The Role of Contextual Factors in Shaping Urban Older Adults' Intention of Institutional Care in China: A Mixed-Methods Study.

BACKGROUND: This mixed-methods study explores older people's intention of institutional care and its contributing contextual factors, and the meaning given to their intention by older adults in the transitioning Chinese society. METHODS: Guided by the extended Anderson model and frameworks of the ecological theory of aging, survey data collected from 1937 Chinese older adults were used. Transcripts from six focus group interviews were analyzed to incorporate the voices of the participants. RESULTS: Community environment and services, health services, financial services, and regional service organizations were related to the institutional care intention of older people. The qualitative analysis showed that the reported conflicting feelings about institutional care was driven by the lack of supporting resources and age-friendly environment. The findings of this study suggested that the reported intention of Chinese older adults for institutional care may not be an ideal choice but a compromise or, in some cases, a forced choice. CONCLUSIONS: Rather than treating the stated institutional intention as a simple expression of older Chinese people's likes or desires, the intention of institutional care should be understood within a framework that fully considers the influence of psycho-social factors and contextual organizations.

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.

Neighborhood Effects on the Health of Chinese Older Adults: Beyond the Rural and Urban Dichotomy.

BACKGROUND AND OBJECTIVES: The associations between physical frailty and depressive symptoms among older individuals were established in the existing literature. Taking the person-environment perspective, we argue that neighborhood environment could either buffer the stress derived from being physically vulnerable or worsen it by adding another layer of stressors in the environmental context when physical health declined. The objectives of this study were to explore to what extent the neighborhood-level characteristics moderate the relationship between physical frailty and depressive symptoms. RESEARCH DESIGN AND METHODS: Using the China Health and Retirement Longitudinal Study 2011 wave, 6,245 individuals aged 60 years and older were included for analyses. Multilevel mixed-effects models were fitted to examine the moderating effects of urbanicity and neighborhood-level socioeconomic status (SES) on the relationship between frailty and depressive symptoms among older adults, controlling for individual-level characteristics. RESULTS: Results showed a stronger relationship between deterioration in physical health and depressive symptoms in rural neighborhoods and neighborhoods with lower SES, after controlling for individual-level SES. Also, the moderating effects of the neighborhood-level socioeconomic factors remained after controlling for urbanicity, indicating that neighborhood SES works beyond the rural-urban contexts. DISCUSSION AND IMPLICATIONS: Findings from this study demonstrate the important roles of neighborhood socioeconomic characteristics in reshaping, and the need to redefine, China's rural-urban dichotomy. The findings also identified neighborhoods with low SES as potential targets for policy and practice to reduce the stress associated with health decline.