Risk of Sleep Problems in Middle-Aged and Older Adults Experiencing Bodily Pains: Serial Multiple Mediation Estimates of Emotional Distress and Activity Limitations.

OBJECTIVES: Pain is increasingly becoming common among middle-aged and older adults. While research on the association between pain characteristics and sleep problems (SP) is limited in low- and middle-income countries, the underlying mechanisms of the association are poorly understood. This study examines the association of bodily pain intensity and pain interference with SP and investigates the mediating role of activity limitation and emotional distress in this association. METHODS: We analyzed population-based data, including 1,201 individuals aged ≥50 (mean [SD] age 66.14 [11.85] years) from the 2016-2018 AgeHeaPsyWel-HeaSeeB study in Ghana. Multiple OLS regressions and serial multiple mediation modeling using bootstrapping analyses examined direct and indirect effects from pain to SP through activity limitation and emotional distress. RESULTS: Regressions demonstrated that pain intensity and interference were significantly associated with higher levels of activity limitation, emotional distress, and SP (range: ß = 0.049-0.658). Bootstrapping analysis showed that activity limitation and emotional distress serially mediated the relationship between pain intensity and SP (total effect: ß = 0.264, Bootstrap 95% confidence interval [CI] = 0.165-0.362; direct effect: (ß = 0.107, Bootstrap 95% CI = 0.005-0.210; total indirect effect: ß = 0.156, Bootstrap 95% CI = 0.005-0.210) accounting for ∼59%. Activity limitation and emotional distress mediated pain interference and SP association (total effect: ß = 0.404, Bootstrap 95% CI = 0.318-0.490; direct effect: ß = 0.292, Bootstrap 95% CI = 0.201-0.384; and total indirect effect: ß = 0.112, Bootstrap 95% CI = 0.069-0.156) yielding ∼28%. CONCLUSION: Our data suggest that activity limitation and emotional distress may convey stress-related risks of pain on SP. Future research should evaluate if activity limitation and emotional distress could be effective targets to reduce the effect of pain on sleep in later-life.

Associations of multimorbidity with body pain, sleep duration, and depression among middle-aged and older adults in China.

BACKGROUND: Multimorbidity, body pain, sleep disturbance, and depression are major clinical and public health challenges. This paper aimed to examine the associations of multimorbidity with body pain, sleep duration, and depression; and whether the associations varied by socioeconomic status. METHODS: Data was derived from four waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS), including participants aged 45 years and older in 2011. 12 physical non-communicable diseases and 1 mental chronic disease were used to measure multimorbidity. Educational attainment and annual per-capita household consumption expenditure were employed as proxies for socioeconomic status. RESULTS: Of the 16,931 participants aged 45 + years old, the proportion of people with multimorbidity was 37.87% at baseline. The number of multimorbidity increased with older age and higher socioeconomic status. Multimorbidity was associated with more body pain (incidence rate ratio (IRR) = 1.53, 95% CI = 1.45-1.61), and decreased sleep duration (ß = -0.26, 95% CI = -0.36--0.15). Furthermore, multimorbidity was associated with increased depression risks (odds ratio (OR) = 1.54, 95% CI = 1.44-1.64, adjusted for sociodemographic variables), with the mediating effects of the number of body pain and sleep duration. The associations between multimorbidity and depression persisted among different socioeconomic groups. CONCLUSIONS: Multimorbidity was associated with increased body pain, decreased sleep duration, and further led to increased depression risks. It is necessary to pay attention to the multimorbidity of middle-aged and older adults, relieve their body pain, guarantee sufficient sleep, so as to reduce depression risks.

Revisiting the association between grandparenting and mental health in China: New evidence from the harmonized CHARLS.

BACKGROUND: In the context of the global aging challenge, an increasing number of middle-aged and older adults (MAOAs) are engaging in grandparenting. However, the effect of grandparenting on the mental health of caregivers has shown inconsistent findings. To effectively promote healthy aging, it is imperative to adopt a comprehensive perspective and employ a rigorous approach to further investigate the relationship between these two social phenomena. METHODS: The data from the Harmonized China Health and Retirement Longitudinal Study were analyzed, focusing on MAOAs with at least one grandchild. Mental health assessments used the center for epidemiologic studies depression scale scale. The study employed a series of difference-in-differences (DID) models, especially complemented by propensity score matching, to evaluate the average treatment effect for the treated (ATT) on mental health of caregivers, considering covariates like personal and family characteristics. The intervention perspective includes both the provision and cessation of grandparenting. RESULTS: The study found that providing grandchildren care does not have a significant effect on the mental health of grandparents, in comparison to those who have never engaged in such care (ATT = -0.172, T = 0.65, p = 0.517 in the PSM-DID model). Furthermore, ceasing this care also appears to have no substantial effect on the mental health of the caregivers, relative to individuals who have consistently offered grandchildren care (ATT = 0.060, T = 0.26, p = 0.795 in the PSM-DID model). Furthermore, subsequent robustness analyses consistently supported these findings, even when considering data from different survey waves. CONCLUSIONS: In contrast to many prior studies that have reported either positive or negative effects, our research reveals that grandparenting exerts no significant effect on the mental health of MAOAs. Consequently, health practitioners and policymakers should carefully consider the diverse cultural context when tailoring interventions and support strategies.

