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.

Polypharmacy and Cognition Function Among Rural Adults

Background: Polypharmacy (using≥5 medications) is associated with poor health outcomes. Mixed results from past studies surrounding chronic medication use, control of chronic conditions, and their effects on cognitive performance warrant further attention. Objective: Investigate a link between polypharmacy and cognition function in rural-dwelling adults in Texas, USA. Methods: Project FRONTIER (Facing Rural Obstacles to Healthcare Now Through Intervention, Education & Research) is a cross-sectional epidemiological study using community-based participatory research in three counties of Texas. Residents age > 40 were eligible for inclusion. The primary outcome is cognitive impairment, and exposures of interest are polypharmacy; comorbidities; and diabetes, hypertension, and depression medication. Logistic regression was used to assess association. Results: Six hundred eighty-nine individuals participated; the mean age was 61, and the majority were female (68.7%).The median number of medications taken by participants was 3.3 (IQR: 0–5); the rate of polypharmacy was 29.6%. Anti-hypertensive agents were the most common medications (15%) used. Polypharmacy users were 2.84 times more likely to have cognitive impairment [OR: 2.84, 95%CI (1.32–6.09)] than those using < 5 medications. Participants on hypertensive medications had 1.85 times higher odds [OR: 1.85, 95%CI (1.14–3.01)] of having cognitive impairment than those who did not have cognitive impairment. Conclusion: Polypharmacy increases the odds of cognitive impairment. The odds of presenting with cognitive impairment increased as the number of medications increased. Additionally, we identified a large, concerning number of participants with pharmacotherapy and poor chronic disease management. A larger study should examine medication adherence among rural elders to manage chronic disease and any healthcare barriers to adherence.

Exploring Factors Associated with Self-Management Compliance among Rural Elders with Diabetes

The purpose of the study was to examine the social-ecological factors associated with diabetic self-management compliance among elders with diabetes in China. A total of 2,586 rural elderly residents who were 60-years-old or above participated in the survey. Socio-demographic factors, social support, healthcare accessibility and health risk factors were measured, along with self-reported medication and blood glucose monitoring data. Among the 117 individuals with diabetes, the medication compliance rate was 79.49%. The elderly who had high economic status were more likely to meet medication treatment compliance. Only 58.97% of study participants monitored blood glucose once a month. Younger age (<70-year-old), higher economic status, more social support and better healthcare accessibility were associated with higher blood glucose monitoring compliance odds. Diabetic medication and blood glucose testing tools should be more comprehensively covered by the national insurance program. Healthcare accessibility should be increased through transportation support, building more local facilities, such as mobile labs, and promoting affordable home-visit care. Self-management education programs about diabetes for rural elders should be promoted.

Elders Being Happy and the Influencing Factors in Shivamogga, Karnataka, India

Introduction: India ranks 4th in the elderly population. Ageing play an important role in the well being and associated factors. The present study was conducted to understand the feeling of the elderly residing in urban and rural areas of Shivamogga, Karnataka southern India. Methods: The study was conducted on 200 elderly by a questionnaire on their socio- demographic profile, health, residing place, lifestyle, life satisfaction, dissatisfaction, culture, tradition, the role of technology and government. Data were analyzed with Pearson correlation coefficient. Results: For most of the analysed factors rural elders had shown strong positive correlation compared to urban elders. Health condition is positively significant in rural elders (rs = 0.76, p > 0.05), when compared to urban elders (rs = 0.67, p > 0.05), the place of residing is having strong correlation with rural (rs = 0.97, p > 0.05), because they reside in their own home then urban (rs = 0.56, p > 0.05), as they reside in rented house hence their attachment to rented house is less than own home. Conclusion: The elders of rural-urban areas of shivamogga had shown positive significance with the selected factors, but the strong inclination is towards rural elders. The rural-urban divide and emotional psychological behaviours need further investigation

