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Backgrounds The oldest-old population is increasing sharply in China, and intergenerational support has been their primary source of caregiving. Although intergenerational support has been found to be associated with wellbeing of older people in previous study, most analysis were from the perspective of children’s characteristics and exchange patterns. This study aims to investigate the impact of different types of intergenerational support on subjective wellbeing among Chinese oldest-old and the variation across groups of different economic status, based on their five-tier of needs (physiological needs, safety needs, love/belonging needs, esteem needs, and self-actualization needs). Methods We included older adults aged ≥ 80 years from the 2018 Chinese longitudinal Healthy Longevity Survey (CLHLS). We assessed older people’s subjective wellbeing by their life satisfaction and psychological health. We evaluated four types of intergenerational support: parents provide financial support, receive financial, instrumental and emotional support. We applied binary logistic regression analysis to analyze the association between different intergenerational support and older people’s subjective wellbeing and the moderating effect of self-rated economic status on this relationship. Results A total of 8.794 participants were included, with a mean age of 91,46 years (standard deviation:7.60). Older adults who provide financial support (OR: 1.37, 95% CI: 1.01, 1.85) and receive emotional support (OR: 1.99, 95% CI: 1.40, 2.83) report better subjective wellbeing. However, receiving instrumental support depressed psychological health (OR: 0.67, 95% CI: 0.56, 0.79) while improved life satisfaction (OR: 1.42, 95% CI: 1.04, 1.55). Receiving emotional support promoted parents’ psychological health among all combinations of support, and receiving all the three types together raised their subjective wellbeing most. Conclusions Our study recognizes that higher level of subjective wellbeing for oldest-old is related to providing financial support, receiving emotional and certain instrumental support. In addition, higher economic status can moderate these associations.

Introduction In 2016, the Chinese government officially scaled up family doctor contracted services (FDCS) scheme to guide patients’ health seeking behavior from tertiary hospitals to primary health facilities. Methods This study evaluated the overall gate-keeping effects of this scheme on healthcare utilization of rural residents by using a difference-in-differences (DiD) design. The analysis was based on Shandong Rural Elderly Health Cohort 2019 and 2020. Participants who contracted FDCS in second round and were not contracted with a family doctor in the first round were regarded as treatment group. In total, 310 respondents who have used medical care were incorporated for final study. Results Participants who contracted FDCS (treatment group) experienced a significant decline in the mean level of first-contact health-care facilities, decreasing from 2.204 to 1.981. In contrast, participants who did not contract FDCS (control group), showed an increasing trend in the mean level of first-contact health-care facilities, rising from 2.128 to 2.445. Our results showed that contracting FDCS is associated with approximately 0.54 extra lower mean level of first-contact health-care facilities ( P  = 0.03, 95% CI: -1.03 to 0.05), which suggests an approximately 24.5% reduction in the mean first-contact health-care facility level for participants compared with contracted FDCS than those who did not. Conclusions The study suggested primary healthcare quality should be strengthened and restrictive first point of contact policy should be enacted to establish ordered healthcare seeking behavior among rural residents.

Background Frailty and cognitive impairment are two common geriatric symptoms linking adverse health-related outcomes. However, cognitive frailty, a new definition defined by an international consensus group, has been shown to be a better predictor of increased disability, mortality, and other adverse health outcomes among older people than just frailty or cognitive impairment. This study estimated the prospective association between social support and subsequent cognitive frailty over 1 year follow-up, and whether psychological distress mediated the association. Methods The data was drawn from a prospective repeated-measures cohort study on a sample of participants aged 60 and over. A total of 2785 older people who participated in both of the baseline and 1-year follow-up survey were included for the analysis. Cognitive frailty was measured by the coexistence of physical frailty and cognitive impairment without dementia. Control variables included sex, age, education, marital status, economic status, smoking status, alcohol drinking status, chronic conditions, and functional disability. Path analyses with logistic function were performed to examine the direct effects of social support (predictors) on subsequent cognitive frailty (outcome) at 1-year follow-up and the mediating role of psychological distress (mediator) in this link. Results After adjusting for covariates and prior cognitive frailty status, social support was negatively associated with psychological distress (β = − 0.098, 95% CI = − 0.137 to − 0.066, P  < 0.001) and was negatively associated with the log-odds of cognitive frailty (β = − 0.040, 95% CI = − 0.064 to − 0.016, P  < 0.001). The magnitude of mediation effects from social support to cognitive frailty via psychological distress was a*b = − 0.009, and the ratio of a*b/(a*b + c’) was 24.32%. Conclusions Lower social support is associated with increased rates of subsequent cognitive frailty over 1-year follow-up, and this link is partially mediated through psychological distress, suggesting that assessing and intervening psychological distress and social support may have important implications for preventing cognitive frailty among older people.

