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Given the global demographic shifts and rapid digitalization, digital engagement has emerged as a critical determinant of healthy aging. While previous research has linked digital engagement to cognitive outcomes, the underlying mechanisms remain underexplored among Chinese older adults. This study aimed to analyze the relationships between digital engagement and cognitive function among older adults in China through a moderated mediation model guided by the technological reserve hypothesis, with digital health literacy (DHL) and social support as mediators and living arrangements as a moderator. We conducted a cross-sectional questionnaire survey using stratified multistage sampling from June to November 2024, including 8123 participants aged 55 years and older. Digital engagement, defined as older adults' use of contemporary digital technologies to support routine daily activities, autonomy, independence, and social inclusion, was assessed using a multidimensional questionnaire. The Chinese eHealth Literacy Scale, the 3-item short version of the Perceived Social Support Scale, and the Mini-Cog test were used to assess DHL, social support, and cognitive function. Guided by a directed acyclic graph based on the technological reserve hypothesis, mediation and moderated mediation analyses were performed using the PROCESS macro in SPSS (IBM Corp) with 5000 bootstrap resamples. Digital engagement was positively associated with cognitive function among older adults (β=0.241, 95% CI 0.216-0.265). This association was partially mediated by DHL (β=0.059, 95% CI 0.049-0.069) and social support (β=0.012, 95% CI 0.008-0.016), with the combined indirect effects accounting for 29.5% of the total effect (β=0.071, 95% CI 0.061-0.082). Additionally, living arrangements significantly moderated the associations between digital engagement and cognitive function (β=0.109, 95% CI 0.052-0.166), digital engagement and DHL (β=0.063, 95% CI 0.014-0.112), and digital engagement and social support (β=0.151, 95% CI 0.089-0.212). These effects were stronger among older adults living alone. This study contributes to the understanding of cognitive aging in the digital environment from the perspective of the technological reserve hypothesis and digital engagement. Digital engagement influenced cognitive function via DHL and social support, and these associations of digital engagement with cognitive function, DHL, and social support were stronger among older adults living alone. Digital health interventions and public health policies should target both DHL and social support among older populations and prioritize older adults living alone.

Background The health literacy among older adults deserves further investigation. This study aimed to conduct a multistage research to investigate the current status and key determinants of health literacy among Chinese older adults and evaluate the effectiveness of an active learning intervention in enhancing their health literacy. Methods In the first phase, a cross-sectional study surveyed 608 elderly residents. The second phase was a two-arm parallel randomized controlled trial (RCT) in which 120 older adults were randomly assigned to a three-month intervention ( n  = 60) or control group ( n  = 60). The active learning program intervention included health lectures, active discussions, heuristic questioning, and family homework, while the control group only received health literacy pamphlets. Health literacy scores were the primary outcome and were evaluated from five dimensions. The RCT data was collected at baseline and the completion of the intervention. Results In the cross-sectional study, the median (IQR) health literacy score was 4.355 (4.030, 4.647) (range: 0–5) Quantile regression showed that sex, education, number of children, self-reported health, chronic disease and insurance significantly affected health literacy. The intervention group showed significant improvement in all dimensions ( P  < 0.05), with significant group × time interactions in health knowledge, health behaviours, health skills, health intentions and total health literacy. Multiple linear regression indicated that marriage status related to health knowledge, education level related to health behaviours and total health literacy, chronic diseases and insurance factors related to health skills, and sex and insurance factors related to health intentions have significant effects. Conclusion The health literacy of older adults is influenced by individuals, families, and societal factors. The active learning program effectively enhances comprehensive health literacy and is a valuable strategy for advancing China’s proactive health strategy by mobilizing the roles of the individual, family, and society. Trial registration The trial has been retrospectively registered on April 8, 2025, at the Chinese Clinical Trial Registry (ChiCTR2500100396|| http://www.chictr.org.cn/ ), which is a primary registry of the International Clinical Trial Registry Platform of the World Health Organization.

