Meaningful Aging: A Relational Conceptualization, Intervention, and Its Impacts

Having a meaningful life is one of the most important goals among older adults. This paper provided an overview of a programme of research and practice on meaningful aging among older Chinese adults. It firstly describes the process of developing and validating a relational conceptualization of a meaningful life (i.e., spiritual well-being) among older Chinese adults from its conceptual roots, development, and validation process since 2009 through an academic–community collaboration. In brief, a meaningful life was attributed to five relationships centered on older adults: the relationship with self, relationship with family, relationship with friends, relationship with people other than family and friends, and relationship with the environment. Secondly, the paper explains a validated assessment tool (e.g., the Spirituality Scale for Chinese Elders, (SSCE)) that was developed accordingly. Evidence-based stratified interventions derived from the conceptualization and operationalization were then introduced including a professionally led group intervention protocol, a volunteer-partner intervention protocol, and a self-help-oriented intervention, which shared eight-session core contents. Good practices in applying various interventions among older adults with diversified backgrounds (e.g., health status, age, and gender) and various service settings (e.g., community, long-term care facilities, and home visits) were then synthesized. Thirdly, feedback from stakeholders is illustrated, and good practices are discussed. In conclusion, a culturally sensitive and meaningful aging framework is timely and impactful for the globally aging world.

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What Matters Most to Older Chinese Adults

Journal of Transcultural Nursing ◽

10.1177/10436596211053655 ◽

2021 ◽

pp. 104365962110536

Author(s):

Liza Lai Shan Choi ◽

Piera Jung ◽

Marti Harder ◽

Kelly Zhang

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Health Care ◽

Life Satisfaction ◽

Well Being ◽

Chinese Adults ◽

Older Chinese ◽

Older Chinese Adults ◽

What Matters

Introduction: Although an abundance of gerontological research has focused on subjective well-being, quality of life, and life satisfaction, we know little about what matters most to older adults in sub-cultural groups. The purpose of this study was to explore what matters to older Chinese adults. Methods: The study used a qualitative interpretive design, drawing influences from phenomenology and constructed meaning through participants’ lived experiences. Results: After data analysis, a core theme of cultural foundations and categorical themes emerged. This study emphasized the importance of hearing the voices of Chinese older adults and how they viewed well-being, quality of life, life satisfaction, and health care. Discussion: The findings of this study have added to the body of existing knowledge of what matters most to older adults. These insights may advance nursing as it pertains to culturally congruent health care.

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Prevalence of Insomnia Symptoms in Older Chinese Adults During the COVID-19 Pandemic: A Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.779914 ◽

2021 ◽

Vol 8 ◽

Author(s):

Qian-Qian Zhang ◽

Lan Li ◽

Bao-Liang Zhong

Keyword(s):

Mental Health ◽

Older Adults ◽

Health Planning ◽

Meta Analysis ◽

Well Being ◽

Prevalence Rates ◽

Chinese Adults ◽

Older Chinese ◽

Older Chinese Adults ◽

Insomnia Symptoms

Background: The ongoing COVID-19 pandemic has disproportionately affected the sleep health of older adults, but the limited number of studies on insomnia symptoms of older Chinese adults differed in terms of screener of insomnia, sample size, and prevalence, making mental health planning for this population difficult. This meta-analysis estimated the prevalence of insomnia symptoms in older Chinese adults during the COVID-19 pandemic.Methods: Both Chinese (CNKI, Wanfang, VIP) and English (PubMed, EmBase, PsycInfo) databases were systematically searched to identify cross-sectional studies containing data on the prevalence of insomnia symptoms in older Chinese adults during the pandemic. Risk of bias (RoB) of included studies was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data.Results: Nine studies with a total of 27,207 older Chinese adults were included. RoB scores of these studies ranged between zero and six. The pooled prevalence rates of insomnia symptoms and moderate and severe insomnia symptoms were 24.6% [95% confidence interval (CI): 19.5–30.5%] and 11.1% (95% CI: 7.2–16.9%), respectively. In subgroup analysis, significantly higher prevalence rates were observed in studies defining insomnia symptoms as “Insomnia Severity Index (ISI) ≥ 8” than in those defining them as “ISI ≥ 15” (32.6 vs. 15.6%, P < 0.001) and in older adults living in the COVID-19 epicenter than in those living in other places (35.2 vs. 23.3%, P = 0.006).Conclusion: Nearly one out of every four older Chinese adults suffered from insomnia symptoms during the pandemic. Mental health services for this population during the pandemic should include supportive activities aimed at improving mental well-being, periodic assessment of insomnia symptoms, and psychiatric assessment and treatment when necessary.

