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The dietary patterns of older adults, particularly in relation to meat, egg, and dairy (MED) consumption, significantly impact frailty, a state of heightened vulnerability to adverse health outcomes. This paper investigates the association between MED consumption and frailty among older Chinese adults, considering rural/urban disparities and gender differences. Analyzing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) spanning from 2008 to 2018, this study explores how MED consumption influences frailty levels over time. The results show that moderate MED consumption is associated with slower frailty progression, suggesting a protective effect against frailty among older adults. However, excessive MED consumption, particularly among rural residents and females, is linked to accelerated frailty progression. Urban residents and males report higher MED consumption levels, possibly due to their greater access to diverse food options and traditional dietary preferences. The findings underscore the complex interplay between dietary habits, demographic factors, and frailty outcomes. Understanding these dynamics is crucial for developing targeted interventions to mitigate frailty risk factors and promote healthy aging among Chinese older adults.

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BACKGROUND: Previous studies have suggested that tea consumption may have a positive impact on oral health. However, the effects of different tea types on oral health remain unclear. Therefore, this study aimed to determine the association between residual teeth and consumption habits of different types of tea (green tea, black tea, oolong tea, and scented tea) in older adults. METHODS: We conducted a secondary analysis using data from the Chinese Longitudinal Healthy Longevity Survey in 2018. In a sample of 6,387 older adults, we performed logistic regression analysis to examine the relationship between persistent tea consumption and oral health according to sex and brushing frequency. The indices for particularly healthy oral health and relative health were set at more than 20 teeth and more than 10 teeth, respectively. RESULTS: The study included 2,725 males and 3,662 females, both aged 65 and older. Among individuals with more than 20 teeth, drinking green tea significantly improved oral health in men (adjusted odds ratio [ORs]: 1.377; 95% confidence interval [CI]: 1.082-1.752) and drinking black tea significantly improved the oral health of women (ORs: 2.349, 95%CI: 1.028-5.366). In the daily brushing group, green tea had a significant beneficial effect on increasing the number of teeth in men and black tea had a significant beneficial effect in women. Among individuals with more than 10 teeth, drinking green tea significantly improved oral health in men (ORs: 1.539; 95% CI: 1.209-1.959) and drinking green tea and scented tea significantly improved the oral health of women (ORs: 1.447, 95%CI: 1.052-1.991; ORs: 1.948, 95%CI: 1.137-3.340). In the daily brushing group, consumption of green tea and black tea had significant beneficial effects on increasing the number of teeth in men, whereas that of green tea, black tea, and scented tea had significant beneficial effects in women. CONCLUSION: Long-term green tea consumption in males and black tea consumption in females were significantly associated with maintaining functional dentition (≥20 teeth). Similarly, long-term green tea consumption in males and green tea and scented tea consumption in females were associated with avoiding severe tooth loss (≥10 teeth). Furthermore, in the daily tooth brushing group, long-term consumption of black tea was associated with avoiding severe tooth loss in both sexes. However, tea consumption alone had no effect on oral health without good brushing habits.

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BACKGROUND: Current evidence suggests that the Mediterranean-Dietary Approaches to Stop Hypertension (DASH) diet intervention for Neurodegenerative Delay (MIND) is associated with a reduced risk of cognitive impairment among North American and Oceanian populations. However, there has been limited exploration of whether this association extends to the Asian population. This study aimed to assess the correlation between the Chinese version of the MIND (cMIND) diet and cognitive impairment in older Chinese individuals. METHODS: We utilized data from the 2008 wave of the Chinese Longitudinal Healthy Longevity Survey. Participants aged ≥65 years with normal cognitive function at baseline were enrolled. The cMIND diet score (cMINDDS) was calculated by assessing dietary patterns based on survey responses. The Chinese version of the Mini-Mental State Examination (MMSE) was employed to diagnose cognitive impairment in participants. We stratified the analysis by cMINDDS and conducted additional sensitivity analyses. RESULTS: The cohort consisted of 6411 participants. Over a 3-year follow-up, 1165 (18.6%) individuals who initially had normal cognitive function developed cognitive impairment. A linear association was observed between cMINDDS and cognitive impairment. The increased cMINDDS was associated with a reduced risk of cognitive impairment (quartile 1 vs. quartile 4: the adjusted odds ratio [OR] = 0.77, 95% confidence interval [CI]: [0.60, 0.97], p trend = 0.023). Regarding food composition, higher consumption of fresh fruits and nuts was associated with a decreased risk of cognitive impairment (OR = 0.77, 95% CI: [0.66, 0.89] and OR = 0.70, 95% CI [0.58, 0.86], respectively). CONCLUSIONS: Adherence to the cMIND diet was associated with lower risks of cognitive impairment in older Chinese individuals. The cMIND diet, based on the MIND dietary pattern, could serve as a preventive measure against cognitive impairment.