Background The relationship between physical activity (PA) and falls among older adults is inconsistent, and little is known about the gender-specific association between falls and PA. Moreover, age may modify this relationship. This study aimed to test the association between PA and falls and to investigate the gender and age differences in the association among rural older adults. Methods This cross-sectional data were derived from the baseline survey of Shandong Rural Elderly Health Cohort (SREHC). In total, 3,242 rural older adults aged 60 years and above were included in the analysis. PA was measured by the International Physical Activity Questionnaire Short Form (IPAQ-S). PA levels were classified as low, moderate, elevated and high according to quartiles. Volume of moderate-to-vigorous physical activity (MVPA) was categorized into low, moderate, elevated, and high level based on global recommendations. Information on falls was determined from in-person interviews. Falling was defined to participants as ending up on the floor or ground because they were unable to stop themselves. Logistic regression analysis was employed to explore the association between falls and PA. Results Of 3,242 rural older adults, the incidence of falls was 13.1%. In older adults, high levels of PA [odds ratio (OR) = 0.65, 95% confidence interval (CI): 0.47–0.90] or MVPA (OR = 0.68, 95% CI: 0.50–0.94) were related to falls. Moderate (OR = 4.84, 95% CI: 1.68–13.94) or high (OR = 0.54, 95% CI: 0.30–0.99) levels of MVPA were associated with falls in older men. But elevated levels of PA were associated with falls (OR = 0.60, 95% CI: 0.42–0.87) in older women. Among older people younger than 75 years, elevated (OR = 0.54, 95% CI: 0.37–0.79) or high (OR = 0.68, 95% CI: 0.48–0.98) levels of PA were associated with falls. Conclusions Among Chinese rural older adults, PA and MVPA are associated with falls, and there are gender and age differences. To prevent falls, measures need to account for individuals’ gender and age to encourage rural older adults to participate more actively in PA. We will conduct longitudinal studies to clarify the causal relationship between PA and fall.

Background Evidence concerning the association between body mass index (BMI) and cognitive function among older people is inconsistent. This study aimed to investigate gender and age as moderators in association between BMI and mild cognitive impairment (MCI) among rural older adults. Methods Data were derived from the 2019 Health Service for Rural Elderly Families Survey in Shandong, China. In total, 3242 people aged 60 years and above were included in the analysis. Multilevel mixed-effects logistic regression was used to examine the moderating roles of gender and age, then further to explore the relationship between BMI and MCI. Results There were 601 (18.5%) participants with MCI. Compared with normal BMI group, low BMI group had a higher risk of MCI among older people [adjusted odds ratio (aOR) = 2.08, 95% confidence interval (CI): 1.26–3.44], women (aOR = 2.06, 95% CI: 1.35–3.12), or the older elderly aged ≥75 years old (aOR = 3.20, 95% CI: 1.34–7.45). This effect remained statistically significant among older women (aOR = 3.38, 95% CI: 1.69–6.73). Among older men, elevated BMI group had a higher risk of MCI (aOR = 2.32, 95% CI: 1.17–4.61) than normal BMI group. Conclusions Gender and age moderated the association between BMI and MCI among Chinese rural older adults. Older women with low BMI were more likely to have MCI, but older men with elevated BMI were more likely to have MCI. These findings suggest rural community managers strengthen the health management by grouping the weight of older people to prevent the risk of dementia.

