Cognitive test battery for evaluating elderly Chinese Americans.

ABSTRACTObjectives:This study aimed to determine the diagnostic utility of a Chinese test battery for evaluating cognitive loss in elderly Chinese Americans. METHODS: Data from a pilot study at the Mount Sinai Alzheimer's Disease Research Center was examined. All participants were > 65 years old, primarily Chinese speaking, with adequate sensorimotor capacity to complete cognitive tests. A research diagnosis of normal mild cognitive impairment (MCI) or Alzheimer's disease (AD) was assigned to each participant in consensus conference. Composite scores were created to summarize test performance on overall cognition, memory, attention executive function, and language. Multivariable logistic regression models were used to assess the sensitivity of each cognitive domain for discriminating three diagnostic categories. Adjustment was made for demographic variables (i. e., age, gender, education, primary language, and years living in the USA). RESULTS: The sample included 67 normal, 37 MCI, and 12 AD participants. Performance in overall cognition, memory, and attention executive function was significantly worse in AD than in MCI, and performance in MCI was worse than in normal controls. Language performance followed a similar pattern, but differences did not achieve statistical significance among the three diagnostic groups. CONCLUSIONS: This study highlights the need for cognitive assessment in elderly Chinese immigrants.

Civic Engagement of Older Adults in Mainland China.

Due to great challenges resulting from China's rapid population aging, Chinese elders are mobilized to address problems caused by this demographic trend through civic engagement. Based on an integrative review of policy, research, and practice, this article reveals that today's Chinese elders have a higher level and wider scope of civic engagement than previous cohorts. A set of factors contributing to such improvement are further identified, including the reform of the national economy, transformation of governmental functions, and the use of effective strategies applied to concrete programs. However, several constraints limiting Chinese elders' equal, active engagement in civic life remain, including the social stratification of older adults, preferential selection of participants due to the nation's socioeconomic development strategy, and family care work competing with other types of civic activities. Finally, future directions for policy, research, and practice are proposed in order to increase Chinese elders' civic engagement.

Intergenerational Exchange of Resources and Elderly Support in Rural China.

This study examines how parental investments on children affect elderly support, and how this effect is contingent on emotional closeness or parental authority. Data collected from 770 elderly parents residing in rural China were analyzed. We gathered dichotomous data for (a) whether parents invested on their children via financial or instrumental means (i.e., parental investments) and (b) whether parents reported closeness to their children (i.e., emotional closeness) and whether children respected them (i.e., parental authority). We examined the relation between these variables and children's elderly support (financial, instrumental, and emotional). We tested models in two ways, one examining the direct effect of investments, and another testing the interactions between investments and closeness or authority. We first found that investments were not directly associated with elderly support, although the closeness and authority were. Additionally, the association between investments and support was found within parents who reported authority or closeness with their children.

Chinese Elders' views on their interactions in general practice: a Grounded Theory study.

OBJECTIVES: The Chinese ethnic population are among the UK's largest visible minority but there is limited evidence about this population, their views about their interactions with General Practitioners (GPs) and how this impacts on their health. This study aimed to explore Chinese Elders' experiences of and attitudes towards the provision of health services in primary care. DESIGN: The method of investigation was a Grounded Theory study using open-ended in-depth interviews. Purposive and theoretical sampling was used to recruit thirty-three Chinese Elders from Chinese communities in the North West of England. Face-to-face interviews were conducted and audio-recorded; transcripts were translated, back translated, analysed and coded by all members of the research team to identify concepts following the Grounded Theory approach. Themes were generated from the data and were used to guide the study into the theoretical sampling phase of the investigation. RESULTS: Chinese Elders were inclined to present to GPs only when health concerns were perceived as serious. This was defined as being beyond their ability to self-manage. Elders tended to adopt self-management strategies rather than follow professional advice. This was mainly due to communication difficulties, poor understanding of the advice doctors gave, and the way that Chinese patients interpreted and used the advice they were given. Chinese Elders reported that the purpose of contacting doctors was to obtain medicines. They presumed that once medication had been prescribed their symptoms would be cured, and then they believed that they could self-manage their health, usually without further GP or other medical follow up. CONCLUSION: These data suggest that significant misunderstandings between Chinese Elders and GPs exist. The findings highlight the dissatisfaction expressed by Elders regarding their interactions with UK health professionals. Chinese Elders' perceptions are influenced by the way Chinese people think about health and illness, and also by their GPs' assumptions. These findings are of value to UK GPs and family doctors worldwide who are concerned with improving the quality of health services provided to an increasingly ageing migrant Chinese population.