Objectives: The longitudinal relationship between sarcopenia, depression, and cognitive impairment has been insufficiently studied in China. This study aimed to characterize the association between sarcopenia and cognitive impairment and the mediating role of depression using nationally representative data. Methods: 7091 middle-aged and older adults were analyzed from the China Health and Retirement Longitudinal Study (CHARLS) across three waves (2011, 2013, and 2015). Cognitive trajectories were modeled using a group-based trajectory model (GBTM), while multivariable ordinal logistic regression was employed to evaluate the associations with cognitive trajectories. The mediating role of depressive symptoms was assessed through bootstrap mediation analysis and cross-lagged panel modeling (CLPM). Results: Trajectory analysis identified four distinct cognitive function patterns: “High and Stable” trajectory (n = 2563, 36.73%), “Middle and Stable” group (n = 2860, 38.76%), “Middle and Decline” group (n = 1280, 18.62%), and “Low and Decline” group (n = 388, 5.90%). Sarcopenia and depressive symptoms were associated with the “Low and Decline” trajectory of cognitive function [Overall: OR (95%CI) of 0.315 (0.259, 0.382) and 0.417 (0.380, 0.459)]. Mediation analysis indicated that depressive symptoms accounted for 11.78% of the relationship between sarcopenia and cognitive trajectories. The cross-lagged panel modeling demonstrated a significant mediation pathway of “T1 cognitive function → T2 depression → T3 sarcopenia”, with T2 depression mediating 5.31% of the total effect. Conclusions: Our study identified four distinct cognitive trajectories, with sarcopenia and depressive symptoms significantly associated with worse cognitive trajectories over time. Depressive symptoms mediated the relationship between sarcopenia and cognitive function. This highlights the importance of integrating mental health and physical health interventions to address the interconnected risks associated with aging.

Background With the rapid advancement of digital transformation, digital health literacy (DHL) has emerged as a crucial determinant influencing health outcomes and health inequalities among older adults. However, empirical evidence on how DHL affects health inequalities remains relatively limited. This study aims to investigate the association between DHL and health inequalities while analyzing the potential mechanisms through which DHL exerts its influence via mechanism testing among older adults in China. Methods From June to November 2024, a multicenter cross-sectional study was conducted by five research groups from four universities in China. DHL was assessed using the eHEALS scale, while health inequalities were measured using an index of relative deprivation. Multivariate regression models examined the association between DHL and health inequalities. The Baron and Kenny stepwise regression method was used to examine the mediating effect, and bias-corrected bootstrap resampling with 5000 iterations was applied to calculate 95% confidence intervals (95% CI) to confirm the significance of the mediating effect. Results Overall, 8696 valid individuals were included. DHL demonstrated a significant positive association with self-rated health (SRH) (coef = 0.015, P < .01) and a significant negative association with health inequalities (coef = −0.016, P < .01). DHL indirectly reduced health inequalities through the mediating effects of alleviating depressive symptoms (coef = −0.005, 95%CI: −0.0066, −0.0045) and promoting physical activity (coef = −0.001, 95%CI: −0.0020, −0.0011), respectively. However, the role in promoting health service utilization and regulating unhealthy behaviors was not significant. Bootstrap tests confirmed the significance of the mediating role. Conclusion DHL was associated with health inequalities and mitigates them by alleviating depressive symptoms and promoting physical activity. It is recommended that while bridging the digital divide, more attention could be paid to DHL and the translation of competencies among older adults to reduce health disparities and promote equitable aging.

Burnout among long-term care workers is a public health concern, yet mixed-methods evidence from China is scarce. To examine multilevel correlates of burnout, a convergent mixed-methods study using a Social–Ecological Framework was conducted. In the quantitative strand, 494 workers were surveyed using two-stage cluster sampling, and probability-weighted multivariable linear regression examined factors associated with emotional exhaustion, depersonalization, and reduced personal accomplishment. In the qualitative strand, 15 participants completed semi-structured interviews; transcripts were managed in MAXQDA 2025 and analyzed thematically. Burnout was common (30.77% mild, 33.00% moderate, 17.00% severe). Quantitative findings showed that burnout dimensions were associated with gender, age, marital status, employment arrangement, institution type, training intensity, caregiver burden, and recognition of the long-term care insurance policy (p < 0.05). Qualitative findings highlighted cognitive adaptation, emotional reciprocity with older adults, organizational training and support, and policy recognition as potential buffering resources. These findings suggest that burnout is shaped by influences across multiple levels. Coordinated efforts may help alleviate burnout by strengthening training systems, reducing caregiving burden, enhancing recognition of long-term care policies, and elevating the societal value of care work. Future research should validate these potential courses of action through longitudinal or intervention studies.