Relationship between self-esteem and quality of life in middle-aged and older patients with chronic diseases: mediating effects of death anxiety.

BACKGROUND: Many studies have explored the relationship between self-esteem and quality of life. However, few studies have elucidated the mechanisms underlying the relationship between self-esteem and quality of life in middle-aged and older patients with chronic diseases. The present study aimed to explore the mediating role of death anxiety in this relationship. METHODS: Middle-old-aged patients with chronic diseases were selected as the respondents by using a multi-stage sampling method, random number table method from October 2021 to February 2022 in the Second Affiliated Hospital of Zhejiang University School of Medicine. The Cumulative Disease Rating Scale, the Self-Esteem Scale (SES), the Chinese version of the Death Anxiety Scale (CT-DAS), and the Simplified version of the Quality of Life Scale (SF-12) were used as the researching tools to conduct the survey. SPSS26.0 was used to analysis data. AMOS 23.0 software was used to construct structural equation modeling. RESULTS: 294 valid questionnaires were collected. There were significant differences in quality of life among middle-aged and elderly patients with chronic diseases who have different physical activities, socialization, and chronic pain (P < 0.01); Self-esteem was positively associated with quality of life (r = 0.330, P < 0.01), self-esteem was negatively associated with death anxiety (r = -0.222, P < 0.01), and death anxiety was negatively associated with quality of life (r = -0.263, P < 0.01); Death anxiety partially mediated the relationship between self-esteem and quality of life, with the mediating effect accounting for 18.40% of the total effect. CONCLUSION: Death anxiety partially mediates the relationship between self-esteem and quality of life. Interventions to improve self-esteem and reduce death anxiety should be used to improve the quality of life of middle-aged and senior patients with chronic diseases.

Associations between eating alone, its transition and depressive symptoms among Chinese middle-aged and older adults: evidence from two national cohorts.

BACKGROUND: Few studies have explored the longitudinal association between eating alone and depressive symptoms, and have focused on the effect of eating alone transition. This study aims to explore the longitudinal association between eating alone, its transition and depressive symptoms among two national surveys using a cohort study design. METHODS: The participants aged ≥ 45 years were recruited for the 2016 to 2018 waves China Family Panel Data (CFPS) and 2015 to 2018 waves China Health and Retirement Longitudinal Study (CHARLS). Eating alone was assessed by self-reported. Depressive symptoms were evaluated by Center for Epidemiologic Studies Depression Scale. Cox hazard regression was used to explore the associations between eating alone, its transition and depressive symptoms after adjusting for covariates. RESULTS: A total of 21,476 participants were included in this study. The Cox model showed that compared with commensality, eating alone was associated with a higher risk of depressive symptoms, both in the CFPS, CHARLS and pooled analysis. In addition, compared with commensality consistently, the transition from commensality to alone and eating alone consistently were associated with a higher risk of depressive symptoms. The sensitivity analyses showed that the association remained robust. CONCLUSIONS: Eating alone and a change from commensality to eating alone were associated with higher risks of depressive symptoms among Chinese middle-aged and older adults in two cohorts. This study suggested that providing eating partners may be an effective intervention method to prevent depressive symptoms in middle-aged and older adults.

Socioeconomic status and depression in later life: longitudinal mediation effects of activities of daily living.