Bidirectional association between physical multimorbidity and subclinical depression in Chinese older adults: Findings from a prospective cohort study.

BACKGROUND: Both physical multimorbidity and subclinical depression pose a significant threat to aging population worldwide. The association between these conditions appeared to be in a bidirectional way, however the joint causal relationship yet to be fully understood in elderly Chinese population. METHODS: A total of 4605 Chinese elders from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015) were included for the present study. Physical multimorbidity was defined as having two or more self-reported chronic physical conditions. Subclinical depression was defined by ≥ 12 scores assessed using the 10-item Centre for Epidemiological Studies Depression Scale. The bidirectional association between physical multimorbidity and subclinical depression was examined using multivariable logistic regression models, adjusting for covariates. RESULTS: During study period, 23.99% of participant reported incident episode of subclinical depression and 21.36% reported physical multimorbidity. In fully adjusted model, those with physical multimorbidity were two times more likely to have subclinical depression (OR = 2.05, 95% CI: 1.71-2.46). Besides that, subclinical depression was associated with physical multimorbidity (OR = 1.84, 95% CI: 1.50-2.46), but in slightly less magnitude. Furthermore, the bidirectional association remains statistically significant across different subgroups. LIMITATIONS: Chronic conditions were all self-reported and we couldn't adjust for all confounders, which may be subject to measurement error. CONCLUSIONS: Physical multimorbidity and subclinical depression was associated in a bidirectional way in elderly Chinese population, which highlights the necessary of covering a broad spectrum of aspects of clinical management among adults with physical multimorbidity or subclinical depression.

Effects of Educational Attainment and Housing Condition on Self-Rated Health in Old Age: Heterogeneity and Tendency in China.

In China, the health of the elderly has long been discussed, but few have investigated the diversity of the aging pattern in later life of this population. Although a large body of literature has approved the positive association between socioeconomic status (SES) and health, it still remains controversial regarding whether the association becomes convergent or divergent in old ages. Using data from China's 2010 and 2015 Inter-census Survey (1‰ sample), this paper explored the role of two key SES indicators, educational attainment and housing condition in modifying the self-rated health of Chinese elders aged 60 and above. We observed the diversified patterns of how educational attainment and housing condition have made an impact on the health of these elders in their old age and the temporal changes of the two SES indicators. We found higher educational attainment and better housing condition can lead to higher self-rated health. This positive significance however diminished with age over time, as we observed from 2010 to 2015, indicating the convergent effects of SES on health in old age. We also found that although educational attainment and housing condition were both positively correlated with health, their effects were differentiated. The influence of educational attainment on health waxed, whereas on housing conditions waned over time. These findings suggested the heterogeneity of health and SES effects among Chinese elders.

Factor Structure and Measurement Invariance Across Gender Groups of the 15-Item Geriatric Depression Scale Among Chinese Elders.

The 15-item Geriatric Depression Scale (GDS-15) is widely used to screen depression among elders. But the factor structure of the Chinese version GDS-15 remains unclear. This study was conducted to determine the best-fit factor structure of GDS-15 and to assess measurement invariance across gender groups in a sample of Chinese elders recruited from Mainland China (final sample N = 2428). The best-fit factor structure was examined by confirmatory factor analysis (CFA). Multigroup CFA was utilized to test the measurement invariance across genders of the factor structure. The results of CFA revealed that a three-factor model, including life satisfaction (four items), general depressive affect (seven items), and withdrawal (three items), fits the structure of the GDS-15 best. Measurement invariance across genders was supported, fully assuming different degrees of invariance.

The Efficacy of General Practitioner Assessment of Cognition in Chinese Elders Aged 80 and Older.

OBJECTIVES: This study examined the efficacy of the General Practitioner Assessment of Cognition-Chinese version (GPCOG-C) in screening dementia and mild cognitive impairment (MCI) among older Chinese. METHODS: Survey questionnaires were administered to 293 participants aged 80 or above from a university hospital in mainland China. Alzheimer disease and MCI were diagnosed in light of the National Institute on Aging and the Alzheimer's Association (NIA/AA) criteria. The sensitivity and specificity of GPCOG-C and Mini-Mental State Examination (MMSE) in screening dementia and MCI were compared to the NIA/AA criteria. RESULTS: The GPCOG-C had the sensitivity of 62.3% and specificity of 84.6% in screening MCI, which had comparable efficacy as the NIA/AA criteria. In screening dementia, GPCOG-C had a lower sensitivity (63.7%) than the MMSE and a higher specificity (82.6%) higher than the MMSE. CONCLUSIONS: The GPCOG-C is a useful and efficient tool to identify dementia and MCI in older Chinese in outpatient clinical settings.

