The association between financial support of adult children to their parents and informal care provision in China and its differences in household registration, residence arrangement and community-based care services: 2008 ~ 2018.

BACKGROUND: The changes in demographic and family structures have weakened the traditional norms of filial piety and intergenerational relationships dramatically. This study aims to examine the dynamic association between financial support of adult children to their parents and informal care provision in China and its differences in household registration, residence arrangement and community-based care services. METHODS: Data was derived from the 2008-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), which is a longitudinal survey of a nationally representative sample of individuals aged 60 and over. Random effects model was used to assess the association between financial support and informal care provision of adult children to their parents. RESULTS: It was found that financial support showed an upward trend while informal care provision showed a download trend from 2008 to 2018. The result indicated a significant and negative association between financial support and informal care provision of adult children to their parents (B = -0.500, 95% confidence interval (CI) = -0.761 to -0.239). And the association was significant among elderly people who were from urban areas (B = -0.628, 95% CI = -0.970 to -0.287), co-resided with adult children (B = -0.596, 95% CI = -0.939 to -0.253), and had community-based services (B = -0.659, 95% CI = -1.004 to -0.315). CONCLUSION: Financial support was negatively associated with informal care provision of adult children to their parents in China, and the association has differences in household registration, residence arrangement and community-based care services. It is suggested that policymakers should prioritize planning interventions for elderly care services and establish a family caregiver support system.

Association between mild cognitive impairment and falls among Chinese older adults: the mediating roles of balance capacity and depressive symptoms.

BACKGROUND: This study aimed to examine the association between mild cognitive impairment (MCI) and the follow-up risk of falls among Chinese older adults, exploring the mediating roles of balance capacity and depressive symptoms in the association between MCI and falls. METHODS: A total of 5482 adults aged 60 years and above from waves 2015 and 2018 of the China Health and Retirement Longitudinal Study were included for analysis. Cognition was assessed by a global cognition score, which included three tests: episodic memory, figure drawing and Telephone Interview of Cognitive Status. Depressive symptoms were assessed with the Centre for Epidemiological Studies Depression Scale. Logistic regression models were used to estimate the association between MCI and falls. Mediation analysis was employed to explore the potential mediating roles of balance capacity and depressive symptoms in the association between MCI and falls. RESULTS: MCI was significantly associated with the risk of falls (OR 1.259, 95% CI 1.080 to 1.467). Balance capacity and depressive symptoms played parallel mediating roles in the association between MCI and falls, and the mediating effects were 0.004 (95% CI 0.003 to 0.024) and 0.010 (95% CI 0.004 to 0.016), respectively. CONCLUSIONS: It is necessary to screen for and recognise MCI in order to prevent falls among older adults. More efforts should be made to improve balance capacity and relieve depressive symptoms to reduce the risk of falls among older adults with MCI.

Erythropoietin prevented the decreased expression of aquaporin1-3 in ureteral obstructive kidneys in juvenile rats.

BACKGROUND: Urinary tract obstruction is associated with impaired renal urinary concentration; even after the release of the obstruction, patients still suffer from polyuria. It has been reported that the decreased expression of aquaporins (AQPs) is associated with postobstructive polyuria, and erythropoietin (EPO) can promote the recovery of decreased AQP2 expression induced by bilateral ureteral obstruction. However, whether EPO can promote the recovery of the expression of AQP1-3 after the release of unilateral ureteral obstruction (UUO) has not yet been reported. AIMS: To investigate the effects of EPO treatment on the expression of renal AQP1-3 after the release of UUO. METHODS: UUO was established in rats by 24-h temporary unilateral obstruction of renal ureters. Three days following EPO treatment, the kidneys were removed to determine the expression levels of AQP1-3, NLRP3, caspase-1, and IL-1ß via semiquantitative immunoblotting and immunohistochemistry. RESULTS: EPO inhibited the expression of NLRP3, caspase-1, and IL-1ß; reduced plasma creatinine and urea; and promoted the recovery of AQP1-3 expression in UUO rats. CONCLUSIONS: EPO treatment prevented the decreased expression of renal AQPs and the development of impaired urinary concentration capacity after the release of UUO, which may partially occur by way of anti-inflammasome effects. IMPACT: EPO treatment could prevent the decreased expression of renal water transporter proteins AQP1-3 and the development of impaired renal functions, which may be associated with its anti-inflammasome effects. EPO regulated the expression of renal water transporter proteins AQP1-3, which could provide the potential for the treatment of postobstructive polyuresis. EPO treatment could be one of the effective methods by participating in multiple dimensions for patients with obstructive nephropathy.

