Boye Fang

Despite consistent evidence linking elder abuse to adverse mental health outcomes, quantitative estimates remain limited. This study aimed to conduct a systematic review and meta-analysis focusing on the negative mental health consequences associated with elder abuse. A comprehensive search was performed across Web of Science, PubMed, Embase, PsycINFO, and Scopus for peer-reviewed quantitative studies examining elder abuse as an independent variable and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)-defined mental health outcomes among adults aged ≥60, published up to January 2024. A total of 23 studies comprising 73 effect sizes that met the inclusion criteria were reviewed. The meta-analyses revealed that older adults who experienced abuse were at a significantly higher risk of adverse mental health outcomes, with a pooled odds ratio (OR) of 2.524 (95% CI [2.300, 2.769]), including depression (OR = 2.833 [2.419, 3.319]), anxiety (OR = 2.495 [2.000, 3.113]), suicidal ideation (OR = 2.249 [1.827, 2.769]), and sleep problems (OR = 2.368 [1.827, 3.070]). Despite evidence of publication bias, trim-and-fill adjustments moderately reduced effect sizes (overall: adjusted OR = 2.197; depression: adjusted OR = 2.094, sleep problems: adjusted OR = 1.732) without affecting robustness. Sensitivity analyses confirmed that results were stable after removing individual studies. Findings are primarily generalizable to community-dwelling older adults due to limited institutional data. Moderator analyses for anxiety outcomes should be interpreted with caution, given covariance among study-level factors. This is the first quantitative synthesis of elder abuse and mental health outcomes, emphasizing the need for targeted interventions and policies to mitigate these risks.

Background: Depression among older adults is a growing concern globally, influenced by both environmental stressors and individual health conditions. This study examines the impact of heatwave exposure and multimorbidity on depressive symptom trajectories among older Chinese adults. Methods: Data from 3819 adults aged 60 and older across 5 waves of the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Latent growth curve modeling identified depressive trajectories, and machine learning algorithms (Random Forest, Decision Tree, XGBoost, and Support Vector Machine) were applied to predict trajectory categories. Multinomial logistic regression further explored the moderating effects of multimorbidity on the heatwave-depression relationship. Results: Five distinct depressive symptom trajectories were identified: consistently high, high but decreasing, consistently low, high and increasing, and low but increasing. Heatwave exposure was associated with a higher likelihood of persistent or worsening depressive symptoms, particularly among individuals with multimorbidity. Machine learning analysis highlighted maximum temperature as one of the most influential predictors, and further demonstrated that multimorbidity amplified the effect of heatwave exposure on depression trajectories. Multinomial logistic regression confirmed that individuals with multimorbidity were significantly more likely to exhibit worsening depressive symptoms when exposed to elevated temperatures. Conclusions: This study highlights the vulnerability of older adults with multimorbidity to worsened depression under heatwave exposure, emphasizing the need for tailored mental health interventions. Integrating climate adaptation and multimorbidity care is crucial for mitigating mental health impacts in this population. Policymakers should prioritize targeted interventions, incorporating climate adaptation and heatwave preparedness into mental health protocols to reduce adverse outcomes.

Prolonged exposure to air pollution and systemic inflammation has both been associated with deteriorating self-reported health (SRH), however, the underlying mechanisms remained poorly understood. This study included 8,292 middle-aged and older adults (≥45 years) from the China Health and Retirement Longitudinal Study (CHARLS). High spatial-temporal gridded air pollution datasets were utilized to estimate individual air pollution exposure at county level. Systemic inflammation was measured using C-reactive protein (CRP) and white blood cell (WBC) numbers from CHARLS blood samples. Generalized linear modeling (GLM) was employed to examine the relationships between air pollution exposure, systemic inflammation, and SRH. After adjusting for confounders, this study found that a 3-year average PM2.5 concentration was associated with a higher risk of poor SRH (OR = 1.005, 95% CI: 1.002-1.009). Elevated CRP and WBC levels were also linked to an increased risk of poor SRH (OR = 1.019, 95% CI: 1.011-1.027; OR = 1.035, 95% CI: 1.010-1.061, respectively). Interaction analysis revealed that elevated CRP levels exacerbated the adverse effect of chronic air pollution exposure on SRH. In addition, residential location and educational attainment influenced how systemic inflammation moderated the relationship between PM2.5 exposure and SRH. Long-term exposure to air pollution was associated with an increased likelihood of poor SRH among middle-aged and older adults, with inflammatory markers potentially amplifying this association. Therefore, it is essential to implement multidisciplinary strategies to reduce air pollution and alleviate systemic inflammation in this population.