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Abstract@#To investigate the status and influencing factors of tooth loss among the elderly population in China, so as to provide insights into early prevention of tooth loss.@*Methods@#Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS), data of the elderly people aged 65 years and older who participated in the survey in 2018 were collected, including demographic information, lifestyle, dietary habits, medical history, number of teeth remaining and self-assessment indicators. The status of tooth loss among the elderly were described based on the standard of 28 teeth, and factors affecting tooth loss were analyzed using a multivariable ordinal logistic regression model.@*Results@#A total of 5 260 people was recruited, including 3 346 males (63.61%) and 1 914 females (36.39%). The median age was 78.00 (interquartile range, 18.00) years. The median number of teeth remaining was 12.00 (interquartile range, 23.00), and the median number of missing teeth was 16.00 (interquartile range, 23.00). Multivariable ordinal logistic regression analysis showed that the elderly who were female (OR=1.270, 95%CI: 1.098-1.470), had advanced age (OR=1.090, 95%CI: 1.083-1.098), lived in rural areas (OR=1.369, 95%CI: 1.165-1.610) and urban areas (OR=1.208, 95%CI: 1.027-1.422), smoked (past, OR=1.471, 95%CI: 1.240-1.746; always, OR=1.545, 95%CI: 1.300-1.838) and brushed teeth less than once a day (OR=1.791, 95%CI: 1.488-2.160) had more missing teeth; while the elderly who had high levels of education (junior high school, OR=0.819, 95%CI: 0.681-0.972; high school, OR=0.626, 95%CI: 0.507-0.771; college and above, OR=0.468, 95%CI: 0.334-0.657), kept physical exercise (OR=0.840, 95%CI: 0.736-0.958) and were overweight/obese (OR=0.868, 95%CI: 0.769-0.980) had less missing teeth.@*Conclusion@#Gender, age, residence, educational level, smoking, physical exercise, teeth brushing frequency and overweight/obese are the influencing factors for tooth loss among the elderly in China.

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Within the realm of aging, the nexus between diet and health has garnered considerable attention. However, only select studies have amalgamated insights into the correlation between plant and animal food consumption and frailty. Our aim was to appraise the connections between the overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) and frailty in the elderly, utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). This cohort study drew upon CLHLS data spanning from 2008 to 2018. The PDI, hPDI, and uPDI were gauged using a simplified food frequency questionnaire (FFQ). A frailty index, encompassing 35 variables across major health domains, was formulated. Cox proportional hazard models were employed to scrutinize the associations between the three plant-based dietary indices and frailty in older adults, including an exploration of gender disparities in these associations. A cohort of 2883 study participants was encompassed, with 1987 (68.9%) observed to be either frail or in the pre-frail stage. The Cox model with penalized spline exhibited linear associations of PDI, hPDI, and uPDI with the frailty index. Following covariate adjustments, it was discerned that older adults situated in the highest quartiles of PDI (HR = 0.86, 95% CI: 0.77-0.95) and hPDI (HR = 0.83, 95% CI: 0.74-0.93) experienced a 14% and 17% diminished risk of frailty compared to those in the lowest quartiles of PDI and hPDI, respectively. Conversely, when contrasted with those in the lowest quartile of uPDI, older adults adhering to the highest tertile of uPDI exhibited a 21% elevated risk of frailty (HR = 1.21, 95% CI: 1.08-1.36), with both associations achieving statistical significance (p < 0.01). Moreover, additional subgroup analyses revealed that the protective effects of PDI and hPDI against frailty and the deleterious effects of uPDI were more conspicuous in men compared to women. To forestall or decelerate the progression of frailty in the elderly, tailored dietary interventions are imperative, particularly targeting male seniors.