Safety and effectiveness of indocyanine green fluorescence imaging-guided laparoscopic hepatectomy for hepatic tumor: a systematic review and meta-analysis.

Introduction: Previous clinical investigations have reported inconsistent findings regarding the feasibility of utilizing indocyanine green fluorescence imaging (ICGFI) in laparoscopic liver tumor removal. This meta-analysis aims to comprehensively evaluate the safety and effectiveness of ICGFI in laparoscopic hepatectomy (LH). Methods: A systematic search of pertinent clinical studies published before January 30th, 2023 was conducted in databases including PubMed, Embase, Cochrane, and Web of Science. The search strategy encompassed key terms such as "indocyanine green fluorescence," "ICG fluorescence," "laparoscopic hepatectomy," "hepatectomies," "liver Neoplasms," "hepatic cancer," and "liver tumor." Additionally, we scrutinized the reference lists of included articles to identify supplementary studies. we assessed the quality of the incorporated studies and extracted clinical data. Meta-analysis was performed using STATA v.17.0 software. Either a fixed-effects or a random-effects model was employed to compute combined effect sizes, accompanied by 95% confidence intervals (CIs), based on varying levels of heterogeneity. Results: This meta-analysis encompassed eleven retrospective cohort studies, involving 959 patients in total. Our findings revealed that, in comparison to conventional laparoscopic hepatectomy, patients receiving ICGFI-guided LH exhibited a higher R0 resection rate (OR: 3.96, 95% CI: 1.28, 12.25, I2 = 0.00%, P = 0.778) and a diminished incidence of intraoperative blood transfusion (OR: 0.42, 95% CI: 0.22, 0.81, I 2 = 51.1%, P = 0.056). Additionally, they experienced shorter postoperative hospital stays (WMD: -1.07, 95% CI: -2.00, -0.14, I 2 = 85.1%, P = 0.000). No statistically significant differences emerged between patients receiving ICGFI-guided LH vs. those undergoing conventional LH in terms of minimal margin width and postoperative complications. Conclusion: ICGFI-guided LH demonstrates marked superiority over conventional laparoscopic liver tumor resection in achieving R0 resection and reducing intraoperative blood transfusion rates. This technique appears to hold substantial promise. Nonetheless, further studies are needed to explore potential long-term benefits associated with patients undergoing ICGFI-guided LH. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD 42023398195.

Can community-based care moderate widowhood's health impact? -A longitudinal study among older Chinese adults.

The plethora of pathways leading to health problems of later life has made the causal assessment of widowhood on the health of older adults difficult. This research aimed to assess the short-term impact of widowhood on the objective health of older adults and to the moderating role of community-based care (CBC) in improving the health outcomes of older adults. In this study, the activities of daily living (ADLs) and number of hospitalisations of older adults were measured, and PSM-DID models were conducted. Widowhood had a significant negative impact on the objective health of older adults. Widowed adults had higher ADL scores (B = 0.569, 95 percent CI: 0.295 to 0.844) and more hospitalisations (B = 2.551, 95 percent CI: 1.189 to 3.914) than nonwidowed adults. Meanwhile, CBC in urban areas can significantly reduce ADL scores (B = -0.154, SE = 0.082) and the number of hospitalisations (B = -1.402, SE = 0.348) in older adults, whereas CBC in rural areas can only significantly reduce ADL scores (B = -0.197, SE = 0.087). Taken together, there is an urgent need to focus on the health of widowed and older adults and to provide CBC in both urban and rural areas equally.

