Peiyi Lu

Background: Sarcopenia is an age-related condition that contributes to disability and healthcare burden worldwide. Yet cross-national evidence on prevalence and multi-level risk factors is limited. Methods: We pooled data from 10 nationally representative or population-based ageing studies, including 144 226 adults aged ≥50 years from 36 high- and middle-income countries. Sarcopenia and severe sarcopenia were defined using 2019 revised European Working Group on Sarcopenia in Older People criteria. Prevalence was standardised by age and gender within each country. We examined associations between sarcopenia and individual-level sociodemographic and health characteristics, and country-level socioeconomic indicators. Results: Sarcopenia prevalence ranged from 2.1% to 17.4% across 36 countries, with 16 countries above 5.0% and three above 10.0%. Approximately 92.7 million of 1.07 billion adults ≥50 in these countries were projected to have sarcopenia. At the individual-level, higher risk was associated with older age, gender (men), lower education, being unmarried or not partnered, non-full-time employment, lower household wealth, current smoking, non-recent drinking, physical inactivity and ≥2 chronic diseases (e.g. men: RR = 1.47; 95% CI: 1.32, 1.64). At the country-level, higher gross domestic product (GDP) per capita, higher Gender Development Index and lower Labor Force Participation Rate were associated with lower sarcopenia risk (e.g. GDP per capita: RR = 0.42; 95% CI: 0.30, 0.60). Conclusion: Sarcopenia varies widely across countries and is more common in middle-income than high-income settings, pointing to a pattern shaped by both personal and contextual conditions. Addressing the emerging burden of sarcopenia will require integrated strategies targeting modifiable risk factors while tackling contextual and structural inequalities.

Background and Objectives: Housing insecurity is an established social determinant of health, with older adults being disproportionately vulnerable. Despite growing research attention, no studies have reviewed the measurement tools existing specifically for this population. This systematic review synthesizes quantitative measures of housing insecurity used among older adults, examines their dimensional structures, and evaluates their psychometric properties. Research Design and Methods: Following PRISMA 2020 guidelines, a systematic search was conducted across 5 electronic databases with no date restrictions. Eligible studies were required to include samples of older adults or mixed-age adults without an upper age limit, employ quantitative housing insecurity measures, and report psychometric evaluation. Results: A total of 1,310 articles were retrieved initially, and 13 studies were included in the final review. Most studies constructed composite indices from secondary survey data rather than purpose-built instruments. Six core dimensions were identified: housing unaffordability, instability, poor physical quality, inadequacy, lack or disrepair of housing durables, and poor neighborhood quality. Age-friendly housing characteristics were incorporated in only one study. Internal consistency was reported in two studies and test-retest reliability in none, with validity evidence largely confined to informal content justifications. Discussion and Implications: The reviewed tools showed considerable fragmentation in measurement approaches, uneven dimensional coverage, and insufficient psychometric reporting. The near-universal absence of age-friendly indicators across reviewed tools presents a notable gap. Future research may benefit from developing purpose-built, comprehensively validated instruments that integrate aging-specific dimensions across diverse policy and cultural contexts.

China's rapidly growing oldest-old population (aged ≥80) faces significant challenges in financial security. This study sought to quantitatively evaluate the effect of old age subsidy on the mental health of older Chinese. Data were from China Health and Retirement Longitudinal Study 2011-2020, including 27,940 respondents residing in the provinces with a universal old age subsidy policy. Eligibility was restricted to individuals aged ≥80. Fuzzy regression discontinuity analysis evaluated the effects of receiving the subsidy on three mental health outcomes (depressive symptoms, life satisfaction, and cognition). Results showed that individuals just above age 80 who received the subsidy had similar mental health scores compared to those just below age 80 who did not receive the subsidy. The treatment effect was null across all three mental health outcomes, with robust p-values >0.05 and 95% CIs that included zero. Findings remained consistent in subgroup analyses, after adjusting for covariates and comparing different algorithms. There is no strong evidence that old age subsidy significantly improved the mental health of older Chinese. This may be attributed to the study's statistical underpower, low benefit level, improper usage, highly restrictive age eligibility, decreasing impact of financial condition in older age, and other factors.

The impact of modifiable housing factors on the mental health of caregivers of older adults and people with disabilities is often underestimated. This study examines the role of housing modifications in influencing caregiver burden and resilience in Hong Kong. Data from a population-based survey of 2,960 caregivers of older adults (aged 60 and over) and younger individuals with disabilities (under 60) were analysed. Modifications to the care recipients’ homes- classified as any, wheelchair-accessible, stair/chairlift, or other modifications- and the proportion of homes modified within each building or estate were assessed. Quantile regression models of the Caregiver Burden Inventory and the Connor-Davidson Resilience Scale were used to estimate the association between home modifications and caregiver burden and resilience. Caregivers living with their care recipients in buildings or estates where all homes had been modified reported approximately 0.3 standard deviations lower burden (at the 90^th quantile) and 0.23 standard deviations higher resilience (at the 80^th quantile) than those in non-modified buildings or estates. Similar associations were observed between modifications of individual care recipients’ homes and caregiver burden, although not for resilience. There is some evidence that home modifications are associated with reduced caregiver burden and increased caregiver resilience, particularly when measured at the building or estate level. Enhancing the housing quality of older adults and people with disabilities may improve not only their well-being, but also that of their caregivers.