Extra Health and Health-Related Costs of Living With Frailty Among Rural and Urban Elders in China

Growing attention has been focused on how to improve the affordability and accessibility of healthcare services, especially for elders (aged 55 and above) who have higher levels of medical needs. Following the standard of living approach, which assumes that people’s standard of living would be negatively affected if additional needs (i.e., healthcare) arise at a given level of household income, this secondary research examines elders’ extra health and health-related costs of having chronic diseases and disabilities in rural (n=5,509) and urban (n=3,225) areas of China. Bivariate analyses show there were no significant differences between rural and urban groups in terms of the prevalence of having one or more chronic diseases (56% vs. 58%) and at least one type of disability (15% vs. 13%). Multivariate analyses indicate that living with chronic diseases incurred more extra costs for rural elders than their urban peers, after controlling for individual and household characteristics. On average, rural elders who had at least three chronic medical conditions would spend 108.3% more on medical services than those who had no chronic disease; elders with at least two types of disabilities would spend 59.8% more than those with no disability. The extra health-related costs were boosted when people had at least one type of disability (63.6%), but this was not the case for those who had chronic diseases. Statistical significance was not found among urban elders in China regarding both health and health-related expenditures. The results suggest that rural elders need support to manage their chronic health conditions.

Built form and depression among the Chinese rural elderly: a cross-sectional study

ObjectivesFew data on the association between housing structure and depression among rural elders in China are available. We examined the impact of built forms on depression.DesignThis is a cross-sectional study.SettingA representative sample of rural residents aged 60 years or older in China.ParticipantsA total of 5090 older adults in 2019 in rural Suzhou, China.Outcome measuresAssociations of built form with odds of probable and possible depression.ResultsThere was significant difference among elders living in varied sizes of house. Older age (vs 60–64 years: 75–79 years AdjOR, 1.737; 95% CI, 1.309 to 2.305; ≥80 years AdjOR, 2.072; 95% CI, 1.439 to 2.981), male sex (AdjOR, 0.719; 95% CI, 0.593 to 0.871), single (AdjOR, 1.303; 95% CI, 1.032 to 1.646), self-care disability (AdjOR, 4.761; 95% CI, 3.960 to 5.724), three or more chronic diseases (AdjOR, 2.200; 95% CI, 1.657 to 2.920), living alone (AdjOR, 1.443; 95% CI, 1.059 to 1.966), living in cottage (AdjOR, 1.426; 95% CI, 1.033 to 1.967), living space (vs <50 m2: 201–250 m2 AdjOR, 0.566; 95% CI, 0.359 to 0.893; >250 m2 AdjOR, 0.337; 95% CI, 0.223 to 0.511) and space per person (vs <30 m2: 30- m2 AdjOR, 0.502; 95% CI, 0.362 to 0.697; 40- m2 AdjOR, 0.473; 95% CI, 0.347 to 0.646; 50- m2 AdjOR, 0.418; 95% CI, 0.339 to 0.515) were associated with risk of depression among Chinese rural elders.ConclusionThe built form was significantly and meaningfully associated with depression among Chinese rural elders. More attention should be paid to preventing mental illness among the rural elderly living in the small housing area and cottages in China.

Multi-Dimensional Social Relations and Mental Health among Rural Older Adults

To date, knowledge of the association between social-relational patterns and health among rural elders in non-Western social and cultural contexts is scant. Using regional population data in rural South Korea, this study examines comprehensive social relations among rural elders, and the extent to which heterogeneous patterns of social relations were associated with cognitive impairment and depression. Using comprehensive social-relational indicators with (a) the structure of social relations (b) the quality of social relations, we applied latent class analysis identified four subgroups of social relations among rural older adults: Restricted, Spouse Focused-Ambivalent, Community Engaged-Positive, and Diverse. We found that the Community-Engaged group was less likely to be depressed as well as have co-ocurring problems of cognitive impairment and depression.

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.