International Journal of Environmental Research and Public Health

Research

14 pages, 774 KiB

Open AccessArticle

Social Inequalities and Loneliness as Predictors of Ageing Well: A Trend Analysis Using Mixed Models

by Jens Klein, Olaf von dem Knesebeck and Daniel Lüdecke

Int. J. Environ. Res. Public Health 2020, 17(15), 5314; https://doi.org/10.3390/ijerph17155314 - 23 Jul 2020

Cited by 4 | Viewed by 3429

Background: This study examines if education, income, and loneliness are associated with physical functioning and optimism in an ageing population in Germany. Furthermore, time trends of physical functioning and optimism as well as of associations with social inequality and loneliness are analyzed. [...] Read more.

Background: This study examines if education, income, and loneliness are associated with physical functioning and optimism in an ageing population in Germany. Furthermore, time trends of physical functioning and optimism as well as of associations with social inequality and loneliness are analyzed. Methods: The German Ageing Survey (DEAS), a longitudinal population-based survey of individuals aged 40 years and older, was used (four waves between 2008 and 2017, total sample size N = 23,572). Physical functioning and optimism were introduced as indicators of ageing well. Educational level, net equivalent income, and loneliness were used as predictors in linear mixed models for longitudinal data. Results: Time trends show that physical functioning decreases over time, while optimism slightly increases. Education and income are positively associated with physical functioning, while higher loneliness correlates with lower physical functioning. Higher optimism was associated with higher income and particularly with lower loneliness. Income and notable educational inequalities in physical functioning increase over time. Time trends of the associations with optimism show decreasing income inequalities and increasing disparities in loneliness. Conclusions: Increasing educational inequalities in physical functioning and a strong association of loneliness with optimism provide information for further interventions. Targeted health promotion among the aged and addressing maladaptive social cognition are options to tackle these issues. Key areas for action on healthy ageing include, for instance, the alignment of health systems to the needs of older populations or the creation of age-friendly environments. Full article

(This article belongs to the Special Issue Health Inequalities in Ageing Societies and the Impact on Ageing Well)

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15 pages, 336 KiB

Open AccessArticle

Age-Friendly Environments in ASEAN Plus Three: Case Studies from Japan, Malaysia, Myanmar, Vietnam, and Thailand

by Sariyamon Tiraphat, Doungjai Buntup, Murallitharan Munisamy, Thang Huu Nguyen, Motoyuki Yuasa, Myo Nyein Aung and Aung Hpone Myint

Int. J. Environ. Res. Public Health 2020, 17(12), 4523; https://doi.org/10.3390/ijerph17124523 - 23 Jun 2020

Cited by 15 | Viewed by 5154

Abstract

Promoting age-friendly environment is one of the appropriate approaches to support quality of life toward ageing populations. However, the information regarding age-friendly environments in the Association of Southeast Asian Nations (ASEAN) Plus Three countries is still limited. This study aimed to survey the [...] Read more.

Promoting age-friendly environment is one of the appropriate approaches to support quality of life toward ageing populations. However, the information regarding age-friendly environments in the Association of Southeast Asian Nations (ASEAN) Plus Three countries is still limited. This study aimed to survey the perceived age-friendly environments among ASEAN Plus Three older populations. The study employed cross-sectional quantitative research using multistage cluster sampling to select a sample of older adults in the capital cities of Japan, Malaysia, Myanmar, Vietnam and Thailand. The final sample was composed of 2171 older adults aged 55 years and over, including 140 Japanese, 510 Thai, 537 Malaysian, 487 Myanmarese, and 497 Vietnamese older adults. Data collection was conducted using a quantitative questionnaire with 20 items of perceived age-friendly environments with the rating scale based on the World Health Organization (WHO) standard. The score from the 20 items were analyzed and examined high-risk groups of “bad perception level” age-friendly environments using ordinal logistic regression. The research indicated the five highest inadequacies of age-friendly environments including: (1) participating in an emergency-response training session or drill which addressed the needs of older residents; (2) enrolling in any form of education or training, either formal or non-formal in any subject; (3) having opportunities for paid employment; (4) involvement in decision making about important political, economic and social issues in the community; and (5) having personal care or assistance needs met in the older adult’s home setting by government/private care services. Information regarding the inadequacy of age-friendliness by region was evidenced to guide policy makers in providing the right interventions towards older adults’ needs. Full article

