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.

Bridging the Digital Divide for Rural Older Adults by Family Intergenerational Learning: A Classroom Case in a Rural Primary School in China

Rural older adults often feel disconnected from the ever-expanding digital world. To bridge the digital divide, researchers have investigated the effectiveness of formal education and training offered by various social institutions. However, existing research highlights a critical shortcoming in these approaches: a lack of attention paid to rural older adults’ individual needs and interests. Based on the theories of post-metaphorical culture, endogenous development, home-school cooperation, and technology adoption and acceptance, this study implements a family intergenerational learning (FIL) project. FIL characterizes learning between grandparents and grandchildren within the household, suggesting a more practical and individualized strategy to help rural older adults gain digital literacy. By conducting a three-month FIL Project in a rural primary school class in China, the study employs a qualitative method to analyze learning records and interviews from 10 sets of participating grandparents and grandchildren. The analysis renders two critical findings on the effectiveness of the FIL Project for rural older adults. First, FIL can help rural older adults adapt into the digital world by (1) gaining knowledge about digital society, (2) improving their digital skills, (3) changing their lifestyles, and (4) understanding the integration between technology and society. Second, among grandchildren, FIL can cultivate an awareness of lifelong learning and their moral obligations to their grandparents. By illustrating this specific case, this study puts forward a new approach to help the older adults overcome the digital divide in rural areas.

Challenges with Pain Treatment for Rural Older Adults: Family Caregivers' Views

Family caregivers face various challenges in assisting older adults experiencing pain and difficult symptoms. Living in rural areas poses additional obstacles to their caregiving. The purpose of this study was to explore family caregivers’ lived experiences in caring for older adults with pain and discomfort in rural communities. A qualitative research design was adopted to capture the common essence of participants’ experiences through a phenomenological method. Purposeful sampling was used, and the participant criteria was: age 18+, have good thinking skills, resident of Alabama, provide unpaid assistance to a family/relative who has chronic/serious health conditions and experienced pain/discomfort in the last 3 months. Ten participants were recruited from rural counties of Alabama. Individual semi-structured interviews were conducted via phone and were recorded and transcribed verbatim. Inductive, thematic analysis of the data revealed themes in five categories: 1) impact of pain (physical and psychological/emotional toll), 2) coping strategies (faith/contentment with life/logistical adaptation), 3) impact of Covid-19 (physical health/social interaction/mental health/added caregiving), 4) challenges in pain treatment (transportation (time/distance/driver/cost) and non-transportation related problems (healthcare provider issues/health insurance/financial burden)), and 5) suggestions (transportation-related (more transportation options/tailored services) and non-transportation-related support (home-based services/better health insurance coverage)). Findings of this study highlight rural family caregivers’ unique experiences in assisting older adults’ access to pain treatment, particularly during the Covid-19 pandemic. Policy- and program-level intervention is called for to increase individualized transportation options, improve health insurance coverage, and expand financial support for rural older adults experiencing pain and their caregivers.

Rural Older Adults’ Experiences With Pain From Chronic Illnesses and Its Treatment

Although pain control is an essential factor in promoting quality of life, pain is undertreated among certain sub-populations, such as older adults and rural residents. The purpose of this study was to explore pain experiences and its treatment among rural older adults. A qualitative research design was adopted to capture the common essence of participants’ experiences through a phenomenological method. Purposeful sampling was used, and the participant criteria was: age 55+, have good thinking skills, resident of Alabama, have chronic/serious health conditions, and experienced pain or discomfort in the last 3 months. Twenty-three participants were recruited from rural counties of West and South Alabama through the local Area Agency on Aging and health and senior service centers. Individual semi-structured interviews were conducted via phone and were recorded and transcribed verbatim. Thematic analysis was conducted to identify emerging themes and repeated patterns from the data. Our results revealed themes in four categories: 1) impact of pain: physical limitations and coping strategies, 2) Impact of Covid-19: physical health, social, and mental health impact, 3) challenges in pain treatment: transportation (driver/time/cost/Covid-19 exposure) and non-transportation related problems (lacking resources/mistrust/limited health insurance coverage), and 4) suggestions: transportation-related (more transportation options/financial assistance) and non-transportation-related support (improved insurance coverage/non-pharmacological care) . Findings of this study highlight rural older adults’ unique needs in access to pain treatment, further amplified during the Covid-19 pandemic. Increase in sustainable, funded transportation programs and the supply of local pain specialists is critical to meet such needs and improve their quality of life.

