Multidomain Social Determinants of Depressive Symptoms for the Elderly with Chronic Diseases: Evidence from the China Health and Retirement Longitudinal Study

Elderly individuals with chronic diseases (CDs) have a much higher risk of mental disorders, especially depression. This study aimed to identify the multidomain social determinants of occurrence and degree of depressive symptoms for the Chinese elderly with CDs. Data of 3438 elderly individuals (aged over 60 years) with CDs were drawn from the fourth wave of the China Health and Retirement Longitudinal Study implemented in 2018. Logistic regression was used to describe associations with the occurrence of depressive symptoms within and across multidomain social determinants (demographic, economic, neighborhood, environmental, and social and cultural). The Shapley value decomposition method was used to measure the relative importance of variables of the five domains. A quantile regression model was used to test how the effects of social factors vary across different points of depression score distributions. Approximately 40.1% of Chinese elderly individuals with CDs reported depressive symptoms. Respondents who were female, had a low income, experienced a disability, lived in rural areas, and were not engaged in work had a higher probability of suffering from depressive symptoms. Conversely, increased age, being covered by social security and being well-educated had a protective effect. Data also showed that the effects of these associated factors varied across different points of depression score distributions. The fact that socially disadvantaged people are more vulnerable to severe depressive symptoms implies that psychological health services and intervention strategies should target this population.

Tourist motivation and satisfaction of Chinese senior tourists on day trips

<p>Purpose: The study explores the tourist motivation and satisfaction of Chinese senior tourists on day trips. The purpose of this study is to identify the model of tourist motivation and satisfaction for Chinese senior tourist on day trips, thereby filling the theoretical gap in the field of day trips in China. Design: This study proposes a conceptual framework of the tourist motivation and satisfaction for the Chinese senior tourist on day trips based on the literature in the field and analysing the tourism motivation and satisfaction of Chinese senior tourists on day trips by using the quantitative research method of the positivist paradigm. Findings: This study validated some of the previous research results in this field and confirmed most of them. Similar to some research results, this study found the most important push motivation category for Chinese senior tourists on day trips is “knowledge-seeking”, and the most important pull motivation category is “advantages of the scenic spot”. For tourist satisfaction of Chinese senior tourists on day trips, the three most important influencing factors are: “scenic security”, “attractive scenery”, and “service quality of scenic service personnel”. The study also found the demographic characteristics of senior tourists have an impact on tourist motivation and factors affecting tourist satisfaction. For example, fitness is an important reason for people aged 50-55 travel, but it doesn't important to people over 55 years old. Senior people with more knowledge will be more concerned with the needs of intangible cultures. For male seniors, the most important factor affects tourist satisfaction is “attractive scenery”. But for the elderly women, the first important factor affecting tourist satisfaction is “scenic security”. Furthermore, the results identify as tourism motivation becomes higher, the Chinese senior tourists evaluate the tour quality better. Similarly, as the tourism expectation becomes higher, Chinese senior tourists evaluate the tour quality better, which increases tourist satisfaction. Tourist satisfaction affects the future behavioural intention of the Chinese elderly negatively. Meanwhile, the mean value of tourists' future behavioural intention shows that as the tourist satisfaction of the Chinese elderly becomes higher, they tend to recommend to their friends. The lower the tourist satisfaction of the Chinese elderly, the more they tend to complain to their friends. Originality and Value: This study has proved some existing theories about tourist motivation and satisfaction of senior tourists can also be applied to Chinese senior tourists on day trips. The academic contribution of this study is the model of tourist motivation and satisfaction for Chinese senior tourists on day trips that has been identified. This empirical model is a new theory for the Chinese day trips field, which fills the theoretical gap in it and it can be used for many other works. Meanwhile, this study can also help other researchers in other related research work. The study may be able to provide some related materials such as research data etc. The findings of this study will help Chinese tourism practitioners responsible for designing tourism products and providing services. This study can help tourism practitioners to understand more about the needs of senior people participating in tourism activities, thus can design suitable tourism products for the senior people.</p>

