The effects of pension on depressive symptoms in Chinese older adults: A moderated multiple mediator model.

OBJECTIVES: This study investigates the impact of pension on depressive symptoms among Chinese older adults. Additional effort is made to test the mediating effect of multidimensional downward intergenerational support and the moderating effect of age on this relationship. METHODS: A total of 1828 Chinese older community-dwellers who met our inclusion criteria are drawn from the 2018 China Health and Retirement Longitudinal Study. Multivariate regression modeling is applied to analyze the effect of pensions on depressive symptoms of older adults. Additionally, bootstrap method with resampling strategies is used to estimate the mediating effect of three dimensions of downward intergenerational support (instrumental, emotional, and financial support). Further, Johnson-Neyman technique is employed to analysis and visualize the moderating effect of age. RESULTS: The findings reveal a significant inverse relationship between pension levels and depressive symptoms (B = -6.664, SE = 2.826, p < 0.05). The analysis shows that downward intergenerational emotional support (B = -0.195, Boot SE = 0.103, 95% Boot CI [-0.404, -0.003]) serves as a partial mediator in this relationship. Furthermore, the results highlight the moderating role of age in the linkage between pension and depressive symptoms (B = 0.065, SE = 0.039, p < 0.1). DISCUSSION: This investigation is pioneering in simultaneously assessing the mediating role of multidimensional downward intergenerational support and the moderating effect of age in the context of pension and depressive symptoms. The study underscores the necessity of an interdisciplinary approach in devising comprehensive intervention strategies. These should encompass pension policy consultation, respite services, and other crucial elements aimed at mitigating the severity or reducing the risk of depressive symptoms among the older adults.

Associated factors of discrepancy between older adults and their family caregivers in reporting elder abuse.

AIMS AND OBJECTIVES: This study focuses on elder abuse against older adults with mild-to-moderate cognitive and physical impairment who were receiving family care in Chinese context. Specifically, the study examined the associated factors of discrepancy between family caregiver and care recipient reports of elder abuse committed by the caregivers. BACKGROUND: Many studies identified the discrepancies between caregivers and care recipients reports of elder abuse, but they did not examine factors contributing to such discrepancies. Various cultural factors may contribute to the accuracy of elder abuse reports. METHODS: A consecutive sample of 1,002 older adults with mild-to-moderate cognitive and physical impairment and their family caregivers was surveyed. DESIGN: Quantitative study with cross-sectional design. RESULTS: Moderate-to-substantial agreement in caregiver and care recipient reports was found for all forms of abuse (Cohen's kappa = 0.39 to 0.76). Care recipient reports consistently generated higher rates than caregiver reports for psychological abuse (51.1% vs. 42.8%), physical abuse (1.2% vs. 1.0%), caregiver neglect (65.0% vs. 50.2%) and financial exploitation (40.8% vs. 34.2%). Similar factors were found for dyadic discrepancy in the reporting of various forms of elder abuse, which included desire to gain face, fear of losing face and sense of familism in the caregivers, as well as older age, cognitive impairment and female gender of the care recipient. This study was presented in adherence to the Strobe Checklist. CONCLUSIONS: The results suggest that family caregivers might not be reliable as the sole informants to report their care recipients' victimization experiences. Information from multiple parties should be gathered and synthesized to obtain more accurate reporting of the frequency and severity of elder abuse. Meanwhile, cultural factors should be taken into account when seeking information related to elder abuse. RELEVANCE TO CLINICAL PRACTICE: There is a need for multiple parties to provide and report information about the elder abuse. It is also need to consider cultural factors when detecting and intervening elder abuse.

Perceived Support Protects Against Negative Affective Experiences of Momentary Solitude: An Ecological Momentary Assessment Study.

