Although the Geriatric Self-Care Scale (GSS) has been widely used in community investigations in China, its reliability and validity have yet to be analyzed.

This study aimed to examine the reliability and validity of the GSS in community-dwelling Chinese older adults.

This prospective observational study included 29428 older adults. Content validity was analyzed using the Content Validity Index (CVI). Reliability analysis included internal consistency and test-retest reliability. Differences in participants who could live independently versus those who could not were analyzed for discriminant validity. The Barthel Index was used as the gold standard. Spearman's correlation and Receiver Operating Characteristic (ROC) analysis were used to assess convergent validity.

The CVI for the GSS was 0.920, with CVI values of 1.000, 0.900, 1.000, 0.800 and 0.900. The Cronbach's alpha for the GSS was 0.869 (for all participants) and 0.867 (for participants aged ≥ 65 years) and the item Cronbach's alpha coefficients were all >0.8. The Pearson and intraclass correlation coefficients for both the scale and each item were greater than 0.8. There were significant differences (p < 0.05) between participants who could live independently and those who could not. There were significant correlations (p < 0.05) between the GSS and Barthel Index for each item and the total score. ROC analysis revealed that all areas under the curve were greater than 0.8, with a sensitivity and specificity exceeding 0.8.

The GSS showed good reliability and validity among community-dwelling older adults in China.

Little is known about the associations between adverse childhood experiences (ACES) and physical, depressive, and cognitive (PDC) disorders and their multimorbidity. Moreover, no study has assessed whether loneliness mediates any such associations. Using a nationally population-based study in China, we aimed to investigate the associations between ACES and PDC disorders and their multimorbidity among 11,124 middle-aged and older adults. Eight categories of outcomes including no disorders, physical disorder, depressive symptoms, cognitive disorder, and their four combinations were assessed. Twelve ACES indicators were measured using a validated questionnaire. Multivariate logistic regression and stratification analyses were performed to explore the association between ACES and PDC disorders and their multimorbidity, as well as potential modifiers. Mediate analyses were applied to examine the potential pathways via loneliness. Of the 11,124 individuals (45.8 % women, mean [SD] age: 60.1 [8.9] years), 79.3 % had at least one ACE. Compared with individuals without ACES, those who had four or more ACES had elevated risks of PDC disorders and their multimorbidity. The estimated odds ratios (OR) were 2.95 (95 % CI: 2.46-3.54) for physical-depressive multimorbidity, 1.59 (1.28-1.98) for physical-cognitive multimorbidity, 2.58 (2.01-3.31) for depressive-cognitive multimorbidity, and 2.91 (2.15-3.96) for PDC multimorbidity, respectively. There is an exposure-response relationship between cumulative ACES with different outcomes. These associations were mediated by loneliness, with a mediation proportion varying from 8.7 % to 32.5 %. However, no significant modification was observed by sex, age, educational level, and childhood economic status. Our findings provided important insights for reducing childhood adversity to prevent chronic multimorbidity.

Swallowing dysfunction and depressive symptoms are prevalent among older adults. This study explored the association between swallowing function and depressive symptoms among community-dwelling older adults.

This cross-sectional study included Chinese community-dwelling older adults (≥65 years old) in 2023, using cluster random sampling. Questionnaires were used to collect information on swallowing function (10-item Eating Assessment Tool), depressive symptoms (9-item Patient Health Questionnaire), sociodemographic characteristics, health status, and lifestyle. Multivariable logistic regression models and Directed Acyclic Graphs were used to identify factors associated with depressive symptoms. Propensity Score Matching (PSM) was used to explore the association between swallowing function and depressive symptoms.

Totally, 8388 participants were included. The prevalences of depressive symptoms and swallowing dysfunction were 16.40 % (95 % CI: 15.52 %-17.19 %) and 22.06 % (95%CI: 19.86 %-24.25 %), respectively. The multivariate regression model showed that swallowing function was one of the factors associated with depressive symptoms (OR = 1.699, 95 % CI = 1.448-1.995, P < 0.001). The risk ratio for depressive symptoms was significantly higher in the participants with swallowing dysfunction than those with normal swallowing function [(23.29 %, 431/1850) vs. (945/6538, 14.45 %), P < 0.001] There were 17 out 38 of variates enrolled in the PSM covariate set. A total of 1850 pairs of participants were matched and PSM revealed a 6.64 % difference in the risk ratio for depressive symptoms [(23.29 %, 431/1850) vs. (16.65 %, 308/1850), P < 0.001]. The PSM robustness test supported the stability and reliability of the results.

In Chinese community-dwelling older adults, swallowing dysfunction was positively associated with depressive symptoms.

Objective: To study the clinical and laboratory characteristics of hemorrhagic fever with renal syndrome (HFRS) in Chinese elderly patients. Methods: The clinical data of hospitalized patients diagnosed with HFRS from 2011 to 2022 were extracted from the inpatient record system of the Second Affiliated Hospital of Air Force Medical University. A comparative analysis was conducted between young and elderly individuals regarding the male-to-female ratio, disease classification, clinical laboratory indices, and prognosis. Results: Among the patients diagnosed with HFRS, the elderly population accounted for 14.86%, comprising 199 males and 86 females. The proportion of severe-type cases among elderly patients was 25.96%, while the proportion of critical cases was 32.63%. Critically, the proportion of critical-type cases in this age group was significantly higher compared to individuals aged 20-60 years. Comparing the clinical indices of elderly patients with HFRS with different clinical outcomes, our findings revealed deceased cases exhibited significantly higher body temperature, hemoglobin (HGB) levels, and white blood cell (WBC) counts compared to surviving patients. Conversely, albumin (ALB) levels, fibrinogen (FIB) levels, and platelet counts were significantly lower in deceased patients than in surviving patients. Conclusion: The incidence of HFRS in the elderly presents a higher proportion of severe-type and critical-type cases and a greater mortality rate compared to younger individuals. Elevated body temperature, HGB levels, and WBC counts, and lower ALB and FIB levels suggest a poorer prognosis.

Frailty is a challenging issue in China, however the prevalence of frailty across different population groups and whether this is changing over time remain unclear.

Unstandardized and age-and sex-standardized prevalence of frailty (95 % confidence interval (95 % CI)) (Frailty Index) in the overall sample and for subgroups defined by equity factors (PROGRESS-Plus framework) from 2011 to 2020 were estimated using analyses of cross-sectional surveys in adults aged 45 and older participating in 5 waves (N = 16,784 to 18,904 across waves) of the China Health and Retirement Longitudinal Studies (CHARLS). Poisson regression was used to estimate prevalence ratios (PRs) of frailty by equity factors.

Unstandardized prevalence of frailty increased from 13.6 % (13.0 %-14.1 %) in 2011 to 18.7 % (18.1 %-19.3 %) in 2020.The standardized prevalence increased from 13.5 % (13.0 %-14.0 %) in 2011 to 16.3 % (15.8 %-16.9 %) in 2020. Frailty was consistently more prevalent at advanced ages, in rural areas, among females, as well as those less educated, without social engagement, and non-drinkers. Based on the Poisson regression model, non-north region, being female and older, lower education, having no social engagement, smoking and non-drinking, and higher household capital consumption were associated with higher prevalence.

The prevalence of frailty among the middle-aged and older population in China has increased. There will be an associated health and social care cost. Interventions targeted at older adults, those in rural areas, women, as well as those less educated, having no social engagement, and non-drinkers to mitigate the negative effects of frailty may be warranted.

