Can cultural capital, cognitive ability, and economic capacity help rural older adults bridge the digital divide? Evidence from an empirical study.

Background: The digital divide is the difference between individuals who use the Internet and those who do not. Under the triple social environment of urban-rural dichotomy, population aging, and the digital era in China, the existence of digital divide among rural older adults has seriously affected their access to health information through the Internet, so it is urgent to bridge the digital divide problem they face. Methods: Based on Maslow's Hierarchy of Needs Theory and Stress Coping Theory, the impact of cultural capital on the digital divide among rural older adults was systematically analyzed using hierarchical regression and Chained Mediation Effect Tests using data from the Chinese Family Panel Studies (CFPS). Results: Cultural capital has a significant positive effect on the digital divide among rural older adults (ß = 0.178, p < 0.01). Cognitive ability and economic capacity both play independent intermediary effects between cultural capital and digital divide among rural older adults, and the intermediary chain formed by the two plays a chain intermediary effect. The increase in the cultural capital of rural older adults has led to an increase in their cognitive ability and economic capacity, which ultimately has a favorable effect on the bridging of the digital divide. Heterogeneity results suggest that cultural capital is more effective in bridging the digital divide among male rural older adults aged 60-69. Conclusion: Cultural capital is able to bridge the digital divide faced by rural older adults and is age and gender heterogeneous. At the same time, improved cognitive ability and economic capacity can also help rural older adults bridge the digital divide. Therefore, it is proposed that we increase the construction of public cultural service infrastructure in rural areas, liaise with community neighborhood committees and village committees to do a good job of publicity, improve training measures for key groups, and maintain the enthusiasm of rural older adults for learning, so as to provide references for the rural older adults in China and developing countries in general to bridge the digital divide.

Association between Dietary Patterns and Cardiometabolic Multimorbidity among Chinese Rural Older Adults.

BACKGROUND: The global population is aging rapidly, leading to an increase in the prevalence of cardiometabolic multimorbidity (CMM). This study aims to investigate the association between dietary patterns and CMM among Chinese rural older adults. METHODS: The sample was selected using a multi-stage cluster random sampling method and a total of 3331 rural older adults were ultimately included. Multivariate logistic regression analysis was used to examine the association between the latent dietary patterns and CMM. RESULTS: The prevalence of CMM among rural older adults was 44.64%. This study identified four potential categories: "Low Consumption of All Foods Dietary Pattern (C1)", "High Dairy, Egg, and Red Meat Consumption, Low Vegetable and High-Salt Consumption Dietary Pattern (C2)", "High Egg, Vegetable, and Grain Consumption, Low Dairy and White Meat Consumption Dietary Pattern (C3)" and "High Meat and Fish Consumption, Low Dairy and High-Salt Consumption Dietary Pattern (C4)". Individuals with a C3 dietary pattern (OR, 0.80; 95% CI, 0.66-0.98; p = 0.028) and a C4 dietary pattern (OR, 0.70; 95% CI, 0.51-0.97; p = 0.034) significantly reduced the prevalence of CMM compared with the C1 dietary pattern. CONCLUSIONS: Rural older adults have diverse dietary patterns, and healthy dietary patterns may reduce the risk of CMM.

Associations between social isolation, perceived ageism and subjective well-being among rural Chinese older adults: A cross-sectional study.

OBJECTIVE: This study aimed to investigate the relationship between social isolation, perceived ageism and subjective well-being among rural Chinese older adults and its mechanisms of action. METHODS: A total of 403 rural resident older adults were surveyed from March to April 2024. Data were collected using the General Information Questionnaire, the General Alienation Scale (GAS), the Perceived Ageism Questionnaire (PAQ), and the Memorial University of Newfoundland Scale of Happiness (MUNSH). SPSS 27.0 and PROCESS macro were used to analyze the data. RESULTS: Pearson correlation analysis revealed a significant negative correlation (p<0.01) between subjective well-being and social isolation (r = -0.720) and perceived ageism (r = -0.661) among rural older adults. Perceived ageism partially mediated the effect between social isolation and subjective well-being in rural older adults, and the mediating effect accounted for 29.9 % of the total effect (p<0.001). CONCLUSION: Social isolation can reduce the subjective well-being of rural older adults through perceived ageism.