BACKGROUND: Socioeconomic status (SES) is associated with both depression and activities of daily living (ADL and IADL). However, the role of ADL as a biological mechanism in the relationship between SES and late-life depression, examined through longitudinal data, remains understudied. This study explored the longitudinal mediation effects of basic ADL or IADL on the SES-depression link in older adults. METHODS: Data from the China Health and Retirement Longitudinal Study (N = 4104) were utilized. Mediation analysis was performed using parallel process latent growth curve modeling. RESULTS: The average age of participants was 57.76 years, and 55.7% being females. Significant linear growth over time was observed in ADL, IADL, and depression. Adjusting for covariates, SES was positively linked to the initial levels (intercepts) of ADL (ßiADL=-0.100[-0.143, -0.057]), IADL (ßiIADL=-0.140[-0.185, -0.095]), and depression (ßiDEP=-0.103[-0.158, -0.048]). However, SES showed no significant correlation with the rate of change (slopes) in ADL, IADL, or depression (P > 0.05). The intercepts of ADL (ßiDEP = 0.566[0.503, 0.629]) and IADL (ßiDEP = 0.607[0.544, 0.670]) were positively correlated with the depression intercept but negatively with the depression slope. Conversely, the slopes of ADL and IADL were positively associated with the depression slope. These results suggest a negative indirect relationship between SES and the initial level of depression, but a positive indirect relationship with the rate of increase in depression through ADL (or IADL) intercept. CONCLUSIONS: Higher SES is associated with a lower initial risk of depression and ADL difficulties. However, this same higher SES may relate to a faster increase in ADL difficulties and depression among middle-aged and older adults. The findings underscore the need for increased governmental healthcare funding and improved healthcare accessibility. Additionally, maintaining adequate sleep and physical activity can help prevent disability and reduce depression risk later in life, particularly among older adults with lower SES.

Internet use and frailty in middle-aged and older adults: findings from developed and developing countries.

BACKGROUND: With increasing trend of internet use in all age groups, whether internet use can prevent frailty in middle-aged and older adults remains unclear. METHODS: Five cohorts, including Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS), the Survey of Health, Ageing and Retirement in Europe (SHARE), English Longitudinal Study of Aging (ELSA), and Mexican Health and Aging Study (MHAS), were used in this study. Internet use, social isolation, and frailty status was assessed using similar questions. The Generalized estimating equations models, random effects meta-analysis, COX regression, and mediation analysis were utilized. RESULTS: In the multicohort study, a total of 155,695 participants were included in main analysis. The proportion of internet use was varied across countries, ranging from 5.56% in China (CHARLS) to 83.46% in Denmark (SHARE). According to the generalized estimating equations models and meta-analysis, internet use was inversely associated with frailty, with the pooled ORs (95%CIs) of 0.72 (0.67,0.79). The COX regression also showed that participants with internet use had a lower risk of frailty incidence. Additionally, the association was partially mediated by social isolation and slightly pronounced in participants aged 65 and over, male, not working for payment, not married or partnered, not smoking, drinking, and not co-residence with children. CONCLUSIONS: Our findings highlight the important role of internet use in preventing frailty and recommend more engagements in social communication and activities to avoid social isolation among middle-aged and older adults.

Association between City-Level Particulate Matter Exposure and Frailty among Middle-Aged and Older Adults in China.

INTRODUCTION: The effects of exposure to particulate matter and frailty, as well as its exposure-response relationship, have not been effectively explored. This study aimed to explore the association between long-term exposure to particulate matter and frailty state and each dimension in Chinese middle-aged and older adults, in addition to the exposure-response relationship. METHODS: The data were obtained from the National Urban Air Quality Real-Time Dissemination Platform and China Health and Retirement Longitudinal Study (CHARLS). Frailty was measured by a frailty index containing 39 indicators. Annual averages of seven pollutants were calculated from hourly monitoring data. We used multilevel regression modeling to explore the association between long-term exposure to particulate matter and frailty. Meanwhile, we explored the exposure-response relationship based on a multilevel generalized summation model. We performed a sensitivity analysis using a multi-pollution model and a quantile-based g-computation (QGC) model. RESULTS: A total of 15,611 participants were included in the analysis. We find that long-term exposure to PM2.5 was associated with an increased risk of pre-frailty and frailty (all p < 0.05). PMc and PM10 exhibited similar associations. The exposure-response relationship between PM2.5 showed a linear relationship, whereas the exposure-response relationship between PM10, PMc showed a nonlinear relationship. Elevated PM2.5 concentrations showed significant positive associations with the number of chronic disease score, IADL score, and functional limitation status score (all p < 0.05). PM10 and PMc showed similar positive correlations. These results remained robust after sensitivity analyses using a multi-pollution model and QGC model. CONCLUSION: Chronic exposure to particulate matter was significantly associated with increased risk of frailty. The exposure-response relationship between PM2.5 concentration and frailty showed a linear relationship, and the exposure-response relationship between PM10 and PMc showed a nonlinear relationship. Exposure to a mixture of pollutants carried a higher risk of frailty than exposure to a single pollutant.