(This article belongs to the Special Issue Health Inequalities in Ageing Societies and the Impact on Ageing Well)

19 pages, 1736 KiB

Open AccessArticle

Giving Voice to the Environment as the Silent Partner in Aging: Examining the Moderating Roles of Gender and Family Structure in Older Adult Wellbeing

by Michal Isaacson, Ashwin Tripathi, Tannistha Samanta, Lisa D’Ambrosio and Joseph Coughlin

Int. J. Environ. Res. Public Health 2020, 17(12), 4373; https://doi.org/10.3390/ijerph17124373 - 18 Jun 2020

Cited by 6 | Viewed by 3382

Abstract

Gerontological scholarship has long seen the environment to be a silent partner in aging. Environmental Gerontology, an established approach in Social Gerontology, has shown how the everyday lives of older adults are deeply entangled in socio-spatial environments. Adopting an Environmental Gerontology approach, we [...] Read more.

Gerontological scholarship has long seen the environment to be a silent partner in aging. Environmental Gerontology, an established approach in Social Gerontology, has shown how the everyday lives of older adults are deeply entangled in socio-spatial environments. Adopting an Environmental Gerontology approach, we explore social and cultural dimensions of the association between out-of-home mobility and wellbeing among older adults in a north western city of India. This was established by combining high resolution time-space data collected using GPS receivers, questionnaire data and time diaries. Following a multi-staged analytical strategy, we first examine the correlation between out-of-home mobility and wellbeing using bivariate correlation. Second, we introduce gender and family structure into regression models as moderating variables to improve the models’ explanatory power. Finally, we use our results to reinterpret the Ecological Press Model of Aging to include familial structure as a factor that moderates environmental stress. Findings emphasize the central role that social constructs play in the long-established relationship between the environment and the wellbeing of older adults. Full article

(This article belongs to the Special Issue Health Inequalities in Ageing Societies and the Impact on Ageing Well)

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15 pages, 1069 KiB

Open AccessArticle

Longitudinal Association of Built Environment Pattern with Physical Activity in a Community-Based Cohort of Elderly Hong Kong Chinese: A Latent Profile Analysis

by Jie-Sheng Lin, Faye Ya-Fen Chan, Jason Leung, Blanche Yu, Zhi-Hui Lu, Jean Woo, Timothy Kwok and Kevin Ka-Lun Lau

Int. J. Environ. Res. Public Health 2020, 17(12), 4275; https://doi.org/10.3390/ijerph17124275 - 15 Jun 2020

Cited by 9 | Viewed by 3234

Abstract

A large number of studies have focused on the associations between single built environment (BE) characteristics and physical activity (PA). Combinations of BE characteristics offer a more comprehensive approach to identify the BE–PA associations. We aimed to examine the BE–PA associations in a [...] Read more.

A large number of studies have focused on the associations between single built environment (BE) characteristics and physical activity (PA). Combinations of BE characteristics offer a more comprehensive approach to identify the BE–PA associations. We aimed to examine the BE–PA associations in a cohort of elderly Hong Kong Chinese. Between 2001 and 2003, 3944 participants (65–98 years of age) were recruited and followed for a mean of 7.8 years. BE characteristics were assessed via geographic information system. PA levels were obtained using the Physical Activity Scale for the Elderly questionnaire at baseline and three follow-ups. Latent profile analysis was first conducted to classify the BE characteristics, and linear mixed-effects models were then used to explore the longitudinal associations between the BE classes and changes in the PA levels. Three classes of BE were identified. Class 3 (characterized by greater green space and sky view factor) demonstrated a significant decline in household PA (β = −1.26, 95% confidence interval: −2.20, −0.33) during the study period, and a slower decline in walking PA (1.19 (0.42, 1.95)) compared with Class 2 (characterized by a greater proportion of residential land use). Our results indicate that BE patterns characterized by high green space and a sky view factor may help promote the walking PA level. Full article