The association between reproductive history and the multidimensional health of older adults in rural China and its gender differences: Evidence from the Chinese longitudinal healthy longevity survey.

Background: Few studies have examined the association between reproductive history and the multidimensional health of older adults with more diverse reproductive histories and poorer health status in rural China. The purpose of this study is to explore the effect of parity, sex ratio of children and late childbearing on multidimensional health and its gender differences. Methods: The analytical sample consisted of 3,377 older adults in rural China who participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018. Linear regression models were applied to estimate the relationship between reproductive history and multidimensional health, with separate models for each indicator of health outcomes. Results: Older adults in rural areas with greater parity were more likely to have better cognitive function (ß = 0.409, 95% CI: 0.255-0.563), fewer Activities of Daily Living (ADL) limitations (ß = -0.085, 95% CI: -0.137 to -0.034) and symptoms of depression (ß = -0.396, 95% CI: -0.577 to -0.216). The social mechanism of intergenerational support from children later in life partly explained the positive effect of parity. Late childbearing had negative effects on cognitive function (ß = -1.220, 95% CI: -1.895 to -0.545), ADL (ß = 0.253, 95% CI: 0.028-0.478) and symptoms of depression (ß = 1.025, 95% CI: 0.237-1.812). Women were more likely to be influenced by the positive effect of parity; the association between late childbearing and health was only significant in the male group. Conclusions: Parity and late childbearing are associated with cognitive function, activities of daily living, and symptoms of depression in the older adults in rural China. Older adults with more children might be in better health, and this finding is especially significant in women. However, late childbearing had a negative effect on multidimensional health, especially for men. The social mechanism and gender differences between reproductive history and health need to be further explored.

Activation of the TGF-ß1/Smads/α-SMA pathway is related to histological and functional changes in children with neurogenic bladder.

This research is to investigate the expression of the TGF-ß1/Smads/α-SMA pathway and its effect on bladder histology and function in children with neurogenic bladder (NB). The bladder specimens from 10 children with NB and 8 children with vesicoureteral junction obstruction were collected into the NB and control groups. The expression of TGF-ß1, Smad2, Smad3, Smad4, Smad6, α-SMA, fibronectin, collagen I and collagen III in bladder tissues was detected. In addition, the histological characteristics of the bladder were evaluated. A preoperative urodynamic study was performed on all children with NB. We analysed the correlations among the expression of the marker protein a-SMA in myofibroblasts, effector cells of the pathway, and bladder function parameters. Compared with those in the control group, the expression of TGF-ß1, Smad2, Smad3, Smad4, α-SMA, fibronectin, collagen I and collagen III was significantly increased in the NB group, while the expression of Smad6 was decreased (p < 0.01). HE and Masson staining in the NB group showed increased collagen levels and hypertrophy of smooth muscle cells. Children with NB had a low bladder volume ratio (BVR), low compliance (△C) and high maximum bladder pressure, low maximum flow rate, large postvoid residual volume, low bladder contraction index and low bladder voiding efficiency. The expression of α-SMA was negatively correlated with the BVR (r = - 0.7066, P = 0.0223) and △C (r = - 0.6516, P = 0.0412). We conclude that the TGF-ß1/Smads/α-SMA pathway is activated in the bladder tissue of children with NB and may be involved in the processes causing histological and functional changes.

Optimism and survival: health behaviors as a mediator-a ten-year follow-up study of Chinese elderly people.