Association of perceived childhood socio-economic status and health with depressive symptoms among middle-aged and older adults in India: using data from LASI Wave I, 2017-2018.

BACKGROUND: Childhood adverse experience has been linked with poor health outcomes across the life course. Nevertheless, whether such an association or direction could be projected to older people's life remains still unclear and needs to generate more evidence, particularly in India. Therefore, this study was conducted to examine the association of childhood socio-economic status and health with depressive symptoms amongst middle- aged and older adults in India. METHODS: The data for the study was drawn from national representative survey "Longitudinal Ageing Study in India (LASI)" Wave I, 2017-2018 in order to conduct cross-sectional study. Multivariable regression analysis was used to examine the association of childhood socioeconomic status and health with depressive symptoms in the older population. RESULTS: Poor childhood health was significantly and positively associated with depressive symptoms (AoR: 1.56, CI: 1.19, 2.04). Likewise, respondents who were bedridden for a month during their childhood had high odds of developing depressive symptoms (AoR: 1.16 CI: 1.01, 1.34). In addition to this, the odds of having depressive symptoms increased significantly among the average (AoR: 1.28 CI: 1.08, 1.51) and poor childhood socioeconomic status group (AoR: 1.31 CI: 1.11, 1.55) as compared to the higher socioeconomic category. CONCLUSIONS: Childhood socioeconomic status and health have a significant role in determining mental health in later life. Results suggest that considering childhood socioeconomic status and health is important while diagnosing depression in older population in order to identify the significant associated factors in early childhood and thus help in preventing depressive symptoms in later life.

Association between physical frailty, circadian syndrome and cardiovascular disease among middle-aged and older adults: a longitudinal study.

BACKGROUND: Physical frailty (PF) and circadian syndrome (CircS) are proposed as novel risks for cardiovascular disease (CVD), but little attention is paid to their combined impact on CVD. This study aimed to investigate the association of PF, CircS and CVD in middle-aged and older adults. METHODS: The sample comprised 8512 participants aged at least 45 years from the China Health and Retirement Longitudinal Study (CHARLS) 2011. PF was examined by the physical frailty phenotype scale. CircS was assessed by the components of the International Diabetes Federation (IDF) MetS plus short sleep duration and depression. The cut-off for CircS was set as ≥ 4. CVD was defined as the presence of physician-diagnosed heart disease and/or stroke. A total of 6176 participants without CVD recruited from CHARLS 2011 and were followed up in 2018. RESULTS: The prevalence of CVD in total populations, neither CircS or PF, PF alone, CircS alone and both CircS and PF were 13.0%, 7.4%, 15.5%, 17.4%, and 30.2%, respectively. CircS was more likely to be PF [OR (95%CI): 2.070 (1.732 ∼ 2.472)] than those without CircS. Both CircS alone [OR (95% CI): 1.954 (1.663 ∼ 2.296)], and coexisting CircS and PF [3.508 (2.739 ∼ 4.494)] were associated with CVD. Longitudinal analysis showed that individuals with both CircS and PF (HR: 1.716, 95%CI: 1.314 ∼ 2.240) and CircS alone [1.520 (1.331 ∼ 1.737)] were more likely to have new onset CVD than neither CircS or PF peers. CONCLUSION: PF and CircS together are associated with higher CVD risk, which provided new evidence for a strong relation that warrants attention to assessing PF and CircS and in community to promote healthy aging.

Total life expectancy and disability-free life expectancy and differences attributable to cigarettes' smoking among Chinese middle-aged and older adults.

OBJECTIVES: Middle-aged and older adults smoking for years are afflicted by smoking-related diseases and functional limitations; however, little is known about the effect of smoking on nonfatal conditions in middle and later life. This study aims to investigate the impact of smoking on both total life expectancy (TLE) and disability-free life expectancy (DFLE) and the variations in such effects by educational level in China. METHODS: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), 2011-2018, with a total sample of 16,859 individuals aged 45 years or older involved in the final analysis. The Activities of Daily Living (ADL) scale was used to measure disability, and the population-based multistate life table method was used to estimate the differences in TLE and DFLE by smoking status and educational attainment. RESULTS: At baseline, 28.9% of participants were current smokers, 8.5% were former smokers, and 62.6% never smoked. Approximately 5.6% were identified with ADL disability. Both current smokers and former smokers experienced lower TLE and DFLE than never smokers, and such differences were particularly prominent among men. Intriguingly, former smokers manifested a lower DFLE for both sexes and a lower TLE among women, though a longer TLE among men, compared with current smokers. Similar differences in TLE and DFLE by smoking status were observed for groups with different levels of education. CONCLUSION: Never smokers live longer and healthier than current smokers and persons who quit smoking. Smoking was associated with greater reductions in TLE and DFLE among men. However, educational attainment might not moderate the adverse effect of smoking on both fatal and nonfatal conditions in the context of China. These findings have implications for disability prevention, aged care provision and informing policies of healthy aging for China and elsewhere.