Associations of toxic metals and their mixture with hyperuricemia in Chinese rural older adults.

Previous studies have related single toxic metals (TMs) to hyperuricemia (HUA) among the general population, however, the association of the TM mixture with HUA, especially in older adults, remains poorly understood. We aimed to examine the relationships between individual TMs and their mixture and HUA in Chinese rural older adults. This study consisted of 2075 rural older adults aged 60 years or over. Blood concentrations of aluminum (Al), arsenic (As), barium (Ba), cadmium (Cd), cesium (Cs), gallium (Ga), mercury (Hg), lead (Pb), thallium (Tl), and uranium (U) were detected using inductively coupled plasma mass spectrometry. The associations of single TMs with HUA were assessed using logistic regression and restricted cubic spline (RCS) models, and the association of TM mixture with HUA was explored using the elastic net with environmental risk score (ENET-ERS), quantile g-computation (QGC), and Bayesian kernel machine regression (BKMR) models, respectively. Adjusted logistic regression model showed that Cs (OR = 1.65, 95% CI 1.37-1.99) and Pb (OR = 1.46, 95% CI 1.28-1.67) were positively related to HUA, and RCS model exhibited a positive linear association of Cs and Pb with HUA. ENET-ERS and QGC models quantified a positive correlation between the TM mixture and the odds of HUA, with estimated ORs of 1.15 (95% CI 1.11-1.19) and 1.84 (95% CI 1.37-2.47), respectively, and Cs and Pb had the most weight. BKMR model demonstrated a significant linear association between the TM mixture and increased odds of HUA, with the posterior inclusion probabilities (PIPs) of both Cs and Pb being 1.00. Moreover, we observed a positive interaction between Cs and Pb on HUA. The TM mixture is associated with increased odds of HUA in rural older adults, which may mainly be driven by Cs and Pb. Subsequent studies are warranted to confirm these findings and clarify the mechanisms linking multiple TMs with HUA.

Analysis of the life course effects of the disability dilemma among rural older adults in China.

Objective: To analyse whether the accumulation of early adverse experiences among individuals of different generations has an impact on disabilities and evaluate the cumulative effects of disadvantages in rural older adults in China. Methods: A Binary Logit Model was used to analyse the life course effects of the disability dilemma among rural older adults. Results: Regarding Activities of Daily Life (ADLs), there was no significant difference between older adults that experienced 1 adverse events and the control group. The probability of older adults experiencing difficulties in 2, 3, 4, or more types of ADLs was 1.486 times, 2.173 times, and 3.048 times higher than that of the control group, respectively. Regarding Instrumental Activities of Daily Life (IADLs), there was no significant difference between the population that experienced 1 or 2 adverse events and the control group. The probability of experiencing difficulties in 3, 4, or more types of IADLs was 1.527 times and 1.937 times higher than that of the control group, respectively. Early adverse events had a cumulative disadvantageous effect on disability in older adults. The longer the duration of adverse experiences, the higher the risk of disability in old age. Education had a significant mitigating effect on health risks. Conclusion: Pay attention to early factors in the life course, strengthen the promotion of health prevention concepts, and pay attention to the moderating and relieving effects of education on health. We should also gradually improve the rural disability care system and family health security capabilities in China's rural areas.

The impact of intergenerational support on social participation patterns of older adults in rural China.

Objectives: This study aimed to examine the association between different dimensions of bi-directional intergenerational support and the social participation patterns of rural older adults, while also exploring the heterogeneity of these older adults by gender and age. Methods: Based on longitudinal survey data from the 'Well-Being of Older People in Anhui Province (WESAP)' in 2018 and 2021, this study used latent class analysis to identify social participation patterns and used multinomial logistic regressions to explore the relationship between intergenerational support and social participation patterns among rural older adults. Results: First, the social participation patterns of rural older persons can be divided into four categories: leisure type (9%), work type (11%), housekeeping type (57.9%) and family labor type (22.1%). Second, there is heterogeneity in the relationship between intergenerational support and social participation patterns in older people, among them, receiving financial support decreased the likelihood of older adults being categorized as work type and family labor type by 14 and 7.7%, respectively, while providing financial support increased the likelihood of older adults belonging to the family labor type by 7.5%; receiving caring support increased the likelihood of older parents being categorized as leisure type by 6%, while providing caring support decreased the likelihood of older parents being categorized as leisure type by 10%; emotional support is related to all patterns of social participation among older adults. Third, the effects of intergenerational support vary across subgroups based on gender and age. Conclusion: Two-way intergenerational support was significantly associated with social participation among rural older adults, and there was significant heterogeneity in this association. Children and older persons should be encouraged to strengthen two-way intergenerational mobility to give full play to the positive impact of different dimensions of intergenerational support on the social participation of older persons in rural areas, ultimately enhancing the quality of life for rural older adults.