(This article belongs to the Special Issue Health Inequalities in Ageing Societies and the Impact on Ageing Well)

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12 pages, 339 KiB

Open AccessArticle

Outpatient Visits among Older Adults Living Alone in China: Does Health Insurance and City of Residence Matter?

by Jianyun Wang, Yaolin Pei, Renyao Zhong and Bei Wu

Int. J. Environ. Res. Public Health 2020, 17(12), 4256; https://doi.org/10.3390/ijerph17124256 - 15 Jun 2020

Cited by 6 | Viewed by 2226

Abstract

This study aimed to examine the association between health insurance, city of residence, and outpatient visits among older adults living alone in China. A sample of 3173 individuals was derived from “Survey on Older Adults Aged 70 and Above Living Alone in Urban [...] Read more.

This study aimed to examine the association between health insurance, city of residence, and outpatient visits among older adults living alone in China. A sample of 3173 individuals was derived from “Survey on Older Adults Aged 70 and Above Living Alone in Urban China” in five different cities. Logistic regression models indicated that older adults living alone who had urban employee basic medical insurance, urban resident basic medical insurance, and public medical insurance were more likely to have outpatient visits than those without any health insurance. After controlling the number of chronic diseases, only those with public medical insurance were more likely to have outpatient visits than uninsured older adults. Additionally, older adults who resided in Shanghai and Guangzhou were more likely to have outpatient visits than those in Chengdu, whereas older adults who were in Dalian and Hohhot were less likely to have outpatient visits. To improve the equity of outpatient visits among older adults living alone in China, policy efforts should be made to reduce fragmentation of different health insurance plans, expand the health insurance coverage for older adults, provide programs that consider the needs of this special group of older adults, and reduce the inequality in health resources and health insurance policies across cities. Full article

(This article belongs to the Special Issue Health Inequalities in Ageing Societies and the Impact on Ageing Well)

15 pages, 604 KiB

Open AccessArticle

Social Frailty Is Independently Associated with Mood, Nutrition, Physical Performance, and Physical Activity: Insights from a Theory-Guided Approach

by Kalene Pek, Justin Chew, Jun Pei Lim, Suzanne Yew, Cai Ning Tan, Audrey Yeo, Yew Yoong Ding and Wee Shiong Lim

Int. J. Environ. Res. Public Health 2020, 17(12), 4239; https://doi.org/10.3390/ijerph17124239 - 14 Jun 2020

Cited by 75 | Viewed by 6050

Abstract

Notwithstanding the increasing body of evidence that links social determinants to health outcomes, social frailty is arguably the least explored among the various dimensions of frailty. Using available items from previous studies to derive a social frailty scale as guided by the Bunt [...] Read more.

Notwithstanding the increasing body of evidence that links social determinants to health outcomes, social frailty is arguably the least explored among the various dimensions of frailty. Using available items from previous studies to derive a social frailty scale as guided by the Bunt social frailty theoretical framework, we aimed to examine the association of social frailty, independently of physical frailty, with salient outcomes of mood, nutrition, physical performance, physical activity, and life–space mobility. We studied 229 community-dwelling older adults (mean age 67.22 years; 72.6% females) who were non-frail (defined by the FRAIL criteria). Using exploratory factor analysis, the resultant 8-item Social Frailty Scale (SFS-8) yielded a three-factor structure comprising social resources, social activities and financial resource, and social need fulfilment (score range: 0–8 points). Social non-frailty (SNF), social pre-frailty (SPF), and social frailty (SF) were defined based on optimal cutoffs, with corresponding prevalence of 63.8%, 28.8%, and 7.4%, respectively. In logistic regression adjusted for significant covariates and physical frailty (Modified Fried criteria), there is an association of SPF with poor physical performance and low physical activity (odds ratio, OR range: 3.10 to 6.22), and SF with depressive symptoms, malnutrition risk, poor physical performance, and low physical activity (OR range: 3.58 to 13.97) compared to SNF. There was no significant association of SPF or SF with life–space mobility. In summary, through a theory-guided approach, our study demonstrates the independent association of social frailty with a comprehensive range of intermediary health outcomes in more robust older adults. A holistic preventative approach to frailty should include upstream interventions that target social frailty to address social gradient and inequalities. Full article