Childhood intra- and extra-familial maltreatment and later-life trajectories of depressive symptoms: evidence from China.

BACKGROUND: Both late-life depression and childhood maltreatment have become major global public health issues, given their prevalence and social-economic and health consequences. However, previous studies have solely focused on the relationship of childhood maltreatment to average levels of depressive symptoms. The current study addresses this gap of knowledge by simultaneously examining the impacts of childhood intra- and extra-familial maltreatment on age trajectories of depressive symptoms in later life in the Chinese context. METHODS: Hierarchical linear models were applied to data from the China Health and Retirement Longitudinal Study (2011-2018, N = 12,669 individuals aged 45 to 80, comprising N = 43,348 person-years). Depressive symptoms were measured by the CES-D-10 scale. Childhood intra-familial maltreatments were measured by physical abuse and emotional neglect, while extra-familial maltreatment was measured by peer bullying. All analyses were conducted separately by gender in Stata 16. RESULTS: Childhood extrafamilial peer bullying (ß = 1.628, p < 0.001), and intrafamilial physical abuse (ß = 0.746, p < 0.001) and emotional neglect (ß = 0.880, p < 0.001) were associated with higher later-life depressive symptoms levels in the whole sample. Peer bullying differences in depressive symptoms widened with age for both men and women. Physical abuse differences in depressive symptoms remained stable over the life course among men but increased among women. Emotional neglect differences in depressive symptoms decreased with age among men, while it increased first and then decreased among women. CONCLUSIONS: Findings in this study suggest that childhood maltreatment is not only associated with later-life poorer mental health but contributes to increasing inequalities in mental health as people age, especially among peer-bullying victims and women.

Longitudinal association between the dynamic nature of depression with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH).

BACKGROUND: Depression is associated with an increased risk of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). Whether the dynamic nature of depression affects the incidence of LUTS/BPH remains unknown. A four-year cohort study based on the China Health and Retirement Longitudinal Study (CHARLS) was conducted to assess their association. METHODS: This study included 3433 Chinese men from the CHARLS 2011, representative of > 95 million individuals. All eligible individuals underwent three assessments of LUTS/BPH and depression in 2011, 2013 and 2015. The dynamic nature of depression was classified as acute depression with remission, acute depression with recurrence, or chronic major depression. Weighted, generalized additive analyses with three binomial models were used to investigate the relationship between LUTS/BPH and the dynamic nature of depression. RESULTS: During the four-year follow-up, 11.5% (95% confidence interval [95% CI] = 9.5-13.3%) of Chinese men were diagnosed with newly incident LUTS/BPH. Meanwhile, there were 60.6% (95% CI = 58.5-62.7%) of the individuals without depression and 8.9% (95% CI = 7.9-10%) of the individuals with chronic major depression. A total of 25.1% (95% CI = 23.4-26.9%) and 5.4% (95% CI = 4.6-6.3%) of the individuals were categorized as acute depression with remission and recurrence. After weighted, adjusted all included confounding risk factors, chronic major depression (RR = 1.63, 95% CI = 1.14-2.33, P < 0.01) but not acute depression with remission (RR = 1.2, 95% CI = 0.92-1.56, P = 0.18) and recurrence (RR = 1.32, 95% CI = 0.82-2.10, P = 0.26) significantly increased the incidence of LUTS/BPH compared with no depression. The subgroup analysis showed that the above relationships appeared to be evident among Chinese men < 60 years. CONCLUSIONS: Our results suggest that the dynamic nature of depression has a different effect on the incidence of LUTS/BPH. The monitoring and treatment of depression are important in preventing LUTS/BPH.

Association between socioeconomic status and post-stroke depression in middle-aged and older adults: results from the China health and retirement longitudinal study.