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Purpose: Given the increasing longevity of the population, the consolidation of familial structures, and the scarcity of economic resources required to sustain an aging society, the Chinese government faces a complex and urgent challenge in effectively addressing the growing needs of older adults and establishing a long-term care services system that is both sustainable and equitable. Patients and Methods: This study harnesses the comprehensive CLHLS data from 2011 to 2018 and utilizes the "Pilot Industrialization of Old-Age Service in a Market-Oriented Way" policy as a quasi-natural experiment. Employing the Difference-in-Differences (DID) method, our study aims to evaluate the impact of industrializing older adult care services on the physical and mental health outcomes of older adults in China. Results: The findings strongly indicate that the government's adoption of a market-driven fiscal approach within its policies, aimed at attracting social capital and fostering the industrialization of older adult care services, positively influences the physical and mental well-being of the aged population. Furthermore, through heterogeneity analysis, it becomes evident that the health promotion effect is particularly pronounced among older individuals living without a spouse, lacking family care from children or grandchildren, or residing in financially underdeveloped regions. Conclusion: In summary, these results underscore the potential efficacy of employing financial policy instruments to facilitate the industrialization of older adult care services, thereby advancing the promotion of a society characterized by healthy aging and ensuring equitable health outcomes for older people.

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Purpose: As one of the most rapidly aging countries in the world, the elderly population is expected to reach over 400 million in China by 2032. Many studies have suggested a positive association between sleep duration and adverse health events among elderly individuals. This study aimed to investigate the sleep conditions of Chinese elderly individuals between 2005 and 2018. Patients and methods: Data for 53,013 elderly individuals were taken from five cycles of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) during 2005-2018. Sex- and age-specific means and 95% confidence intervals (95% CIs) were used to estimate sleep duration trends. Changes in sleep patterns were explored during this period. The prevalence of short and long sleep durations was assessed and age-standardized by the 2010 census. Finally, self-reported sleep quality was used to determine sleep conditions from another perspective among elderly individuals. Results: The mean sleep duration decreased from 7.87 (95% CI: 7.83-7.91) to 7.29 (95% CI: 7.25-7.33) hours between 2005 and 2018. Changes in sleep duration patterns were found during the study period. The proportion of the elderly population who slept ≤6 hours increased and that of those who slept ≥9 hours decreased noticeably over the past 13 years. The age-standardized prevalence of short sleep duration increased from 32.7% (95% CI: 32.7-32.9%) to 38.4% (95% CI: 38.3-38.5%). A significant decrease was observed in the prevalence of long sleep duration. Conclusion: Sleep conditions are gradually shifting toward a shorter sleep duration and poorer sleep quality among Chinese elderly individuals.

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We aimed to explore the correlation between plant-based diet indices and abdominal obesity with depression and anxiety among older Chinese adults. This study used a cross-sectional design using data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used a simplified food frequency questionnaire to evaluate the overall plant-based diet index (PDI), the healthful plant-based diet index (hPDI), and the unhealthful plant-based diet index (uPDI) separately, based on the potential health effects of the foods. Waist circumference (WC) was used to define abdominal obesity. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7) were applied to estimate depression symptoms and anxiety symptoms, respectively. Multi-adjusted binary logistic regression models were conducted to explore the effects of the three plant-based diet indices, abdominal obesity status, and their interaction on depression and anxiety. We enrolled a total of 11,623 participants aged 83.21 ± 10.98 years, of which 3140 (27.0%) participants had depression and 1361 (11.7%) had anxiety. The trend in the prevalence of depression/anxiety across increasing quartiles of the plant-based diet indices was statistically significant after controlling for potential confounders (p-trend < 0.05). Abdominal obesity was related to a lower prevalence of depression (OR = 0.86, 95% CI: 0.77-0.95) and anxiety (OR = 0.79, 95% CI: 0.69-0.90) compared with non-abdominal obesity. The protective effects of the PDI and hPDI against depression (OR = 0.52, 95% CI: 0.41-0.64; OR = 0.59, 95% CI: 0.48-0.73, respectively) and anxiety (OR = 0.75, 95% CI: 0.57-1.00; OR = 0.52, 95% CI: 0.39-0.70, respectively) were more pronounced in non-abdominally obese participants. The harmful effects of the uPDI against depression (OR = 1.78, 95% CI: 1.42-2.23) and anxiety (OR = 1.56, 95% CI: 1.16-2.10) were more pronounced in non-abdominally obese participants. In addition, a significant interaction between the plant-based diet indices and abdominal obesity was observed in terms of causing the prevalence of depression and anxiety. Consuming more of a healthful plant-based diet and less of an animal-based diet is related to a lower prevalence of depression and anxiety. A healthful plant-based diet plays a vital role in non-abdominally obese individuals.