Network cultivation, diurnal cortisol and biological ageing: The rejuvenation hypothesis.

A stronger motivation to cultivate social ties in older adults (ages range from 62 to 86 years) has been associated with a cortisol profile similar to that observed in undergraduate students, who are decades younger. We have shown the cultivation of social networks buffers against increases in diurnal cortisol common in old age. Cortisol is crucial for the response to stress and the process of ageing, and a recent study has demonstrated that a lower cortisol level is associated with longevity. We link the findings of social network cultivation and cortisol profile to the processes of biological ageing through DNA telomere length. Telomeres are repeated DNA sequences that cap and protect the ends of chromosomes, and telomere length is considered a potential biomarker for biological age because it is closely related to the cellular process of ageing and chronic stress and is inversely related to chronological age. Studies examining biological ageing have shown an association between an altered cortisol profile and telomere length dynamics. Together, these findings on social networks, cortisol profiles and telomere length suggest that seniors who are motivated to maintain social ties are biologically younger. We therefore propose the 'rejuvenation hypothesis', which posits that seniors with a stronger motivation for social network cultivation are biologically younger, as measured by cortisol levels and telomere length, than their peers who are less motivated to pursue social relationships. This idea suggests a new perspective and potentially fruitful direction for geriatric research. The focus on social network cultivation adds an important psychosocial dimension to rejuvenation therapies that so far have been dominated by biomedical approaches. The rejuvenation hypothesis also has important implications for social policy by supporting the viability of promoting network cultivation among the elderly to facilitate healthy ageing.

Developing a smartphone-based ecological momentary assessment protocol to collect biopsychosocial data with community-dwelling late-middle-aged and older adults.

Although ecological momentary assessment (EMA) has been used in youth and adult populations, very few of the studies provided evidence of the feasibility and utility of smartphone-based EMA protocols to collect biopsychosocial data from aging populations. This study aimed to describe the design and implementation of a smartphone-based EMA protocol, and to evaluate the feasibility and utility of this EMA protocol among community-dwelling late-middle-aged and older Chinese. A sample of 78 community-dwelling Chinese aged between 50 and 70 years was trained to participate in a 1-week EMA data collection, during which each participant carried an Android smartphone loaded with a researcher-developed EMA application and a smartphone-based electrocardiogram (ECG) monitor to provide psychosocial (e.g., daily activities, social interaction, affect) data and ECG recordings six times daily. Adherence was demonstrated with a total response rate of 91.5% of all scheduled assessments (n = 3,822) and a moderately high level of perceived feasibility. Female participants reported higher compliance to the study and rated the overall experience as more pleasant and interesting than male participants. Our study provided the first evidence of the feasibility and utility of smartphone-based EMA protocols among late-middle-aged and older Chinese. Key areas for improvement in future design and implementation of mobile-based EMA include the incorporation of usable technology, adequate and training, and timely assistance.

Clinical use of low-dose aspirin for elders and sensitive subjects.

The use of low-dose aspirin (LDA) has been a common preventive measure to reduce the risk of cardiovascular events. This is attributed to aspirin's ability to inhibit platelet activation. On the other hand, the use of LDA in human subjects has been associated with the development of gastrointestinal injuries like ulcer and bleeding, especially for those sensitive subjects such as elder human subjects. This opinion review will summarize the recent clinical reports regarding the use of LDA and the development of gastrointestinal conditions in China. Based on these reports, it seems that the use of LDA is commonly associated with gastrointestinal injuries, and stopping its use leads to recovery in elderly subjects. Therefore, we would like to suggest that gastroduodenal health and conditions should be seriously taken into consideration when LDA is recommended to the elderly, or other alternative means to reduce the risk of cardiovascular events such as nutritional interventions should be suggested.

The Role of Meaning in Life for the Quality of Life of Community-Dwelling Chinese Elders With Low Socioeconomic Status.