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Depressive Symptoms Among Rural “Left-Behind” Older Adults: A Test of the High Outmigration Penalty Hypothesis

The Journals of Gerontology Series B ◽

10.1093/geronb/gbab040 ◽

2021 ◽

Author(s):

Qian Song ◽

Haowei Wang ◽

Jeffery A Burr

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Rural Communities ◽

Older Adult ◽

Psychological Health ◽

Economic Conditions ◽

Adult Density ◽

Chinese Adults ◽

Older Chinese ◽

Older Chinese Adults

Abstract Objectives We investigated whether there was a “high outmigration penalty” for psychological health among older adults in rural China by assessing 2 potential community stressors associated with major sociodemographic changes in the community—increased outmigration and older adult density. We also investigated whether disparities in community economic conditions moderated the association between community stressors and depressive symptoms. Methods We employed 3 waves of data from the China Health and Retirement Longitudinal Study (2011–2015), using multilevel negative binomial models to address our research questions. Results Our results supported the “high outmigration penalty” hypothesis. Older adults living in low-income rural communities may experience an aggravated mental health penalty compared to those living in high-income rural communities. Higher older adult density was also associated with more depressive symptoms but only in less wealthy communities. Community differences in economic conditions were key factors buffering the high outmigration disadvantage associated with the psychological health of older Chinese adults. Discussion Rural outmigration may have deepened existing intercommunity health disparities among older adults. Policies should be developed to address community-level factors negatively associated with the well-being of older Chinese adults living in high outmigration and less wealthy rural communities.

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Speech Perception in Noise Is Associated With Different Cognitive Abilities in Chinese-Speaking Older Adults With and Without Hearing Aids

Frontiers in Psychology ◽

10.3389/fpsyg.2021.640300 ◽

2022 ◽

Vol 12 ◽

Author(s):

Yuan Chen ◽

Lena L. N. Wong ◽

Shaina Shing Chan ◽

Joannie Yu

Keyword(s):

Older Adults ◽

Working Memory ◽

Executive Function ◽

Speech Perception ◽

Cognitive Function ◽

Verbal Learning ◽

Chinese Adults ◽

Speech Perception In Noise ◽

Older Chinese ◽

Older Chinese Adults

Chinese-speaking older adults usually do not perceive a hearing problem until audiometric thresholds exceed 45 dB HL, and the audiometric thresholds of the average hearing-aid (HA) user often exceed 60 dB HL. The purpose of this study was to examine the relationships between cognitive and hearing functions (measured as audiometric or speech reception thresholds) in older Chinese adults with HAs and with untreated hearing loss (HL). Participants were 49 Chinese older adults who used HAs and had moderate to severe HL (HA group), and 46 older Chinese who had mild to moderately severe HL but did not use HAs (untreated; or UT group). Multiple linear regression analysis was employed to evaluate how well age, education level, audiometric thresholds, and speech perception in noise were related to performance on general cognitive function, working memory, executive function, attention, and verbal learning tests. Results showed that speech perception in noise alone accounted for 13–25% of the variance in general cognitive function, working memory, and executive function in the UT group, and 9–21% of the variance in general cognitive function and verbal learning in the HA group (i.e., medium effect sizes). Audiometric thresholds did not explain any proportion of the variance in cognitive functioning in the HA or UT group. Thus, speech perception in noise accounts for more variance in cognitive performance than audiometric thresholds, and is significantly associated with different cognitive functions in older Chinese adults with HAs and with untreated HL.