Physical dysfunction is common in older adults and increases disease risk. The atherogenic index of plasma (AIP) is a promising biomarker for this condition. This study explored the dose-response relationship between AIP and physical dysfunction.

Data from 11,369 CHARLS participants (aged ≥45 years) in 2015 and 2018 were analyzed using univariate and multivariate logistic regression, adjusting for demographics and lifestyle factors. The restricted cubic splines were used to examine possible non-linear associations and visualize the dose-response relationship between AIP and physical dysfunction. ROC curve analysis assessed AIP's predictive performance, and subgroup analyses evaluated interactions.

Each interquartile range (IQR) increase in AIP was associated with a 13.4% higher odds of physical dysfunction (adjusted OR = 1.134, 95% CI: 1.066-1.207, p < 0.001), with a dose-response threshold identified at an AIP value of approximately 0.37. Beyond this threshold, the odds of physical dysfunction increased steadily, confirming a non-linear relationship. AIP exhibited moderate predictive accuracy for physical dysfunction (AUC = 0.748, 95% CI: 0.738-0.758). Stratified analysis showed AIP was significantly linked to higher physical dysfunction risk in subgroups including those aged <65, females, married individuals, high school or college-educated, rural residents, non-smokers, and non-drinkers (p < 0.05), with no significance in other subgroups. Interaction analysis identified marital status (p = 0.035) and education level (p = 0.034) as significant effect modifiers, where subgroup differences notably altered the AIP-dysfunction association, warranting further study.

Elevated AIP is significantly associated with increased physical dysfunction risk, highlighting its potential as a simple, predictive biomarker.

Falls are the second leading cause of unintentional injury deaths globally and are strongly associated with a variety of psychological and physiological factors. Studies have suggested an association between depressive symptoms and fall risk, but the mechanism of action is unclear. This study aimed to investigate the association between depressive symptoms and the risk of falls and severe falls, and to examine whether activities of daily living (ADL) impairment mediates this relationship.

This study included 12,440 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 6,627 participants from the English Longitudinal Study of Ageing (ELSA). Depressive symptoms were assessed using the Centre for Epidemiological Studies of Depression Scale (CES-D). Falls were defined as any fall experienced since the last follow-up. Severe falls were defined as falls that required medical treatment. Logistic regression was used to assess the association of depressive symptoms and ADL impairment with the risk of falls/severe falls. Further, we analyzed the mediating role of ADL impairment between depressive symptoms and falls/severe falls.

The proportions of depressive symptoms in the CHARLS and ELSA longitudinal studies were 25.6% and 11.7%, respectively. Depressive symptoms were significantly associated with falls in both longitudinal studies: the OR was 1.78 (95% CI: 1.62, 1.96) for CHARLS and 1.85 (95% CI: 1.57, 2.18) for ELSA. The association between depressive symptoms and severe falls was also significant, with an OR of 1.61 (95% CI: 1.41, 1.85) for CHARLS and 1.74 (95% CI: 1.37, 2.22) for ELSA. The association of depressive symptoms with falls and severe falls remained significant after controlling for ADL impairment. In addition, ADL impairment was significantly associated with fall risk, with ORs of 1.66 (95% CI: 1.49, 1.85) for CHARLS and 2.32 (95% CI: 2.01, 2.68) for ELSA; The association between ADL impairment and severe falls was also significant, with ORs of 1.61 (95% CI: 1.38, 1.87) for CHARLS and 1.75 (95% CI: 1.40, 2.18) for ELSA. Mediation analysis revealed significant mediating effects of ADL impairment in the effect of depressive symptoms on the risk of falls and severe falls, with mediation effects all exceeding 20%, ranging from 22.2 to 27.3%.

This study revealed the key role of depressive symptoms and ADL impairment in the risk of falls/severe falls in middle-aged and older adults, and highlighted the mediating role of ADL impairment between depressive symptoms and falls/severe falls. In addition, fall risk in the UK was more affected by depressive symptoms than in China. This study provided a scientific basis for the management of depressive symptoms and falls prevention, suggesting the introduction of interventions for ADL impairment in the management of depressive symptoms to reduce the risk of falls and their associated health burden.

Not applicable.

Recent basic biological research found that obesity accelerates biological aging and increases cardiovascular disease (CVD) risk. However, there is still a lack of real-world population evidence. This study aimed to explore the potential mediation roles of biological age acceleration in the associations between different dimensions of obesity characterization and incident CVD.

This international multi-cohort study included participants aged over 45 years with 3 waves longitudinal data from China Health and Retirement Longitudinal Study (CHARLS). China Health and Nutrition Survey (CHNS) was used to develop Klemera-Doubal method-biological age (KDM-BA), and the validation analysis was performed in UK Biobank (UKB) and Hongguang Elderly Health Examination Cohort (HEHEC). Obesity indices including body mass index (BMI), waist circumference (WC), waist height ratio (WtHR), body roundness index (BRI) for body shape; Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP) for visceral fat accumulation; triglyceride-glucose index (TyG) and its derivatives (TyG-BMI, TyG-WC, TyG-WtHR) for metabolic function were used to measure obesity across different dimensions. Biological age acceleration was evaluated by the classic KDM-BA acceleration (KDM-BAacc). Causal mediation analyses assessed the role of biological age acceleration in mediating obesity and incident CVD.

In CHARLS, the median follow-up period was 9.00 years, with a baseline age of 58 (52, 65) years. Obesity, KDM-BAacc, and CVD were all significantly associated with each other. For each 1-year increase in KDM-BAacc, the risk of incident stroke, heart disease and CVD increased by 68% (OR 1.68, 95% CI 1.35-2.09), 35% (OR 1.35, 95% CI 1.15-1.59), and 44% (OR 1.44, 95% CI 1.25-1.65), respectively. KDM-BAacc mediated the associations between BMI, WC, WtHR, BRI, CVAI, LAP, TyG-BMI, TyG-WC, TyG-WtHR, with CVD, with the mediation proportions ranging from 10.03 to 25.46%. However, the mediating effect was significant mostly in middle-aged individuals aged 45-65 years. Furthermore, sex differences existed in the mediation mechanisms. Biological age acceleration strongly mediated body shape indices and incident CVD in males, whereas in females, it predominantly mediated visceral fat accumulation and metabolic function dimensions with incident CVD. Similar main results were found in UKB and HEHEC.

Biological age acceleration partially mediates the relationship between obesity and incident CVD. This temporal evidence firstly validated the mediation pathway based on international cohorts, emphasizing the importance of addressing biological aging processes in population aged 45-65 years while providing sex-specific obesity intervention strategies to prevent CVD.

The potentially biasing impacts of low language fluency, illiteracy, and sensory impairments on cognitive test performance are unknown, which may have implications for understanding their roles in cognitive decline and dementia.

We investigated effects of these features on cognitive test item completion and performance among older adults in China, a multilingual country with high prevalence of illiteracy and sensory impairment.

We used cognitive test data from the Harmonized Cognitive Assessment Protocol of the China Health and Retirement Longitudinal Study conducted in 2018 (N = 9755, age 60 + years). We first tested associations of fluency in spoken Mandarin, literacy, and sensory impairment (hearing and vision) with missingness of cognitive items. We then tested for differential item functioning (DIF) in observed cognitive items by these features.

We observed high levels of missing data in most cognitive test items - on average 13% and as high as 65%. Low fluency in spoken Mandarin, illiteracy, and impairments in hearing and vision were each associated with greater odds of missingness on nearly all tests. Partly because of differential missingness, there was minimal evidence of DIF by these features in items in which we expected a priori to find DIF (e.g., repetition of a spoken phrase among those with hearing impairment). Several cognitive test items exhibited statistically significant DIF, however there was minimal evidence of meaningful DIF.