INTRODUCTION: Post-stroke depression (PSD) is a common neuropsychiatric complication that affects approximately one-third of stroke patients. The treatment and prognosis of this disease are poor. Socioeconomic status (SES) is closely related to health outcomes; however, only a few previous studies have focused on the association between SES and PSD. Given the substantial population of stroke patients in China, it is crucial to examine the potential risk factors associated with PSD. Conducting studies on this population and investigating the influence of economic conditions can provide valuable guiding theoretical insights into PSD prevention and management. METHODS: We used data from the 2018 China Health and Retirement Longitudinal Study and selected appropriate samples for analysis. Depression was estimated using the Center of Epidemiologic Studies Depression Scale-10, a validated tool for assessing depression in the general population. Multiple logistic regression analysis was employed to assess the association between SES and PSD and to evaluate any urban-rural differences. RESULTS: Of the 749 respondents, 370 (49.4%) had depression. Stroke patients with a middle school education demonstrated a greater risk of developing depression than those with a primary school education or below after adjusting for all control variables (odds ratio (OR) = 1.60, 95% confidence interval (CI): 1.03-2.51, P = 0.036). However, stroke patients with a high school education or above had a lower risk of developing depression than those with a primary school education or below (OR = 0.50, 95% CI: 0.28-0.88, P = 0.016). In rural areas, stroke patients with a high school or above education level had lower rates of depression than those with a primary school education or below (OR = 0.44, 95% CI: 0.21-0.91, P = 0.027). This difference was not significant in urban areas. CONCLUSIONS: SES significantly influences the occurrence of PSD, which is reflected by education attainment and annual household expenditures. Education attainment was an independent influence on PSD, with a more pronounced effect in rural versus urban areas. We hope to reduce the prevalence of PSD and enhance the comprehensive management of this disease by modifying the influencing factors. Sex, self-reported health status, activities of daily living, night-time sleep duration, and life satisfaction also influenced the occurrence of PSD.

Changes in frailty and depressive symptoms among middle-aged and older Chinese people: a nationwide cohort study.

BACKGROUND AND AIMS: The older people bears a severe burden of disease due to frailty and depressive symptoms, however, the results of association between the two in the older Chinese people have been conflicting. Therefore, this study aimed to investigate the developmental trajectories and interactions of frailty and depressive symptoms in the Chinese middle-aged and older adults. METHODS: The study used four waves of data from 2011, 2013, 2015 and 2018 in the China Health and Retirement Longitudinal Study (CHARLS) database, focused on middle-aged and older people ≥ 45 years of age, and analyzed using latent growth models and cross-lagged models. RESULTS: The parallel latent growth model showed that the initial level of depressive symptoms had a significant positive predictive effect on the initial level of frailty. The rate of change in depressive symptoms significantly positively predicted the rate of change in frailty. The initial level of frailty had a significant positive predictive effect on the initial level of depressive symptoms, but a significant negative predictive effect on the rate of change in depressive symptoms. The rate of change in frailty had a significant positive predictive effect on the rate of change in depressive symptoms. The results of the cross-lagged analysis indicated a bidirectional causal association between frailty and depressive symptoms in the total sample population. Results for the total sample population grouped by age and gender were consistent with the total sample. CONCLUSIONS: This study recommends advancing the age of concern for frailty and depressive symptoms to middle-aged adults. Both men and women need early screening and intervention for frailty and depressive symptoms to promote healthy aging.

Trends in the prevalence of social isolation among middle and older adults in China from 2011 to 2018: the China Health and Retirement Longitudinal Study.