Tourist motivation and satisfaction of Chinese senior tourists on day trips

<p>Purpose: The study explores the tourist motivation and satisfaction of Chinese senior tourists on day trips. The purpose of this study is to identify the model of tourist motivation and satisfaction for Chinese senior tourist on day trips, thereby filling the theoretical gap in the field of day trips in China. Design: This study proposes a conceptual framework of the tourist motivation and satisfaction for the Chinese senior tourist on day trips based on the literature in the field and analysing the tourism motivation and satisfaction of Chinese senior tourists on day trips by using the quantitative research method of the positivist paradigm. Findings: This study validated some of the previous research results in this field and confirmed most of them. Similar to some research results, this study found the most important push motivation category for Chinese senior tourists on day trips is “knowledge-seeking”, and the most important pull motivation category is “advantages of the scenic spot”. For tourist satisfaction of Chinese senior tourists on day trips, the three most important influencing factors are: “scenic security”, “attractive scenery”, and “service quality of scenic service personnel”. The study also found the demographic characteristics of senior tourists have an impact on tourist motivation and factors affecting tourist satisfaction. For example, fitness is an important reason for people aged 50-55 travel, but it doesn't important to people over 55 years old. Senior people with more knowledge will be more concerned with the needs of intangible cultures. For male seniors, the most important factor affects tourist satisfaction is “attractive scenery”. But for the elderly women, the first important factor affecting tourist satisfaction is “scenic security”. Furthermore, the results identify as tourism motivation becomes higher, the Chinese senior tourists evaluate the tour quality better. Similarly, as the tourism expectation becomes higher, Chinese senior tourists evaluate the tour quality better, which increases tourist satisfaction. Tourist satisfaction affects the future behavioural intention of the Chinese elderly negatively. Meanwhile, the mean value of tourists' future behavioural intention shows that as the tourist satisfaction of the Chinese elderly becomes higher, they tend to recommend to their friends. The lower the tourist satisfaction of the Chinese elderly, the more they tend to complain to their friends. Originality and Value: This study has proved some existing theories about tourist motivation and satisfaction of senior tourists can also be applied to Chinese senior tourists on day trips. The academic contribution of this study is the model of tourist motivation and satisfaction for Chinese senior tourists on day trips that has been identified. This empirical model is a new theory for the Chinese day trips field, which fills the theoretical gap in it and it can be used for many other works. Meanwhile, this study can also help other researchers in other related research work. The study may be able to provide some related materials such as research data etc. The findings of this study will help Chinese tourism practitioners responsible for designing tourism products and providing services. This study can help tourism practitioners to understand more about the needs of senior people participating in tourism activities, thus can design suitable tourism products for the senior people.</p>

Determining Appropriate Screening Tools and Cutoffs for Cognitive Impairment in the Chinese Elderly

Background: The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are the most commonly used tools for cognitive impairment screening. The present study aimed to investigate the ability of the MOCA and MMSE to differentiate between cognitively normal elderly individuals, MCI patients and dementia patients at different ages and education levels and to establish the optimal cutoff scores of the MoCA and MMSE for MCI and dementia in the Chinese elderly.Methods: A total of 2,954 Chinese elderly individuals, including 1,746 normal controls, 599 MCI patients and 249 dementia patients, were consecutively recruited in the study. The optimal cutoffs for MoCA and MMSE were determined using receiver operating characteristic (ROC) analysis among the different age and education levels in the three groups. Furthermore, comparison of ROC curves were made to evaluate the performances of the two tests.Results: The area under the curve(AUC) of the MoCA (0.82) for detecting MCI was significantly higher than that of the MMSE (0.75) (P &lt; 0.001). When the sample was divided according to age and education level, the AUC of the MoCA (0.84) was higher than those of the MMSE (0.71) for MCI (P &lt; 0.001) in the younger and more highly-educated groups. The optimal cutoff scores of the MoCA for the groups aged ≤ 75 years old and education ≤ 6 years, aged &gt; 75 years old and education ≤ 6 years, aged ≤ 75 years old and education &gt; 6 years, aged &gt; 75 years old and education &gt; 6 years in screening for MCI were identified as 19.5, 15.5, 24.5 and 24.5, respectively, and the optimal cutoff scores for dementia were 18.5, 10.5, 18.5 and 20.5, respectively. For MMSE in the above four groups, the cutoff scores to detect MCI were 26.5, 22.5, 28.5 and 26.5, respectively, and the optimal cutoff scores for dementia were 23.5, 19.5, 23.5 and 23.5, respectively.Conclusion: Compared to MMSE, the MoCA is more suitable for discriminating MCI in younger and more highly educated elderly Chinese individuals. However, the MMSE has advantage over MoCA in screening MCI in individuals with lower education levels and the older groups of Chinese elderly.

