Background: Existing self‐care measures for the Chinese population are specific to single chronic conditions. No generic self‐care measures exist for the Chinese population with multiple chronic conditions.Objectives: To test the structural validity, concurrent validity and reliability of the Self‐care of Chronic Illness Inventory (SC‐CII) in Chinese older adults with multiple chronic conditions.Methods: This cross‐sectional study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology guideline. A diverse sample of Chinese older adults with multiple chronic conditions (n = 240) was recruited. Structural validity was assessed with confirmatory factor analysis. Concurrent validity was investigated with hypotheses testing of the relationships between perceived stress, resilience and self‐care. Reliability was assessed with Cronbach's alpha and McDonald's omega. Finally, a simultaneous confirmatory factor analysis was conducted to test the general model with all items and all three subscales.Results: Confirmatory factor analysis supported the two‐factor structure of theself‐care maintenanceandself‐care managementsubscales and the one‐factor structure of theself‐care monitoringsubscale. Concurrent validity was supported by the significant negative correlation (rranged from −0.18 to −0.38,p < .01) with perceived stress and the significant positive correlation (rranged from 0.31 to 0.47,p < .01) with resilience. Reliability estimates ranged from 0.77 to 0.82 across the three subscales. The simultaneous confirmatory factor analysis did not support the more general model with the combined set of items.Conclusion: The SC‐CII is valid and reliable for Chinese older adults with multiple chronic conditions. Future cross‐cultural assessment should be conducted to investigate the measurement equivalence of the SC‐CII in individuals from Western and Eastern cultural groups.Implications for practice: With the increasing number of older adults in China who are living with multiple chronic conditions and the call for culturally tailored self‐care interventions, this self‐care measure can be used in geriatric primary care settings, long‐term facilities and homes to improve the understanding and practice of self‐care in older Chinese adults.

Studies examining the associations of chronic stressors with sleep health in older adults have shown conflicting results. While the COVID‐19 pandemic increased perceived stress at the population level, less is known about chronic stressors experienced by older adults in the context of the COVID‐19 pandemic and its impact on sleep health in an aging population. This study aims to examine the association of older adults' chronic stress with insomnia symptoms during the first year of the COVID‐19 pandemic. A cross‐sectional analysis was performed using early‐release COVID‐19 data from the Health and Retirement Study. Data on chronic stressors and insomnia symptoms in older adults (N = 2021; mean age = 68.8) were examined. Co‐occurrence network analysis, latent class analysis, Rao–Scott χ² tests, and multivariable logistic regression were used to characterize the co‐occurrence of chronic stressors and associations with insomnia symptoms. The most common co‐occurring chronic stressors during the first year of the COVID‐19 pandemic were self‐health issues, family‐health issues, and financial stress. Older adults experiencing frequent stress co‐occurrence had 91% higher odds of difficulty initiating sleep (p < 0.001), 40% higher odds of frequent nocturnal awakening (p = 0.028), and 83% higher odds of nonrestorative sleep (p < 0.001). However, adjustment for health risk factors and COVID‐19 concerns attenuated the effects, leaving strongest association for difficulty initiating sleep (odds ratio = 1.51, p = 0.010). Frequent stress co‐occurrence plays an important role linking chronic stress to insomnia symptoms in an aging population. Ongoing research is needed to examine the lingering effects of frequent stress co‐occurrence on older adults' sleep health in the post COVID‐19 era.

Financial stress has been linked to an increased risk of metabolic syndrome, yet, it remains unclear whether suboptimal sleep duration and physical inactivity are the adaptive responses to financial stress or effect modifiers in the association between financial stress and metabolic syndrome. Hence, this study aims to examine whether physical activity and sleep duration mediate or moderate the bivariate association between financial stress and metabolic syndrome. A prospective secondary analysis was conducted using data from the Wisconsin Sleep Cohort Study (N = 445, mean [SD] age = 64 [7] years). Baseline moderation effect was examined using subgroup analysis with model constraints; prospective mediation model was examined using bias‐corrected bootstrap confidence intervals. Results indicate that participants with higher financial stress were less likely to meet physical activity and sleep recommendations. Baseline moderation analysis indicates that meeting current recommendations of sleep duration and physical activity attenuated the association between financial stress and metabolic syndrome. In the prospective mediation analysis, weekly physical activity levels partially mediated the relationship between financial stress and metabolic syndrome, but sleep duration did not mediate this relationship. In conclusion, the joint effect of optimal sleep duration and physical activity disassociates financial stress from the risk of metabolic syndrome. Future interventions addressing metabolic risk might achieve better outcomes if clinicians and researchers factor in the behavioral adaptation of physical inactivity in financially stressed adults (Clinical Trial Registration: NCT00005557).

Background: Cognitive and social engagement is an important yet underdocumented aspect of older adult engagement and function. Objective: The purpose of this study was to examine relationships between cognitive and social engagement and health and psychological outcomes in a cohort of community-dwelling older adults aged approximately 55–70 years. Methods: Analysis of data from the Wisconsin Registry for Alzheimer’s Prevention, a multiwave cohort study with 1,582 participants, using a 1:1 prospective case–control design to examine whether lower cognitive and social engagement at Visit 4 (baseline) is associated with worse health and psychological outcomes at Visit 5 (2 years after Visit 4). Wisconsin Registry for Alzheimer’s Prevention participants were included in this study if they had complete data on cognitive and social engagement and self-rated health at both visits. Results: After matching potential covariates using propensity scores, participants with low cognitive and social engagement (cases) at baseline continued to have significantly lower cognitive and social engagement than the controls (participants with high cognitive and social engagement at baseline) at Visit 5, and they had lower self-rated health and higher surgery rate. Depressive symptoms, cognitive status, and hospitalization at Visit 5 did not significantly differ between cases and controls. Discussion: This study provides evidence supporting cognitive and social engagement as an important marker of early decline in activity engagement that may indicate a potential later decline in functional, psychological, and health outcomes.

Background: Although evidence from birth cohort analysis has indicated the metabolic risk of early-life exposure to the Great Leap Forward Famine (GLFF) in China, three confounding effects, including the exposure windows, aging, and geographical variations in famine severity, have been brought to debates for a decade. This study aimed to address these confounding effects and extensively examine how GLFF exposure is associated with diabetes risk in mid-to-late life and its interaction with urban-rural migration. Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS) were analyzed with age-stratification and stepped wedge approaches. Weighted prevalence and multivariable logistic regression were used to investigate the effects of GLFF exposure and urban-rural migration on mid-to-late life diabetes risk and the interaction between GLFF exposure and urban-rural migration. Birth provinces were controlled as a fixed effect to account for variations in famine severity across provinces. Results: Compared to those who were never exposed to GLFF, fetal GLFF exposure was associated with a higher risk of adult-onset diabetes after controlling for provinces, demographics, and health statuses. Yet, after adding the proxy of childhood growth environments into the model, fetal exposure to GLFF was not significantly associated with adult-onset diabetes risk (OR = 1.22, p = 0.10), compared to those who were never exposed to GLFF. Across the three age-stratification groups, static urban residents, in general, had a higher risk of diabetes compared to static rural residents. Interaction effects between GLFF exposure and urban-rural migration were insignificant across all three age-stratification groups. Conclusion: Fetal exposure to GLFF might have a traceable effect on adult-onset diabetes risk. Yet, the growth environment and urban lifestyle outweigh and further confound the impact of GLFF exposure on adult-onset diabetes risk.