Objectives: This study investigates the impact of pension on depressive symptoms among Chinese older adults. Additional effort is made to test the mediating effect of multidimensional downward intergenerational support and the moderating effect of age on this relationship.Methods: A total of 1828 Chinese older community‐dwellers who met our inclusion criteria are drawn from the 2018 China Health and Retirement Longitudinal Study. Multivariate regression modeling is applied to analyze the effect of pensions on depressive symptoms of older adults. Additionally, bootstrap method with resampling strategies is used to estimate the mediating effect of three dimensions of downward intergenerational support (instrumental, emotional, and financial support). Further, Johnson‐Neyman technique is employed to analysis and visualize the moderating effect of age.Results: The findings reveal a significant inverse relationship between pension levels and depressive symptoms (B = −6.664, SE = 2.826, p < 0.05). The analysis shows that downward intergenerational emotional support (B = −0.195, Boot SE = 0.103, 95% Boot CI [−0.404, −0.003]) serves as a partial mediator in this relationship. Furthermore, the results highlight the moderating role of age in the linkage between pension and depressive symptoms (B = 0.065, SE = 0.039, p < 0.1).Discussion: This investigation is pioneering in simultaneously assessing the mediating role of multidimensional downward intergenerational support and the moderating effect of age in the context of pension and depressive symptoms. The study underscores the necessity of an interdisciplinary approach in devising comprehensive intervention strategies. These should encompass pension policy consultation, respite services, and other crucial elements aimed at mitigating the severity or reducing the risk of depressive symptoms among the older adults.

Momentary solitude (the objective state of being alone) has a strong association with negative affective experiences in older people, but little is known about how the role of social relationship characteristics on relationship between momentary solitude and affect. We examined the momentary association between momentary solitude and negative affect (NA), and whether such association was moderated by the structural and functional aspects of social relationships. A sample of 153 late-middle-aged and older adults were recruited and provided a total of 6,742 ecological momentary assessment surveys, of which momentary solitudes were reported for 1,885 (28%) surveys. Hierarchical linear model was used to examine how social networks and social support moderated the association of momentary solitude with NA experiences. The association of momentary solitude with NA experiences was significant among middle-aged and older adults (b = 0.025, SE = 0.008, p < .01). Family networks had the main effect on NA. Perceived social support buffered against increased NA in momentary solitude: Individuals with a higher level of perceived support reported fewer increases in NA during momentary solitude than those perceiving a lower level of support. Momentary solitude was experienced less negatively for middle-aged and older persons embedded in a context of higher levels of perceived social support. Practitioners need to pay more attention to the promotion of social resources when delivering programs to improve the subjective well-being of late-middle-aged and older adults.