(This article belongs to the Special Issue Health Inequalities in Ageing Societies and the Impact on Ageing Well)

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10 pages, 317 KiB

Open AccessArticle

Educational Inequalities in Life and Healthy Life Expectancies among the 50-Plus in Spain

by Aïda Solé-Auró, Unai Martín and Antía Domínguez Rodríguez

Int. J. Environ. Res. Public Health 2020, 17(10), 3558; https://doi.org/10.3390/ijerph17103558 - 19 May 2020

Cited by 24 | Viewed by 3936

Abstract

This study computes educational inequalities in life expectancy (LE), healthy life expectancy (HLE), and unhealthy life expectancy (ULE) by gender and education level in Spain in 2012. Death registrations and vital status by level of education were obtained from Spain’s National Institute of [...] Read more.

This study computes educational inequalities in life expectancy (LE), healthy life expectancy (HLE), and unhealthy life expectancy (ULE) by gender and education level in Spain in 2012. Death registrations and vital status by level of education were obtained from Spain’s National Institute of Statistics. Health prevalences were estimated from the National Health Survey for Spain. We used Sullivan’s method to compute HLE, ULE, and the proportion of time lived with health problems. Our results reveal that Spanish women live longer than men in all education groups, but a higher proportion of women report poor health. We detect substantial differences in unhealthy life by gender and education, with higher effect for women and for those with low levels of education. Poor self-perceived health shows the largest educational gradient; chronic diseases present the lowest. This is the first work that provides evidence on health inequalities by education level in Spain. Our findings seem to be in line with reports of the smaller social inequalities experienced in Southern Europe and highlight the importance of education level on extending the proportion of years spent in good health in a Mediterranean country. Full article

(This article belongs to the Special Issue Health Inequalities in Ageing Societies and the Impact on Ageing Well)

13 pages, 312 KiB

Open AccessArticle

“Unworthy of Care and Treatment”: Cultural Devaluation and Structural Constraints to Healthcare-Seeking for Older People in Rural China

by Xiang Zou, Ruth Fitzgerald and Jing-Bao Nie

Int. J. Environ. Res. Public Health 2020, 17(6), 2132; https://doi.org/10.3390/ijerph17062132 - 23 Mar 2020

Cited by 12 | Viewed by 4543

Abstract

This paper examines the experiences of seeking healthcare for rural Chinese older people, a population who experiences the multiple threats of socio-economic deprivation, marginalization, and lack of access to medical care, yet have been relatively overlooked within the existing scholarly literature. Based on [...] Read more.

This paper examines the experiences of seeking healthcare for rural Chinese older people, a population who experiences the multiple threats of socio-economic deprivation, marginalization, and lack of access to medical care, yet have been relatively overlooked within the existing scholarly literature. Based on ethnographical data collected from six-month fieldwork conducted in a rural primary hospital in Southern China, this paper identifies a widespread discouraging, dispiriting attitude regarding healthcare-seeking for rural older members despite the ongoing efforts of institutional reforms with a particular focus on addressing access to health services amongst rural populations. Such an attitude was expressed by older people’s families as well as the public in their narratives by devaluing older members’ health care demands as “unworthy of care and treatment” (“buzhide zhi” in Chinese). It was also internalized by older people, based on which they deployed a family-oriented health-seeking model and strategically downgraded their expectation on receiving medical care. Moreover, underpinning this discouragement and devaluation, as well as making them culturally legitimate, is the social expectation of rural older people to be enduring and restrained with health-seeking. Simultaneously, this paper highlights the sourc2e of institutional and structural impediments, as they intersect with unfavorable socio-cultural values that normalize discouragement and devaluation. Full article

(This article belongs to the Special Issue Health Inequalities in Ageing Societies and the Impact on Ageing Well)

15 pages, 347 KiB

Open AccessArticle

Correlates of Blood Pressure and Cholesterol Level Testing Among a Socially-Disadvantaged Population in Poland

by Małgorzata Znyk, Kinga Polańska, Leokadia Bąk-Romaniszyn and Dorota Kaleta

Int. J. Environ. Res. Public Health 2020, 17(6), 2123; https://doi.org/10.3390/ijerph17062123 - 23 Mar 2020

Cited by 4 | Viewed by 2928

Abstract

As part of cardiovascular disease prevention, the performance of BMI determination, blood pressure measurement, biochemical tests, as well as a lifestyle-related risk assessment are recommended. The aim of this study was to evaluate the correlates of blood pressure and cholesterol level testing among [...] Read more.