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Background: Home and community-based services are considered an appropriate and crucial caring method for older adults in China. However, the research examining demand for medical services in HCBS through machine learning techniques and national representative data has not yet been carried out. This study aimed to address the absence of a complete and unified demand assessment system for home and community-based services. Methods: This was a cross-sectional study conducted on 15,312 older adults based on the Chinese Longitudinal Healthy Longevity Survey 2018. Models predicting demand were constructed using five machine-learning methods: Logistic regression, Logistic regression with LASSO regularization, Support Vector Machine, Random Forest, and Extreme Gradient Boosting (XGboost), and based on Andersen's behavioral model of health services use. Methods utilized 60% of older adults to develop the model, 20% of the samples to examine the performance of models, and the remaining 20% of cases to evaluate the robustness of the models. To investigate demand for medical services in HCBS, individual characteristics such as predisposing, enabling, need, and behavior factors constituted four combinations to determine the best model. Results: Random Forest and XGboost models produced the best results, in which both models were over 80% at specificity and produced robust results in the validation set. Andersen's behavioral model allowed for combining odds ratio and estimating the contribution of each variable of Random Forest and XGboost models. The three most critical features that affected older adults required medical services in HCBS were self-rated health, exercise, and education. Conclusion: Andersen's behavioral model combined with machine learning techniques successfully constructed a model with reasonable predictors to predict older adults who may have a higher demand for medical services in HCBS. Furthermore, the model captured their critical characteristics. This method predicting demands could be valuable for the community and managers in arranging limited primary medical resources to promote healthy aging.

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BACKGROUND: The association between fine particular matter (PM2.5) and frailty is less studied, and the national burden of PM2.5-related frailty in China is unknown. OBJECTIVE: To explore the association between PM2.5 exposure and incident frailty in older adults, and estimate the corresponding disease burden. DESIGN: Chinese Longitudinal Healthy Longevity Survey from 1998 to 2014. SETTING: Twenty-three provinces in China. SUBJECTS: A total of 25,047 participants aged ≥65-year-old. METHODS: Cox proportional hazards models were performed to evaluate the association between PM2.5 and frailty in older adults. A method adapted from the Global Burden of Disease Study was used to calculate the PM2.5-related frailty disease burden. RESULTS: A total of 5,733 incidents of frailty were observed during 107,814.8 person-years follow-up. A 10 µg/m3 increment of PM2.5 was associated with a 5.0% increase in the risk of frailty (Hazard Ratio = 1.05, 95% confidence interval = [1.03-1.07]). Monotonic, but non-linear exposure-response, relationships of PM2.5 with risk of frailty were observed, and slopes were steeper at concentrations >50 µg/m³. Considering the interaction between population ageing and mitigation of PM2.5, the PM2.5-related frailty cases were almost unchanged in 2010, 2020 and 2030, with estimations of 664,097, 730,858 and 665,169, respectively. CONCLUSIONS: This nation-wide prospective cohort study showed a positive association between long-term PM2.5 exposure and frailty incidence. The estimated disease burden indicated that implementing clean air actions may prevent frailty and substantially offset the burden of population ageing worldwide.

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PURPOSE: The associations of duration of subjective poverty and poverty status with mortality among older people remains inconclusive, and the underlying mechanisms of mental health on them are rarely discussed in population-based epidemiological studies. METHODS: We used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2008-2018). The Cox regression model was used to estimate hazard ratio (HR) and 95% confidence intervals (CIs) for mortality. Mediation analysis was applied to assess the effect of mental health. RESULTS: When compared with participants without subjective poverty, those who reported subjective poverty at one time point (2008 or 2011) or two time points (2008 and 2011) had a higher risk of death, with multivariable-adjusted HR (95% CIs) of 1.08 (1.00-1.16) and 1.22 (1.06-1.39), respectively. For poverty status, the multivariable-adjusted HR (95% CIs) of mortality were 0.81 (0.66-0.98) for "just objective poverty" and 0.78 (0.62-0.98) for "neither subjective nor objective poverty" compared with participants who reported "just subjective poverty", while there was no statistically significant association between "poverty subjectively and objectively" and mortality (HR = 0.88, 95% CI 0.72-1.07). Besides, we found that the proportion mediated by mental health was 26.6%, and age was a significant effect modifier. CONCLUSIONS: Subjective poverty may be associated with a higher risk of death among Chinese older people. This study showed that promoting mental health alone may not substantially reduce socioeconomic inequality in health. Further explorations of measures to tackle the social determinants of health are still needed.

