Adequate access to healthcare and added life expectancy among older adults in China.

BACKGROUND: Adequate access to healthcare is associated with lower risks of mortality at older ages. However, it is largely unknown how many more years of life can be attributed to having adequate access to healthcare compared with having inadequate access to healthcare. METHOD: A nationwide longitudinal survey of 27,794 older adults aged 65+ in mainland China from 2002 to 2014 was used for analysis. Multivariate hazard models and life table techniques were used to estimate differences in life expectancy associated with self-reported access to healthcare (adequate vs. inadequate). The findings were assessed after adjusting for a wide range of demographic factors, socioeconomic status, family/social support, health practices, and health conditions. RESULTS: At age 65, adequate access to healthcare increased life expectancy by approximately 2.0-2.5 years in men and women and across urban-rural areas compared with those who reported inadequate access to healthcare. At age 85, the corresponding increase in life expectancy was 1.0-1.2 years. After adjustment for multiple confounding factors, the increase in life expectancy was reduced to approximately 1.1-1.5 years at age 65 and 0.6-0.8 years at age 85. In women, the net increase in life expectancy attributable to adequate access to healthcare was 6 and 8% at ages 65 and 85, respectively. In men, the net increases in life expectancy were generally greater (10 and 14%) and consistent after covariate adjustments. In contrast, the increase in life expectancy was slightly lower in rural areas (2.0 years at age 65 and 1.0 years at age 85) than in urban areas (2.1 years at age 65 and 1.1 years age 85) when no confounding factors were taken into account. However, the increase in life expectancy was greater in rural areas (1.0 years at age 65 and 0.6 years at age 85) than in urban areas (0.4 years at age 65 and 0.2 years at age 85) after accounting for socioeconomic and other factors. CONCLUSIONS: Adequate access to healthcare was associated with longer life expectancy among older adults in China. These findings have important implications for efforts to improve access to healthcare among older populations in China.

A comparison of perceived uselessness between centenarians and non-centenarians in China.

BACKGROUND: Self-perceived uselessness is associated with poorer health in older adults. However, it is unclear whether there is a difference in self-perceived uselessness between centenarians and non-centenarians, and if so, which factors contributed to the difference. METHODS: We used four waves of a nationwide longitudinal dataset from 2005 to 2014 in China to investigate these research goals. We first performed multinomial logit regression models to examine the risk of the high or moderate frequency of self-perceived uselessness relative to the low frequency among centenarians (5778 persons) in comparison with non-centenarians aged 65-99 (20,846 persons). We then conducted a cohort analysis for those born in 1906-1913, examining differences in self-perceived uselessness between those centenarians and those died between ages 91 and 99 during 2005-2014. RESULTS: Compared to persons aged 65-79, centenarians had 84% (relative risk ratio (RRR) = 1.84, 95% CI:1.69-2.01) and 35% (RRR = 1.35, 95% CI: 1.25-1.46) higher risk to have the high frequency and the moderate frequency of feeling useless versus low frequency, respectively, when only demographic factors were controlled for. However, centenarians had 31% (RRR = 0.69, 95% CI: 0.54-0.88), 43% (RRR = 0.57, 95% CI: 0.49-0.68), and 25% (RRR = 0.75, 95% CI: 0.67-0.83) lower risk, respectively, to have the high frequency of self-perceived uselessness relative to the low frequency when a wide set of study covariates were controlled for. In the case of the moderate versus the low frequency of self-perceived uselessness, the corresponding figures were 18% (RRR = 0.82, 95% CI: 0.66-1.02), 22% (RRR = 0.78, 95%CI: 0.67-0.90), and 13% (RRR = 0.87, 95% CI: 0.79-0.96), respectively. The cohort analysis further indicates that those who became centenarians were 36-39% less likely than those died at ages 91-94 to report the high and the moderate frequencies of self-perceived uselessness versus the low frequency; no difference was found between centenarians and those died at ages 95-99. In both period and cohort analyses, behavioral and health-related factors affected the perception substantially. CONCLUSIONS: Overall, centenarians were less likely to perceive themselves as useless compared to non-centenarians of younger birth cohorts when a wide set of covariates were considered and non-centenarians of the same birth cohort. How centenarians manage to do so remains an open question. Our findings may help improve our understanding about the longevity secrets of centenarians.