Aims and objectives: This study focuses on elder abuse against older adults with mild‐to‐moderate cognitive and physical impairment who were receiving family care in Chinese context. Specifically, the study examined the associated factors of discrepancy between family caregiver and care recipient reports of elder abuse committed by the caregivers.Background: Many studies identified the discrepancies between caregivers and care recipients reports of elder abuse, but they did not examine factors contributing to such discrepancies. Various cultural factors may contribute to the accuracy of elder abuse reports.Methods: A consecutive sample of 1,002 older adults with mild‐to‐moderate cognitive and physical impairment and their family caregivers was surveyed.Design: Quantitative study with cross‐sectional design.Results: Moderate‐to‐substantial agreement in caregiver and care recipient reports was found for all forms of abuse (Cohen’s kappa = 0.39 to 0.76). Care recipient reports consistently generated higher rates than caregiver reports for psychological abuse (51.1% vs. 42.8%), physical abuse (1.2% vs. 1.0%), caregiver neglect (65.0% vs. 50.2%) and financial exploitation (40.8% vs. 34.2%). Similar factors were found for dyadic discrepancy in the reporting of various forms of elder abuse, which included desire to gain face, fear of losing face and sense of familism in the caregivers, as well as older age, cognitive impairment and female gender of the care recipient. This study was presented in adherence to the Strobe Checklist.Conclusions: The results suggest that family caregivers might not be reliable as the sole informants to report their care recipients’ victimization experiences. Information from multiple parties should be gathered and synthesized to obtain more accurate reporting of the frequency and severity of elder abuse. Meanwhile, cultural factors should be taken into account when seeking information related to elder abuse.Relevance to clinical practice: There is a need for multiple parties to provide and report information about the elder abuse. It is also need to consider cultural factors when detecting and intervening elder abuse.

Objectives: To examine the association between caregiver (CG) depression and increase in elder mistreatment and to investigate whether change in care recipient (CR) neuropsychiatric symptoms (NPS) and change in CG-perceived burden influence this association. Methods: Using 2-year longitudinal data, we analyzed a consecutive sample of 800 Chinese primary family CGs and their CRs with mild cognitive impairment or mild-to-moderate dementia recruited from the geriatric and neurological departments of 3 Grade-A hospitals in the People’s Republic of China. Participatory dyads were assessed between September 2015 and February 2016 and followed for 2 years. Results: CG depression at baseline was associated with a sharper increase in psychological abuse and neglect. For CRs with increased NPS, having a depressed CG predicted a higher level of psychological abuse than for those CRs without NPS. For CGs with decreased burden, the level of depression was associated with a slower increase in neglect than for CGs who remained low burden. Discussion: This study showed the differential impact of CG depression on the increase in elder mistreatment depending on the change in CR NPS and CG-perceived burden. The present findings provide valuable insights into the design of a systematic and integrative intervention protocol for elder mistreatment that simultaneously focuses on treating CG depression and perceived burden and CR NPS.

Objectives: To determine the effects of baseline and changes in frailty states on subsequent depressive symptoms, and whether sleep duration would modify these effects. Design: Prospective, cohort study. Setting: The 2011 baseline and 2013 follow‐up waves of the China Health and Retirement Longitudinal Study (CHARLS). Participants: Community‐dwelling old adults who were aged 60 or above at baseline and participated in the 2011 and 2013 waves of the CHARLS (N = 5,026). Measurements: Frailty was measured using the physical frailty phenotype (PFP) scale. Levels of depressive symptoms were measured by the 10‐item Center for Epidemiologic Studies Depression Scale (CES‐D). Using the generalized estimating equations (GEE), the effects of baseline and transitions in frailty states were examined on subsequent depressive symptoms, adjusting for a range of confounding variables. Results: Baseline prefrail ( b = 0.97, P < .05) and frail states ( b = 0.35, P < .05) were associated with higher subsequent level of depressive symptoms 2 years later. Within individuals who were robust at baseline, transitioning into prefrail/frail ( b = 3.04, P < .001) was associated with a higher subsequent level of depressive symptoms, and this association was accelerated by short sleep duration. Within individuals who were prefrail at baseline, transitioning into frail ( b = 1.76, P < .001) was associated with higher subsequent levels of depressive symptoms, and this association was stronger among those who reported short sleep duration. Conclusion: Baseline and transitions in frailty states were significantly related with higher subsequent levels of subsequent depressive symptoms. Short sleep duration significantly moderated the effects of baseline or transitions of frailty on subsequent depressive symptoms. Targeted interventions could be implemented to improve sleep quality for prefrail and frail older adults.