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OBJECTIVES: To investigate whether loneliness and social isolation could independently predict subsequent risk of cognitive impairment in Chinese oldest old, and to examine possible gender differences. METHODS: The sample included 2,732 older adults aged 80 years and above with intact cognitive function from the Chinese Longitudinal Healthy Longevity Survey 2002-2018 waves, with an average follow-up of 4.24 years. Loneliness was measured by a single-item question about how often the participant felt lonely. Social isolation was defined by marital status, frequent visits by family members, and social activity engagement. Cognitive impairment was defined based on Mini-Mental State Examination scores. RESULTS: Cox regression showed that social isolation independently predicted a higher risk of developing cognitive impairment at follow-up (HR = 1.14, 95% CI [1.03, 1.27], p = 0.014). Importantly, although there was no main effect of loneliness, a significant interaction between gender and loneliness (p = 0.013) suggested that increased loneliness was associated with a higher risk of developing cognitive impairment for men but not for women. CONCLUSION: To prevent cognitive impairment and promote healthy longevity, socially isolated adults in their oldest old age should receive more attention, and men who often feel lonely should be offered with more emotional support.

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BACKGROUND: To promote healthy aging, the information about the development of quality of life (QoL) is of great importance. However, the explorations of the heterogeneity in the change of QoL under the Chinese context were limited. This study aimed to identify potential different development patterns of QoL and the influential factors using a longitudinal, nationally representative sample of the Chinese elderly. METHODS: We adopted a five-wave longitudinal dataset from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), and a total of 1645 elderly were obtained. The sample had a mean age of 72.7 years (SD = 6.64) and was 47.2% male. Overall QoL was measured through self-report during the longitudinal process. We utilized the conditional growth mixture model (GMM) with time-invariant covariates (TICs) to explore various development patterns and associated factors. RESULTS: Three distinct trajectories of self-reported overall QoL were identified: the High-level Steady Group (17.08%), the Mid-level Steady Group (63.10%), and the Low-level Growth Group (19.82%). Results also indicated that several factors predicted distinct trajectories of self-reported overall QoL. Those elderly who received enough financial resources, had adequate nutrition, did not exhibit any disability, engaged in leisure activities, and did less physical labor or housework at the baseline were more likely to report a higher level of overall QoL over time. CONCLUSIONS: There existed three development patterns of self-reported overall QoL in elders, and the findings provided valuable implications for the maintenance and improvement of QoL among the Chinese elderly. Future studies could examine the influence of other confounding factors.

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OBJECTIVE: To investigate the impact of 10 common foods (including staple foods, fruits, vegetables, sugar, meat, fish, eggs, beans, salt-preserved vegetables, and garlic) on cognitive function in Chinese older adults. METHODS: Cross-sectional data on demographic characteristics, lifestyle, and dietary habits were taken from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Cognition was assessed using the Mini-Mental State Examination (MMSE). Food consumption was measured by participants reporting the frequency of their food consumption. Association between food groups and cognitive function was evaluated using mixed-effect regression model analysis. RESULTS: Compared with those who rarely or never consumed vegetables, meat, fruits, beans, and garlic, older adults who consumed these foods almost daily were 56%, 30%, 23%, 34%, and 29% less likely to have cognitive impairment, respectively. No associations between staple foods, sugar, fish, and eggs consumption and cognitive impairment were found. Low-frequency consumption of salt-preserved vegetables may be associated with cognitive function. Regular vegetables consumption had the greatest associated risk reduction of all food types. Interactions indicated that the co-ingestion of vegetables and beans or sugar, meat and beans may have antagonistic effect, while the co-ingestion of salt-preserved vegetables and garlic may have synergistic effect. Subgroup analyses showed that sex and age were the significant effect modifiers for meat and fish, respectively. CONCLUSIONS: Cognitive function of Chinese older adults may be related to food groups. Future research should measure food types and consumption level with greater granularity.