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Association between the number of teeth and frailty among Chinese older adults: a nationwide cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-029929 ◽

2019 ◽

Vol 9 (10) ◽

pp. e029929 ◽

Cited By ~ 7

Author(s):

Yaohua Gu ◽

Wenwen Wu ◽

Jinbing Bai ◽

Xuyu Chen ◽

Xiaoli Chen ◽

...

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Health Behaviours ◽

Secondary Outcome ◽

Multiple Logistic Regression ◽

Chinese Adults ◽

Cross Sectional ◽

Number Of Teeth ◽

Older Chinese ◽

Older Chinese Adults

ObjectivesTo explore the association between the number of teeth and frailty among older Chinese adults using a nationally representative sample.DesignCross-sectional analysis was carried out using the 2014 wave data from the Chinese Longitudinal Healthy Longevity Survey, which used a targeted random-sampling design.SettingThis research was conducted in communities from nearly half of the counties and cities in 22 out of 31 provinces throughout China.ParticipantsOf the 6934 interviewees aged ≥65 years, the final analysis included 3635 older adults who had completed the 2014 wave survey on the variables included in the study.Primary and secondary outcome measuresOutcome variables included frailty, measured by the Frailty Index, and number of teeth. Covariates included demographic characteristics (ie, age, sex, co-residence, marital status, years of education and financial support), body mass index (BMI) and health behaviours (ie, smoking, drinking and exercise). A univariate logistic regression was used to test the factors associated with frailty. A multiple logistic regression model was used, using the frailty score as the dependent variable and the number of teeth together with significant covariates as the independent variables.ResultsThe prevalence of frailty was 27.68%. The mean number of teeth present was 9.23 (SD=10.03). The multiple logistic regression showed that older adults’ demographic variables, health behaviours, BMI, tooth number and chewing pain were significantly associated with frailty. After adjusting for the covariates, older adults with fewer teeth had significantly higher odds of frailty than those with 20 or more teeth (no teeth: OR=2.07, 95% CI 1.53 to 2.80; 1 to 10 teeth: OR=1.77, 95% CI 1.31 to 2.38), except for older adults with 11 to 20 teeth (OR=1.30, 95% CI 0.93 to 1.82).ConclusionsThe presence of fewer teeth is significantly associated with frailty status among older Chinese adults. Future studies are needed to explain the specific mechanisms underlying how oral health status is associated with frailty.

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SOCIAL CAPITAL AND HOME- AND COMMUNITY-BASED SERVICE UTILIZATION AMONG URBAN OLDER CHINESE ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.2372 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S637-S637

Author(s):

Changmin Peng ◽

Jeffery A Burr ◽

Kyungmin Kim ◽

Nan Lu

Keyword(s):

Older Adults ◽

Social Capital ◽

Behavioral Model ◽

Chinese Adults ◽

Community Based ◽

Older Chinese ◽

Cognitive Social Capital ◽

Older Chinese Adults ◽

The Relationship ◽

Structural Social Capital

Abstract Home- and Community-Based Services (HCBS) are increasingly important for older adults who want to maintain their independence and remain in their communities. Although HCBS systems have been developed widely in many western countries and in some countries in Asia, China is just beginning to grapple with its rapidly aging population by offering HCBS in a limited fashion. The purpose of this study was to investigate the relationship between structural (e.g., citizenship activities, volunteering) and cognitive (e.g., social trust, a sense of belonging) social capital and HCBS utilization among older Chinese adults. The study also examined the mediating effect of structural social capital for the the relationship between cognitive social capital and HCBS utilization. We frame the study within the Andersen behavioral model of health services utilization and argue that within this framework social capital is an enabling factor. We analyzed survey data from 456 community-dwelling older adults living in the Gusu district of the city of Suzhou, China in 2015. Structural equation modeling was used to test the hypothesized relationships. The results showed that both cognitive and structural social capital were significantly associated with HCBS utilization. Structural social capital also served as a mediator between cognitive social capital and HCBS utilization, even after controlling for sociodemographic characteristics and other relevant covariates. The findings supported the utility of employing Andersen’s behavioral model and social capital theory for better understanding older Chinese adults’ utilization of HCBS. Interventions for increasing social capital may be useful for improving HCBS utilization in Chinese urban communities.