OBJECTIVES: Momentary solitude (the objective state of being alone) has a strong association with negative affective experiences in older people, but little is known about how the role of social relationship characteristics on relationship between momentary solitude and affect. We examined the momentary association between momentary solitude and negative affect (NA), and whether such association was moderated by the structural and functional aspects of social relationships. METHODS: A sample of 153 late-middle-aged and older adults were recruited and provided a total of 6,742 ecological momentary assessment surveys, of which momentary solitudes were reported for 1,885 (28%) surveys. Hierarchical linear model was used to examine how social networks and social support moderated the association of momentary solitude with NA experiences. RESULTS: The association of momentary solitude with NA experiences was significant among middle-aged and older adults (b = 0.025, SE = 0.008, p < .01). Family networks had the main effect on NA. Perceived social support buffered against increased NA in momentary solitude: Individuals with a higher level of perceived support reported fewer increases in NA during momentary solitude than those perceiving a lower level of support. DISCUSSION: Momentary solitude was experienced less negatively for middle-aged and older persons embedded in a context of higher levels of perceived social support. Practitioners need to pay more attention to the promotion of social resources when delivering programs to improve the subjective well-being of late-middle-aged and older adults.

Concurrent and lagged associations of social participation and frailty among older adults.

Frailty is a pervasive symptom among the older population, and social participation is a beneficial factor of late-life well-being. However, studies on the bidirectional association between social participation and frailty are limited. This study examined the cross-sectional and lagged associations of social participation and frailty. The analytic sample contained 6865 community-dwelling older adults, with 21,141 observations, from the first four waves (2011-2018) China Health and Retirement Longitudinal Study (CHARLS). Frailty was measured by the Frailty Index (FI). Social participation was measured by the accumulation of the frequencies of six social activities. Random intercept two-level models were used to analyse the concurrent and lagged association between social participation and frailty. The results showed significantly cross-sectional associations between higher levels of frailty and lower levels of social participation in the same wave. Moreover, there was a lagged association of social participation in the prior wave with the current frailty (b = -0.001, SE = 0.001, p = 0.028), and frailty in the prior wave with the current social participation (b = -0.634, SE = 0.088, p < 0.001) even after adjusting for sociodemographic characteristics, and frailty or social participation in the prior wave. The bidirectional associations between social participation and frailty imply the necessity of enhancing social participation to prevent or slow the frailty progression, and improving the physical and social environment to reduce social participation restrictions imposed by frailty status.

The Moderation Role of Neuroticism for Anxiety among Burdened Dementia Caregivers: A Study on Care Giver-Recipient Dyads.

Caregiving burden proves to be a risk factor of anxiety disorders and anxiety affection. The current study investigates how an endogenous personality dimension - neuroticism - moderates the association between caregiving burden and anxiety affection. Between 2015 and 2017, the study deployed a cross-sectional survey of 674 (response rate = 89%) older adults who were hospitalized for dementia at two hospitals. From all primary caregivers of these patients, 661 agreed to participate in the survey which yielded 661 matched dyads as the final sample. Caregiving burden, neuroticism, and anxiety affection were each measured by established assessment instruments. We employed multivariate OLS regression to test the moderator and regressor effects. We found that care burden is a significant risk factor of higher levels of anxiety affection (ß = .17, p < .001), and accounts for 4.6% of the variance in anxiety. Neurotic personality is also significantly associated with a greater level of anxiety (ß = .26, p < .001). Neurotic personality moderates the association between anxiety and care burden (ß = .24, p < .001). Our findings suggest that social and healthcare workers should assess caregiver personality and burden as well as provide support, resources, and coping strategies to those with neurotic personality traits or high care burden in an effort to reduce anxiety among caregivers.

The Differential Impact of Multimorbidity Patterns and Subsequent Accumulation on Longitudinal Trajectories of Physical Function Decline in a Population-Based Cohort of Older People.