BACKGROUND: Optimism-the generalized expectation that good things will happen-is a promising health asset. Mounting evidence indicates that there are specific associations between optimism and survival rates. However, for public health purposes, it is critical to consider whether the relationship between optimism and survival holds for older adults as a whole and to explore the role of health behaviors as potential mediators. METHODS: Prospective data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Optimism was measured in 2008, and survival was measured by survival time of the interviewees during the whole observation period from 2008 to 2018. Cox proportional hazard models were employed to evaluate the association between optimism and survival among the elderly. The mediating effect analysis method was used to explore the potential mediating role of health behaviors on the association between optimism and survival. RESULTS: Compared to less optimistic older adults, optimistic individuals were associated with lower odds of mortality (HR = 0.94, 95% CI = 0.89 - 0.99). Health behaviors are key elements that play a positive role in survival (HR = 0.95, 95% CI = 0.94 - 0.96). Health behaviors played an intermediary role in the relationship between optimism and mortality, and the mediating effect was -0.005. CONCLUSIONS: Optimism and health behaviors were broadly and robustly associated with a lower risk of mortality. Health behaviors mediate the relationship between optimism and mortality. Appropriate intervention should be carried out on optimism and health behaviors among elderly people to improve the likelihood of health in aging.

The association between falls and anxiety among elderly Chinese individuals: The mediating roles of functional ability and social participation.

BACKGROUND: Elderly individuals who experience falls suffer from higher levels of anxiety because of physical or mental injury. This study examined the association between falls and anxiety among elderly Chinese individuals. It also explored the mediating roles of functional ability and social participation in the link between falls and anxiety. METHODS: The analytical sample included 8233 elderly people aged 60 and above, and prospective data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Anxiety was evaluated by a 7-item Generalized Anxiety Disorder (GAD-7) scale, and falls were determined by self-report. The association between falls and anxiety was assessed by linear regression. Mediation analysis was used to explore the potential mediating roles of functional ability and social participation on the association between falls and anxiety. RESULTS: Suffering falls predicted higher anxiety levels among elderly individuals (B = 0.608, 95% CI: 0.471, 0.746). Functional ability and social participation play partial mediating roles in the association between falls and anxiety, and the mediating effects were 0.036 (95% CI: 0.020, 0.058) and 0.005 (95% CI: 0.003, 0.014), respectively. The serial mediating effect of functional ability and social participation on the association between falls and anxiety was 0.003 (95% CI: 0.002, 0.005). LIMITATIONS: This study is based upon cross-sectional data, which limit inferring causality. CONCLUSIONS: This study suggests that policy-makers should explore how to encourage elderly individuals who experience falls to restore functional ability and participate in appropriate social activities to alleviate anxiety.

The evolution trend of availability of China's community-based care services and its impact on the cognitive function of elderly people: 2008-2018.

BACKGROUND: To address the challenge of the aging population, community-based care services (CBCS) have been developed rapidly in China as a new way of satisfying the needs of elderly people. Few studies have described the evolution trend of availability of CBCS in rural and urban areas and evaluated their effectiveness. This study aims to show the availability of China's CBCS and further analyze the effect of the CBCS on the cognitive function of elderly people. METHODS: Longitudinal analysis was performed using data from the 2008 to 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 23937 observations from 8421 elderly people were included in the study. The Chinese version of the Mini-Mental State Examination (MMSE) was used to assess cognitive function. We aggregated similar CBCS to generate three binary variable categories (daily life support, emotional comfort and entertainment services, medical support and health services) indicating the availability of CBCS (1 = yes, 0 = no). Multilevel growth models were employed to estimate the association between CBCS and cognitive function while adjusting for many demographic and socioeconomic characteristics. RESULTS: The availability of CBCS increased a lot from 2008 to 2018 in China. Although the availability of CBCS in urban areas was higher than that in rural areas in 2008, by 2018 the gap narrowed significantly. Emotional comfort and entertainment services (B = 0.331, 95% CI = 0.090 to 0.572) and medical support and health services (B = 1.041, 95% CI = 0.854 to 1.228) were significantly and positively associated with cognitive function after adjusting for the covariates. CONCLUSION: There was a significant increase in the availability of CBCS from 2008 to 2018 in China. This study sheds light on the positive correlation between CBCS and cognitive function among Chinese elderly individuals. The results suggest that policymakers should pay more attention to the development of CBCS and the equity of the supply of CBCS in urban and rural areas.

Longitudinal associations between sleep duration and cognitive function in the elderly population in China: A 10-year follow-up study from 2005 to 2014.

