Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Objective: The objective of this study was to examine whether loneliness was associated with the risk of developing dementia in Chinese older adults and whether the association was moderated by gender. Method: A 3-year cohort study was conducted using data from the 2008/2009 and 2011/2012 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression was used to analyze the relationship between loneliness and dementia. The interaction between loneliness and gender was also evaluated. Results: At 3-year follow-up, 393 of the 7867 participants had dementia. Loneliness was associated with dementia (odds ratio (OR) = 1.31, 95% confidence interval (CI) = 1.11–1.56) after adjustment for sociodemographic characteristics, lifestyle, and baseline health status. A significant interaction between loneliness and gender was also found (OR = 0.81, 95% CI = 0.65–0.99). Conclusion: Loneliness increased the risk of developing dementia among people aged 65 years and older in China. Moreover, the effect of loneliness on dementia risk varied by gender. Specifically, men who felt lonely were more likely to suffer from dementia than women.

This article used the nationally representative Chinese Longitudinal Healthy Longevity Survey to explore the associations between living arrangements and health among older adults. Living arrangements were stratified into six categories. Health was measured by self-rated health, activities of daily living (ADL) disability, and cognitive impairment. Random-effects ordered probit regressions were applied. The results indicated that coresidence had a positive effect on self-rated health compared with living alone. After introducing psychological well-being, the health differences observed in living with a spouse and living with both spouse and children were not significant. Participants with each of the living arrangement were more likely to have a higher rate of cognitive impairment and ADL disability than those living alone. Living arrangements were associated with older adults’ health. Psychological well-being was a key factor in this association, which may result from living with a spouse, and could contribute to the self-rated health of older adults.

This study aimed to examine the association of social engagement (SE) and changes in SE with the risk of dementia among older adults in China. Data were collected from the 2002, 2005, 2008/2009, and 2011/2012 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Random-effects logistic regression models were used to examine the association of SE and changes in SE with the risk of dementia. Of the 7511 older Chinese adults aged 65 years and over, 338 developed dementia during the 9-year follow-up. SE was associated with dementia risk after adjusting for sociodemographic characteristics, lifestyles and health status (odds ratio (OR) = 0.71, 95% confidence interval (CI) = 0.63–0.81). Participants with consistently high or increased SE had a lower risk of dementia than those with consistently low SE ((OR = 0.14, 95% CI = 0.06–0.28 and OR = 0.33, 95% CI = 0.23–0.48, respectively). Higher SE can reduce the risk of dementia. Furthermore, consistently high or increasing SE is associated with a lower risk of dementia.

We aimed to investigate the association between loneliness and cognitive impairment among older men and women in China. Data for 6898 eligible participants aged 65 years and older were derived from the latest two waves (2008/2009 and 2011/2012) of the Chinese Longitudinal Healthy Longevity Survey. A logistic regression analysis was performed to determine whether the association between loneliness at baseline and the risk of cognitive impairment at follow-up varied by sex, with adjustment for social-demographic variables, social isolation, lifestyles, and health status. The rates of baseline loneliness and follow-up cognitive impairment were both higher among women than men. Loneliness at baseline was significantly associated with cognitive impairment at follow-up among elderly men (OR = 1.30; 95% CI 1.01–1.69), even after adjusting for potential confounding variables; however, a similar association was not observed among elderly women (OR = 0.98; 95% CI 0.81–1.19). Multiple imputations were applied to address missing data. Although elderly women more frequently reported feelings of loneliness, the impact of loneliness on cognitive impairment was significant among elderly men but not elderly women. Interventions designed to decrease the incidence of loneliness may be particularly beneficial for the reduction of cognitive impairment among elderly Chinese men.

Given that there is limited research examining the specific role social isolation plays in stroke risk, we aimed to estimate the controlled direct effect of social isolation on stroke risk in China. A nationally representative sample (n = 12,662) of persons aged 45 years or more at baseline (2011), with corresponding follow-ups in 2013 and 2015, was taken from the China Health and Retirement Longitudinal Study. Stroke was assessed through a self- or proxy-reported physician’s diagnosis. Social isolation was measured by incorporating marital status, frequency of contact with friends, family, and children, and participation in social activities. A marginal structural model with stabilized inverse probability weights was applied to examine the controlled direct effect of social isolation on stroke risk. Overall, 245 persons had a stroke within the 4-year timeline under study. The total effect model indicated that persons experiencing social isolation had a 64% increased risk of stroke (odds ratio (OR) = 1.64, 95% confidence interval (CI): 1.26, 2.13). Results from the marginal structural model also indicated that socially isolated persons had an increased risk of stroke (OR = 2.39, 95% CI: 1.49, 3.82) after adjustment for depression. Interventions to reduce social isolation may be particularly beneficial in preventing the occurrence of stroke among middle-aged and older adults in China.