BACKGROUND: Epidemiological studies have shown that social isolation, which is prevalent in older adults, is associated with a range of adverse health outcomes, but the prevalence of and trends in regard to social isolation remain ambiguous in China. The aim of this study was to elucidate the trends regarding the prevalence of social isolation among middle-aged and older adults in China from 2011 to 2018 and to further identify associated risk factors. METHODS: A repeated cross-sectional study, The data were derived from panel sample data of four waves conducted from May 2011 to August 2018 in the nationally representative China Health and Retirement Longitudinal Study (CHARLS) using multistage probability sampling. Social isolation was ascertained by the five item Steptoe Social Isolation Index. The potential covariates were demographic characteristics, lifestyle factors, and health status. Linear-by-linear association was used to assess the trends in regard to social isolation over time under the influence of the potential covariates. Linear-by-linear association and an age-period-cohort analysis were used to explore the trends, and two-level (time, individual) generalized estimating equation models (GEE) linked multivariate binary logistic regression were performed to identify risk factors. RESULTS: A high prevalence of social isolation and a moderate upward trend from 2013 to 2018 were observed among a U-shaped trend prevalence of social isolation from 2011 to 2018 across China, with rates of 38.09% (95% CI = 36.73-39.45) in 2011, 33.66% (32.32-35.00) in 2013, 39.13% (37.59-40.67) in 2015, and 39.95% (38.59-41.31) in 2018 (p < 0.001). The prevalence of social isolation increased with age and educational attainment. Females had a higher prevalence than males. The prevalence of social isolation was found to be significantly lower in pensioners than in non-pensioners between 2011 and 2018 (p < 0.001). The prevalence of social isolation was 38.9%, 34.9%, 38.5%, and 44.08% about three times higher among those who doid not use the Internet and 13.44%, 11.64%, 12.93%, and 16.73% than among those who doid in 2011, 2013, 2015 and 2018 respectively. The participants with short (0-5 h) and long sleep (9 or more hours), and poor self-rated health had a higher prevalence of social isolation than the others. Older age, lower educational attainment, living in a rural region, lack of medical insurance or pension, lack of internet use and poor health were risk factors (p < 0.05). CONCLUSIONS: We found a U-shaped prevalence of social isolation trends from 2011 to 2018 and revealed increasing trends from 2013 to 2018 among middle-aged and older adults in China. The findings of the study highlight the urgent need for interventions to reduce social isolation including improving sleep quality and internet skills. Disadvantaged groups in terms of age, economic status, and health status should be the focus of such interventions, especially in the era of COVID-19.

Predictive role of depressive symptoms on frailty and its components in Chinese middle-aged and older adults: a longitudinal analysis.

BACKGROUND: To investigate the cross-sectional and longitudinal associations between depressive symptoms and the prevalence of frailty and its components in a nationally representative sample of middle-aged and older Chinese adults. METHOD: The China Health and Retirement Longitudinal Study (CHARLS) provided data on 2581 (after inclusion and exclusion criteria) adults aged ≥ 45 years. Every two years, face-to-face, computer-aided personal interviews (CAPI), and structured questionnaires were used to follow up with the respondents. The Chinese version of the Center for Epidemiologic Studies-Depression Scale (CES-D) was used to evaluate depressive symptoms, and the Fried criteria were used to measure frailty. The odds ratio (OR) and 95% confidence interval (CI) for the association of exposure (depressive symptoms at baseline) with the onset of the outcome (frailty and its components) in the individuals at baseline were analyzed by binary logistic regression. RESULTS: At baseline, 11.62% of participants had frailty, and 57.92% had depressive symptoms. In the cross-sectional analysis, depressive symptoms (OR = 5.222, 95%CI 3.665-7.442) were associated with frailty. In the longitudinal analysis, after adjusting for the full set of covariates among participants free of baseline frailty, depressive symptoms were significantly associated with incident frailty during the short term (OR = 2.193, 95%CI 1.324-3.631) and the long term (OR = 1.926, 95%CI 1.021-3.632). Meanwhile, depressive symptoms were associated with an increased risk of weakness (OR = 1.990, 95%CI 1.250-3.166), slowness (OR = 1.395, 95%CI 1.044-1.865), and exhaustion (OR = 2.827, 95%CI 2.150-3.719) onset during the short-term. Depressive symptoms were associated with an increased risk of exhaustion (OR = 2.869, 95%CI 2.004-4.109) onset during the long-term. CONCLUSION: Among middle-aged and older adults, depressive symptoms could predict frailty during 2 years of follow-up and 4 years of follow-up. When considering potential confounding factors, depressive symptoms were considered a predictor of weakness, slowness, and exhaustion. Interventions aimed at preventing depressive symptoms may be beneficial in reducing frailty and its components.

Association of dietary behavior patterns of middle-aged and older adults with their obesity metabolic phenotype: a cross-sectional study.

