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.

The Health Effect of the Number of Children on Chinese Elders: An Analysis Based on Hukou Category

Based on the 2018 China Health and Retirement Longitudinal Study (CHARLS 2018), from the perspective of urban-rural disparity, this paper investigates how fertility affects Chinese elders' health. We exploit the enactment of the one-child policy in 1979 to construct instrumental variables capturing the health effect of having only one child rather than multiple children. The empirical results show that the health condition of rural elders having only one child is worse than elders having multiple children, while the negative health effect of lower fertility becomes statistically insignificant for urban elderly parents. After considering the selection on both levels and gains, the results are still robust in marginal treatment effect (MTE) estimation. We investigate the potential mechanism in four ways, the results suggest that having only one child instead of multiple children depresses the upstream intergenerational transfer payments more for rural parents; ameliorates offspring's educational attainment more for urban parents; improves housing conditions more for urban elders; and decreases the visit frequency of children to both urban and rural parents. Our findings have important implications, in the context of increasing population aging, the urban-rural inequality caused by the hukou system has been magnified by the declining fertility rate. The Chinese government should pay more attention to rural elders with only one child, and more public-funded socioeconomic resources are needed for one-child parents in rural areas to improve their health. Moreover, the empirical results also imply that urbanization in China may be able to soften the health deterrent effect of lower fertility.

How Poverty, Residence Status and Health Insurance Predict Unmet Healthcare Needs among Chinese Elders?

This study focuses on the variability in unmet healthcare needs among vulnerable Chinese elders and the degree to which these unmet needs are associated with socioeconomic disadvantages. We use the 2013 wave of China Health and Retirement Longitudinal Study (CHARLS) and a multinomial logistic model to investigate how poverty, residence status and particular health insurance schemes influence unmet healthcare needs independently and in combination. Our results show that poverty and rural residence are strong predictors of unmet healthcare needs due to financial and non-financial constraints, respectively. Although health insurance can reduce financial barriers, its influence varies with different insurance schemes, thus generating unequal healthcare access among heterogeneous vulnerable subgroups of elders and putting poor rural migrants at the highest risk for unmet healthcare needs. Our findings direct attention to the differences in resources available to various subgroups of elders and the importance of social stratification in predicting unmet health care needs.

Relationship between skeletal muscle mass with metabolic syndrome in Chinese elders

Background: The association between regional skeletal muscle mass and metabolic syndrome (MetS) remains unclear. Therefore, the present study aimed to investigate these associations with MetS risk among Chinese elders.Methods: On the basis of health check-up program, a case-control study was performed among participants over 65 years of age, 250 MetS participants were identified and 750 healthy subjects were randomly selected as controls. Skeletal muscle mass was estimated via bioelectric impedance analysis. Muscle mass of each region was standardized by weight to obtain its muscle mass index. Conditional logistic regression models and restricted cubic spline models were implemented to evaluate the associations between MetS and the muscle mass in different regions.Results: As compared the highest category with the lowest category, leg muscle mass index (LMI) (OR = 0.12; 95%CI: 0.05, 0.32; P for trend < 0.001), trunk muscle mass index (TMI) (OR = 0.11; 95%CI: 0.04, 0.29; P for trend < 0.001) and skeletal muscle mass index (SMI) (OR = 0.11; 95%CI: 0.04, 0.29; P for trend < 0.001) were inversely associated with MetS risk after adjusting for age, gender, duration of education, exercise, smoking status, alcohol drinking status, total energy intake, proteins, fats, carbohydrates, serum fasting glucose and lipid profiles. Dose-response analysis showed that per standard deviation increment of LMI (OR = 0.45; 95%CI: 0.34, 0.58; P for trend < 0.001), TMI (OR = 0.39; 95%CI: 0.28, 0.53; P for trend < 0.001) and SMI (OR = 0.29; 95%CI: 0.19, 0.43; P for trend < 0.001) were inversely associated with MetS risk, respectively.Conclusion: The present results showed that higher LMI, TMI and SMI were associated with the low risk of MetS in Chinese elders.

Resilience Improves the Sleep Quality in Disabled Elders: The Role of Perceived Stress

The current research aims to prove the impact of resilience on sleep quality and to investigate the mediating function of perceived stress in the paths from resilience to sleep quality among disabled Chinese elders. The participants were 196 elders with visual and physical disability who resided in the nursing houses in Shanghai, including 102 males and 94 females whose mean age was 74.5 years old (standard deviation = 6.81). All the elders were measured with the 10-item Connor-Davidson Resilience Scale, Pittsburgh Sleep Quality Index (PSQI), and Perceived Stress Scale. The results showed that all the demographic variables were significantly related to perceived stress and PSQI scores. High levels of resilience could significantly enhance the quality of sleep in disabled Chinese elders. In addition, the two-step mediation models also confirmed the impact of resilience on sleep quality as mediated through perceived stress in this special aged population. Better knowledge on the mechanisms of sleep quality among older adults could benefit the prevention and treatment of some geriatric diseases.

Constructing a hero–victim identity through reminiscing: a phenomenological study on rural Chinese elders

Reminiscing contributes to the formulation of identity in later adulthood through integrating individuals’ recomposed past, perceived present and envisioned future. Aiming to understand rural Chinese elders’ identity construction through reminiscing, we conducted semi-structured interviews with 20 elders living in ShiGo, a village located in the south-west of China. Data analysis suggests the rural elders in this study constructed a hero–victim identity through telling stories about the hardships they went through and the sacrifices they made. The participants narrated suffering from lack of basic living needs in the past, in particular before the 1980s while they were involved in turmoil brought on by wars and national movements, from destructive relationships, from making sacrifices for the country and their families, and from adapting to challenges brought on by the hardships. The rural elders shared life experiences with other villagers in daily life through bitter-sweet telling and wanted their suffering and sacrifices to be witnessed. Witnessing connects suffering, sacrifice, hero and victim into a self-enforcing system that helps the elders maintain interdependence and defence against existential concerns like death anxiety. A hero–victim dialectic model was presented to capture the self-enforcing attribute of the hero–victim identity. Findings of this study could be used to make sense of rural ageing in China and benefit clinical professionals working with rural Chinese elders.