Background: The cognitive function of the elderly has become a focus of public health research. Little is known about the changes of cognitive function and the risk factors for cognitive impairment in the Chinese elderly; thus, the purposes of this study are as follows: (1) to describe changes in cognitive function in the Chinese elderly from 2005–2014 and (2) to explore risk factors for cognitive impairment of the Chinese elderly. Design and setting: A total of 2603 participants aged 64 years and above participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and were followed up from 2005 to 2014. Cognitive function and cognitive impairment were assessed using the Chinese version of the Mini-Mental State Examination (MMSE). Binary logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence intervals (CI) of cognitive impairment. Results: Results revealed that the cognitive function of the Chinese elderly shows diversified changes: deterioration (55.09%), unchanged (17.21%) and improvement (27.70%). In addition, there are significant demographic differences in gender, age, education, marriage and other aspects when it comes to the changes of cognitive function in Chinese elderly. In the binary logistic regression analysis, female, increased age, lower education level, no spouse, less income, worse PWB (psychological well-being), less fresh fruit and vegetable intake, more activities of daily living (ADL) limitations, lower social engagement were significantly associated with higher odds for cognitive impairment. Conclusions: Various interventions should be implemented to maintain cognitive function in Chinese elderly.

Background Catastrophic health expenditure (CHE) among the Chinese elderly warrants attention. However, the incidence, intensity and determinants of CHE have not been fully investigated. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e., those aged 60 years or older. Methods Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. The cut-off points used in this study for CHE were 10% of the total expenditures and 40% of non-food expenditure. Under the guidance of Andersen’s model of health services utilization, this study used logistic regression analysis to explore the determinants of CHE. Results The incidence of CHE defined as more than 40% of non-food expenditure rose over the study period, 2011–2015, from 20.86% (95% CI: 19.35 to 22.37%) to 31.00% (95% CI: 29.28 to 32.72%). The intensity of CHE also increased. The overshoot (O) based on non-food expenditure rose from 3.12% (95% CI: 2.71 to 3.53%) to 8.75% (95% CI: 8.14 to 9.36%), while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99 to 16.92%) to 28.23% (95% CI: 26.26 to 30.19%). Thus, the problem of CEH was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, were disabled, were members of a poor expenditure quartile, lived in the middle and western zones or resided in an urban area. In contrast, CEH was not significantly affected by respondents being older than 75 years or having a chronic health condition, by household size or by insurance type. Conclusions Key policy recommendations include the gradual improvement of medical assistance and the expansion of the use of health insurance to reduce household liability for health expenditures.

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Purpose The purpose of this paper is to investigate the effect of online service failure on online customer satisfaction and offline customer loyalty, and the moderating role of brand strength is also examined. While extant research on brick and click service mode recognizes the positive spillover effect from offline stores to online stores, this study analyzes the negative spillover effect from online stores to offline stores. Design/methodology/approach This paper tests the hypotheses by two studies. Study 1 is based on a 2 (failure severity: mild vs severe) × 2 (brand strength: strong vs weak) between-subjects experimental design using scenarios in a brick and click retailer context, while study 2 is based on data collected from a scenario-based questionnaire survey and analyzed through the structural equation modeling. Findings The results indicate that participants exposed to severe online service failure show lower online satisfaction as compared to their counterparts exposed to mild online service failure, but they show the similar level of offline loyalty in both degrees of online service failure. Nevertheless, these results are not moderated by brand strength significantly. Research limitations/implications An experimental design and a scenario-based questionnaire survey are used to test the framework. However, the generalizability of the research findings is still limited to a specific study setting. Future research in a different setting is needed to further validate the presented findings. Practical implications The findings suggest that physical service providers should adopt aggressive online expansion strategy to seize the market and pay more attention to online service quality rather than online marketing only. Originality/value This is one of few studies to explore the risk of brick and click service mode, and provide a clear understanding of the likely occurrence of online service failure and its impact on online customer satisfaction and offline customer loyalty. It extends prior research by exploring non-existence of negative perceptual effect from online service failure to offline customer loyalty in the short run and weakening brand effect, which contributes to cross-channel spillover effect in the integrated multi-channel context and brand building in the internet era.

Summary Since China initiated new health‐care reforms in early 2009, a variety of measures have been implemented to slow the growth of medical expenses. This study was conducted to investigate the effect of controlling medical expenses. Based on inpatients' medical expenses at the largest tertiary hospital in Shenzhen, China, from 2009 to 2017, this study analyzed the changes in medical expenses and expense structures according to payment sources (insured or self‐financed), stratifying the medical expenses according to the ICD‐10 classification chapters of the principal diagnoses of the inpatients in two years (2009 and 2017) in order to control for confounding diseases. The results showed that mean inpatient expenses continued to rise from 2009 to 2017, and the expenses of the self‐financed group began to exceed those of the insured group after 2011. Drug and consumable expenses were still the main factors that affected inpatient expenses, and consumable expenses remarkably increased, becoming the highest proportion of expenses. New health‐care reforms were effective in controlling growing medical expenses for insured patients but did not make a significant difference in the expenses of self‐financed patients. The excessive use of consumables has become a new driver of growing medical expenses.

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We examined the influencing factors of the undermet care needs of the Chinese disabled oldest old people when their children are both caregivers and are themselves older people. Data were obtained from a cross-sectional survey: the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018. The study participants included 1617 disabled oldest old people whose primary caregiver were their children or children-in-law and were aged 60 years and over. The results showed that the prevalence of undermet needs remained high, with 49.6% disabled oldest old people reporting undermet care needs. Binary logistic regression analysis revealed that living in a rural area (OR = 1.309, 95% CI = 1.133–1.513) and a higher frailty index (OR = 1.103, 95% CI = 1.075–1.131) were significantly positively associated with higher odds for undermet care needs, while a higher annual household income (OR = 0.856, 95% CI = 0.795–0.923), more financial support from children (OR = 0.969, 95% CI = 0.941–0.997), higher care expenditures (OR = 1.044, 95% CI = 1.002–1.088), better caregiver’s performance (OR = 0.282, 95% CI = 0.196–0.407) and sufficient income to pay for daily expenses (OR = 0.710, 95% CI = 0.519–0.973) were significantly inversely associated with higher odds for undermet care needs. This evidence suggests the importance of policies to establish a community-based socialized long-term care system and supporting family caregivers of the disabled oldest old people.

Gamers like to socially interact with other players and show off their avatar whenever it is conceivable in performance and appearance. This study aimed to develop a new construct—“Celebrity Avatar”—based on the celebrity endorsement model and player-avatar identification theory and add value to the survey using theory of consumption value (TCV) as a mediating role. As we know, celebrity and avatar identification show a positive influence on consumer behavioral decisions, so celebrity avatars altogether as a new construct showed positive results. The self-brand connection (SBC) and fantasy have a positive effect on the celebrity avatar. We found that four components of TCV, that is, enjoyment value, character competency value, visual character value, and monetary value, are applicable for depicting how celebrity avatars can persuade consumers to buy in-game items.