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It remains unclear whether limitations in activities of daily living (ADL) increase the risk of stroke in older Chinese adults. This longitudinal study used data from the Chinese Longitudinal Healthy Longevity Survey to investigate the effects of limitations in ADL on the incidence of stroke in older adults. Between 2002 and 2011, 46,728 participants from 22 provinces in China were included in this study. Of participants, 11,241 developed limitations in ADL at baseline. A 3-year follow-up was performed to determine the incidence of stroke. During the 3-year follow-up, 929 participants (8.26%) and 2434 participants (6.86%) experienced stroke in the ADL limitations group and non-ADL limitations group, respectively. Logistic regression was used to analyze the effect of ADL limitations on the risk of stroke. The results showed that after adjusting for the confounding factors gender, age, weight, hypertension, diabetes, heart disease, natural teeth, hearing impairment, visual impairment, smoking, alcohol abuse, exercise, ethnicity, literacy, residential area, and poverty, the ADL limitations group had a 77% higher risk of developing stroke than the non-ADL limitations group. After propensity score matching, the ADL limitations group still had a 33% higher risk of developing stroke than the non-ADL limitations group (OR = 1.326, 95% CI: 1.174-1.497). These findings suggest that limitations in ADL are a stroke risk factor.

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BACKGROUND: Increasing number of studies have suggested the time to first cigarette after waking (TTFC) have significant positive effect on respiratory diseases. However, few of them focused on the Chinese population. This study aims to estimate the impact of TTFC on the prevalence of chronic respiratory diseases (CRD) in Chinese elderly and explore the association in different sub-populations. METHODS: Cross-sectional data of demographic characteristics, living environment, smoking-related variables, and CRD were drawn from the Chinese Longitudinal Healthy Longevity Survey in 2018. Multivariate stepwise logistic regression analyses were conducted to examine the association of the TTFC with the prevalence of CRD. RESULTS: This study includes 13,208 subjects aged 52 years and older, with a mean age of 85.3 years. Of them, 3,779 participants were ex- or current smokers (44.9% had the TTFC ≤30 minutes, 55.1% >30 minutes) and 1,492 had suffered from CRD. Compared with non-smokers, participants with TTFC ≤30 minutes seemed to have higher prevalence of CRD (OR 1.97; 95% CI, 1.65-2.35) than those with TTFC >30 minutes (OR 1.70; 95% CI, 1.44-2.00), although the difference was statistically insignificant (Pinteraction = 0.12). Compared with TTFC >30 minutes, TTFC ≤30 minutes could drive a higher prevalence of CRD among female participants, those aged 90 years and older, urban residents, and ex-smokers (Pinteraction < 0.05). CONCLUSION: Shorter TTFC relates to higher prevalences of CRD in Chinese older females, those aged 90 years and older, urban residents, and ex-smokers. Delaying TTFC might partially reduce its detrimental impact on respiratory disease in these specific subpopulations.

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This study used data from the Chinese Longitudinal Healthy Longevity Survey (n = 9765, age 65+) to investigate the impact of biomass fuels on the mortality of the Chinese elderly population. The association between biomass fuels and mortality was examined using a Cox proportional hazards model. We evaluated the difference in risk of death between those who switched fuel types from biomass to clean fuels and from clean to biomass fuels versus those who did not during the follow-up period. Participants who used biomass fuels had a higher risk of death than participants who used clean fuels (HR = 1.09, 95% CI: 1.01-1.17). For participants who switched cooking fuel types during the follow-up period, switching from biomass to clean fuels significantly reduced the risk of death (HR = 0.78, 95% CI: 0.67-0.91), while no evidence of an association between switching from clean to biomass fuels and risk of death was found (p > 0.05). Interactions and subgroup analyses indicated that effect estimates were greater for women and non-smokers. Biomass fuels may be associated with a higher risk of death among Chinese elderly. Research measuring personal exposure levels to indoor air pollution caused by biomass fuels combustion is required to confirm our results.

