Probabilistic linguistic fuzzy cognitive maps: applications to the critical factors affecting the health of rural older adults.

BACKGROUND: Achieving healthy ageing has become the only way for China to alleviate the pressure of ageing, especially in rural areas. However, the factors affecting the health of rural older adults are numerous and complex. It is important to identify the critical factors that affecting the health of older adults in rural areas and provide decision-making support for targeted health interventions. METHODS: To overcome some limitations of existing works, an extended probabilistic linguistic fuzzy cognitive map model is proposed in this paper as a useful tool for modeling the cause-effect relationship between factors. The proposed model integrates the advantages of probabilistic linguistic term sets and fuzzy cognitive maps. In the end, to rank and identify the critical factors affecting the health, a novel similarity measure based on Euclidean distance and Z-mapping function is proposed. RESULTS: The proposed model can effectively deal with the uncertainty of experts and reflect different opinions of groups well. In terms of representing uncertainty and ambiguity, the proposed method outperforms other models in modeling complex systems. In the real-world case analysis, we find that education is the most important factor affecting the health of rural older adults, followed by previous occupational experiences, psychology, and physical exercise, among other things. Intergenerational relationship has become another important factor affecting the health of rural older adults in China as the development of Chinese society. CONCLUSIONS: From a macro perspective, social economic status, living environment, lifestyle, and health management, are the variables that have the greatest impact on the health of rural older adults. As a result, providing more precise health interventions with the characteristics of factors influencing health is a crucial guarantee for preserving and improving the health of rural older adults in China.

Hearing loss, depression, and medical service utilization among older adults: evidence from China.

OBJECTIVES: To acquire a better understanding of the mechanisms underlying the association between hearing loss and medical service utilization, this study examined the relationship between hearing loss, depression, and medical service utilization. STUDY DESIGN: Using the methods of probability proportional to size, a survey conducted in 28 provinces, 150 countries/districts, 450 villages/urban communities, 11,628 households, and 19,816 individuals of China in 2018. METHODS: The data for this article were derived from the 2018 China Health and Retirement Longitudinal Study, which enrolled 14,455 people aged 50-80 years. Hearing loss was determined using self-reported hearing status. Self-reported outpatient visits in the last month and hospitalization within the last year were used to determine medical service utilization. Depression was obtained from the CES-D-10 scale. Logistic regression and stepwise regression methods were used. RESULTS: Older adults with hearing loss problems used significantly more outpatient care services (odds ratio [OR] = 1.292, 95% confidence interval [CI] 1.152, 1.449; P < 0.001) and inpatient care services (OR = 1.238, 95% CI 1.021, 1.501; P < 0.05) than those without hearing loss problems. Following that, individuals with hearing loss problems were more likely to experience depressive symptoms (OR = 1.467, 95% CI 1.345, 1.599; P < 0.001) than those without. Moreover, respondents with depressive symptoms used outpatient care services at a significantly higher rate (OR = 1.292, 95% CI 1.152, 1.449; P < 0.001) and inpatient care service at a significantly higher rate (OR = 1.238, 95% CI 1.021, 1.501; P < 0.05) compared with those without depressive symptom. CONCLUSION: This article discovered that depression acted as a mediation variable in the relationship between hearing loss and medical service utilization. This research provided possible interventions for reducing the burden of the healthcare system and society that older adults with hearing loss imposed.

The effect of religious belief on Chinese elderly health.

BACKGROUND: With the accelerated ageing of the population in China, the health problems of elderly people have attracted much attention. Although religious belief has been shown to be a key way to improve the health of elderly people in various studies, little is known about the causal relationship between these variables in China. This paper explores the effect of religious belief on the health of elderly people in China, which will provide an important reference for China to achieve healthy ageing. METHODS: Balanced panel data collected between 2012 and 2016 from the China Family Panel Studies (CFPS) were used. Health was assessed using self-rated health, and religious belief was measured by whether the respondents believed in a religion. The DID+PSM method was employed to solve the endogeneity problem caused by self-selection and omitted variables. In addition, the CESD score (replacing self-rated health) and different matching methods (the method of PSM after DID method) were used to perform the robustness test. RESULTS: The results show that religious belief has no significant effect on the health of elderly people. With the application of different matching methods (one-to-one matching, K-nearest neighbour matching, radius matching and kernel matching) and replacing the health indicator (the CESD score) with the above matching methods, the results are still robust. CONCLUSION: In China, religious belief plays a limited role in promoting "healthy ageing", and it is difficult to improve the health of elderly people only via religious belief. Therefore, except for focusing on the guidance of religion with regard to healthy lifestyles, multiple measures need to be taken to improve the health of elderly people.