Objective: Depression is prevalent among empty nest older adults who do not live with their children. With rapid technological development, online interaction presents a new opportunity to improve older adults' mental health. However, the relationship of online parent‐child interaction with depressive symptoms among empty nesters remains under‐examined. Guided by the social support theory, this cross‐sectional study examined the association between online parent‐child interaction and depressive symptoms among middle‐aged and older Chinese empty nesters. Methods: A total of 5198 Chinese empty nesters aged 45+ from the 2018 China Health and Retirement Longitudinal Study were included. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Participants reported the frequency they contacted their children via online. Negative binomial and Poisson regression were utilized. Interaction terms examined the moderation role of gender, marital status, and education in the relationship. Results: 36.5% of participants reported elevated depressive symptoms and 59.8% of them contacted their children weekly or biweekly. More frequent online parent‐child interaction was significantly associated with lower risk of depressive symptoms (incident rate ratio = 0.981, 95% CI = 0.972, 0.990; relative risk = 0.978, 95% CI = 0.963, 0.993). The moderation role of gender and education was not significant ( p > 0.05). However, married/partnered participants had stronger association than their partnerless counterparts. Conclusion: Online parent‐child interaction was associated with fewer depressive symptoms among Chinese empty nesters in this cross‐sectional study. These findings suggest that digital family communication may be a meaningful social context to understand their psychological well‑being.

Objectives: Social mobility plays an important role in shaping mental health in older age. However, most research focused on mobility across 2 generations and relied on limited socioeconomic status (SES) indicators (e.g., education and occupation). This study explored patterns of social mobility across 3 generations using 4 SES indicators and examined their association with depressive symptoms among middle-aged and older Chinese. Methods: Respondents (aged ≥45) from the China Health and Retirement Longitudinal Study were included (N = 3,349). Information on hukou, education, occupation, and Communist Party membership was retrieved for the respondents, their parents, and their children. Latent class analysis was used to identify distinct patterns of multigenerational social mobility. Mixed-effects models examined the association between class membership and the depressive symptom trajectory from 2011 to 2018. Results: Five classes were identified: Class 1 (40.43%) showed a slow rise in SES while remaining rural hukou; Class 2 (29.50%) exhibited a steady rise in SES while remaining rural hukou; Class 3 (21.80%) experienced a rapid rise in SES and their hukou converted from rural to urban; Class 4 (1.16%) showed a steady rise in SES while remaining urban hukou; Class 5 (7.11%) maintained a high SES and remained urban hukou. Compared to the Class 1 “slowly rising rural,” steadily or rapidly rising or stably high SES was associated with a lower risk of depressive symptoms at baseline. Discussion: This study underscores the disadvantaged status of individuals with rural hukou and slow multigenerational upward mobility, calling for more targeted mental health support for them.

Objectives: Adult children are primary caregivers in dementia care. While relationship‐centered care highlights shared decision‐making (SDM) between caregivers and people with dementia (PwD), existing SDM tools often overlook the perspective of adult‐child caregivers in nonclinical home‐based care context, creating a gap in understanding how families make care arrangements decisions. Therefore, this study aimed to culturally adapt and validate SDM‐Q‐Doc (renamed as SDM‐Q‐C) for use among Chinese adult‐child caregivers of PwD. Methods: We established a pilot study with 7 caregivers to establish face validity and conducted Delphi study with 9 experts to assess content validity, followed by a quantitative survey to examine psychometric validation. In the survey, 142 adult‐child caregivers completed SDM‐Q‐C, the Modified version of Control Preferences Scale in post‐decision (CPS _post ), and Decision Regret Scale (DRS). We assessed internal consistency through reliability analysis and structural validity through principal component analysis and confirmatory factor analysis. Construct validity was evaluated by the average variance extracted (AVE) and correlations with CPS post and DRS. Results: Based on feedback from the pilot study regarding the comprehensibility of the initial translated version (Version I), a revised Version II was developed and subsequently evaluated through the Delphi study. Following expert consensus, Version III was finalized for survey administration and underwent psychometric validation, ultimately resulting in the refined 4‐item SDM‐Q‐C as the final instrument (Version IV). SDM‐Q‐C had excellent internal consistency (Cronbach’s alpha = 0.907). It demonstrated a single structure (78.42% variance explained) with an excellent model fit ( χ ² = 1.426, df = 1, p = 0.232; CFI = 0.999, TLI = 0.994; RMSEA = 0.053, SRMR = 0.008). It had satisfactory convergent validity (AVE = 0.687 > 0.5) and discriminant validity (√AVE = 0.829 was larger than correlation with DRS, r = 0.056, p > 0.05). Conclusions: SDM‐Q‐C was the first validated scale assessing SDM in Chinese adult‐child caregivers of PwD, with satisfactory psychometric properties. Future research could cross‐validate it and test its cross‐cultural applicability in diverse populations. Practice Implications: The SDM‐Q‐C scale can be used in community and home‐based care practice to assess and improve SDM between adult‐child caregivers and their parents with dementia. This tool enables practitioners to identify communication challenges and provide targeted support for family‐centered care planning.