BACKGROUND: Although both the patterns and accumulation of multimorbidity are important for predicting physical function, studies have not simultaneously examined their impact on functional decline. This study aimed to associate multimorbidity patterns and subsequently developed conditions with longitudinal trajectories of functional decline, and it tested whether the effects of newly developed conditions on functional decline varied across distinct multimorbidity patterns. METHODS: We included 6 634 participants aged at least 60 years from the China Health and Retirement Longitudinal Survey. Latent class analysis identified multimorbidity patterns from 14 chronic conditions. Mixed negative binomial models estimated the changes in physical function measured across 4 waves as a function of multimorbidity patterns, subsequently developed conditions, and their interactions. RESULTS: Five distinct patterns were identified 3 years before Wave 1: stomach/arthritis (15.7%), cardiometabolic (6.7%), arthritis/hypertension (47.9%), hepatorenal/multisystem (18.3%), and lung/asthma (11.4%). The hepatorenal/multisystem and the lung/asthma pattern were associated with worse baseline physical function, and the hypertension/arthritis pattern was associated with greater decline of physical function. The effect of developing new conditions on decline of physical function over time was most evident for individuals from the cardiometabolic pattern. CONCLUSIONS: Considering both the combinations and progressive nature of multimorbidity is important for identifying individuals at greater risk of disability. Future studies are warranted to differentiate the factors responsible for the progression of chronic conditions in distinct multimorbidity patterns and investigate the potential implications for improved prediction of functional decline.

Impact of Subjective and Objective Sleep Quality on Peptic Ulcer Rebleeding in Older Adults.

OBJECTIVE: This study aimed to examine the association of subjective and objective sleep quality with subsequent peptic ulcer rebleeding among older patients. METHODS: Of 1196 older patients with peptic ulcer bleeding (PUB) recruited from 12 grade A hospitals in the People's Republic of China, 1106 achieved full recovery from PUB, and they were followed up for up to 30 days. Using multiple measures at 1-week intervals, patients who presented PUB symptoms were invited to have an esophagogastroduodenoscopy examination. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index. Objective sleep quality domains were measured using an accelerometer, including sleep onset latency, sleep efficiency, total sleep time, and the number of awakenings. RESULTS: This study documented a 30-day cumulative ulcer rebleeding rate of 15.3%. Multivariate analyses showed that longer sleep onset latency (hazard ratio [HR] = 2.136 [1.336-2.558]) and more nighttime awakenings (HR = 1.698 [1.169-2.666]) increased the risk of ulcer rebleeding. However, a longer total sleep time (HR = 0.768 [0.698-0.887]) and better sleep efficiency (HR = 0.795 [0.682-0.975]) protected against ulcer rebleeding. Older patients who perceived poorer sleep quality were also more likely to experience ulcer rebleeding (HR = 2.295 [1.352-3.925]). CONCLUSIONS: The present results highlight the importance of proper treatment and prevention of sleep problems in older adults after successful PUB treatment. Our results, if replicable in future studies with more rigorous design and representative samples, might shed light on the etiology of ulcer rebleeding and suggest new pathways for preventing this disease.

Association Between Caregiver Depression and Elder Mistreatment-Examining the Moderating Effect of Care Recipient Neuropsychiatric Symptoms and Caregiver-Perceived Burden.

OBJECTIVES: To examine the association between caregiver (CG) depression and increase in elder mistreatment and to investigate whether change in care recipient (CR) neuropsychiatric symptoms (NPS) and change in CG-perceived burden influence this association. METHODS: Using 2-year longitudinal data, we analyzed a consecutive sample of 800 Chinese primary family CGs and their CRs with mild cognitive impairment or mild-to-moderate dementia recruited from the geriatric and neurological departments of 3 Grade-A hospitals in the People's Republic of China. Participatory dyads were assessed between September 2015 and February 2016 and followed for 2 years. RESULTS: CG depression at baseline was associated with a sharper increase in psychological abuse and neglect. For CRs with increased NPS, having a depressed CG predicted a higher level of psychological abuse than for those CRs without NPS. For CGs with decreased burden, the level of depression was associated with a slower increase in neglect than for CGs who remained low burden. DISCUSSION: This study showed the differential impact of CG depression on the increase in elder mistreatment depending on the change in CR NPS and CG-perceived burden. The present findings provide valuable insights into the design of a systematic and integrative intervention protocol for elder mistreatment that simultaneously focuses on treating CG depression and perceived burden and CR NPS.