Factors associated with active aging in Chinese elderly in rural areas of Xiangtan County, China†

Objectives To explore the level of active aging and correlates among rural elderly in Xiangtan County, China. Methods A cross-sectional survey was conducted from July to November 2019. A total of 945 rural elderly from 3 towns in Xiangtan County, China, were investigated by using the positive aging evaluation questionnaire (PAEQ), the activity of daily living scale (ADL), and the depression in old-age scale (DIA-S). Results The average score in the PAEQ among the rural elderly of Xiangtan County was 72.81 (range = 21–105). A moderate negative correlation was found between the score in the PAEQ and those in the ADL (r = −0.361) and DIA-S (r = −0.495). Symptoms of depression (β: −0.321, P = 0.001), number of chronic diseases (β: −0.281, P = 0.001), subjective economic status (β: 0.239, P = 0.001), ADL (β: −0.196, P = 0.001), education (β: 0.126, P = 0.001), number of children (β: 0.097, P = 0.001), and marital status (β: −0.060, P = 0.001) were significantly associated with levels of active aging in rural elderly, whereas gender and age were not independently related to active aging. Conclusions The level of active aging is at a moderately high level in the Chinese elderly in rural areas in Xiangtan County. The focus group of active aging in rural areas should be elderly people suffering from chronic diseases, physical decline, poor education and economic conditions, childlessness, and those without partners.

The Multi-Modal Risk Analysis and Medical Prevention of Lumbar Degeneration, Fatigue, and Injury Based on FEM/BMD for Elderly Chinese Women Who Act as Stay-Home Grandchildren Sitters

Background: An increasing number of Chinese elderly women stay at home and act as grandchildren sitters. In consequence of the frequent load-bearing, chronic lumbar fatigue probably caused a higher risk of lumbar degeneration, fatigue, and injury which has become one of the most important aging and health problems in China. In this study, a multi-mode lumbar finite element model (FEM) with specific bone mineral density (BMD) were developed and validated for further spine injury prevention and control.Methods: The material properties of lumbar vertebra were modified according to degenerated bone mineral density, and geometry was adjusted based on intervertebral disc height. The motion of lifting children was simulated by a 76 year-old Chinese women's FEM, and the stress distribution was calculated and predicted.Results: The pressure of L5-S intervertebral disc in the bending 3-year-old dummy lifting posture was significantly higher than the same posture without lifting, the maximum effective stress of endplate cartilage in the upright child lifting posture was 1.6 times that of the bending without lifting posture. And the fatigue risk limitation frequency of the upright with dummy posture was predicted with the functional equation of fatigue and stress which was deduced by genetic algorithm, which combined with the effective stress of lumbar vertebrae spongy bone calculated from FEM.Conclusions: The child-lifting motion could increase the risk of lumbar degeneration, fatigue, and injury in elderly women, and they should keep below the frequency limit of the motion of lifting children in their daily life. This study could put forward scientific injury prevention guidance to Chinese elderly women who lift children in daily life frequently.

Trends in Cognitive Function Among Chinese Elderly From 1998 to 2018: An Age-Period-Cohort Analysis

Objectives: To investigate the effects of age, period, and cohort (APC) on trends in cognitive function among the Chinese elderly, and to explore how gender gaps in cognitive function change with age, period, and cohort.Methods: This study used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018, and included 90,432 participants aged above 65 years old. The measurement of cognitive function was the score of the Mini-Mental State Examination (MMSE). Cross-classified random-effect models were used to investigate age, period, and cohort trends in cognitive function.Results: Mini-Mental State Examination scores decreased with age at an increasing rate. While the cohort effect was nearly stable, the period effect demonstrated a downward trend from 1998 to 2002 followed by a nearly flat line. Females were associated with lower MMSE scores than males. When age increased, the gender gaps in MMSE scores further increased. The period-based gender gaps in MMSE scores diverged throughout the 20 years, while the cohort-based gender disparities in MMSE scores converged with successive cohorts.Conclusions: Age, period, and cohort had different and independent effects on cognitive function among the Chinese elderly. The effect of age was stronger than that of period and cohort. Gender disparities in cognitive function increased with age and period, and decreased with successive cohorts.