OBJECTIVE: Sleep duration is increasingly recognized as an important determinant of cognitive function among elderly. However, longitudinal studies on the relationship between sleep duration and cognitive function in Chinese elderly are rare. We sought to investigate the longitudinal association between sleep duration and cognitive function in Chinese elderly during a 10-year follow-up. METHOD: This longitudinal study analyzed 2148 elderly (the baseline including 43.16% aged 70%-79%, 23.79% aged 80 and over) who had participated in four waves of the Chinese Longitudinal Healthy Longevity Survey during 2005-2014. Cognitive function (including global functioning and cognitive domains) was assessed using the Chinese version of the Mini-Mental State Examination. Sleep duration was assessed via self-reports. Mixed model analysis was used to evaluate the association between sleep duration and cognitive function, adjusting for sociodemographic variables and risk factors for cognitive function. RESULTS: There is an inverted U-shaped relationship between sleep duration and global cognition and cognitive domains, with the highest cognitive scores observed for sleep durations between 6 and 9 h and the curve shifting from smooth to steeper from 2005 to 2014. The regression model showed that long sleep duration (>9 h) is significantly associated with global cognition and four cognitive domains: orientation, attention and calculation, immediate recall and visual construction. Both long and short sleep durations are significantly associated with delayed recall and not significantly associated with category fluency, language or the ability to follow a three-stage command. The five cognitive domains related to sleep duration are the domains that exhibited a rapid rate of decline. CONCLUSIONS: Sleep duration can be identified as a modifiable risk factor for cognitive decline, as long or short sleep duration is associated with the five cognitive domains that exhibit cognitive decline. These findings suggest the need for intervention measures to maintain healthy sleep durations among Chinese elderly people.

The Association between Widowhood and Cognitive Function among Chinese Elderly People: Do Gender and Widowhood Duration Make a Difference?

Few studies have examined the effects of widowhood on cognitive function in Chinese elderly individuals. We conducted a longitudinal study to assess the association between widowhood and cognitive function and further explored gender differences in this association and the impact of widowhood duration. The analytical sample consisted of 5872 Chinese elderly people who participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and were followed up from 2005 to 2014. We used the Chinese version of the Mini-Mental State Examination (MMSE) to assess cognitive function. Widowhood duration was calculated from the self-reported year at which the spouse passed away. Multilevel growth models were employed to estimate the association between widowhood and cognitive function while adjusting for many demographic and socioeconomic characteristics. Widowhood status was associated with cognitive decline among Chinese elderly individuals after adjusting for covariates (B = -0.440, 95% CI -0.727 to -0.152), and this association was only statistically significant among men (B = -0.722, 95% CI -1.104 to -0.339). Being widowed for 5 years or less (B = -0.606, 95% CI -1.112 to -0.100), 16-20 years (B = -0.937, 95% CI -1.685 to -0.190), and 21+ years (B = -1.401, 95% CI -1.967 to -0.834) predicted worse cognitive function in men, while being widowed for more than 21+ years (B = -0.655, 95% CI -1.186 to -0.124) was associated with cognitive decline in women. More attention should be directed towards widowed men and long-term widowed elderly individuals.

METTL3/N6-methyladenosine/ miR-21-5p promotes obstructive renal fibrosis by regulating inflammation through SPRY1/ERK/NF-κB pathway activation.