Longitudinal Impact of Frailty States and Sleep Duration on Subsequent Depressive Symptoms of Older Adults.

OBJECTIVES: To determine the effects of baseline and changes in frailty states on subsequent depressive symptoms, and whether sleep duration would modify these effects. DESIGN: Prospective, cohort study. SETTING: The 2011 baseline and 2013 follow-up waves of the China Health and Retirement Longitudinal Study (CHARLS). PARTICIPANTS: Community-dwelling old adults who were aged 60 or above at baseline and participated in the 2011 and 2013 waves of the CHARLS (N = 5,026). MEASUREMENTS: Frailty was measured using the physical frailty phenotype (PFP) scale. Levels of depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Using the generalized estimating equations (GEE), the effects of baseline and transitions in frailty states were examined on subsequent depressive symptoms, adjusting for a range of confounding variables. RESULTS: Baseline prefrail (b = 0.97, P < .05) and frail states (b = 0.35, P < .05) were associated with higher subsequent level of depressive symptoms 2 years later. Within individuals who were robust at baseline, transitioning into prefrail/frail (b = 3.04, P < .001) was associated with a higher subsequent level of depressive symptoms, and this association was accelerated by short sleep duration. Within individuals who were prefrail at baseline, transitioning into frail (b = 1.76, P < .001) was associated with higher subsequent levels of depressive symptoms, and this association was stronger among those who reported short sleep duration. CONCLUSION: Baseline and transitions in frailty states were significantly related with higher subsequent levels of subsequent depressive symptoms. Short sleep duration significantly moderated the effects of baseline or transitions of frailty on subsequent depressive symptoms. Targeted interventions could be implemented to improve sleep quality for prefrail and frail older adults.

Association between Caregiver Neurotic Personality Trait and Elder Abuse: Investigating the Moderating Role of Change in the Level of Caregiver Perceived Burden.

OBJECTIVES: To investigate whether caregiver neuroticism affects the level of elder abuse and whether changes of caregiver perceived burden alter this relationship. METHODS: Using 2-year longitudinal data, a consecutive sample of 800 Chinese family caregivers and their care recipients with dementia were recruited from the geriatric and neurological departments of 3 grade-A hospitals in the People's Republic of China. All the participatory dyads were assessed between September 2015 and February 2016 and followed up for 2 years. RESULTS: Significant increase in the prevalence was found for physical abuse, psychological abuse, and caregiver neglect. Caregiver neuroticism was associated with an increased level of physical and psychological abuse over the 2-year observation period; however, change in the level of caregiver perceived burden altered this association. Specifically, the absence and decrease of perceived care burden prevented an increase in the level of physical and psychological abuse among caregivers high in neuroticism. Although caregiver neuroticism was also associated with an increased level of caregiver neglect, caregiver perceived burden did not appear to have an impact on this relationship. DISCUSSION: This study provided evidence that caregiver neuroticism was associated with an increased level of physical and psychological abuse, while changes in the level of caregiver perceived burden may alter this trajectory. These findings suggest the importance of implementing caregiver-centered intervention and prevention programs for elder abuse by specifically targeting caregivers' behaviors related to their neurotic personality trait and cognitive appraisal of caregiving stressors associated with such personality traits.

Abuse of Older Persons With Cognitive and Physical Impairments: Comparing Percentages Across Informants and Operational Definitions.