Differential missingness in cognitive items by spoken language, literacy, and sensory impairments is potentially more of an inferential threat than measurement differences in test items.

Exposure to high altitudes elicits multiple adaptive mechanisms that intricately impact the entire body, causing deleterious health outcomes. However, high-altitude exposure effects on accelerated aging and aging-related changes remain uncertain.

To comprehensively assess the associations of high-altitude exposure with overall aging and related changes and to provide insights into the treatment and prevention of aging-associated deficits in populations living in high-altitude areas.

This population-based cross-sectional study used data from 2 prospective studies in Western China: West China Natural Population Cohort (WCNPCS) and West China Health and Aging Trend (WCHAT). The WCNPCS cohort was constructed from May 2019 to June 2021. Data were collected from participants aged 18 years and older in 4 populous regions (Mianzhu, Longquan, Pidu, and Ganzi) in Sichuan Province. The WCHAT was initiated in 2018 and recruited participants aged 50 years and older from various regions (Sichuan, Yunnan, Guizhou, and Xinjiang). Participants were selected via sequential cluster sampling from the permanent residents of the participating community. Data for the present study were analyzed between March and October 2024.

The participants' altitudes were determined using the global Shuttle Radar Topography Mission 4 data based on residential addresses. High-altitude areas refer to regions with altitudes of greater than or equal to 1500 m (4921 feet) above the mean sea level.

Biological aging (BA) and aging acceleration (AA) were measured through the Klemera-Doubal Biological Age (KDM-BA) and PhenoAge methods. Multidimensional aging-related metrics were based on questionnaire, measurement, and self-report.

A total of 9846 participants from the WCNPCS cohort (mean [SD] age, 55.73 [11.06] years; 6730 women [68.35%]) and 3593 participants from the WCHAT cohort (mean [SD] age, 62.27 [8.40] years; 2253 women [62.71%]) were included. The participants living at high altitudes presented increased KDM-BA acceleration by 0.85 years for the WCNPCS cohort and 0.71 years for the WCHAT cohort. The PhenoAge results were similar, with even larger effect sizes (WCNPCS, β, 2.08 years; 95% CI, 1.77-2.39 years; WCHAT, β, 2.23 years; 95% CI, 1.91-2.54 years). The association between high-altitude exposure and biologically accelerated aging was particularly pronounced among smokers. Associations between high-altitude exposure and various multidimensional aging-related metrics were also observed.

These findings suggest that extended periods at high altitudes may hasten BA and contribute to the onset of aging-related illnesses. Implementing public health interventions for individuals residing in high-altitude regions may aid in alleviating the disease burden within these communities.

The dose-response relationship between cystatin C (CysC) levels and chronic lung disease (CLD) development remains unclear and warrants further investigation. A more in-depth study of the relationship between serum CysC levels and CLD prevalence based on data from the China Health and Retirement Longitudinal Study (CHARLS). A cross-sectional analysis of 10,275 middle-aged and older adults aged 45 years and older was conducted using 2015 CHARLS data. Binary logistic regression models, restricted cubic spline curves (RCS), and threshold effects analyses were used to explore the association between different CysC levels and CLD prevalence in the middle-aged and older population, and subgroup analyses were performed to verify the robustness of the findings. When CysC was used as a categorical variable, the risk of CLD was increased by 38% in the T3 group compared with T1 (P < 0.001), and when CysC was used as a continuous variable, the risk of CLD was increased by 96% for each unit increase in CysC level (P < 0.001). In addition, there was a nonlinear relationship between CysC levels and the risk of CLD prevalence (P for non-linearity < 0.012), and the risk of CLD prevalence increased significantly with increasing CysC levels when CysC levels ≥ 0.754 mg/L. When CysC ≥ 0.754 mg/L, we need to be highly concerned about the risk of developing chronic lung disease in middle-aged and older populations, and those aged 45-64 years should be the focus of screening.

This study aimed to assess the current situation and influencing factors of life satisfaction among Chinese older adults with hypertension and to identify its key factors.

In this study, 4,197 hypertensive patients were selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database for inclusion in the analysis. A multivariate logistic regression model was used to analyze the influencing factors of life satisfaction in hypertensive patients, and the random forest was further used to rank the importance of the significant influencing factors.

Overall, 29.52% of hypertensive patients reported dissatisfaction with their lives. The life satisfaction of these patients was influenced by a combination of factors. According to the results of the random forest, the variables that significantly influenced life satisfaction, in descending order of importance, are self-rated health, economic status, depressive symptoms, sleep duration, fruits, living arrangements, hearing impairment, heart disease, and gender.

Our research indicates that currently, people with hypertension experience a high level of dissatisfaction with their lives, making it necessary to take preventive and intervention measures from multiple aspects.

Biological age (BA) and frailty represent two distinct health measures that offer valuable insights into the aging process. Comparing and analyzing blood-based biomarkers from the machine learning (ML) predictors of BA and frailty helps deepen our understanding of aging. This study aimed to develop a novel framework to identify biomarkers of aging by combining BA and frailty ML predictors with eXplainable Artificial Intelligence (XAI) techniques. We utilized data from middle-aged and older Chinese adults (≥ 45 years) in the 2011/2012 wave (n = 9702) and the 2015/2016 wave (n = 9455, as test set validation) of the China Health and Retirement Longitudinal Study (CHARLS). Sixteen blood-based biomarkers were used to predict BA and frailty. Four tree-based ML algorithms were employed in the training and validation, and performance metrics were compared to select the best models. Then, SHapley Additive exPlanations (SHAP) analysis was conducted on the selected models. CatBoost performed the best in the BA predictor, and Gradient Boosting performed the best in the frailty predictor. Traditional ML feature importance identified cystatin C and glycated hemoglobin as the major contributors for their respective models. However, subsequent SHAP analysis demonstrated that only cystatin C was the primary contributor in both models. The proposed framework can easily incorporate additional biomarkers, providing a scalable and comprehensive toolset that offers a quantitative understanding of biomarkers of aging.

Social isolation is considered a risk factor for depression in older adults. Since there may be heterogeneity in the experience of social isolation, we aimed to investigate social isolation patterns and their association with depressive symptoms, for older adults with different functional status separately.

This study used data from the fifth wave of the China Health and Retirement Longitudinal Study (CHARLS). A total of 8262 participants, defined as older adults aged 60 years and above, were included in the analysis, comprising 49.9 % (n = 4124) men and 50.1 % (n = 4138) women. Latent class analysis was conducted to identify social isolation patterns. Binary logistic regression was used to estimate the association between latent classes and depressive symptoms.

Two distinct classes were identified in participants with functional dependency and three classes were identified in participants without functional dependency. The severely isolated with minimal family and social contact group was associated with a higher risk of depressive symptoms in both subgroups (participants with functional dependency: OR = 1.319, 95%CI: 1.032-1.686; participants without functional dependency: OR = 1.537, 95%CI: 1.209-1.953). No difference was found in the risk of depressive symptoms between the moderately isolated with family contact group and the low isolated group among participants without functional dependency (OR = 1.020, 95%CI: 0.83-1.252).

Risk of depressive symptoms varies with different social isolation patterns among older people with different functional status.