The relationship between childhood adversity and sleep quality among rural older adults in China: the mediating role of anxiety and negative coping.

BACKGROUND: Studies have revealed the effects of childhood adversity, anxiety, and negative coping on sleep quality in older adults, but few studies have focused on the association between childhood adversity and sleep quality in rural older adults and the potential mechanisms of this influence. In this study, we aim to evaluate sleep quality in rural older adults, analyze the impact of adverse early experiences on their sleep quality, and explore whether anxiety and negative coping mediate this relationship. METHODS: Data were derived from a large cross-sectional study conducted in Deyang City, China, which recruited 6,318 people aged 65 years and older. After excluding non-agricultural household registration and lack of key information, a total of 3,873 rural older adults were included in the analysis. Structural equation modelling (SEM) was used to analyze the relationship between childhood adversity and sleep quality, and the mediating role of anxiety and negative coping. RESULTS: Approximately 48.15% of rural older adults had poor sleep quality, and older adults who were women, less educated, widowed, or living alone or had chronic illnesses had poorer sleep quality. Through structural equation model fitting, the total effect value of childhood adversity on sleep quality was 0.208 (95% CI: 0.146, 0.270), with a direct effect value of 0.066 (95% CI: 0.006, 0.130), accounting for 31.73% of the total effect; the total indirect effect value was 0.142 (95% CI: 0.119, 0.170), accounting for 68.27% of the total effect. The mediating effects of childhood adversity on sleep quality through anxiety and negative coping were significant, with effect values of 0.096 (95% CI: 0.078, 0.119) and 0.024 (95% CI: 0.014, 0.037), respectively. The chain mediating effect of anxiety and negative coping between childhood adversity and sleep quality was also significant, with an effect value of 0.022 (95% CI: 0.017, 0.028). CONCLUSIONS: Anxiety and negative coping were important mediating factors for rural older adult's childhood adversity and sleep quality. This suggests that managing anxiety and negative coping in older adults may mitigate the negative effects of childhood adversity on sleep quality.

Comparative Effectiveness of Clinician- Versus Peer-Supported Problem-Solving Therapy for Rural Older Adults With Depression.

OBJECTIVE: Self-guided and peer-supported treatments for depression among rural older adults may address some common barriers to treatment. This pilot study compared the effect on depression of peer-supported, self-guided problem-solving therapy (SG-PST) with case management problem-solving therapy (CM-PST) among older adults in rural California. METHODS: Older adults with depression (N=105) received an introductory PST session with a clinician, followed by 11 sessions of CM-PST with a clinician (N=85) or SG-PST with a peer counselor (N=20). RESULTS: Both interventions resulted in clinically significant improvement in depression by week 12. Depression scores in the CM-PST group dropped by 4.1 points more than in the SG-PST group between baseline and week 12 (95% CI=0.99-7.22, p<0.001, Hedges's g=1.08). CONCLUSIONS: The results suggest that peer-supported SG-PST is a viable, acceptable option for rural older adults with depression as a second-line treatment if access to clinicians is limited.

Physical activity attenuates the association of long-term exposure to nitrogen dioxide with sleep quality and its dimensions in Chinese rural older adults.

