Leisure activities and cognitive impairment in old age: The role of life course socioeconomic status.

In the current literature on cognitive function, life course socioeconomic status (SES) and engaging in leisure activities are often viewed as parallel measures of cognitive reserve that independently affect cognitive impairment in old age. Some studies also suggest that leisure activity mediates the effect of SES on cognitive impairment. What is less examined is the modification effect of SES on the association between engaging in leisure activities and cognitive impairment, especially from a life course perspective. In this study, we focus on the interaction effects of specific measures of SES and leisure activities on cognitive impairment.We use data from the Chinese Longitudinal Healthy Longevity Survey, which includes five waves of interviews with adults aged 65 and older between 2002 and 2014. Cognitive impairment is measured by the Chinese version of the Mini-Mental Status Examination. Childhood and adulthood SES and participation in seven leisure activities are included in this analysis. We adopt a lagged independent variable approach and the Generalized Linear Mixed Model to conduct the analysis.Findings confirm that higher SES in both childhood and adulthood are associated with low levels of cognitive impairment in the older Chinese population. Furthermore, there are significant interaction effects between specific life course SES and leisure activities with a consistent pattern: Those of higher life course SES enjoy extra benefits from engaging in leisure activities.The findings point to a modification mechanism that connects life course SES, leisure activities, and cognitive health inequality among older adults.

Air pollution, economic development of communities, and health status among the elderly in urban China.

In Western societies, the impact of air pollution on residents' health is higher in less wealthy communities. However, it is not clear whether such an interaction effect applies to developing countries. The authors examine how the level of community development modifies the impact of air pollution on health outcomes of the Chinese elderly using data from the third wave of the Chinese Longitudinal Health Longevity Survey in 2002, which includes 7,358 elderly residents aged 65 or more years from 735 districts in 171 cities. The results show that, compared with a 1-point increase in the air pollution index in urban areas with a low gross domestic product, a similar increase in the air pollution index in areas with a high gross domestic product is associated with more difficulties in activities of daily living (odds ratio = 1.41, 95% confidence interval (CI): 1.09, 1.83), instrumental activities of daily living (linear coefficient = 0.98, 95% CI: 0.58, 1.37), and cognitive function (linear coefficient = 2.67, 95% CI: 1.97, 3.36), as well as a higher level of self-rated poor health (odds ratio = 2.20, 95% CI: 1.68, 2.86). Contrary to what has been found in the West, Chinese elderly who live in more developed urban areas are more susceptible to the effect of air pollution than are their counterparts living in less developed areas.

Assessment of pneumonia in older adults: effect of functional status.

OBJECTIVES: Evaluate the effect of preadmission functional status on severity of pneumonia, length of hospital stay (LOS), and all-cause 30-day and 1-year mortality of adults aged 60 and older and to understand the effect of pneumonia on short-term functional impairment. DESIGN: Prospective cohort study. SETTING: University hospital. PARTICIPANTS: One hundred twelve patients with radiograph-proven pneumonia (mean age 74.6) were enrolled. MEASUREMENTS: Functional status and comorbidities were assessed using the Functional Autonomy Measurement System (SMAF) and Charlson Comorbidity Index. Clinical information was used to calculate the Pneumonia Prognostic Index (PPI). RESULTS: Eighty-four (75%) patients were functionally independent (FI) before admission, with a SMAF score of 40 or lower. Dementia and aspiration history were higher in the group that was functionally dependent (FD) before admission (P<.001). The FI group had less-severe pneumonia per the PPI and shorter mean LOS+/-standard deviation (5.62+/-0.51 days) than the FD group (11.42+/-2.58, P<.004). The FI group had lower 1-year mortality (19/65, 23%) than the FD group (14/28, 50%), and the difference remained significant after adjusting for Charlson Index and severity of illness (P=.009). All patients lost function after admission, with loss being more pronounced in the FI group (mean change 19.24+/-12.9 vs 4.72+/-6.55, P<.001). CONCLUSION: Older adults who were FI before admission were more likely to present with less-severe pneumonia and have a shorter LOS. In addition, further loss of function was common in these patients. Assessment of function before and during hospitalization should be an integral part of clinical evaluation in all older adults with pneumonia.

Financial consequences of rural hospital long-term care strategies.

Data for 540 rural hospitals from 1982 to 1997 were analyzed to determine whether adoption of long-term-care (LTC) strategies improved hospital financial performance. Adoption of external and internal LTC strategies (other than swing-beds) was generally, but not unambiguously, associated with higher profits, increased occupancy, and/or lower costs.

Incidence of four-generation family lineages: is timing of fertility or mortality a better explanation?

OBJECTIVES: This article estimates the percentage of lineages that include four or more generations for a sample of the U.S. population and explores how social status and race are related to lineage depth. METHODS: We assembled data from Waves 1 and 2 of the National Survey of Families and Households in order to estimate the proportion of adults in four or more generations for the Wave 2 sample (1992-1994). When necessary, we used various decision rules to overcome an absence of information about specific generations. We examine relationships between lineage depth and sociodemographic variables by using logistic regressions. RESULTS: The data show that 32% of the respondents were in lineages comprising four or more generations. Blacks and individuals of lower social class were more likely to be in four-generation lineages, especially shorter-gapped lineages. Whites and individuals of higher social class were not more likely to be in longer-gapped, four-generation lineages. DISCUSSION: The majority of the adult population in the early 1990s was in three-generation lineages. The verdict is still out on whether population aging results in the wholesale verticalization of lineages. Social differentials in four-generation lineages in the early 1990s were mainly due to differences in the timing of fertility, rather than mortality.

Diversity and structure of intergenerational relationships: elderly parent-adult child relations in Korea.

Korean society has undergone a rapid demographic transition that has challenged traditional patterns of family exchanges. The structure and directions of support flows have become more complex as multiple generations coexist. This article examines the complexity of contemporary Korean intergenerational relationships. The study analyzed two different samples to address anticipated differences in perceptions of and attitudes toward relationships between adult children and elderly parents. The researchers used maximum likelihood latent structure analysis to discover the latent patterns of the association among three main subdimensions of intergenerational relationships: geographic proximity, exchange of support, and cultural norms of family support. Results show that the perspectives on intergenerational relationships differ significantly between middle-aged children and elderly parents. Intergenerational relationships among middle-aged adults comprise five distinct patterns: strong reciprocal, strong traditional, intermediate normative, intermediate circumstantial, and weak. The interpretation of intergenerational relationships from the elders' perspectives is more straightforward, with only three patterns: traditional, reciprocal, and weak. Along with significant socioeconomic differences in the prevalent patterns of intergenerational relationships, these results emphasize the complex interplay of contingency and path dependency in diversifying the value and support exchanges of intergenerational relationships.