Comparing the role of social connectivity with friends and family in depression among older adults in China: evaluating the moderating effect of urban-rural status.

Background: Social connectivity and support can reduce depressive symptoms. Few studies have examined urban-rural differences in the relationship between social support and depressive symptoms in the context of urbanization for Chinese older adults. The overall aim of this study is to examine urban-rural differences in the relationship between family support and social connectivity on depression among Chinese older adults. Methods: This cross-sectional study used data from the 2010 Sample Survey on Aged Population in Urban/Rural China (SSAPUR). Depressive symptoms were measured using the Geriatric Depression Scale short-form (GDS-15). Family support was measured by structural, instrumental, and emotional support. Social connectivity was measured using the Lubben Social Network Scale-6 (LSNS-6). Descriptive analysis was conducted using chi-square and independent t-tests to examine urban-rural differences. Adjusted multiple linear regressions were conducted to examine the moderating effect of urban-rural status on the association between types of family support and social connectivity with depressive symptoms. Results: In rural areas, respondents who felt their children exhibited filial piety (ß = -1.512, p < 0.001) and had more social connectivity with family (ß = -0.074, p < 0.001) were more likely to report fewer depression symptoms. In urban areas, respondents who received instrumental support from their children (ß = -1.276, p < 0.01), who thought their children exhibited filial piety (ß = -0.836, p < 0.01), and who had more social connectivity with friends (ß = -0.040, p < 0.01) were more likely to report fewer depression symptoms. In the fully adjusted regression model, social connectivity with family was associated with decreased depressive symptoms, although to a lesser degree among urban-dwelling older adults (urban-rural interaction effect, ß = 0.053, p < 0.05). Social connectivity with friends was similarly associated with decreased depressive symptoms, although this effect was greater among urban-dwelling older adults (urban-rural interaction effect, ß = -0.053, p < 0.05). Conclusion: The results of this study suggested that older adults both in rural and urban areas with family support and social connectivity were associated with fewer depression symptoms. Differences observed in the role of family and friend social connectivity by urban-rural status may provide practical information for developing targeted social support strategies for improving depressive symptoms among Chinese adults, and call for further mixed-methods research to disentangle mechanisms behind these differing associations.

Objective and subjective financial status and mortality among older adults in China.

The association between financial status and mortality in older adults is well documented. However, it is unclear whether the association may vary by objective and subjective indicators of financial status. To examine this issue, we used the latest four waves (2005, 2008/2009, 2011/2012, and 2014) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) of community-residing adults aged 65 and older (n = 25,954). Financial status was assessed using eight objective, subjective, and culturally-oriented measures to capture various dimensions of financial resources at older ages. Multivariate hazard models were used to examine how different indicators of financial status were associated with subsequent mortality in all older adults and by age, gender, and urban-rural residence. Results showed that higher financial status-either objective or subjective-was associated with lower risks of mortality. Subjective assessments of financial status had stronger associations with mortality than objective assessments. The patterns were generally similar between young-old (aged 65-79) and the oldest-old (aged 80+), between women and men, and between rural and urban areas. Together, the findings offer new evidence to help improve the socioeconomic gradient in mortality among older adults in China.

Mediating Effect of Social Participation on the Relationship between Incontinence and Depressive Symptoms in Older Chinese Women.

Urinary and fecal incontinence affect older women's social participation and mental health. This study examined the relationship between incontinence severity and depressive symptoms, focusing on the mediating effect of social participation, based on secondary analysis of structured interview data collected in December 2010 from 467 women age 60 and over in mainland China. Incontinence was significantly and positively associated with depressive symptoms but negatively associated with social participation. Social participation was significantly and negatively associated with depressive symptoms and fully mediated the relationship between incontinence and depressive symptoms. These findings can inform mental health interventions for incontinent older women, including preventing and responding to depressive symptoms by promoting social participation.