronically ill people. With China's ageing population and increased prevalence of people with chronic diseases, the improvement of unhealthy behaviours in this population has become crucial. Although recent studies have highlighted the importance of social participation for health and quality of life (QoL) among older people, no study to date has included social participation along with more traditional health behaviours. Therefore, this study aimed to identify associations of multiple health behaviours (social participation, physical activity, maintenance of a healthy diet and not smoking) with health and QoL outcomes (including cognitive and physical function) among chronically ill older adults in China. METHODS: For this nationally representative cross-sectional study, wave 1 data from the World Health Organization's Study on global AGEing and adult health (China) were examined. In total, 6629 community-dwelling older adults (mean age, 64.9 years) with at least one chronic disease were included. Multivariate linear regression analyses were used to evaluate associations of health behaviours with health and QoL outcomes while controlling for background characteristics. RESULTS: Greater social participation was associated with better QoL [ß = 0.127, standard error (SE) = 0.002, p < 0.001], cognitive function (ß = 0.154, SE = 0.033, p < 0.001) and physical function (ß = - 0.102, SE = 0.008, p < 0.001). Physical activity was associated with better QoL (ß = 0.091, SE = 0.015, p < 0.001) and physical function (ß = - 0.155, SE = 0.062, p < 0.001). Sufficient fruit and vegetable consumption was associated with better QoL (ß = 0.087, SE = 0.015, p < 0.001). CONCLUSIONS: Our findings suggest that social participation is an important health behaviour for quality of life and cognitive function among chronically ill older people in China. Health promotion programmes should expand their focus to include social participation as a health behaviour, in addition to physical activity, maintenance of a healthy diet and not smoking.

How Prevalent Are Implausible EQ-5D-5L Health States and How Do They Affect Valuation? A Study Combining Quantitative and Qualitative Evidence.

BACKGROUND: When designing a valuation study, a criterion that has been used for selecting health states for direct valuation is whether the health states are plausible for respondents, because it is assumed that inclusion of implausible states would compromise data quality. OBJECTIVES: To understand which health states are implausible, and how their values differ from the values of the plausible counterparts. METHODS: One thousand six hundred Chinese students valued all 3125 health states of the 5-level EuroQol 5-dimensional questionnaire (EQ-5D-5L) using the EuroQol visual analogue scale. Of these, 890 students also indicated whether each valued state was implausible or not using a binary scale. Additional qualitative interviews were conducted concerning the thought processes involved in the valuation of implausible states. We calculated an implausible score for each state. Then we examined the effect of implausibility on visual analogue scale values by fitting 2 regression models. Two independent researchers analyzed the qualitative transcripts using thematic analysis. RESULTS: Approximately 30% of the EQ-5D-5L health states were rated as implausible by at least 50% of the respondents, but there was substantial heterogeneity in views about the plausibility of EQ-5D-5L states. Health states with dimensions that conflicted were more likely to be judged as implausible states. Health states that respondents deemed as implausible were more difficult to value and had lower values. CONCLUSIONS: When respondents found the EQ-5D states to be implausible, they tended to give them lower values. Nevertheless, completely excluding implausible states from a valuation study is not possible because there is a lack of agreement among respondents on which states are implausible.

Risk factors and protective factors associated with incident or increase of frailty among community-dwelling older adults: A systematic review of longitudinal studies.

INTRODUCTION: Frailty is one of the greatest challenges facing our aging population, as it can lead to adverse outcomes such as institutionalization, hospitalization, and mortality. However, the factors that are associated with frailty are poorly understood. We performed a systematic review of longitudinal studies in order to identify the sociodemographic, physical, biological, lifestyle-related, and psychological risk or protective factors that are associated with frailty among community-dwelling older adults. METHODS: A systematic literature search was conducted in the following databases in order to identify studies that assessed the factors associated with of frailty among community-dwelling older adults: Embase, Medline Ovid, Web of Science, Cochrane, PsychINFO Ovid, CINAHL EBSCOhost, and Google Scholar. Studies were selected if they included a longitudinal design, focused on community-dwelling older adults aged 60 years and older, and used a tool to assess frailty. The methodological quality of each study was assessed using the Quality of Reporting of Observational Longitudinal Research checklist. RESULTS: Twenty-three studies were included. Significant associations were reported between the following types of factors and frailty: sociodemographic factors (7/7 studies), physical factors (5/6 studies), biological factors (5/7 studies), lifestyle factors (11/13 studies), and psychological factors (7/8 studies). Significant sociodemographic factors included older age, ethnic background, neighborhood, and access to private insurance or Medicare; significant physical factors included obesity and activities of daily living (ADL) functional status; significant biological factors included serum uric acid; significant lifestyle factors included a higher Diet Quality Index International (DQI) score, higher fruit/vegetable consumption and higher tertile of all measures of habitual dietary resveratrol exposure; significant psychological factors included depressive symptoms. CONCLUSIONS: A broad range of sociodemographic, physical, biological, lifestyle, and psychological factors show a longitudinal association with frailty. These factors should be considered when developing interventions aimed at preventing and/or reducing the burden associated with frailty among community-dwelling older adults.

Higher Incidence of Deteriorated Mental Health in Older People Being Mistakenly Labeled as Dementia: A Two-Year Consecutive Community-Dwelling Study in Shanghai, China.

Dementia has been increasingly paid attention by policymakers in China. However, the majority of the public has an indistinct concept of dementia and its diagnostic criteria. Therefore, many abnormal characteristics and actions of older people are labeled as having dementia while diagnosed without dementia. We examined a multi-stage cluster sample of 11,223 participants aged 60 years and above who have been clinically confirmed by general practitioners as not having dementia in 2013, and 7,861 participants were willing to participate the following study and were followed-up in 2014. To assess the differences of status of older people who were mistakenly labeled as having dementia or not, we asked main caregivers 'Do you think this older person suffers from dementia?', and found out that 244 participants had been mistakenly labeled as having dementia since 2013. Related effects were measured using international generic scales as well, and the results showed that participants with better physical status deteriorated more rapidly if they were mistakenly labeled as having dementia. Additionally, the mental health of these 244 participants also deteriorated more quickly. Older adults that were not labeled as having dementia were more willing to participate in social activities relative to their labeled counterparts. In conclusion, being mistakenly labeled as having dementia without a medical diagnosis impaired older adults' physical functioning and mental health. Moreover, the reduction of social activities of labeled older people leads to separation and social exclusion.