The aim of this study was to clarify the taxonomic identification of a hemoflagellate and assess the effect of trypanosome infection on Larimichthys crocea . Giemsa staining showed the presence of three morphotypes of trypomastigotes. The trypanosomes had the following morphological characteristics: a slender body with a long flagellum at the front; body size 12.30–30.90 × 1.13–2.33 μm; elongated oval nucleus situated in the median region; kinetoplast small, oval, located at the posterior end. The parasite had significant morphological differences from Trypanosoma epinepheli Su, Feng, Jiang, Guo, Liu & Xu, 2014 and Trypanosoma carassii (Mitrofanov) Doflein, 1901. The 18S rDNA sequences of the trypanosome from L. crocea had the highest homology (98.4%) with T. carassii . Phylogenetic analysis indicated that the parasite clustered with freshwater fish trypanosomes. Based on the differences in morphological characteristics and molecular data, it is considered a new species, Trypanosoma larimichthysi n. sp. Trypanosome infection had no effect on the growth of L. crocea , but significantly increased the concentration of blood urea nitrogen (BUN), and induced pathological changes in the gills, liver, spleen and kidney. The pro-inflammatory immune genes, including TNF-α , IFN-γ , IL-1β , CXCL8 and iNOS , were significantly upregulated in the L. crocea infected with trypanosomes. These results suggest that the trypanosome has negative impacts on host health. Le but de cette étude était de clarifier l’identification taxonomique d’un hémoflagellé et d’évaluer l’effet de l’infection trypanosomienne sur Larimichthys crocea . La coloration au Giemsa a montré la présence de trois morphotypes de trypomastigotes. Les trypanosomes avaient les caractéristiques morphologiques suivantes : un corps élancé avec long flagelle à l’avant; taille du corps 12,30–30,90 × 1,13–2,33 μm; noyau ovale allongé situé dans la région médiane; kinétoplaste petit, ovale, situé à l’extrémité postérieure. Le parasite présentait des différences morphologiques significatives par rapport à Trypanosoma epinepheli Su, Feng, Jiang, Guo, Liu & Xu, 2014 et Trypanosoma carassii (Mitrofanov) Doflein, 1901. Les séquences d’ADNr 18S du trypanosome de L. crocea présentaient la plus forte homologie (98,4 %) avec T. carassii . L’analyse phylogénétique a indiqué que le parasite se regroupait avec les trypanosomes de poissons d’eau douce. Sur la base des différences dans les caractéristiques morphologiques et les données moléculaires, il est considéré comme une nouvelle espèce, Trypanosoma larimichthysi n. sp. L’infection par les trypanosomes n’a eu aucun effet sur la croissance de L. crocea , mais a augmenté de manière significative la concentration d’azote uréique du sang (BUN) et a induit des modifications pathologiques des branchies, du foie, de la rate et des reins. Les gènes immunitaires pro-inflammatoires, dont TNF-α , IFN-γ , IL-1β , CXCL8 et iNOS , ont été significativement régulés à la hausse chez les L. crocea infectés par les trypanosomes. Ces résultats suggèrent que le trypanosome a des impacts négatifs sur la santé de l’hôte.

Background Epidemiological studies show inconsistent links between hearing/vision impairment and dementia risk. Using multisource data, we investigated how single or combined sensory impairments relate to risks of all-cause and specific types of dementia. Methods We employed a triangulation approach combining three methodologies. We analyzed 90,893 UK Biobank (UKB) adults to explore single and joint effects of hearing and vision impairments on all-cause and Alzheimer’s disease (AD), vascular dementia (VD) and non-AD non-VD (NAVD). A meta-analysis of prospective studies involving 937,908 participants provided stronger evidence. Finally, we conducted Mendelian randomization (MR) analysis using genome-wide association studies from UKB (361,194 participants) and FinnGen (412,181 participants) to validate relationships between sensory impairments and dementia occurrence. Results In the UKB cohort study, compared to participants with normal hearing, those in the mild and severe hearing impairment groups had progressively and significantly higher risk of all-cause dementia (mild: HR1.52, 95%CI 1.31–1.77; severe: HR1.80, 95%CI 1.36–2.38), AD (mild: HR1.63, 95%CI 1.30–2.04; severe: HR2.18, 95%CI 1.45–3.27), VD (mild: HR1.68, 95%CI 1.19–2.37; severe: HR1.47, 95%CI 1.22–1.78), and NAVD (mild: HR1.47, 95%CI 1.22–1.78; severe: HR1.98, 95%CI 1.43–2.75). Besides, vision impairment was associated with an increased risk of all-cause dementia (HR1.55, 95%CI 1.18–2.04) and NAVD (HR1.51, 95%CI 1.07–2.13). Furthermore, dual sensory impairment was associated with stepwise increased risks of all-cause and cause-specific dementia than single hearing or vision impairment. In the meta-analysis of 31 prospective cohort studies, risks of all-cause dementia and AD were elevated in participants with single hearing impairment (all-cause dementia: HR1.30, 95%CI 1.21–1.40; AD: HR1.30, 95%CI 1.21–1.40) and dual sensory impairment (all-cause dementia: HR1.63, 95%CI1.14–2.12; AD: HR 2.55, 95%CI 1.19–3.91), while single vision impairment only associated with higher risk of all-cause dementia (HR1.43, 95%CI 1.16–1.71) but not AD. Finally, the MR analysis revealed a significant association between hearing impairment and all-cause dementia (OR1.74, 95%CI 1.01–2.99), AD (OR1.56, 95%CI 1.09–2.23), and NAVD (OR1.14, 1.02–1.26), as well as vision impairment and NAVD (OR1.62, 95%CI 1.13–2.33). Conclusions Our findings showed significant associations between hearing and vision impairments and increased risks of all-cause and cause-specific dementia. Standardized hearing and vision assessment and intervention should be emphasized in dementia prevention strategies.