This study aimed to identify and analyze the factors associated with the prevalence of diabetes among Chinese adults, using data from the China Health and Retirement Longitudinal Study (CHARLS). Data from the CHARLS cohort, with a mean age of 63.3 years, were analyzed using SPSS software. Descriptive statistics were performed for the overall population, as well as urban and rural subgroups. Logistic regression models were employed to assess the association between diabetes and variables such as age, gender, smoking, alcohol consumption, hypertension, and mental health disorders. Paired-sample t-tests were conducted to evaluate changes in diabetes prevalence across 2015, 2018, and 2020. The average of diabetes increased from 1.08 in 2015 to 1.15 in 2020, with a statistically significant difference (P < 0.001). Paired-sample t-tests showed significant differences between 2020 and 2018, as well as between 2018 and 2015 (P < 0.001). Logistic regression analysis identified hypertension (aOR = 0.447, 95% CI: 0.410-0.488, P < 0.001) and chronic disease (aOR = 0.024, 95% CI: 0.013-0.042, P < 0.001) as key risk factors for diabetes. Mild physical exercise was a protective factor (aOR = 0.813, 95% CI: 0.708-0.935, P < 0.01), while smoking (aOR = 1.220, 95% CI: 1.088-1.369, P < 0.001) and alcohol consumption (aOR = 1.125, 95% CI: 1.020-1.242, P < 0.05) increased the risk. Smoking and alcohol had a greater impact in urban areas, while hypertension and mental health disorders were more influential in rural areas. This study demonstrates that age, gender, smoking, alcohol consumption, hypertension, and mental disorders significantly influence the risk of diabetes among Chinese adults aged 45 and above. Distinct risk factors were identified between urban and rural populations, highlighting the necessity for tailored intervention strategies. The longitudinal analysis from 2015 to 2020 revealed a substantial increase in diabetes prevalence, underscoring the critical need for sustained and targeted public health efforts.

Chinese older adults frequently encounter limitations in activities of daily living (ADL) and experience depression. Prior research has not deeply explored the interconnectedness of these factors through network analysis.

The study utilized data from 2,137 older adults aged 65 and older, sourced from the 2018 China Health and Retirement Longitudinal Study (CHARLS). The ADL scale and CESD-10 were employed to assess ability to perform ADL and depression, respectively. We conducted network modeling and bridge expected influence (BEI) evaluations to investigate the relationships between these ADL and depression.

Our network analysis revealed robust connections between ADL and depressive symptoms. Specifically, somatic symptoms emerged as significant predictors of depression risk with the highest BEI of 0.21, whereas positive symptoms exhibited a protective effect with the highest BEI of 0.13. Notably, toileting with the highest BEI of 0.04 among the ADL was identified as a pivotal node linking ADL to depression.

This study illuminated the complex interplay between ADL and depression in Chinese older adults, with toileting serving as a crucial connecting point. Our findings offer valuable insights that can inform efforts to enhance mental health and improve the quality of life for this population.

This study aims to assess the correlation between vertebral compression fractures (VCFs) and frailty and to identify the possible link between the number of VCFs and frailty intensity in patients with osteoporosis (OP).

Between January 2025 and February 2025, a total of 204 patients (143 males, 61 females; mean age: 71.8±5.5 years; range, 65 to 89 years) over 65 years who received treatment for OP in the inpatient setting were included. The patients were divided into two groups according to their Clinical Frailty Scale (CFS) scores as the frail group (n=141, CFS ≥4) and the non-frail group (n=63, CFS <4). Demographic and clinical characteristics, geriatric syndromes, and fracture prevalence were recorded.

The handgrip strength was significantly reduced in the frail group (19 kg vs. 21 kg, p=0.004), with a probable sarcopenia rate of 42% (p=0.034). The rate of participants with no fractures, a single fracture, and multiple fractures was 42%, 26%, and 22% in the non-frail group, compared to 57%, 73%, and 77% in the frail group, respectively (p=0.018). This difference was particularly evident in patients with multiple fractures (odds ratio [OR]=2.34, 95% confidence interval [CI]: 1.13-4.87, p=0.023).

Frailty is strongly associated with a higher incidence of VCFs and multiple fractures in older individuals with OP.

Few studies have focused on comparing the effect of cognitive frailty (CF) with either cognitive impairment or frailty alone on fall risk. Further, studies investigating the effect of reversible cognitive frailty (RCF) or potentially reversible cognitive frailty (PRCF) on fall risk are scarce. This study aimed to investigate the influence of RCF and PRCF on falls in community-dwelling older adults of China and determine whether CF conferred a higher risk than cognitive impairment or frailty alone.

This study used data from five waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted from 2011 to 2020. A total of 3,200 participants were divided into six groups: Healthy, cognitive impairment [subjective cognitive decline (SCD) and mild cognitive impairment (MCI)], Frailty, and CF (RCF and PRCF), according to their baseline cognitive and frailty status. A generalized estimating equation was applied to measure the association of cognitive status, frailty, and CF with risk of falls. Multivariate logistic regression models were employed to analyze potential multiplicative and additive interactions of baseline cognitive impairment and frailty on fall risk.

Of the 3,200 participants, 17.7% and 8.3% experienced falls and fall-induced injuries, respectively, in wave 2013. After adjusting for all covariates, the participants in the PRCF group [odds ratio (OR) = 1.442, 95% confidence interval (CI): 1.179-1.922] had a higher risk of falling than those in the RCF group (OR = 1.302, 95% CI: 1.053-1.593), while cognitive impairment alone or frailty alone were not associated with increased risk. The interaction analyses revealed a lack of multiplicative (OR = 0.952, 95% CI: 0.618-1.468) or additive [relative excess risk (RERI) =-0.043, 95% CI: -0.495-0.409; attributable proportion (AP) =-0.035, 95% CI: -0.400-0.329; synergy index (S) = 0.840, 95% CI: 0.172-4.095] interactions of cognitive impairment and frailty for falls.

We found that the risk of falls increased in RCF and PRCF compared to either cognitive impairment or frailty alone, with PRCF being associated with a higher risk than RCF.

Not applicable.

Limited research has explored the link between functional dependency, care needs, and depression among older adults. This study aims to explore the association between dependency levels and depression among Chinese older adults, as well as examine the relationship between hygiene environment and these two factors. Data were obtained from the CHARLS 2011-2018. A total of 4871 individuals aged 60 years and older were included. Generalized estimating equations were employed for the analysis. A conceptual framework was established to longitudinally illustrate the pathway from hygiene environment to dependency levels to depression. Findings indicated higher dependency levels and poorer hygiene environments were associated with an increased risk of depression, with dependency serving as a mediator between hygiene environment and depression. Policymakers should prioritize improvements in rural sanitation and long-term care policies, healthcare providers should enhance depression screening and caregiver training, and clinicians should provide personalized interventions to better address mental health challenges.

With population ageing, the development and implementation of pragmatic care strategies for older people with functional dependencies have become critical issues. In alliance with WHO's Integrated Care for Older People framework, China implemented the Integrated Medical and Social Care Policy (IMSCP) in several cities in 2016. This study aims to evaluate whether and to what extent the IMSCP has achieved its primary objectives of reducing functional dependency and addressing care needs in Chinese older adults aged 65 years and older.

The IMSCP was initiated in 2016 in several pilot cities from various provinces. We did a quasi-experimental study with a difference-in-differences analysis by using the data collected in the 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Participants from pilot cities constituted the intervention group, whereas participants from non-pilot cities were assigned into the control group. Functional dependency was measured based on activities of daily living and instrumental activities of daily living. Care deficits were recorded for those who were functionally dependent, and for whom care needs were unmet. We used fixed-effects models to examine between-group differences in functional dependency and care deficits.