As part of cardiovascular disease prevention, the performance of BMI determination, blood pressure measurement, biochemical tests, as well as a lifestyle-related risk assessment are recommended. The aim of this study was to evaluate the correlates of blood pressure and cholesterol level testing among a socially-disadvantaged population in Poland. This cross-sectional study was performed between 2015 and 2016 among 1710 beneficiaries of government welfare assistance. Face-to-face interviews conducted by trained staff at each participant’s place of residence allowed for completion of questionnaires that covered socio-demographic, health and lifestyle-related information. Sixty-five percent of the participants declared a blood pressure and 27% of them cholesterol level testing at least once within the year proceeding the study. A higher chance of having blood pressure testing was observed among the women (OR = 1.5; p = 0.002) and people with high blood pressure (OR = 3.9; p < 0.001). The women (OR = 1.4; p = 0.04) and older people (OR = 1.9; p = 0.02; OR = 2.6; p < 0.001, OR = 2.7; p = 0.002, for the following age groups: 30-39, 40-49, 50-59 years respectively), the respondents who declared health problems such as heart attack (OR = 3.0; p = 0.04), high blood pressure (OR = 2.3; p < 0.001) and type 2 diabetes (OR = 3.3; p = 0.004) and those with a family history of chronic diseases (OR = 1.5; p = 0.03) had a higher chance of cholesterol level checking. Higher healthy lifestyle index, indicating that the study participants have followed almost all of the studied lifestyle-related recommendations, was a significant correlate of cholesterol level testing (OR = 1.7; p = 0.006). Actions that promote lifestyle changes, blood pressure, and cholesterol level testing should take into account the needs of the disadvantaged population and should especially target men, people with existing chronic diseases, and those with unfavorable lifestyle characteristics. With respect to the socially-disadvantaged population, the social assistance institutions and outpatient clinics are the best places to conduct activities promoting a healthy lifestyle. The most commonly applied strategies to promote lifestyle changes can cover risk assessment, increasing awareness, emotional support and encouragement, as well as a referral to specialists. Full article

(This article belongs to the Special Issue Health Inequalities in Ageing Societies and the Impact on Ageing Well)

16 pages, 332 KiB

Open AccessArticle

Socioeconomic Inequalities in Frailty in Hong Kong, China: A 14-Year Longitudinal Cohort Study

by Ruby Yu, Cecilia Tong, Jason Leung and Jean Woo

Int. J. Environ. Res. Public Health 2020, 17(4), 1301; https://doi.org/10.3390/ijerph17041301 - 18 Feb 2020

Cited by 11 | Viewed by 3458

Abstract

The prevalence of frailty varies among socioeconomic groups. However, longitudinal data for the association between subjective social status and frailty is limited. In this study, we examined whether subjective social status was associated with incident frailty. Data were obtained from a 14-year cohort [...] Read more.

The prevalence of frailty varies among socioeconomic groups. However, longitudinal data for the association between subjective social status and frailty is limited. In this study, we examined whether subjective social status was associated with incident frailty. Data were obtained from a 14-year cohort of Chinese men and women (n = 694) aged 65 years and older who participated in the MrOs study—a longitudinal study on osteoporosis and general health in Hong Kong. Subjective social status at baseline (2001–2003) was assessed using a 10-rung self-anchoring scale. Incident frailty at the 14-year follow-up (2015–2017) was defined as proposed by Fried and colleagues. Ordinal logistic regressions were used to examine the association between subjective social status (high, middle, or low) and incident frailty. After adjustment for age, sex, marital status, objective socioeconomic status, medical history, lifestyle, mental health, and cognitive function, subjective social status at baseline was negatively associated with risk of developing frailty over time (OR 2.3, 95% CI 1.2–4.6). In sex-stratified analysis, the social gradient in frailty was only found in men. Social inequality in frailty in men but not in women supports interventions specific to gender inequality and frailty. Full article