Background The prevalence of chronic conditions increases rapidly among older population. However, it is unclear how different chronic conditions progression contributes to the health care utilization, and whether intergenerational support modified this relationship. This study aimed to explore the longitudinal link between chronic condition progression and health care utilization, and examine whether intergenerational financial support is a moderator in this relationship among Chinese rural older people. Methods Data was derived from the Shandong Rural Elderly Health Cohort (SREHC), which was conducted from 2019 to 2020. A total of 2,785 participants were included in this study. Kruskal-Wallis rank tests and generalized estimating equation (GEE) models were employed to analyze the association between chronic condition progression and health care utilization. Moderating effect analysis was performed using GEE model and margins plot. Results Older people with progressive chronic conditions used more outpatient (no chronic condition to emerging multimorbidity: OR = 1.83; p  = 0.028; one chronic condition to emerging multimorbidity: OR = 2.17; p  < 0.001; remained multimorbidity while chronic conditions increased: OR = 3.26; p  < 0.001) and inpatient services (no chronic condition to emerging multimorbidity: OR = 2.76; p  < 0.001; one chronic condition to emerging multimorbidity: OR = 3.40; p  < 0.001; remained multimorbidity while chronic conditions increased: OR = 5.32; p  < 0.001) than those remained no chronic conditions. Intergenerational financial support may alleviate outpatient utilization of older people with multimorbidity (remained multimorbidity × intergenerational financial support: OR = 0.40; p  = 0.013; remained multimorbidity while chronic conditions increased × intergenerational financial support: OR = 0.35; p  = 0.019). Conclusion This study showed that the changes of chronic condition were associated with health care utilization, and intergenerational financial support moderated this relationship. It is vital to continuously monitor and timely intervene the chronic condition progression among rural older people.

ObjectivesThe purpose of this study is to explore the mediating effect of physical disability as well as the role of physical activity (PA) as a moderator in the relationship between physical frailty and health-related quality of life (HRQoL) among rural older adults in China.DesignCross-sectional analysis.SettingRural households in Shandong of China (Rushan, Qufu, Laolin).Participants and methodsA survey was conducted among 3243 rural older adults. The data were collected using questionnaires measuring physical frailty, physical disability, HRQoL and PA. Bootstrap analyses were employed to explore the mediating effect of physical disability and also the moderating role of PA on physical frailty and HRQoL.ResultsAfter controlling for age and education, physical disability partially mediated the effect of physical frailty on HRQoL (indirect effect=−0.143, 95% CI −0.175 to –0.113), with the mediating effect accounting for 33.71% of the total effect. PA moderated the relationship between physical frailty and physical disability as well as the relationship between physical disability and HRQoL. Specifically, the interaction term between physical frailty and PA significantly predicted physical disability (β=−0.120, t=−7.058, p<0.001), and the interaction term between physical disability and PA also had a significant predictive effect on HRQoL (β=0.115, t=6.104, p<0.001).ConclusionsPA appears to moderate the indirect effect of physical disability on the association between physical frailty and HRQoL. This study provides support for potential mechanisms in the association between physical frailty and HRQoL. Encouraging rural older adults to increase PA appropriately might improve HRQoL for older adults with physical frailty and physical disability problems.

Background In China, some previous studies have investigated the signing rate and willingness of residents to sign the family doctor contract services (FDCS). Few studies have explored residents’ willingness to renew the FDCS. This study is designed to understand the family characteristics difference towards rural households’ willingness of maintaining the FDCS. Methods A total of 823 rural households were included in the analysis. A descriptive analysis was conducted to describe the sample characteristics. The binary logistic regression model was used to explore the family characteristics that influence the renewal willingness for FDCS among rural households in Shandong province, China. Results Our study found that about 95.5% rural households had willingness to maintain the FDCS in Shandong, China. Those households with catastrophic health expenditures (CHE) (OR = 0.328, 95%CI = 0.153–0.703), with highest level of education at graduate or above (OR = 0.303, 95%CI = 0.123–0.747) were less willing to maintain the FDCS. Those whose households have more than half of the labor force (OR = 0.403, 95%CI = 0.173–0.941) and those households living in economically higher condition were less willing to maintain the FDCS. Conclusions This study demonstrates a significant association between family characteristics (CHE, highest education in households, proportion of the household labor force) and willingness to maintain FDCS among rural households in Shandong, China. Targeted policies should be made for rural residents of identified at-risk families.