3080 individuals who participated in both the 2014 and 2018 surveys were included (mean age 81·7 years [SD 9·1] in 2014; 1621 [52·6%] were female and 1459 [47·4%] were male). Of these, 1146 (37·2%) were in the intervention group and 1934 (62·8%) were in the control group. Implementing the IMSCP was associated with a reduced risk of functional dependency (odds ratio [OR] 0·72 [95% CI 0·58-0·89], p=0·0024). Among those who were functionally dependent, the IMSCP was also associated with less care deficits (0·62 [0·41-0·95], p=0·029). We also examined the relatively long-term impact of the IMSCP with duration from 2014 to 2021; the influence of the IMSCP on mitigating functional dependency remained in male participants (OR 0·45 [95% CI 0·23-0·87], p=0·017) but not in female participants (0·85 [0·52-1·39], p=0·524); while its association with bridging care deficits remained among the total participants.

Implementing integrated medical and social care policy could reduce the risk of both functional dependency in older adults and care deficits in those who need care. These findings support the continued and expanded implementation of the IMSCP to address the growing care needs of China's ageing population.

National Natural Science Foundation of China, National Key Research and Development Project of China, and National Science and Technology Major Project of China.

The public long-term care insurance (LTCI) scheme offers a potential solution to growing long-term care needs. This study investigated its effects on perceived filial responsibility norms and evaluated the heterogeneity of these effects.

Using data from the 2014, 2016, 2018, and 2020 waves of the China Longitudinal Aging Social Survey, we focused on 10 042 older adults aged 60 and above living in communities. The quasi-experimental design of staggered difference-in-differences analyses with propensity score matching was employed to assess the policy effects.

The LTCI scheme significantly influenced perceived filial responsibility norms, reducing the likelihood of older adults believing that children should bear primary responsibility for their care by 6%. This effect was more pronounced among older adults who were more educated, lived with their children, or were in better health.

The implementation of the public LTCI scheme has had a negative impact on traditional filial piety in China. These findings highlight the importance for countries adopting LTCI or similar policies to develop strategies that prevent the excessive erosion of this cultural value. Geriatr Gerontol Int 2025; 25: 606-619.

Caregiver-friendly workplace policies (CFWPs) are rare in Hong Kong. With Hong Kong facing a "silver tsunami" in the near future, it is important to understand the need for such policies and the views of employers for future facilitation.

This study aimed to identify the support that is currently provided or that could be provided to caregiver-employees (CEs) caring for older adults in Hong Kong and assess the challenge and facilitative support for employers to adopt CFWPs in the specific context of Hong Kong.

A qualitative research design with semistructured individual in-depth interviews with employers from Hong Kong was adopted for this study. A purposive snowball sampling method was used to recruit participants from the 7 primary industries mentioned in the Hong Kong census and from all 3 employer types (private, public, and nongovernmental organizations), which allowed the inclusion of participants sensitized to the idea and potential of CFWPs. Thematic framework analysis was used to evaluate the data collected during the interviews.

We interviewed 17 employers and managers from 7 major industries in Hong Kong (2.5 to 120,000 employees). There were 4 (24%) male and 13 (76%) female participants, and the participant age ranged from 30 to 50 years. All participants held managerial positions at the time of the interview. Of the 17 participants, 13 were from private companies, 2 were from public institutions, and 2 were from nongovernmental organizations. Four of the companies had a global presence. Four main themes were identified: (1) current support and potential support for CEs (which was limited to discretionary annual leave and unpaid leave when annual leave was exhausted), (2) challenges in adopting CFWPs, (3) facilitating support for adopting CFWPs, and (4) incentives for adopting CFWPs. The participants rated information and resources for CEs (mean 8.56, SD 0.37), bereavement leave (mean 8.47, SD 0.63), flexible working hours (mean 8.32, SD 0.48), and caregiver-inclusive corporate culture (mean 8.32, SD 0.48) as essential CFWPs for CEs in Hong Kong.

While several studies have reported the types of CFWPs and their impacts on CEs, stakeholders' perspectives on CFWPs have been rarely investigated. This study found that although employers consider CFWPs as necessary and see them as a catalyst for a long-term win-win situation, the current support for CEs is discretionary and industry-specific. Government leadership is critical for formulating, piloting, and implementing CFWPs to create a friendly environment that encourages disclosure with trust and respect across industrial sectors in Hong Kong. This study identified the current unmet needs and demands of CEs from the employer's perspective, the barriers to large-scale adoption of CFWPs, and the path forward to inform further discourse and policy formulation in Hong Kong.

Sarcopenia significantly increases the risk of cognitive impairments in older adults. Early detection of mild cognitive impairment (MCI) in individuals with sarcopenia is essential for timely intervention.

To develop an accurate prediction model for screening MCI in individuals with sarcopenia.

We employed machine learning and deep learning techniques to analyze data from 570 patients with sarcopenia from the China Health and Retirement Longitudinal Study (CHARLS). Our model forecasts MCI incidence over the next four years, categorizing patients into low and high-risk groups based on their risk levels.

The model was constructed using CHARLS data from 2011 to 2015, incorporating eight validated variables. It outperformed logistic regression, achieving an Area Under the Curve (AUC) of 0.708 (95% CI: 0.544-0.844) for the test set and accurately classifying patients' risk in the training set. The deep learning model demonstrated a low false-positive rate of 10.23% for MCI in higher-risk groups. Independent validation using 2015-2018 CHARLS data confirmed the model's efficacy, with an AUC of 0.711 (0.95 CI, 0.588-0.823). An online tool to implement the model is available at http://47.115.214.16:8000/ .

This deep learning model effectively predicts MCI risk in individuals with sarcopenia, facilitating early interventions. Its accuracy aids in identifying high-risk individuals, potentially enhancing patient care.

Exposure to ultraviolet (UV) radiation may increase the risk of age-related macular degeneration (AMD), the leading cause of blindness in the elderly. However, prevention measures of UV radiation at population-level remain lacking, exacerbating the health inequity. Given the protective effect of residential greenness on human health, we aim to identify the impact of greenness on the UV-AMD association.

We used data from 19,832 participants in a national cohort in China conducted from 2018 to 2023. Satellite-based models and ophthalmological fundus images were used to evaluate the exposures (UV radiation and residential greenness) and outcome (incident AMD), respectively. The effects of UV radiation, residential greenness, and their interplay on incident AMD were furtherly estimated through multiple Cox proportional hazard models.

A total of 3800 incident AMD cases were diagnosed during follow-up. Higher UV radiation elevated the hazard of incident AMD, while excessive greenness showed a significant protective effect, with hazard ratios of 1.35 (1.29, 1.41) and 0.90 (0.86, 0.94) for per tertile increment, respectively. These relationships remained consistent in two-exposure models, and a significant modification effect of greenness on the UV-AMD association was observed. Notably, when the residential greenness over 0.4, the hazard of UV on incident AMD became non-significant. This greenness threshold remained consistent across rural-urban and south-north subgroups.

Maintaining the residential greenness above 0.4, as a low-cost measure at population-level, could mitigate the UV-AMD association and facilitate the health equity in China, regardless of the regions.

To investigate the association between depressive symptoms in spousal caregivers and both fall risk and the frequency of falls requiring medical treatment in care recipients with disabilities.

A retrospective cohort study.

Data from the China Health and Retirement Longitudinal Study.

1357 patient-caregiver dyads.

Not applicable.

The incidence of falls and the frequency of falls requiring medical treatment among care recipients.