BACKGROUND: Joint impacts of air pollution and physical activity (PA) on sleep quality remain unaddressed. We aimed to investigate whether PA attenuates the association of long-term exposure to nitrogen dioxide (NO2) with sleep quality and its dimensions in older adults. METHODS: This study included 3408 Chinese rural older adults. Annual NO2 was estimated using the Space-Time Extra-Trees model. PA was assessed by International Physical Activity Questionnaire. Sleep quality was evaluated using Pittsburgh Sleep Quality Index (PSQI) scale. Linear regression models were used to assess the associations of long-term NO2 exposure and PA with sleep quality and its dimensions, and interaction plots were used to depict the attenuating effect of PA on associations of NO2 with sleep quality and its dimensions. RESULTS: Three-year (3-y) average NO2 (per 0.64-µg/m3 increment) was positively associated with global PSQI (ß = 0.41, 95 % CI: 0.23, 0.59), sleep duration (ß = 0.16, 95 % CI: 0.11, 0.21), and habitual sleep efficiency (ß = 0.22, 95 % CI: 0.17, 0.27), while PA was negatively associated with global PSQI (ß = -0.33, 95 % CI: -0.46, -0.20) and five domains of PSQI other than sleep duration and sleep disturbances. The associations of NO2 with global PSQI, sleep duration, and habitual sleep efficiency were attenuated with increased PA (Pinteraction were 0.037, 0.020, and 0.079, respectively). CONCLUSIONS: PA attenuates the adverse impacts of long-term NO2 exposure on sleep quality, especially on sleep duration, and habitual sleep efficiency, in Chinese rural elderly people. Participating in PA should be encouraged in this population, and continued efforts are still needed to reduce air pollution.

Potential factors associated with resilience among older adults in rural China: a multilevel analysis.

BACKGROUND: Resilience is crucial for older adults who experience adversities, but research on the issue in rural China remains limited. This study aims to examine factors associated with resilience among older adults in rural China, as related to different types of resilience, and under different levels of adversity. METHODS: Data were taken from the eight-wave (2001-2021) Longitudinal Study of Older Adults in Anhui Province, China. We used data from the eighth wave (2021) for the outcome variables and lagged predictors (2018) to avoid reverse causal effects. The study sample included individuals 60 years and above, excluding new participants from 2021, those without any adverse events, and any respondents with incomplete analytic data. Resilience was operationalized as residuals of the regressions of life satisfaction (Life Satisfaction Scale) and depressive symptoms (CES-D) on adversity, referred to as Type-1 and Type-2 resilience respectively. These two types of resilience were then treated as the outcome variables in subsequent multilevel regressions, with the predictors focusing on individual, social, and environmental characteristics and resources. This study adheres to STROBE guidelines. RESULTS: 43% of rural older adults exhibited both Type-1 and Type-2 resilience, whereas 18% exhibited only Type-1 resilience and 7% exhibited only Type-2 resilience. Common factors associated with both types of resilience included self-rated health, satisfaction with one's own financial situation, and the prestigiousness of social networks. Predictors for higher levels of Type-1 resilience included higher levels of financial and emotional support and more options for places of leisure. Predictors for higher levels of Type-2 resilience included greater access to medical care. The prestigiousness of social networks, higher levels of emotional support and instrumental support, access to medical care, and more options of places of leisure were positively associated with resilience in the low-adversity group (first tertile of adversity), only satisfaction with financial situation was positively correlated with the resilience of the middle-adversity group (second tertile), while better self-rated health, satisfaction with financial situation, and financial support yielded greater resilience in the high-adversity group (third tertile). CONCLUSIONS: We examined two types of resilience among older adults in rural China, and found that they have shared and unique associated factors. In addition, the potential factors influencing resilience varied with the level of adversity.

Does Early Parental Conflict Impact Current Depression Among Older Adults in Rural China? A Chain-Mediated Model Analysis.

Purpose: The study aimed to investigate the relationships between early parental conflict, marital and parent-child relationships, and current depression among rural older adults, and to examine its gender differences. Methods: Using data obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2018, we selected 2347 adults aged 60 years and older in rural China and used a structural equation model to evaluate the mechanisms behind early parental conflict and current depression among such adults. Results: Early parental conflict impacted current depression among rural older adults, and marital and parent-child relationships played mediating roles in the mechanism. However, there were gender differences in the paths: early parental conflict directly impacted older males' depression, but not among females; marital relationships acted as a mediator between early parental conflict and current depression among older females, but not among males. Conclusion: Among older adults in rural China, early parental conflict can affect current depression through the indirect path of marital relationships as well as the chain mediating path between marital and parent-child relationships.