This study compared percentages of elder abuse reported by older adults and their family caregivers, using reports from attending medical professionals to triangulate the reports. Percentages were also compared using different criteria proposed in the literature. In total, 1,002 older Chinese aged 55 years or above and their primary family caregivers were recruited from three leading public hospitals in Guangdong, People's Republic of China. Caregivers and care recipients were separately interviewed and provided information on their demographic characteristics and past year percentages of abuse. A clinical team including a chief physician, two attending physicians, three resident physicians, and two senior nurses provided observer measures through reviewing the medical records and their daily observations. Regardless of the informants and operational definitions used, caregiver neglect was the most commonly reported (35.4% to 65.0%), followed by psychological abuse (11.1% to 51.1%), financial exploitation (17.9% to 40.8%), and physical abuse (0.8% to 2.2%). This study found huge variations in percentages of elder abuse by different informants and operational definitions. Depending on the types of abuse concerned, different informants should be consulted to yield more reliable estimates.

Initially Negative Affect Predicts Lower Satisfaction With Future Social Contact: A Time-Lagged Analysis Using Ecological Momentary Assessment.

OBJECTIVES: Prior research has linked subjective features of social situations with short-term changes in affect (e.g., across days, hours), but little is known about the directionality of such links. Our study examined the concurrent and lead-lag relationships between social contact satisfaction and affect in the flow of daily life. METHOD: Using ecological momentary assessment (EMA), wherein 78 late-middle-aged and older adults reported on 2,739 social contacts (average 5.02 per day, SD = 2.95) across seven consecutive days, we examined how the level of social contact satisfaction was concurrently and prospectively associated with affect (high-arousal and low-arousal positive affect [PA], high-arousal and low-arousal negative affect [NA]). RESULTS: Higher contact satisfaction was concurrently associated with more high- and low-arousal PA and less high- and low-arousal NA. The influence of contact satisfaction remains for predicting greater low-arousal PA (quietness, calmness) during the next social contact. NA (either high- or low-arousal) predicted lower satisfaction during the next social contact, but such sustainable influence was not observed for PA. DISCUSSION: The study reveals a cycle in which elevated NA may trigger unsatisfactory social contact, which subsequently predicted less low-arousal PA such as quietness and calmness. Our study provided a more nuanced and differentiated picture of the temporal sequencing of everyday social contact and momentary affect. Practitioners may gain insights from our study into the development of just-in-time adaptive interventions that aim for the betterment of affective well-being in old age.

Continuous participation in social activities as a protective factor against depressive symptoms among older adults who started high-intensity spousal caregiving: findings from the China health and retirement longitudinal survey.

OBJECTIVES: Previous studies documented that caregiving affects the mental health of spousal caregivers, and social participation is a favorable contributor to late-life well-being. However, it remains unclear whether changing social participation influences caregivers' mental health during their transition into spousal caregiving. The present study investigated the influence of transitioning into spousal caregiving, continuity and changes in social participation, and their interactions on older adults' depressive symptoms over time. METHOD: Information on caregiving transitions and social participation for 2,436 baseline noncaregivers was drawn from the 2011‒2015 China Health and Retirement Longitudinal Survey. Generalized estimating equations were used for estimating the effects of caregiving transitions (transition into low-intensity caregiving, transition into high-intensity caregiving versus no caregiving) and changing social participation (increased participation, decreased participation, continuous participation versus no participation) on follow-up depressive symptoms. RESULTS: Individuals who transitioned into spousal care provision over a four-year period reported more elevated depressive symptoms than those who remained noncaregivers. Individuals who continued or increased social participation reported fewer depressive symptoms than those who reported no participation over the four-year period. Increases in depressive symptoms were less severe among individuals who maintained continuous or increased social participation when transitioning into high-intensity care provision than among their counterparts who were not continuously involved in social participation during the transition. CONCLUSIONS: Continuous social participation protected against adverse psychological consequences during the transition into high-intensity spousal caregiving. Clinical attention should be directed at supporting spousal caregivers who meet difficulties in maintaining social participation when starting a demanding caregiving role.

Association between elder abuse and telomere shortening in older adults: A 2-year prospective study.