The mean (standard deviation) age of care recipients was 61.6 (9.1) years, and 62.1% of them were women. After adjusting for covariates, it was found that caregiver depressive symptoms were associated with a 32% higher risk of falls (relative risk [RR], 1.32; 95% confidence interval [CI], 1.08-1.61). Moreover, caregivers who exhibited depressive symptoms only at follow-up had a RR of falls requiring medical treatment of 2.74 (95% CI, 1.28-5.88), whereas those who had depressive symptoms at both the baseline and follow-up had a RR of 2.13 (95% CI, 1.19-3.80). The likelihood ratio test showed that grouping depressive symptoms significantly improved the model fit for both fall risk (likelihood ratio [LR] χ²(3)=8.89, P=.031) and falls requiring medical treatment (LR χ²(3)=14.50, P=.002).

Caregiver depressive symptoms are significantly associated with an increased risk of falls and a higher frequency of falls requiring medical treatment among care recipients with disabilities. Addressing the mental health of caregivers may help reduce fall-related risks in this population.

The objective of this systematic review is to synthesize and compare policies and implementation strategies on long-term care insurance for older people in China.

Current information about China's long-term care insurance from a textual perspective is limited. Due to late inception and fragmented management, textual evidence on this topic will offer a unique perspective on the structure and implementation strategies of long-term care insurance policies in China.

The population of this review will be adults aged 60 years or older. The phenomena of interest will be long-term care insurance policies and implementation strategies in China. Published sources and gray literature in English and Chinese since 2016 will be included. Exclusions will apply to hospitalized individuals as well as those under 60 years of age who are permanently disabled due to illness or disability.

The proposed systematic review will be conducted in line with the JBI methodology for systematic reviews of textual evidence. Databases to be searched will include PubMed, Embase (Ovid), CINAHL (EBSCOhost), Web of Science Social Science Citation Index, China National Knowledge Infrastructure (CNKI), and the National Social Science Database. For gray literature, we will conduct an advanced Google search as well as searching ProQuest Dissertations & Theses Global and ProQuest Central. Additionally, we will search the websites of local governments in pilot cities. The JBI critical appraisal checklist for textual evidence will be used to evaluate the quality of textual sources. All identified sources will be retrieved and assessed in detail by 2 independent reviewers. Data extraction and synthesis will be conducted, and a meta-aggregative approach will be employed to synthesize data and conclusions, which will be graded using ConQual. A recommendation will be issued as a Good Practice Statement.

PROSPERO CRD42023414967.

Despite the recognized importance of social connections in Chinese culture, research on how childhood peer relationship deficits impact health later in life has been limited. This study aimed to investigate the association between childhood peer relationship deficits and the odds of disability among older Chinese adults and to explore the potential mediating roles of social isolation, loneliness, and cognitive function. Using the longitudinal sample of respondents aged 60 years and older in the China Health and Retirement Longitudinal Study 2013-2018 (N = 7133), the link between peer relationship deficits in childhood and disability in late life was assessed using marginal structural models, and the potential mediating effects of social isolation, loneliness, and cognitive function were examined by the inverse odds ratio weighting technique. Participants who experienced greater childhood peer relationship deficits were more prone to disability (odds ratio: 1.19, 95% CI: 1.09, 1.29) than those with more positive childhood peer interactions. The inverse odds ratio weighting analysis indicated that social isolation, loneliness, and cognitive function individually played partial mediating roles in the association between childhood peer relationships and disability by 11.36% (95% CI: 4.04%-18.99%), 11.95 % (95% CI: 4.65%-19.23%), and 24.58% (95% CI: 17.01%-32.43%), respectively. The combined mediation effect of the three mediators was 30.57% (95% CI: 23.52%-39.91%). These findings suggest that interventions to enhance social connections and cognitive health in older adults may help mitigate the long-term impacts of childhood peer relationship deficits on disability among older Chinese adults.

Many countries are extending working lives to counteract the shrinking labor force caused by population aging. However, the health implications of this approach for middle-aged and older adults remain unclear, particularly in low- and middle-income countries.

Data were drawn from the 2011-2020 China Health and Retirement Longitudinal Study to analyze the effect of labor force participation on multidimensional health, with a focus on activities of daily living disability, depressive symptoms, and cognitive impairment. A longitudinal g-formula was applied to address the endogeneity associated with long-term employment and simulate the life course of a synthetic cohort aged 45-80 years. The impact of extending working lives to age 63 for men and age 58 for women on health outcomes was estimated.

Labor force participation was negatively associated with the onset of activities of daily living disability but positively associated with the onset of depressive symptoms and cognitive impairment among middle-aged and older adults. Extending working life slowed the progression of activities of daily living disability but increased the risk of depressive symptoms and cognitive impairment, especially in women. These effects persisted beyond working years and into postretirement. Higher education levels mitigated the negative impact of extended working lives on cognitive function.

While extending working lives may benefit physical functioning, it poses risks to depressive symptoms and cognitive health, particularly for women. National policies promoting longer working lives should incorporate targeted preventive measures to protect the psychological and cognitive health of middle-aged and older adults.

This study aims to investigate the relationship between cognitive impairment, depressive symptoms, and Activities of Daily Living (ADL)/ Instrumental Activities of Daily Living (IADL) dependency among older people living in rural areas.

We analyzed data from the China Health and Aging Longitudinal Study 2020, focusing on the rural older adults over 60. We identified four groups and constructed three regression models (models 1-3) to investigate the relationship between cognitive impairment or depression and dependency.

Based on a logistic regression model, older adults living in rural areas face a sequentially increased risk of dependence on ADL if they in group 2 (OR = 1.33, 95% CI = 1.09-1.63), group 3 (OR = 1.76, 95% CI = 1.43-2.17), or group 4 (OR = 2.38, 95% CI = 1.95-2.91), when compared to a reference group 1. Group 2 (OR = 2.44, 95% CI = 2.03 to 2.93) was more likely to be at risk of IADL dependence than Group 3 (OR = 1.99, 95% CI = 1.64 to 2.43).

This study highlights the substantial impact of depression and cognitive impairment on ADL/IADL dependence among rural older adults, with an especially heightened risk when both disorders are present simultaneously. Moreover, factors such as gender, age, inpatient services, outpatient services, and self-rated health are strongly associated with functional dependence in this population.

The study was to investigate the relevant factors that were associated with differences in depressive symptoms between urban and rural middle-aged and elderly population in China, measuring the contribution of related influencing factors. We constructed binary logistic regression models to investigate the primary factors influencing depressive symptoms and employed Fairlie models to examine these factors contributing to the differences in depressive symptoms between urban and rural middle-aged and elderly individuals. The proportion of depressive symptoms among middle-aged and older individuals in China was 38.16%, with findings indicating that rural areas exhibited higher rates (44.47%) of depressive symptoms compared to urban areas (31.85%). The Fairlie decomposition analysis demonstrated 53.51% of the disparities in depressive symptoms could be accounted for, which was mainly linked to differences in self-reported health status (19.16%), education level (14.45%), insurance (8.28%), instrumental activities of daily living dysfunction (6.16%), gender (-3.72%), sleep time (2.35%), falling history (2.31%), age (-2.17%), physical examination (2.03%), and chronic disease condition (-0.50%). The prevalence of depressive symptoms in rural middle-aged and elderly was greater than urban, linked to demographics, lifestyle, health status and social status. This study aided policymakers in reducing health disparities and designing targeted mental health interventions for vulnerable populations.