The impact of adult children's support on the psychological health of rural older adult people in China.

Background: Family old-age care is dominant in Chinese rural society, and children's support is an important force in family old-age care. However, the migration of a large number of young and middle-aged rural laborers has undermined the traditional arrangements for old-age care in rural areas and affected the psychological health of the older adult. Methods: 2014 China Longitudinal Aging Social Survey targets Chinese citizens aged 60 or older and covers 28 provinces in mainland China. In this paper, the database of the CLASS was selected for empirical analysis to explore the impact of children's support on the depression level and loneliness of rural older adults through multiple linear regression, and was divided into two groups according to children's migration to analyze heterogeneity. Results: Children's financial support facilitates the maintenance of mental health among rural older adults. Children's support promotes mental health among rural older adults, but this association does not exist among older adults without children's migration. Individual characteristics of older people have a greater impact on mental health. Discussion: Our study firstly compares the differences of children's migration status between children's support and mental health among the older adult in rural China. In order to improve the mental health of the older adult, it is necessary to create a favorable atmosphere of love and respect for the older adult, improve the social security system in rural areas, and give full play to the strengths of the social forces, so as to ensure that the older adult have a sense of worthiness and enjoyment in their old age.

Association Between Sleep and Cognition of Older Adults in Rural Areas: A Cross-Sectional Study.

Sleep is an essential physiological function for everyone. Limited evidence existed on the associations between multi-factor sleep patterns and cognition among older adults in rural areas. Aimed to assess that, We conducted a cross-sectional study on the living habits and cognitive status in rural areas of Qingdao and 1167 participants aged 65 to 96 years answered the questionnaire. The result showed that poor sleep quality, high sleep disturbance, daytime dysfunction, and hypnotic drug-dominated sleep patterns were related to the cognitive function, and there was no obviously associations between good sleep duration and cognition. In order to solve the sleep problems and preserve cognitive function, support and protection of physical and mental health should be the priority of government policies in helping older adults' group in rural areas.

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

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

A Multilevel Physical Activity Intervention Among Chinese Rural Older Adults (Stay Active While Aging): A Study Protocol for a Clustered Randomized Controlled Trial.

Background: Although a large number of studies have confirmed the benefits of physical activity (PA) in preventing age-related diseases and disabilities, a growing number of older people spent more time in sedentary behavior as opposed to PA. To reverse the alarming trend, numerous studies have corroborated the effectiveness of PA interventions in improving PA among older adults. However, such research is scarce in rural China, where a majority of older adults do not meet the PA recommendation. The Stay Active While Aging (SAWA) aimed to conduct an intervention to improve the PA level among older adults in rural China. Methods: The SAWA is designed as a single-blind, clustered randomized controlled trial carried out in rural Sichuan, China with an 8-week intervention and a 24-month follow-up. The intervention group will receive a multilevel intervention (individual, interpersonal, and community levels), while the control group will not. The primary outcome is the PA level. Secondary outcome measures include sedentary behavior level, self-efficacy, self-regulation, cognitive function, night-time sleep quality, and anthropometry. The difference-in-differences (DID) will be performed to investigate the between-group differences, adjusted for baseline data and covariates. Discussion: The SAWA trial will provide a multilevel intervention based on the socio-ecologic model among older adults in rural China. We target the PA level and health status changes while also focus on the maintenance of such intervention during 24 months. If the SAWA produces positive results, it will be possible to recommend similar strategies to be implemented in other Chinese older adults and beyond. Trial registration: ChiCTR2100045653 (https://www.chictr.org.cn/index.aspx).

The mediating effect of coping style on the relationship between perceived stress and mental health in Chinese rural older adults living alone: A cross-sectional study.