(This article belongs to the Special Issue Health Inequalities in Ageing Societies and the Impact on Ageing Well)

14 pages, 1353 KiB

Open AccessArticle

The Associations of Income, Education and Income Inequality and Subjective Well-Being among Elderly in Hong Kong—A Multilevel Analysis

by Eric TC Lai, Ruby Yu and Jean Woo

Int. J. Environ. Res. Public Health 2020, 17(4), 1271; https://doi.org/10.3390/ijerph17041271 - 17 Feb 2020

Cited by 29 | Viewed by 6715

Abstract

Background: Higher income and education and lower income inequality in a neighbourhood have been shown to be related to better mental health outcome in developed countries. However, it is not clear whether these factors would affect the subjective well-being of the elderly, especially [...] Read more.

Background: Higher income and education and lower income inequality in a neighbourhood have been shown to be related to better mental health outcome in developed countries. However, it is not clear whether these factors would affect the subjective well-being of the elderly, especially in a setting with recent rapid economic development. Methods: This study was conducted in 80 community centres with a total of 7552 community-dwelling elderly (mean age 75.9 years (SD = 7.79), 79% female) in Hong Kong. Income at individual level was measured as perceived disposable income. Education level was also collected. At district level, income was measured by district median household income and education was measured as the proportion of the population with no formal schooling. Income inequality was quantified using Gini coefficients. Low subjective well-being was defined as any one or a combination of the following: not satisfied with life, no meaning of life and being unhappy (Likert scale ≤ 2). Multilevel logistic regression was used to assess the association of income, education and income inequality and low subjective well-being. Results: We found that 15.3% (95% confidence interval (CI): 14.5 to 16.1) of the elderly have low subjective well-being. Compared with elderly who reported a very adequate disposable income, those who reported a very inadequate disposable income are at increased risk of low subjective well-being (OR=5.08, 95%CI: 2.44 to 10.59). Compared with elderly with tertiary education, those with no formal schooling were at higher risk (OR=1.60, 95%CI 1.22 to 2.09). Income inequality was not related to subjective well-being. Conclusions: Elderly with inadequate disposable income and lower education level are more likely to suffer from low subjective well-being. At the neighbourhood level, income inequality was not related to subjective well-being. However, the relationships between neighbourhood income and education level and individuals’ subjective well-being are not clear. Full article

(This article belongs to the Special Issue Health Inequalities in Ageing Societies and the Impact on Ageing Well)

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19 pages, 326 KiB

Open AccessArticle

Older Women in Australia: Facing the Challenges of Dual Sensory Loss

by Chyrisse Heine, Cathy Honge Gong, Susan Feldman and Colette Browning

Int. J. Environ. Res. Public Health 2020, 17(1), 263; https://doi.org/10.3390/ijerph17010263 - 30 Dec 2019

Cited by 5 | Viewed by 3194

Abstract

With the increase in longevity, the number of women living into old age is rising and higher than that of men. Data was derived from the Melbourne Longitudinal Studies on Healthy Ageing Program, which included 533 women and 467 men aged 65 years [...] Read more.

With the increase in longevity, the number of women living into old age is rising and higher than that of men. Data was derived from the Melbourne Longitudinal Studies on Healthy Ageing Program, which included 533 women and 467 men aged 65 years and older, in Australia, over 10 years. Logistic regression modeling was used to investigate the prevalence of dual sensory loss and the unmet needs for vision and hearing devices in older women (compared to men) over time, as well as its impacts on self-reported general health, depression, perceived social activities, community service use and ageing in place. Results suggested that the prevalence of dual sensory loss increased for women from the age of 75 years and over. Dual sensory loss was higher for older women and men who were living alone, with government benefits as their main income source or were divorced, separated or widowed. Dual sensory loss had significant impacts on poor general health, perceived inadequate social activities and community service use for women and men and on depression for women only. Early identification of dual sensory loss is essential to minimize its effects, ensuring continued well-being for this population. Full article

(This article belongs to the Special Issue Health Inequalities in Ageing Societies and the Impact on Ageing Well)

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