The male-female health-survival paradox is characterized by the phenomenon where "women get sicker, but men die quicker." Health expectancy, as a composite metric that encompasses both the quantity and quality of life, serves as a unique tool for analyzing this gender paradox. In this study, we investigate the relationship between educational attainment and the gender paradox among older adults in China.

Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), we focused on community-dwelling individuals aged 60 and above. Health was assessed using the Activities of Daily Living (ADLs). Educational attainment was dichotomized into low (primary education and below) and high (secondary education and above). We controlled for demographic, socioeconomic, and health behaviors confounders. Microsimulation techniques were employed to estimate total life expectancy (TLE), disability-free life expectancy (DFLE), and health ratio.

In China, educational attainment was positively associated with TLE and DFLE, with these benefits being more pronounced in females. Among individuals with lower educational attainment, females had significantly greater TLE (female-male difference: 3.82 years, 95% CI: 3.68 to 3.96) and DFLE (2.91 years, 95% CI: 2.78 to 3.04), but a lower health ratio (-2.14%, 95% CI: -2.41% to -1.87%) compared to males. In contrast, females with higher educational attainment not only lived longer but also healthier. Among these individuals, females had significantly greater TLE (5.89 years, 95% CI: 5.71 to 6.08), DFLE (6.02 years, 95% CI: 5.84 to 6.19), and a more favorable health ratio (95% CI: 2.60% to 3.19%) compared to males.

Education plays a crucial role in enabling females to overcome disadvantages associated with the gender paradox in China. Enhancing gender equality in educational opportunities is expected to promote healthy longevity among females in the country.

Urban-rural differences in depression are evident among older adults in China but not in the United States. By comparing the two countries, this study aims to explore strategies for promoting regional equality in depression in China.

Data from the China Health and Retirement Longitudinal Study (CHARLS) and the Health and Retirement Study (HRS) were utilized. Longitudinal data were used to describe urban-rural differences in depression prevalence among older adults in China (2011-2020) and the United States (2010-2020). Cross-sectional data from 2018 (CHARLS: 9840 participants; HRS: 10,381 participants) were used to identify key modifiable factors. A random forest algorithm was employed to determine the most important factors influencing depression, and comparisons between the two countries were made to identify modifiable factors. Multivariate logistic regression was used to analyze the relationship between these key modifiable factors and depression. A mediation model was applied to assess the mediating role of key modifiable factors in the relationship between residence and depression.

1) From 2011 to 2020, Urban-rural differences in depression prevalence among older adults were observed in China, but not in the United States. 2) In both China and the U.S., the top five factors ranked by importance were activities of daily living disability (ADLs), instrumental activities of daily living disability (IADLs), pain levels, self-reported health (SRH), and age. However, Urban-Rural Differences in ADLs, IADLs, and SRH were present in China but not in the United States. 3) ADLs, IADLs, and SRH collectively mediated 31.6 % (95 % CI: 0.268 - 0.360) of the relationship between residence and depression scores among older adults in China.

Urban-rural differences in physical health status (ADLs, IADLs, and self-reported health) among older adults in China are associated with Urban-Rural Differences in depression. The absence of such inequalities in the U.S. may offer insights for developing policies to promote regional equality in depression among older adults in China.

Person-centered long-term care systems, integral to healthy ageing, should empower older people to achieve ageing in place. Yet evidence on the impact of the design of long-term care systems on older people's choice of place of ageing, especially that from developing countries, is limited. Taking the introduction of Long-Term Care Insurance (LTCI) in City X of China as a policy shock, we examined the impact of becoming eligible for LTCI on program beneficiaries' choice of place of ageing-institution or home-before they started to receive any actual benefit. Based on our analysis of the administrative data of all LTCI applicants between July 2017 and September 2020 from City X, we found that becoming eligible for LTCI increased an older-person's probability of choosing home as her place of ageing even before she received any benefit by ∼16%, and this positive impact was larger for those insured, of higher education level, or of higher disability grade. By bringing more ageing in place, LTCI in City X promoted healthy ageing. Our study suggests that the specifics of the LTCI program, such as who could receive subsidies, family values, and family members' engagement in the labor market, could all work together to shape the substitution pattern between home and institutional care.

Housing is an important social determinant of health. However, limited studies have focused on the relationship between housing quality and sarcopenia, especially in low- and middle-income countries. This study aims to examine the association between housing quality and sarcopenia in older adults in China and India.

The study was based on the China Health and Retirement Longitudinal Study and Longitudinal Aging Study in India. Housing quality was evaluated by five indicators, including housing materials, water sources, sanitation facilities, main fuel for cooking, and availability of electricity. Housing quality is divided into three types: good (0-1 poor housing indicators), medium (2-3 poor housing indicators), and poor (4-5 poor housing indicators). Sarcopenia was evaluated according to the Asian Working Group for Sarcopenia (AWGS) 2019 Consensus. The logistic regression model was performed to examine the association between housing quality and sarcopenia.

The medium (OR = 1.69, 95%CI = 1.49-1.90) and poor housing quality (OR = 2.19, 95%CI = 1.89-2.54) were associated with sarcopenia in CHARLS. Similar results were also observed in the LASI with significantly higher prevalence of sarcopenia in medium (OR = 1.22, 95%CI = 1.11-1.33), and poor housing quality (OR = 1.60, 95%CI = 1.43-1.79). Moreover, we observed a linear relationship between housing quality and the prevalence of sarcopenia both in CHARLS and LASI (all P for trend <0.001).

Poorer housing quality was associated with a higher prevalence of sarcopenia in older adults in China and India. Housing quality improvement plans such as access to tap water, promotion of clean energy may have a positive effect on reducing the prevalence of sarcopenia.

Population aging is an inevitable consequence of demographic transition and an important issue for human society in the 21st century. Physical activity is widely recognized as a critical factor for improving health, yet the specific impact of different intensities of physical activity on the health of older adults remains underexplored.

This study addresses this gap by analyzing data from the China Health and Retirement Longitudinal Survey (CHARLS), a nationally representative survey of a cohort of Chinese people (aged ≥45 years) from 150 counties or districts and 450 villages or urban communities across 28 provinces, who were selected by use of multistage stratified probability-proportionate-to-size sampling. The study employed a regression model aiming to analyse the effect of different intensities of physical activity on the health level of the elder adults.

The results demonstrate that physical activity at all intensity levels-high, moderate, and low-significantly improves the health of older adults, with correlation coefficients of -0.245 (p < 0.01), -0.080 (p < 0.05), and -0.077 (p < 0.10), respectively. Among these, high-intensity physical activity is the most effective in enhancing health outcomes. The result further identifies social activities as a mediating factor in this relationship. Moreover, high-intensity exercise proves to be more beneficial for older adults residing in rural areas compared to their urban counterparts.

This study demonstrates that engagement in physical activity at all intensity levels-high, moderate, and low-substantially enhances the health of older adults, with high-intensity physical activity demonstrating the most significant impact on health outcomes. Furthermore, the research identifies social activities as a mediating factor in this relationship, highlighting the importance of social engagement in conjunction with physical activity. This suggests that interventions promoting both physical activity and social interaction can be particularly effective in improving the health and wellbeing of the ageing population.

As global populations become increasingly aged, existing elderly care models are proving insufficient. The development and application of nursing robots have shown potential in addressing the challenges of elder care in aging societies. This perspective outlines current state and potential applications of nursing robots in promoting healthy aging. Given this background, a networked intelligent elderly care model for nursing robots, which integrates technologies such as big data, artificial intelligence, the Internet of Things, and nursing robotics, is proposed. This model would synergistically combine elderly health monitoring, capability assessment, and intelligent allocation functions to revolutionize global elderly care practices and promote healthy aging.