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Association between rural-to-urban migration and the cognitive aging trajectories of older Chinese adults: results from a prospective cohort analysis

BMC Geriatrics ◽

10.1186/s12877-020-01772-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jinzhao Xie ◽

Jing Liao ◽

Jing Zhang ◽

Jing Gu

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Cognitive Functions ◽

Leisure Activities ◽

Urban Migration ◽

Chinese Adults ◽

Female Migrants ◽

Rural To Urban Migration ◽

Older Chinese ◽

Older Chinese Adults

Abstract Background Increasingly, older Chinese adults from rural areas are moving to urban areas to live with their children who have already migrated to these areas. However, few studies have examined this pattern of migration and its effects on cognitive function. We aimed to investigate the association between domestic rural-to-urban migration and the trajectories of cognitive function in older Chinese adults, as well as the factors contributing to these association. Methods Data for this study were drawn from three waves of the China Health and Retirement Longitudinal Study. Migrants were defined as participants who had rural hukou status (under China’s household registration system) but resided in an urban area. Cognitive functions were measured using an adapted Chinese version of the Mini-Mental State Examination. We used multilevel linear regression models to examine the association between internal migration and cognitive function trajectories. Results The study included 3876 Chinese adults aged ≥60 years at baseline. Compared with their rural non-migrant counterparts, migrants (n = 850) had higher levels of education and reported more interactions with family. Additionally, female migrants were more likely to participate in leisure activities. All cognitive function scores declined over time, but no significant differences were observed in rates of cognitive decline between migrants and non-migrants, regardless of sex. Female migrants exhibited significantly better performance in terms of total cognition (β = 0.77, P < .001) and mental status (β = 0.68, P < .001) than female non-migrants, whereas no inter-group difference was observed regarding memory (β = 0.09, P > .05). Among the male subjects, no significant differences in cognitive function levels were observed between migrants and non-migrants. A series of adjusted models revealed that psychosocial factors such as residing with children, caring for grandchildren, depression and participation in leisure activities partly explained the association between migration and cognition in women. Conclusions Rural-to-urban migration was positively associated with cognitive functions only in women. However, this pattern did not affect the rate of cognitive decline in either sex. Our findings provide directions for tailored interventions improving cognitive functions of older adults and rural non-migrating older adults, especially female non-migrants.

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Cumulative exposure to air pollution and subsequent mortality among older adults in China

Journal of Public Health ◽

10.1093/pubmed/fdy154 ◽

2018 ◽

Vol 41 (3) ◽

pp. 518-526 ◽

Cited By ~ 1

Author(s):

Jiaan Zhang ◽

Sara J McLaughlin ◽

Lydia W Li

Keyword(s):