BACKGROUNDS: Elder abuse is a public health issue associated with increased morbidity and mortality. Its impact on victims' health at the cellular level, however, remains unknown. This study assessed the association between abuse exposure and shortening of telomere length (TL), a promising molecular marker for biological aging, in older victims. SETTING: The geriatric departments of three Grade-A hospitals in the People's Republic of China (PRC). PARTICIPANTS: Six hundred Chinese older adults, including 300 abused victims and 300 non-abused controls were randomly drawn respectively from a larger sample of 467 abused and 518 non-abused older adults recruited at baseline. Participants were assessed for physical and psychological abuse exposure at baseline between September 2015 and February 2016 and assessed for TL 2 years after the abuse assessment. MEASUREMENTS: TL was quantified using a quantitative PCR method and expressed as T/S ratio (the ratio of telomere repeat copy numbers to single-copy gene numbers). Physical and psychological abuse was measured using the Revised Conflicts Tactics Scale. RESULTS: Adjusting for demographic, medical, and behavioral confounders, physical and psychological abuse exposure at baseline were independently associated with shorter TL at follow-up. The association was the most significant between multiple forms of abuse (physical and psychological) exposure and shorter TL. CONCLUSION: This study provides the first evidence on the relationship between abuse and shortened TL in older victims, implying the potential effect of elder abuse on accelerated cellular aging. The findings suggest the importance of routinely assessing and intervening abuse in older adults by healthcare professionals, to promote and maintain physical health in older adults.

Sleep duration, depression, and peptic ulcer recurrence in older patients with mild cognitive impairment.

OBJECTIVES: To examine the longitudinal association between objective measure of sleep duration and subsequent recurrence of peptic ulcer disease (PUD) in older patients with mild cognitive impairment (MCI) and the potential influence of change in the severity of depression on this association. METHOD: Older Chinese patients with MCI and Helicobacter pylori (H. pylori)-infected PUD (N = 2,208) were recruited from hospitals in the People's Republic of China between 2010 and 2014. H. pylori was eradicated and PUD cleared in 2,015 patients by the end of 2014; 1,866 of these were followed for up to 48 months. Sleep duration was measured using an accelerometer. The Kaplan-Meier method was used to assess how PUD recurrence in older patients, as confirmed with esophagogastroduodenoscopy, varied with the levels of sleep duration and change in depression. Multivariate Cox-proportional hazards models were calculated to examine the associations between sleep duration, depression, and PUD recurrence. RESULT: The present results are based on no change, a decrease, or an increase in caregiver-assessed depressive symptoms. Multivariate analyses showed that short sleep duration was associated with PUD recurrence during the 48-month follow-up period (hazard ration [HR] = 2.685; 95% confidence interval [CI: 1.622, 4.538]). Sleep duration did not affect recurrence in patients without depression (HR = 1.325; 95% CI [.878, 1.998]) or with reduced depression (HR = 1.048; 95% CI [.695, 1.581]). However in patients with unchanged or increased depression, a higher risk of PUD recurrence was found in short sleepers (HR = 1.598; 95% CI [1.042, 2.451]; HR:HR = 2.668; 95% CI [1.720, 4.083], respectively) than in medium and long sleepers. DISCUSSION: Short sleep duration is associated with a greater risk of PUD recurrence, but decrease in depression or absence of depression may alter this relationship. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impact of Social Isolation on Subsequent Peptic Ulcer Recurrence in Older Adults With Mild Cognitive Impairment: The Role of Change in Severity of Depression.