AIM: Older adults living alone is becoming the main family structure in rural China. This study aimed to explore the mediating effect of coping style on the relationship between perceived stress and mental health in rural older adults living alone in China. METHODS: 356 rural older adults living alone were recruited in Huzhou, China. Subjects were investigated using the Chinese Perceived Stress Scale (CPSS), Chinese Coping Style Questionnaire (CCSQ), and Mental Health Questionnaire (MHQ). Data were analysed using a structural equation. Bootstrapping was used to validate the mediation effects. RESULTS: Mental health showed significant correlations with a sense of nervousness, of uncontrollability, and with positive and negative coping styles (P < 0.05). The results of structural equation modeling showed a good fit for the total sample (χ2 /df = 2.684, NFI = 0.927, GFI = 0.944, RMSEA = 0.069). Perceived stress (sense of nervousness and uncontrollability) impacted the mental health of rural older adults living alone mainly through two mediating variables, including positive and negative coping styles. The double mediating contribution rates were 42.11%, and 61.82%. CONCLUSION: Coping style partially mediated the relationship between perceived stress and mental health of rural older adults living alone in China. Consequently, to improve the mental health of rural older adults living alone, perceived stress and coping styles should be the focus. Geriatr Gerontol Int 2022; 22: 523-528.

Association between social capital and sleep duration among rural older adults in China.

OBJECTIVE: Sleep disturbances are great challenges to older adults' health promotion. The study tested gender differences in the association between different dimensions of social capital and self-reported sleep duration of Chinese rural older adults. DESIGN: The data of rural older adults were extracted from a national cross-sectional survey of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and analyzed in this study. SETTING: CLHLS covered 23 provinces in China. PARTICIPANTS: The 6552 rural respondents aged ≥65 years old were involved. MAIN OUTCOME MEASURES: Generalized trust, informal social participation, formal social participation and social support were used to assess social capital. Self-reported sleep duration was measured as health outcome. RESULTS: Low level of generalized trust had harmful effect on insufficient sleep (AOR 1.110, 95% CI 1.018-1.324), and having no formal or informal social participation was significantly positively associated with long sleep (AORformal 1.424, 95% CI 1.007-2.013; AORinformal 1.241, 95% CI 1.016-1.516). Rural older female adults with no emotional social support had higher odds of insufficient sleep (AOR 1.502, 95% CI 1.258-1.978). Meanwhile, both informal and formal social participation showed inverse association with long sleep for females. CONCLUSIONS: This study found the relationship between social capital, sleep duration and the gender differences in Chinese rural older adults. More targeted sleep disturbance interventions could be taken in social capital of rural older adults, and gender differences should be considered when making social capital-embedded health promotion policies and interventions.

Social support, self-worth, and subjective well-being in older adults of rural China: a cross-sectional study.

This study explored the relationship between social support and subjective well-being of the rural Chinese older adults and investigated whether self-worth could mediate this association. A total number of 356 older adults from rural areas of China were investigated using three scales. The results were as follows: there were significant correlations between social support, self-worth, and subjective well-being (where P < 0.01 in all of them). Bootstrapping mediation analyses indicated that self-worth partly mediated the association between social support and subjective well-being. Accordingly, social support and self-worth are important targets for improving the subjective well-being level of the rural older adults.

Efficacy of group reminiscence therapy based on Chinese traditional festival activities (CTFA-GRT) on loneliness and perceived stress of rural older adults living alone in China: a randomized controlled trial.

OBJECTIVES: This study aimed to explore the efficacy of group reminiscence therapy based on Chinese traditional festival activities (CTFA-GRT) to mediate the loneliness and perceived stress of older adults living alone in rural China. The results can provide a scientific foundation for improving psychological health. METHOD: A randomized controlled trial of 64 (aged 65.70 ± 3.69 years) Chinese rural older adults living alone was conducted. They were randomly divided into either an eight-month intervention group or a control group. The perceived stress scale (PSS) and the UCLA loneliness scale (UCLA-LS) evaluated the perceived stress and loneliness of the two groups at three different times. A repeated-measures analysis of variance model was used to compare each outcome measure of the two groups. RESULTS: The CTFA-GRT yielded a benefit for the perceived stress and loneliness of rural older adults living alone in the intervention group. Combined with a simple effects test, the PSS and UCLA-LS of those in the intervention groups significantly decreased at eight months after the baseline (F PSS = 23.540, F UCLA-LS = 40.159; all P < 0.01). In addition, the sustainable effect of this program lasted three months after the intervention (F PSS = 65.756, F UCLA-LS = 60.983; all P < 0.01). CONCLUSION: The CTFA-GRT significantly decreased the perceived stress and loneliness of rural older adults living alone in China.

WITHDRAWN: Health risk assessment of rural older population.

Ahead of Print article withdrawn by publisher.