Loneliness and Social Connectedness Among Rural Older Adults Since the COVID-19 Pandemic Onset

Rural areas have a higher proportion of older adults aging in place. Rural areas also face structural barriers to supporting social connectedness among older adults, including transportation barriers, greater geographic distances, and access to technological connectivity. This research aims to discuss rural-specific risks of loneliness and social isolation among older adults, as well as rural/urban differences in loneliness and social isolation among older adults using the national COVID-19 Coping Study. Cross-sectional bivariate analyses highlight rural/urban differences in social activities during the pandemic. For example, rural older adults were more likely to use social media daily, compared with urban older adults (67% vs. 61%, p<0.05), but were less likely to have phone or video calls with others daily (21% vs. 26%, p<0.001). We will also share results of differences within rural older adults in loneliness, isolation, and social activities by socio-demographic characteristics in order to design targeted interventions to improve connectedness.

Social Support and Weight Outcomes Over A Six-Month Weight Loss Intervention for Rural Older Adults

Rural older adults aged ≥65 years with obesity (body mass index (BMI) ≥30 kg/m2) showed an overall favorable response to a six-month, technology-based weight-management intervention. Our objective was to characterize how friends or family support for eating and exercise behaviors at baseline was associated with baseline weight and intervention response. We analyzed data from six subscales of the Social Support and Exercise Survey from 44 participants. Six-month weight change (≥5% of baseline) was considered clinically-significant. For each subscale, continuous and categorial outcomes were modeled with linear and logistic regression models, respectively, adjusted for sex and age. Crude associations of social support clusters, generated in an exploratory hierarchical cluster analysis, and weight outcomes were evaluated. The sample was 73.2 ± 3.9 years, 73% female, with mean baseline weight 97.8±16.3 kg and BMI 36.5±5.2 m/kg2. Family encouragement for healthy eating was negatively associated with baseline weight (β=-0.53, p=0.046). Social support scores were not associated with either six-month weight loss outcome (p>0.10). Two exploratory clusters were found: Cluster 1 (C1) (n=34) and Cluster 2 (C2) (n=9). C2 had higher mean social encouragement and discouragement, with lower mean baseline weight (90.0±11.7 vs 99.8±16.8kg C1; p=0.10). Weight loss was comparable (C1 4.6±3.7 versus C2 4.8±2.6kg; p=0.89), with no differences in clinically-significant weight loss (C1 45% versus C2 67%; p=0.46). These pilot data suggest that family member social support may act as collaterals to support clinical outcomes in the community. Evaluating different types within family support may elucidate associations with physiological outcomes in larger samples.

Adaptation and Coping Among Rural Older Adults Throughout the COVID-19 Pandemic

In the past year, older adults have faced challenges due to COVID-19, yet many have also shown great resilience. This qualitative study explores older adults’ experiences and perceptions of adaptation, social connection, and coping across the first six months of the COVID-19 pandemic, with a particular focus on unique resilience factors among rural older adults. A Midwestern sample (35% rural) of 70 older adults aged 70-97 completed three phone interviews (April, June, and October 2020) about their experiences with social distancing due to COVID-19. Thematic analysis of qualitative responses identified themes of resilience including: 1) purposeful and flexible social connections, 2) positive psychological mindset, and 3) hardiness and life experience. Strains related to the loss of community connections were evident, yet older adults demonstrated signs of adaptability and coping as compensation. Implications and future directions will be discussed in the context of change over time and geographic variation.

Roles of Social Isolation and Rurality on Functional Limitations in Older Adults Living in the US

Social isolation is a growing problem among adults aged ≥65. Using 2019 data from the National Health and Aging Trends Study (NHATS) (n=4,603), we examined the associations of social isolation and rurality with functional limitations in US older adults. We hypothesized that rural older adults would report social isolation more than non-rural adults, and social isolation and rurality would have an interaction effect on difficulty in performing activities of daily living (ADLs). Stress buffering theory guided this research suggesting individuals who have greater social connections also have greater coping skills to buffer against health-related stress. We assessed rural and non-rural older adults’ social isolation (measured by a composite score of engagement in community activities and social connections) and difficulty in completing ADLs (e.g., difficulty in dressing, bathing, and eating in the past month). Our results supported one of the hypotheses that there were differing levels of social isolation among both rural and non-rural older adults. In both rural and non-rural groups, oldest-old (85+), non-White adults, those with poor health or had multiple comorbidities were significantly isolated or experienced severe isolation. These results support (1) the premise that specific demographic characteristics are associated with social isolation as well as (2) a growing body of research showing rural adults have unique characteristics that are protective against social isolation. Our findings are related to demographic predictors which could help target interventions toward specific at-risk groups. Policymakers and healthcare practitioners should be aware of risks for social isolation and prepare to discuss these issues.