Renal fibrosis induced by urinary tract obstruction is a common clinical occurrence; however, effective treatment is lacking, and a deeper understanding of the mechanism of renal fibrosis is needed. Previous studies have revealed that miR-21 impacts liver and lung fibrosis progression by activating the SPRY1/ERK/NF-kB signalling pathway. However, whether miR-21 mediates obstructive renal fibrosis through the same signalling pathway has not been determined. Additionally, studies have shown that N6-methyladenosine (m6 A) modification-dependent primary microRNA (pri-microRNA) processing is essential for maturation of microRNAs, but its role in the maturation of miR-21 in obstructive renal fibrosis has not yet been investigated in detail. To address these issues, we employed a mouse model of unilateral ureteral obstruction (UUO) in which the left ureters were ligated for 3, 7 and 14 days to simulate the fibrotic process. In vitro, human renal proximal tubular epithelial (HK-2) cells were transfected with plasmids containing the corresponding sequence of METTL3, miR-21-5p mimic or miR-21-5p inhibitor. We found that the levels of miR-21-5p and m6 A modification in the UUO model groups increased significantly, and as predicted, the SPRY1/ERK/NF-kB pathway was activated by miR-21-5p, confirming that miR-21-5p plays an important role in obstructive renal fibrosis by enhancing inflammation. METTL3 was found to play a major catalytic role in m6 A modification in UUO mice and drove obstructive renal fibrosis development by promoting miR-21-5p maturation. Our research is the first to demonstrate the role of the METTL3-m6 A-miR-21-5p-SPRY1/ERK/NF-kB axis in obstructive renal fibrosis and provides a deeper understanding of renal fibrosis.

Mechanism and Priority of Botulinum Neurotoxin A versus Sacral Neuromodulation for Refractory Overactive Bladder: A Review.

BACKGROUND: The treatment of common overactive bladder (OAB) has reached a consensus, but there is not a clear answer to the treatment of refractory OAB (ROAB). ROAB is defined as nonresponsive to treatment with behavioural and oral therapies. The disease can influence the physical and mental health of patients, cause poor quality of life, and create an urgent socio-economic burden. With the advancement of medical treatment, the treatment of OAB has improved significantly in the last 2 decades, especially ROAB, by the usage of botulinum neurotoxin A (BoNT-A) and sacral neuromodulation (SNM). Many studies have demonstrated their effectiveness and safety. However, which therapy is the optimal method remains unclear for patients with ROAB, and the exact mechanism involved in the procedures is still unknown. SUMMARY: This review is to clarify the mechanisms, advantages, and disadvantages of SNM and BoNT-A in treatment of ROAB, and determine whether there is an order effect of SNM and BoNT-A in managing ROAB. Key Messages: BoNT-A and SNM mainly act on the peripheral nervous system and central nervous system, respectively. But BoNT-A and SNM may partly act on the central and peripheral nervous systems, separately. SNM may be a better choice than BoNT-A in the long time. At the same time, BoNT-A and SNM can treat the ROAB as the first and next steps, and the sequence of both would not affect the effectiveness of each other.

The TGF-ß1 pathway is early involved in neurogenic bladder fibrosis of juvenile rats.

BACKGROUND: This study investigated whole neurogenic bladder's progression changes, as well as the expression of TGF-ß1 fibrosis pathway-related proteins in bilateral spinal nerve-amputated juvenile rats. METHODS: Sixty-four 8-week-old rats (32 bilateral L6 + S1 spinal nerve amputated and 32 sham operated) were selected. Cystometry was performed. General assessments, Masson, Sirius red, immunohistochemical staining, and western blotting of fibrosis and TGF-ß1 pathway-related proteins were conducted using bladder tissues. RESULTS: Cystometry results showed that the basal intravesical pressures and bladder capacities in nerve-amputated rats were significantly higher than those in sham-operated ones. Compared to the sham-operated groups, the bladder size and wall thickness in the nerve-amputated groups increased initially but then decreased over time. However, bladder weight continuously increased over time. Disintegration, thickening, and hypertrophy of the bladder wall were found over time in the amputated rats. Moreover, there was a significant increase in collagen III, and the ratio of collagen III/I was higher in amputated rats (P < 0.01). Finally, the expression of TGF-ß1, TGF-ßRI, Smad2, and collagen III and I increased in amputated bladder tissues, while Smad6 decreased over time. CONCLUSIONS: The main clinical features of pediatric neurogenic bladder (PNB) were detrusor paralysis and continuous intravesical pressure. Biological molecular findings are earlier than the pathophysiological findings. Therefore, early preventing bladder fibrosis by targeting TGF-ß1/Smad pathway-related proteins once knowing the PNB diagnosis might be an alternative treatment for PNB. IMPACT: The study found that the main clinical features of PNB were detrusor paralysis, continuous intravesical pressure, and increased TGF-beta/Smad signal proteins over time. The study makes contributions to the literature because it suggests biological molecular findings are earlier than the pathophysiological findings by various staining in PNB. The study investigated whole neurogenic bladder's progression changes, as well as the expression of TGF-ß1 fibrosis pathway-related proteins in the spinal nerve-injured PNB juvenile rat models, which suggests that early prevention of bladder fibrosis by targeting TGF-ß1/Smad pathway-related proteins once knowing the PNB diagnosis might be an alternative treatment for pediatric neurogenic bladder.