Older Adults ◽

Air Pollution ◽

Multinomial Logistic Regression ◽

Air Pollutant ◽

Cumulative Exposure ◽

Chinese Adults ◽

Logistic Regression Models ◽

Individual Level ◽

Older Chinese ◽

Older Chinese Adults

Abstract Background Research on the health effects of exposure to air pollution is growing. However, relatively little attention has been paid to the effects of long-term and cumulative exposure to air pollutants. Individual-level studies on the health consequences of air pollution in China are especially scarce. The purpose of this study is to examine the effect of cumulative exposure to sulfur dioxide (SO2), an air pollutant of particular concern in China, on all-cause mortality in older Chinese adults. Methods Using a nationally representative sample of older adults in China (N = 11 199), we tracked mortality over an 11-year period (2000–11). Air pollution data were linked to respondents using provincial identifiers. To examine the effect of cumulative SO2 exposure on mortality, we employed multilevel multinomial logistic regression models that account for within subject clustering of observations over time and clustering at the province level. Results We found that every 10-μg/m3 increase in cumulative exposure to SO2 increased the odds of death by nearly 1% (OR = 1.008; 95% CI: 1.002–1.014), controlling for province- and individual-level social and economic characteristics. Conclusions Our analysis shows that air pollution is a risk factor for morality in older Chinese adults. Findings suggest that stronger SO2 regulations may enhance longevity.

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Attitudes towards Advance Care Planning and Healthcare Autonomy among Community-Dwelling Older Adults in Beijing, China

BioMed Research International ◽

10.1155/2015/453932 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 9

Author(s):

Ning Zhang ◽

Xiao-hong Ning ◽

Ming-lei Zhu ◽

Xiao-hong Liu ◽

Jing-bing Li ◽

...

Keyword(s):

Older Adults ◽

Cross Sectional Study ◽

Influential Factors ◽

Community Dwelling ◽

Chinese Adults ◽

Cross Sectional ◽

Advance Care ◽

Older Chinese ◽

Older Chinese Adults ◽

Beijing China

Objectives. To investigate the preferences of ACP and healthcare autonomy in community-dwelling older Chinese adults.Methods. A community-based cross-sectional study was conducted with older adults living in the residential estate of Chaoyang District, Beijing.Results. 900 residents were enrolled. 80.9% of them wanted to hear the truth regarding their own condition from the physician; 52.4% preferred to make their own healthcare decisions. Only 8.9% of them preferred to endure life-prolonging interventions when faced with irreversible conditions. 78.3% of the respondents had not heard of an ACP; only 39.4% preferred to document in an ACP. Respondents with higher education had significantly higher proportion of having heard of an ACP, as well as preferring to document in an ACP, compared to those with lower education. Those aged <70 years had higher proportion of having heard of an ACP, as well as refusing life-prolonging interventions when faced with irreversible conditions, compared to those aged ≥70 years.Conclusions. Although the majority of community-dwelling older Chinese adults appeared to have healthcare autonomy and refuse life-prolonging interventions in terms of end-of-life care, a low level of “Planning ahead” awareness and preference was apparent. Age and education level may be the influential factors.

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Ethnic Differences in Barriers and Enablers to Physical Activity Among Older Adults

Frontiers in Public Health ◽

10.3389/fpubh.2021.691851 ◽

2021 ◽

Vol 9 ◽

Author(s):

Emily You ◽

Nicola T. Lautenschlager ◽

Ching Shan Wan ◽

Anita M. Y. Goh ◽

Eleanor Curran ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Health Issues ◽

Chinese Adults ◽

Language And Culture ◽

Barriers And Enablers ◽

Older Chinese ◽

Group Interviews ◽

Bad Weather ◽

Older Chinese Adults

Despite its well-known health benefits, most older adults do not commit to undertaking sufficient physical activity (PA). In this study we aimed to examine the perceived benefits of and barriers and enablers to PA from the perspectives of older Caucasian and Chinese adults living in Australia. Individual and group interviews with 17 Caucasian (mean age: 72.8 years) and 47 Chinese adults (mean age: 74.0 years) were conducted and analysed using thematic analysis. Overall, participants knew about the benefits of PA on physical health but had inconsistent views on its benefits on mental and cognitive health. Older Caucasian and Chinese adults reported similar barriers (e.g., health issues, costs, bad weather and lack of time) and enablers (e.g., improving health; environmental enablers such as adequate and walkable spaces and good natural environment; peer support; and self-motivation) to PA. In comparison, older Chinese adults reported barriers more often, and reported some unique barriers relating to language and culture issues. The findings contribute to developing targeted PA programs for older Caucasian and Chinese adults.

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