OBJECTIVE: This study aimed to examine the association between social isolation, change in severity of depression, and subsequent recurrence of peptic ulcer disease (PUD) in older adults with mild cognitive impairment. METHODS: Older adults (≥55 years) with mild cognitive impairment and Helicobacter pylori-infected PUD (N = 2208) were recruited between 2010 and 2014 from 12 hospitals in the People's Republic of China. H. pylori was eradicated and PUD was cleared in 2015 participants by the end of 2014; 1900 of these were followed up for up to 36 months. The Kaplan-Meier method was used to assess how PUD recurrence varied with social engagement levels and changes in depression severity. Multivariate Cox proportional hazard models were used to examine associations between social isolation, changes in depression severity, and PUD recurrence. RESULTS: PUD recurrence was more prevalent in socially isolated (10.8%) than in socially engaged participants (5.5%). However, the rates of PUD were lower in socially isolated individuals without (absence of) depression (7.2%) and those with decreased depression (8.2%), whereas socially isolated individuals with unchanged and increased depression had substantially higher rates of PUD (16.3% and 17.8%, respectively; the social isolation by depression group for PUD recurrence was significant (p < .001). Specifically, although social isolation was associated with PUD recurrence during the 36-month follow-up period (hazard ratio [HR] = 2.665 [1.602-4.518]), it did not increase PUD recurrence risk in participants without depression or with reduced depression. However, in participants with unchanged or increased depression, PUD recurrence was more likely to occur in socially isolated (HR = 1.587 [1.125-2.588]; HR = 1.886 [1.012, 3.522] respectively) than in socially engaged participants. CONCLUSIONS: Social isolation is associated with a greater risk of PUD recurrence; however, the absence of or decreased severity of depression may alter this relationship.

Continued social participation protects against depressive symptoms across the retirement transition: Longitudinal evidence from three waves of the China Health and Retirement Longitudinal Survey.

AIM: Social participation is an important social resource over retirement, but little is known about how changing social participation might affect mental health over retirement. This study examined the impact of retirement status, changes in social participation and their interactions on subsequent depressive symptoms over a 4-year period. METHODS: Data were obtained from the first three waves of the China Health and Retirement Longitudinal Survey. The analytical sample included 2364 individuals with different retirement statuses (remained retired, transitioned to retirement, remained working). Generalized estimating equations were used to examine the impact of retirement status, changes in social participation and their interactions on depressive symptoms. RESULTS: Compared with those who remained working, individuals who remained retired reported reduced depressive symptoms (ß = -0.64, 95% CI -1.23 to -0.05); individuals who transitioned to retirement reported elevated depressive symptoms (ß = 0.74, 95% CI 0.07 to 1.41). Relative to those who reported no participation over the study, individuals who maintained or increased social participation reported reduced depressive symptoms (ß = -1.12, 95% CI -1.67 to -0.56; ß = -1.03, 95% CI -1.90 to -0.17); individuals who decreased social participation reported elevated depressive symptoms (ß = 0.70, 95% CI 0.13-1.28). Individuals with decreased social participation were more influenced by the negative impact of transition to retirement on depressive symptoms (ß = 1.93, 95% CI 0.12-3.74). CONCLUSION: These results highlighted the time-varying effects of retirement on mental health, and continued social participation acting as an adaptive strategy to protect against depressive symptoms over time. Geriatr Gerontol Int 2019; 19: 972-976.

The relationship between comorbidities in dementia patients and burden on adult-child primary caregivers: Does having a secondary caregiver matter?

Primary family caregivers of patients with dementia often experience high caregiver burden and significant decline in a range of health outcomes. The current study examined the relationship between medical comorbidities of inpatients with dementia and caregiver burden in adult-child primary caregivers, and the buffering effect of having a secondary caregiver on the relationship between patients' comorbidities and caregiver burden. The study is a secondary analysis of data from a cross-sectional observational study design. The sample comprised 477 dyads of inpatients with dementia and adult-child primary caregivers attending the neurological department of two grade A hospitals. All the inpatients were assessed with the Charlson Comorbidity Index (CCI) and the Mini-Mental State Examination (MMSE). All the adult-child primary caregivers were assessed with the Zarit Burden Interview (ZBI) and completed the questionnaires on socio-demographic data, caring hours, presence of secondary caregiver, and the level of impairment of the patient. Higher burden was associated with higher scores on the CCI and having a spouse of the patient as the secondary caregiver. A significant interaction occurred between the CCI and caregiver burden when having a spouse as the secondary caregiver, indicating the negative effect of the CCI on caregiver burden was greater when the spouse of the patient served as the secondary caregiver. In summary, the negative impact of patients' comorbidities on caregiver burden in adult-child primary caregivers was heightened when the secondary caregiver role was undertaken by the spouse of the patient with dementia. These results may inform programmes targeted to improve care arrangements for people with dementia and their caregivers.