Influencing Factors of Undermet Care Needs of the Chinese Disabled Oldest Old People When Their Children Are Both Caregivers and Older People: A Cross-Sectional Study.

We examined the influencing factors of the undermet care needs of the Chinese disabled oldest old people when their children are both caregivers and are themselves older people. Data were obtained from a cross-sectional survey: the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018. The study participants included 1617 disabled oldest old people whose primary caregiver were their children or children-in-law and were aged 60 years and over. The results showed that the prevalence of undermet needs remained high, with 49.6% disabled oldest old people reporting undermet care needs. Binary logistic regression analysis revealed that living in a rural area (OR = 1.309, 95% CI = 1.133-1.513) and a higher frailty index (OR = 1.103, 95% CI = 1.075-1.131) were significantly positively associated with higher odds for undermet care needs, while a higher annual household income (OR = 0.856, 95% CI = 0.795-0.923), more financial support from children (OR = 0.969, 95% CI = 0.941-0.997), higher care expenditures (OR = 1.044, 95% CI = 1.002-1.088), better caregiver's performance (OR = 0.282, 95% CI = 0.196-0.407) and sufficient income to pay for daily expenses (OR = 0.710, 95% CI = 0.519-0.973) were significantly inversely associated with higher odds for undermet care needs. This evidence suggests the importance of policies to establish a community-based socialized long-term care system and supporting family caregivers of the disabled oldest old people.

How does social capital affect individual health among the elderly in rural China?-Mediating effect analysis of physical exercise and positive attitude.

BACKGROUND: The elderly in rural areas comprise over half of the older population in China, and their health problems are a matter of great concern for the Chinese government and society. Among the many factors affecting health, social capital has generated much interest in academic research. Exploring the relationship between social capital and individual health among the elderly in rural China provides ways to improve the health of Chinese people, which has a positive impact on policy. METHODS: We selected 3719 respondents from the 2016 China Family Panel Studies (CFPS). Structural and cognitive social capital were obtained via exponentiation of variables (mean of zero and a standard deviation of one) and by giving them equal weight. Ordinary least squares (OLS) and two-stage least squares (2SLS) estimators were used to analyze the association between social capital and individual health. We explored the mechanism linking structural and cognitive social capital with individual health through a mediation effect analysis. RESULTS: After correcting for endogeneity bias, structural social capital had a positive correlation with individual health among the elderly, with a coefficient of 0.062 (95% CI: 0.020-0.104). Cognitive social capital also had a positive correlation with individual health, with a coefficient of 0.097 (95% CI: 0.060-0.135). Physical exercise and positive attitude were two significant mediating variables of the relationship between social capital and individual health in the study group, with mediating effects of 0.018 and 0.054, respectively. CONCLUSIONS: Cognitive social capital played a stronger role than structural social capital in promoting individual health among the elderly. Physical exercise and positive attitude mediated the relationship between social capital and individual health. Policymakers should not only build basic medical and health care systems but also consistently cultivate and strengthen structural and cognitive social capital among the elderly in rural China.

Changes in Cognitive Function and Risk Factors for Cognitive Impairment of the Elderly in China: 2005-2014.