In the context of rapid global aging, the importance of age-friendly community environments for promoting healthy aging and "aging in place" continues to increase. Using data from the 2011-2020 China Health and Retirement Longitudinal Study, this study investigated the impact of an age-friendly community environment on the age trajectories of late-life long-term care (LTC) dependency among older Chinese adults aged 60+ years. Age-friendly community environments were defined according to three levels (poor, moderate, or good) based on the World Health Organization's age-friendly city and community framework, and LTC dependency was classified as level 1 (high), level 2 (medium), or level 3 (low) according to activities of daily living and instrumental activities of daily living scores. We classified participants into two age trajectory groups according to their level of LTC dependency: early-onset and late-onset groups. We found that an age-friendly community environment, especially a good housing environment, was consistently associated with the probability of having late-onset LTC dependency at any level. Having moderate and good social and employment environments reduced the likelihood of having early-onset level 2 and level 3 LTC dependency. Our mechanism analysis also revealed that age-friendly community environments affect LTC dependency through social participation. Our results may help elucidate the importance of promoting age-friendly community environments to maintain late-life functional ability and support healthy aging.

Care dependency, inability to perform basic daily tasks without assistance due to functional impairment, increases substantially with accelerated population ageing and becomes a pressing public health concern worldwide. Socioeconomic disadvantage has been shown to be associated with elevated risks of care dependency, but how risks are modified by changes in socioeconomic position remains unclear. From a life course perspective, we investigated the association between socioeconomic mobility across the lifespan and care dependency in later life.

In this longitudinal multicohort study, we pooled data collected between 2000 and 2019 from six prospective cohort studies across 17 countries from the Program on Global Ageing, Health, and Policy. Socioeconomic status (SES) at three different life stages was assessed based on parental education in childhood, participants' education in early adulthood, and non-housing wealth in middle-late adulthood. Care dependency was measured using activities of daily living (ADLs) and instrumental activities of daily living (IADLs) following WHO recommendations. Ordinal logistic mixed-effect models were applied to investigate associations between socioeconomic inequalities and their mobility across the life course with later-life care dependency. Furthermore, to investigate contributors to inequalities in care dependency, we applied the difference method to estimate the proportion of these inequalities explained by potential risk factors, and quantified the health and economic benefits of targeted interventions using population attributable fractions.

A total of 103,282 individuals were involved in this study, with an average baseline age of 63.29 (SD 10.70) years and a mean follow-up of 8.75 (SD 0.02) years. Low SES at any stage of life was associated with elevated probability, increased severity, and accelerated deterioration of care dependency in later life, with women being particularly vulnerable. For the probability of IADL dependency, socioeconomic differences by parental education persisted and were greatest at ages 75-80 years (18.10%, 95% CI 14.25%-21.95% for women; 10.23%, 5.82%-14.64% for men). Considering the severity of dependency, differences in low ADL dependency reversed in advanced old age, while differences in high ADL dependency widened consistently with age. Differences in high ADL dependency between high and low childhood SES groups increased from 0.66% (0.64%-0.67%) at age 50 to 15.79% (12.19%-19.39%) at age 100. Compared with a stable high SES throughout life, all other SES mobility trajectories were associated with elevated risks of both IADL and ADL dependency. Individuals who experienced a severe SES decline-high in childhood but low in adulthood-showed a more than ten times higher risk (IADL: OR 18.26, 95% CI 12.45-26.79; ADL: 11.95, 8.47-16.88). A lower risk was observed for those who moved from low SES in childhood to high SES in adulthood (IADL: 2.51, 1.00-6.33; ADL: 1.52, 0.62-3.72). Furthermore, out of risk factors ranging from lifestyles, diseases to social connections, lack of social activities was found to be the primary contributor to socioeconomic inequalities in care dependency (explaining up to 66.63%), with corresponding interventions achieving universal health and economic benefits across countries.

Changing socioeconomic status over the lifespan was associated with care dependency risk in later life. Promoting equal educational opportunities from an early age to equitably benefit the most socioeconomically disadvantaged could help mitigate care burdens. Encouraging participation in social activities has the potential to reduce socioeconomic differences in care dependency.

National Natural Science Foundation of China.

With the accelerating population ageing globally, disability has become a major public concern. Residential greenness may be one of the influencing factors of disability, but epidemiological evidence in the associations of residential greenness exposures with disability is limited. We aimed to investigate the associations of residential greenness exposures with the risk of disability in the elderly.

Data of 8408 residents were obtained from the World Health Organization Study on Global AGEing and Adult Health (WHO SAGE) implemented in China during 2007-2018. Participants were matched to the Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI) at their residential address. Disability was measured by the 12-item Chinese version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0). The associations were examined using a generalized linear mixed model with stratified analyses by the covariates.

We observed significantly negative associations of greenness exposures with the summary WHODAS score [NDVI500m: -0.290, 95% Confidence Intervals (95%CI): -0.510, -0.070; EVI500m: -0.453, 95%CI: -0.757, -0.149], and with the score of cognition (EVI500m: -0.472, 95%CI: -0.881, -0.063), mobility (NDVI500m: -0.632, 95%CI: -0.965, -0.299; EVI500m: -0.739, 95%CI: -1.199, -0.280), and participation (NDVI500m: -0.388, 95%CI: -0.651, -0.125; EVI500m: -0.530, 95%CI: -0.893, -0.166). People living alone had a more pronounced association in cognition (NDVI500m: -1.546, 95%CI: -2.471, -0.621). The associations with summary WHODAS score were stronger among participants living in rural areas (NDVI500m: -0.420, 95%CI: -0.683, -0.157), having less education level (NDVI500m: -0.618, 95%CI: -0.982, -0.253), and living in northern China (NDVI500m: -0.381, 95%CI: -0.776, 0.013).

Residential greenness may reduce the onset and worsening of disability, particularly for domains of cognition, mobility, and social participation. Because of its stronger influence among people with low socioeconomic status, increasing greenness levels in areas with lower socioeconomic status may promote health equity.

Physical activity is recommended for older adults; however, the benefits of previous active engagement in physical activity that can be sustained after one becomes inactive remain to be determined. This study investigated the longitudinal associations between physical activity engagement patterns and older adults' well-being. This population-based cohort study used data from the China Health and Retirement Longitudinal Study between 2015 and 2020. People aged 60 years and above were included, and they were categorized as active engagers if they reported engaging in at least 10 min of moderate and/or vigorous exercise consecutively per week in each survey year. Older adults' well-being was evaluated using the healthy aging score, and geographical variations were visualized. The generalized estimating equations model was adopted to examine the differences between various physical activity engagement patterns and older adults' well-being. Among the 3300 older adults (50.5% men; age 66.9 ± 5.7 years) during the five years of follow-up, engagement in physical activity increased from 31.7% to 59.6%. However, their well-being decreased gradually, especially among those who were inactive engagers (beta = -0.20 to -0.21). Physical activity engagement patterns appeared to slow decline in well-being. Geographical variations were noted, with more favorable healthy aging scores observed in northern China than in southern China. As older adults age, well-being deteriorates, and disengagement of physical activity accelerates the rate of decline. Re-engagement in physical activity can slow the rate of decline in well-being. Early identification of and intervention in inactive engagement in physical activity reduce the detrimental effects on older adult's well-being. A national health initiative is an effective strategy to create a supportive environment for older adults to continue and engage in physical activity. The participation of healthcare professionals and community parties is important to encourage and engage older adults in physical activity.