Objectives: There is limited research on the meaning in life among Chinese elders. This study aims to examine the association among functional disabilities, meaning in life, social network, and quality of life in community-dwelling Chinese elders with low socioeconomic status. Methods: A cross-sectional survey was used to collect data from 339 poor community-dwelling Chinese elders aged 60 and above. Results: The results showed that meaning in life and social network were significantly related to quality of life. Moreover, social network was a mediator to the relationship between functional disability and quality of life, and meaning in life was a partial mediator to the relationship between social network and quality of life. Conclusion: Workshops should be organized by the elderly service providers for Chinese elders facing deterioration in health and activity levels to learn to live intentionally and purposefully. A social network among elders should also be fostered in the community.

Factor structure of the Geriatric Depression Scale and measurement invariance across gender among Chinese elders.

BACKGROUND: The Geriatric Depression Scale (GDS) is commonly used in research and clinical settings for screening of depression. The current study aimed to examine the best-fit factor structure model of the GDS among Chinese elders and to evaluate the measurement invariance of the GDS across genders. METHODS: Participants included 1,553 elderly residents from the Hunan, Shandong, and Beijing provinces. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted in tandem to determine the structure of the GDS on a large scale. Multigroup CFA (N = 1553, 45.24% male, mean = 71.33 ±â€¯8.06) was utilized to test the measurement invariance of the depressive symptom structure, which was generated by EFA and confirmed by CFA across gender. RESULTS: A three-factor model with 15 depression, 9 apathy and 4 vigor items presented the best fit indices. Measurement invariance of the new proposed model across gender was supported fully assuming different degrees of invariance. LIMITATIONS: Our sample was entirely Chinese, and thus may not be representative of populations outside of China. Our results are based on a cross-sectional study, which did not take into consideration changes that may occur over time within individuals. CONCLUSIONS: A three-factor model best fits the depressive symptom structure of the GDS among elderly Chinese, with measurement invariance across genders.

Domestic helpers as moderators of spousal caregiver distress.

OBJECTIVES: Although domestic helpers increasingly play a role in elder care in many societies, there is a lack of research on their influence on caregiver distress. This study aimed to examine the influence of domestic helpers on the relationship between stressors (the care needs of frail elders and spousal provision of care) and spousal caregivers' psychological distress. METHOD: This study was a secondary analysis of cross-sectional data collected between 2007 and 2009 from 6,442 Hong Kong adults aged 60 or older who were applying for government-subsidized long-term care services and whose spouses were their primary caregivers. Among the spousal caregivers, 73.04% were women, 44.16% felt distressed, and 5.73% were assisted by domestic helpers. RESULTS: According to logistic regression analysis, spousal caregivers who provided personal care related to activities of daily living were more likely to be distressed if they were not assisted by domestic helpers. DISCUSSION: The findings suggest that domestic help may moderate the effect of stressors on spousal caregivers. Domestic helpers provide support not just to frail older adults but also to spousal caregivers. Further studies are recommended to explore the precise effect of domestic help on family caregivers, care receivers, and the caregiving process.

Ethno-cultural diversity in the experience of widowhood in later life: Chinese widows in Canada.

This paper utilizes Helena Znaniecka Lopata's concept of life frameworks as a lens through which to understand the experience of widowhood amongst elderly Chinese immigrant women living in Toronto, Canada. While Lopata defined life frameworks as including social supports, social relations and social roles, for these widows, personal resources (framed in Chinese cultural context) were also important aspects of life frameworks. In-depth interviews with 20 widows contacted through a Chinese community center were conducted in Mandarin and Cantonese and then transcribed and interpreted through team-based qualitative analyses. These women ranged in age from 69 to 93 years and had been in Canada an average of 17 years, with over half of them widowed following immigration. Our analysis framed the widows' narratives in terms of four types of supports defined by Lopata: social, service, financial and emotional supports. They had fairly extensive social and service supports focused primarily around family and the Chinese community. Although norms of filial piety traditionally dictate sons as primary supports, daughters predominated as providers of supports to these widows. Interpreted from a life course perspective, financial supports were deemed sufficient, despite overall limited financial means. Emotional support was more nuanced and complex for these widows. Loneliness and feelings of social isolation were prevalent. Nevertheless, themes of acceptance and satisfaction dominated our findings, as did reciprocity and exchange. The narrative accounts of these widows depict a complexity of experience rooted in their biographies as Chinese women and as immigrants, rather than primarily in widowhood itself.