Background: The cognitive function of the elderly has become a focus of public health research. Little is known about the changes of cognitive function and the risk factors for cognitive impairment in the Chinese elderly; thus, the purposes of this study are as follows: (1) to describe changes in cognitive function in the Chinese elderly from 2005-2014 and (2) to explore risk factors for cognitive impairment of the Chinese elderly. Design and setting: A total of 2603 participants aged 64 years and above participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and were followed up from 2005 to 2014. Cognitive function and cognitive impairment were assessed using the Chinese version of the Mini-Mental State Examination (MMSE). Binary logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence intervals (CI) of cognitive impairment. Results: Results revealed that the cognitive function of the Chinese elderly shows diversified changes: deterioration (55.09%), unchanged (17.21%) and improvement (27.70%). In addition, there are significant demographic differences in gender, age, education, marriage and other aspects when it comes to the changes of cognitive function in Chinese elderly. In the binary logistic regression analysis, female, increased age, lower education level, no spouse, less income, worse PWB (psychological well-being), less fresh fruit and vegetable intake, more activities of daily living (ADL) limitations, lower social engagement were significantly associated with higher odds for cognitive impairment. Conclusions: Various interventions should be implemented to maintain cognitive function in Chinese elderly.

Differences in the health behaviors of elderly individuals and influencing factors: Evidence from the Chinese Longitudinal Healthy Longevity Survey.

INTRODUCTION: Health behaviors play an important role in determining individual health status; thus, understanding differences in the health behaviors of elderly individuals and their influencing factors is a prerequisite for the formulation and implementation of health behavior promotion policies for elderly individuals. The objectives of this study were to explore differences in health behaviors among Chinese elderly people and their influencing factors. METHODS: Based on data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2014, this paper applied latent class analysis (LCA) to explore differences in the health behaviors of elderly individuals in China and employed a multinomial logit model to identify the influencing factors that cause these differences. RESULTS: Results showed that there are five classes of health behaviors among elderly individuals in China: passive, relatively passive, general, relatively positive, and positive, the proportions of which were 31.07%, 15.86%, 24.06%, 17.24%, and 11.76%, respectively. Community medical and health services, pension, living arrangements, and family income were the primary factors explaining differences in the health behaviors of elderly individuals. In addition, there were significant demographic differences in the health behaviors of elderly individuals in China, including gender, age, education, marital status, census register, region, and others. CONCLUSION: There are significant differences in the behaviors of elderly individuals in China, and the behaviors of the majority of elderly people are not healthy. China is expected to invest more medical and health resources to tackle health prevention and management and to provide targeted education, guidance, and intervention in elderly health behaviors, urging them to control and correct risky health behaviors with a focus on elderly individuals that are the oldest, are females, have low education levels, and live in the countryside and in towns.

The Evolutionary Trends of Health Behaviors in Chinese Elderly and the Influencing Factors of These Trends: 2005⁻2014.

As China is now facing the severe challenge of rapid population ageing, the health behaviors in Chinese elderly people are of great significance for realizing the goal of "Healthy Ageing" and the construction of a "Healthy China". Little is known about the evolutionary trends of health behaviors in the Chinese elderly and about the factors influencing these trends; thus, the purposes of this paper are: (1) To describe the classes and evolutionary trends of health behaviors in the Chinese elderly; and (2) to explore the factors that influence the changes in the health behaviors in the elderly in China. Latent class analysis (LCA) is applied in this study to analyze the classes of health behaviors in the Chinese elderly. Growth mixture modelling (GMM) is employed to describe the evolutionary trends of the health behaviors in elderly people in China. In addition, the Bivariate analysis model is adopted to identify the influencing factors of the evolution of health behaviors. The data were derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2005 to 2014. The results reveal that the health behaviors in the Chinese elderly can be grouped into five classes: Negative, relatively negative, fair, relatively positive, and positive. Approximately 77.2% of the health behaviors in the Chinese elderly have the characteristics of "modified", with a positive tendency. Moreover, approximately 22.8% of the health behaviors in Chinese elderly people have the characteristics of "non-modified", with a negative tendency or remaining unchanged. The evolution of the health behaviors in the elderly in China is more affected by economic factors such as timely medical treatment during childhood, pension, occupations before the age of 60 and family income, as well as by self-rated health (SRH) and demographic characteristics such as household registration, age, and education level. Hence, various possible interventions should be made to improve the health behaviors in elderly people.