Background Loneliness and social isolation are global public health challenges. Sensory impairments (SIs) are highly prevalent among older adults but are often ignored as a part of normal aging. Identifying the role of SIs in loneliness and social isolation could provide insight into strategies for improving public health among older adults. Objective This study aims to analyze the effects of SIs on loneliness and social isolation among older adults in rural and urban China. Methods This cohort study of 3069 older adults (aged 60+) used data from 4 waves (2011, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of adults aged 45 years or older. SIs include hearing impairment (HI), vision impairment (VI), and dual sensory impairment (DSI). DSI is defined as the co-occurrence of VI and HI. Participants with complete data on hearing, vision, social isolation, and loneliness were included in the analysis. Generalized estimating equation models adjusted for covariates were used to examine the relationships of DSI with loneliness and social isolation among older adults. Results Older adults in rural areas have higher prevalence of DSI, loneliness, and social isolation than their urban counterparts. In rural areas, participants with VI only (odds ratio [OR] 1.34, 95% CI 1.12-1.62; P=.002), HI only (OR 1.32, 95% CI 1.02-1.71; P=.03), and DSI (OR 1.84, 95% CI 1.56-2.18; P<.001) were more likely to experience loneliness compared with participants without SIs. DSI showed a statistically significant association with loneliness compared with VI only (OR 1.37, 95% CI 1.22-1.54; P<.001) and HI only (OR 1.39, 95% CI 1.13-1.72; P=.002). In urban areas, participants with VI only (OR 2.44, 95% CI 1.57-3.80; P<.001), HI only (OR 2.47, 95% CI 1.41-4.32; P=.002), and DSI (OR 1.88, 95% CI 1.24-2.85; P=.003) were more likely to experience loneliness compared with participants without SIs. DSI was not associated with the increased likelihood of loneliness compared with HI only or VI only. SIs were not associated with social isolation among older adults in urban and rural areas. Until 2018, 86.97% (2669/3069) reported VI, but only 27.11% (832/3069) and 9.45% (290/3069) were treated with glasses and cataract surgery, respectively; besides, 75 individuals received both glasses and cataract surgery treatment. The prevalence of HI was 74.39% (2283/3069) in 2018, but only 0.72% (22/3069) were treated with a hearing aid. Conclusions SIs are associated with an increased risk of loneliness rather than social isolation. A compounded risk of DSI on loneliness exists in rural areas rather than in urban areas. These findings expand our knowledge about the effects of SIs on loneliness and social isolation in non-Western populations. Interventions targeting HI only and DSI might be particularly effective for mitigating loneliness of older adults in urban and rural areas, respectively. Considering the high prevalence and low treatment rate of SIs, measures should be taken to make treatment more accessible.
Background The underlying mechanism between sensory impairments (SIs) and depressive symptoms among Chinese older adults is not well understood. This study aims to explore the mediating role of functional limitation on the longitudinal relationship between SIs and depressive symptoms among older adults in China. Methods A total of 4130 older adults who participated in the 3‐year follow‐up China Health and Retirement Longitudinal Study (CHARLS) were included in the analysis. The hierarchical multiple linear regression model and nonparametric bootstrapping method were employed to explore the relationship between SIs and depressive symptoms, and the mediating role of functional limitation in this link. Results The prevalence of self‐reported hearing impairment (HI) only, vision impairment (VI) only, and dual sensory impairment (DSI) at baseline were 5.7%, 22.2%, and 58.6%, respectively. After adjusting for controlling variables, older adults with DSI had significantly higher levels of depressive symptoms compared with those without SIs at baseline (β = .07, p = .005). The magnitude of mediation effect from DSI to depressive symptoms via functional limitation was a*b = 0.060 (BCa 95% confidence interval: 0.031–0.094). Conclusions Functional limitation partially mediated the relationship between DSI and depressive symptoms among Chinese older adults. Interventions of DSI and functional limitation should be included in depressive symptoms prevention among older adults in China.
Background and Objectives An aging population has contributed to increasing rates of sensory impairment (SI) among older adults, and a boom in institutional eldercare. However, little is known regarding the association of SI and institutional care willingness. This study identified the association between SI and institutional care willingness among older adults living both in urban and rural China. Research Design and Methods This was an observational study using the sixth National Health Service Survey of Shandong Province, China, in 2018. A total of 8,583 individuals aged ≥ 60 years were included. The primary outcome was institutional care willingness. Self-reported SI was categorized as vision impairment (VI), hearing impairment (HI) and dual sensory impairment (DSI). We used multivariable logistic regression models to estimate the association between SI and institutional care willingness, stratified by the place of residence. Results The overall proportion of older adults with institutional care willingness was 7.8%. In fully-adjusted models, older adults with HI only (OR=1.57, 95% CI: 1.12-2.20) or DSI (OR=1.68, 95% CI: 1.14-2.49) were more likely to show institutional care willingness than those without SI in urban areas, but no significant associations between VI only (OR=0.95, 95% CI: 0.68-1.31), HI only (OR=0.99, 95% CI: 0.73-1.34), or DSI (OR=0.95, 95% CI: 0.68-1.31) and institutional care willingness were observed among rural older adults. Discussion and Implications Our results underscore that the relationship between SI and institutional care willingness varied by place of residence, and provide a reference for making targeted and appropriate endowment policies. Improving the quality of institutional eldercare is vital for urban older adults with SI, while community-based care might be more appropriate for rural older adults with SI.
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