The comparison of healthcare utilization inequity between URRBMI and NCMS in rural China.

BACKGROUND: The inequity of healthcare utilization in rural China is serious, and the urban-rural segmentation of the medical insurance system intensifies this problem. To guarantee that the rural population enjoys the same medical insurance benefits, China began to establish Urban and Rural Resident Basic Medical Insurance (URRBMI) nationwide in 2016. Against this backdrop, this paper aims to compare the healthcare utilization inequity between URRBMI and New Cooperative Medical Schemes (NCMS) and to analyze whether the inequity is reduced under URRBMI in rural China. METHODS: Using the data from a national representative survey, the China Health and Retirement Longitudinal Study (CHARLS), which was conducted in 2015, a binary logistic regression model was applied to analyze the influence of income on healthcare utilization, and the decomposition of the concentration index was adopted to compare the Horizontal inequity index (HI index) of healthcare utilization among the individuals insured by URRBMI and NCMS. RESULTS: There is no statistically significant difference in healthcare utilization between URRBMI and NCMS, but in outpatient utilization, there are significant differences among different income groups in NCMS; high-income groups utilize more outpatient care. The Horizontal inequity indexes (HI indexes) in outpatient utilization for individuals insured by URRBMI and NCMS are 0.024 and 0.012, respectively, indicating a pro-rich inequity. Meanwhile, the HI indexes in inpatient utilization under the two groups are - 0.043 and - 0.028, respectively, meaning a pro-poor inequity. For both the outpatient and inpatient care, the inequity degree of URRBMI is larger than that of NCMS. CONCLUSIONS: This paper shows that inequity still exists in rural areas after the integration of urban-rural medical insurance schemes, and there is still a certain gap between the actual and the expected goal of URRBMI. Specifically, compared to NCMS, the pro-rich inequity in outpatient care and the pro-poor inequity in inpatient care are more serious in URRBMI. More chronic diseases should be covered and moral hazard should be avoided in URRBMI. For the vulnerable groups, special policies such as reducing the deductible and covering these groups with catastrophic medical insurance could be considered.

Hearing loss, depression and social participation of older adults: Evidence from the China health and retirement longitudinal study.

AIM: Hearing loss and depression in older adults are associated with a lower social participation rate. However, few studies have thoroughly analyzed the relationship between them. METHODS: The data were obtained from the China Health and Retirement Longitudinal Study carried out in 2011, 2013 and 2015, and data from 24 306 participants ranging in age from 50 to 80 years were used in this study. Hearing loss, depression and social participation were assessed by self-reported hearing status, the 10-item Center for the Epidemiological Studies of Depression Short Form, and self-reported social participation activity types and frequency. The fixed effects logistic regression and random effects logistic regression were used to examine the relationship between hearing loss and social participation. The Sobel method was used to explore the relationship between hearing loss, depression and social participation. RESULTS: Compared with older adults without hearing loss, persons with hearing loss engaged in significantly fewer types of activities (ß = -0.070, 95% CI -0.109, -0.031, P < 0.001) and at a lower frequency (ß = -0.176, 95% CI -0.260, -0.093, P < 0.001). Depression significantly existed in the relationship between hearing loss and social participation as a mediating variable, and the percentage of indirect effects in this relationship were 16.5% and 20.8%. CONCLUSIONS: The findings of this study suggest that when facing an aging society, improving the hearing status of older adults should be considered by policymakers. More efforts should be made to help older adults cope with depression. Geriatr Gerontol Int 2022; 22: 529-535.