BACKGROUND: Middle-aged and elderly individuals are the most susceptible groups for metabolic diseases, with their dietary behaviors being significant influencing factors. Exploring the association between overall dietary behaviors and obesity metabolic phenotypes is crucial for early prevention and control of chronic diseases, precision treatment and personalized interventions. METHODS: We conducted a cross-sectional study of 15,160 middle-aged and older adults between June 2019 and August 2021 to collect information on their body mass index (BMI), biochemical indices and disease history. The population was classified into four categories by the criteria of obesity metabolic phenotypes: metabolically healthy non-obesity (MHNO), metabolically unhealthy non-obesity (MUNO), metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). Scores were calculated based on compliance with healthy eating behavior patterns (appropriate or light dietary taste, moderately soft and hard food, slightly hot food temperature, medium or slow eating speed, daily intake of dietary supplements and eating with others), and the population was categorized into subgroups 0-2 (did not meet and met only 1 or 2), 3-4 (met 3 or 4), 5-6 (met 5 or 6). The relationship between dietary behavior patterns and different obesity metabolic phenotypes in middle-aged and elderly people were analyzed by multi-categorical logistic regression model. RESULTS: Compared with the 5-6 subgroup, the dietary behavior patterns of 0-2 and 3-4 scores were risk factors for MUNO, MHO and MUO (P < 0.05), and the lower the scores of the dietary behavior patterns, the higher the multiplicity of the occurrence of MUNO, MHO and MUO, especially for females and adults between 45-60 years old. Appropriate or light dietary taste, moderately soft and hard food, and slightly hot food temperature were protective factors for MUNO and MUO (P < 0.05); medium or slow eating speed and daily intake of dietary supplements were protective factors for MUNO, MHO and MUO (P < 0.05). CONCLUSION: Dietary behavior patterns in middle-aged and older adults are associated with different obesity metabolic phenotypes, and healthy dietary behaviors may be beneficial for the prevention and control of MUNO, MHO and MUO.

The impact of chronic diseases on the health-related quality of life of middle-aged and older adults: the role of physical activity and degree of digitization.

BACKGROUND: The incidence of chronic diseases is on the rise worldwide, with a high mortality rate in China, posing a serious threat to the health-related quality of life (HRQoL) of middle-aged and older adults. This study explores the association between chronic diseases and the HRQoL of middle-aged and older adults, as well as the role of physical activity (PA) and degree of digitization in this relationship. METHODS: The data used in this study was obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which included 13,620 middle-aged and older Chinese adults (≥ 45 years). The study utilized correlation analysis, and bootstrapping to investigate the mediating role of PA and the moderating influence of the degree of digitization. Data analysis was conducted using SPSS 26.0. RESULTS: The study findings indicate that the severity of chronic disease has a significant negative predictive effect on HRQoL (PCS, physical component summary; MCS, mental component summary) (PCS: ß = -2.515, p < 0.01, MCS: ß = -0.735, p < 0.01). Further analysis revealed that PA plays a mediating and masking role in the impact of chronic disease on PCS and MCS. Additionally, the degree of digitization moderates the relationship between chronic disease and PA, chronic disease and PCS, and PA and PCS. CONCLUSION: For middle-aged and older persons, chronic diseases have a detrimental effect on their HRQoL; nevertheless, PA can help. Furthermore, proper internet usage can help older individuals to some extent in mitigating the negative impact of chronic diseases. Therefore, it is encouraged to promote PA among the elderly with chronic diseases to improve their physical health, as well as to guide them in the proper use of the Internet to establish healthy behaviors.

Changes in gender disparities of depressive symptoms among middle-aged and older adults in China: an age-period-cohort analysis.

PURPOSE: Depression is one of the most common mental disorders and substantially decreases socioemotional well-being and health-related quality of life. Analyzing temporal patterns in depressive symptoms can reveal emerging risks that require attention and have implications for mental health promotion. The present study disentangled age, period, and cohort (APC) effects on trends in depressive symptoms and their gender disparities among China's nationally representative samples of middle-aged and older adults. METHODS: Using four-wave data (2011, 2013, 2015, and 2018) from the China Health and Retirement Longitudinal Study (N = 65455), APC effects were quantified based on the hierarchical APC model. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to measure depressive symptoms. RESULTS: Depressive symptoms increased during late life and stabilized after reaching an advanced age. After further adjusting for individual characteristics, depressive symptoms exhibited a negative trend with advancing age. The mean levels of depressive symptoms remained stable during the study period. Depressive symptoms varied significantly across cohorts, with those born in 1949-1951 having the most severe depressive symptoms. Significant life-course and cohort variations existed in the gender gaps in depressive symptoms. Although women had higher mean scores on the CES-D-10 scale throughout the life course, the gender gaps in depressive symptoms gradually narrowed with age, as depressive symptoms decreased more rapidly among women. A widening trend in gender gaps in depressive symptoms was found among those born after the mid-1950s, mainly driven by a notable decline in depressive symptoms among men CONCLUSIONS: The convergence of living conditions between genders in late life, as a result of traditional Chinese culture, may have narrowed the gender gap in depressive symptoms. However, given the widening gender disparities in depressive symptoms among younger cohorts, more attention should be paid to women's mental health in the context of China's rapid socioeconomic development.