Effect of Subjective and Objective Sleep Quality on Subsequent Peptic Ulcer Recurrence in Older Adults.

OBJECTIVE: To examine the effect of subjective and objective sleep quality on subsequent recurrence of peptic ulcer disease (PUD) among older patients after Helicobacter pylori eradication. SETTING: Eight grade A hospitals in China. PARTICIPANTS: Of 1689 older Chinese with H. pylori-infected PUD recruited between January 2011 and October 2014, H. pylori were eradicated and PUD was cleared in 1538 patients by the end of 2014; 1420 of these patients were followed up for up to 36 months. MEASUREMENTS: Using multiple measures at 6-month intervals, PUD recurrence was determined with esophagogastroduodenoscopy. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index. Objective sleep quality domains were measured using an accelerometer, including sleep onset latency, sleep efficiency, total sleep time, and number of awakenings. RESULTS: This study documented a 36-month cumulative PUD recurrence of 8.3% (annual rate = 2.8%). Multivariate analyses showed that participants who reported poorer sleep quality were more likely to experience PUD recurrence during the 36-month follow-up period (hazard ratio [HR] = 1.895; 95% confidence interval [CI] = 1.008-3.327). Regarding objective sleep quality domains, longer sleep onset latency (HR = 1.558; 95% CI = 1.156-2.278) and more nighttime awakenings (HR = 1.697; 95% CI = 1.168-2.665) increased the risk of PUD recurrence. However, a longer total sleeping time protected against PUD recurrence (HR = 0.768; 95% CI = 0.699-0.885). CONCLUSIONS: Poor sleep quality predicts a greater risk of PUD recurrence. Accurate diagnosis and effective treatments should, therefore, be provided for older adults afflicted with poor sleep, particularly for those who previously had PUD. It is equally important to include sleep assessment as an integral part while dealing with these patients.

Association between depression and subsequent peptic ulcer occurrence among older people living alone: A prospective study investigating the role of change in social engagement.

OBJECTIVE: To examine whether baseline depression predicts subsequent peptic ulcer disease (PUD) in older people living alone and whether social engagement plays a role in such an association. METHODS: Between May 2010 and May 2015, 2, 850 older people living alone were recruited from eight Grade-A hospitals in the People's Republic of China and followed for up to 36 months. The Kaplan-Meier method was used to investigate how the incidence of PUD varied with depression and social engagement status. Multivariate Cox proportional hazards models were estimated to examine the association between depression and incidence of PUD and assess the role of social engagement in this relationship. RESULTS: Kaplan-Meier curves indicated that the 36-month cumulative incidence of PUD was higher in depressed (10.1%) than non-depressed participants (5.3%). However, among the depressed participants, increased or continued social engagement reduced the incidence to 6.2% and 7.9%, respectively. Multivariate analyses showed that baseline depression was associated with subsequent PUD development (hazard ratio [HR] = 2.520, 95% confidence interval [CI]: 1.525-3.356). The incidence of PUD was similar in non-depressed and depressed participants who reported increased (HR = 1.956, 95% CI: 0.913-3.374) or continued social engagement (HR = 1.827, 95% CI: 0.918-3.690) during the follow-up period. However, depressed participants who reported decreased (HR = 2.485, 95% CI: 1.459-3.295) or no social engagement (HR = 2.896, 95% CI: 1.817-4.228) were more likely to develop PUD than those without depression. CONCLUSIONS: Baseline depression was associated with subsequent incidence of PUD, but this association appears to be reduced by increased or continued social engagement.