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BACKGROUND: Most countries in the world, including China, are experiencing serious aging problems. The decline of cognitive function seriously affects the quality of life of the elderly in their later years and brings an inevitable heavy burden to the family and society. Therefore, in order to achieve successful aging, the purpose of this study is to test the serial multiple mediation effect of anxiety and loneliness between leisure activity and cognitive function in Chinese elderly population. METHODS: Using 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset, we finally selected 6,525 Chinese elderly people over 65 years old after screening. Firstly, we described the basic social demographic information of the sample population. Secondly, Spearman correlation analysis was used to determine whether there is a correlation between leisure activity, anxiety, loneliness and cognitive function in Chinese elderly. Finally, the serial multiple mediation analysis was completed using the SPSS macro PROCESS program. RESULTS: Leisure activity, anxiety, loneliness and cognitive function were significantly correlated (p<0.01). Leisure activity can not only have a direct positive impact on the cognitive function of the elderly (effect=0.2231; SE=0.0122; 95%CI: LL=0.1992, UL=0.2470), but also have an indirect impact on the cognitive function through three paths: the independent mediating role of anxiety (effect=0.0028; SE=0.0015; 95%CI: LL=0.0001, UL=0.0059), the independent mediating role of loneliness (effect=0.0032; SE=0.0016; 95%CI: LL=0.0002, UL=0.0065), and the chain mediating role of anxiety and loneliness (effect=0.0008; SE=0.0004; 95%CI: LL=0.0001, UL=0.0017). LIMITATIONS: All items were self-reported and some results may have biased. In the future, it may be more instructive to explore the impact of specific leisure activity on the cognitive function of the elderly. CONCLUSIONS: The study suggests that leisure activity can improve cognitive function through decreasing anxiety and loneliness among the Chinese elderly. Diversified interventions aimed at increasing leisure activity participation in older adults would be beneficial for their mental health and cognitive function.

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BACKGROUND: Widowhood is a distressful life event that is associated with loneliness in older adults. However, widowhood is not a binary event, and little is known about the role of widowhood duration in loneliness and about the relationship between widowhood duration and loneliness in different age and sex groups. Given the increases in aging population and in widowed older adults in China, we examined whether and how widowhood and widowhood duration were associated with loneliness in different age and sex groups among Chinese older adults. METHODS: Five waves of Chinese Longitudinal Healthy Longevity Survey 2002-2014 were used. The analysis included 34,440 sampled individuals aged 65 and above. Random intercept ordered logistic models were used to examine relations between widowhood, its duration and loneliness in the entire sample and by age and sex groups. RESULTS: Results show that with a wide set of covariates controlled for, widowhood was a significant correlate of loneliness in older adults (OR = 2.34, p < .001); and those who were remarried after widowhood were less likely to be lonely compared to their not-remarried counterparts (OR = 0.47, p < .001). In addition, widowhood was associated with more than twice greater odds of loneliness in the first couple of years following bereavement of spouse (OR = 3.09, p < .001) compared to the currently married older adults. The increased odds ratio of loneliness slightly decreased with the length of widowhood, but it was still significant, even after 40 years of bereavement (OR = 1.96, p < .001). CONCLUSIONS: These findings are mostly consistent across age and sex groups. In conclusion, this study sheds light on the relationship between widowhood duration and loneliness and the role of remarriage in widowed older adults' loneliness based on a nationwide survey in China. Widowhood has an acute and long-lasting effect on loneliness in older adults. Remarriage after widowhood could largely reduce or offset the risk of loneliness.

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OBJECTIVES: Widowhood is a significant predictor of loneliness in older adults and research on the underlying mechanisms of this link using longitudinal data is limited. This study examined whether education would moderate the effect of widowhood on loneliness, and whether such a relationship would differ by gender among Chinese older adults. METHOD: A total of 2,704 older adults from the 2008 wave of the Chinese Longitudinal Healthy Longevity Survey were included. They were aged 65 years and above, were not lonely, and were married. Logistic regression models were applied to examine the interaction between widowhood, education, and gender on loneliness in the 2011 wave. RESULTS: Widowhood was a significant predictor of loneliness and could increase the odds of becoming lonely by 193%. The interaction between widowhood and education was significant only in older women, not in older men. Literate older women reported lower loneliness than did their illiterate counterparts when they remained married during the follow-up. However, when their spouse passed away, literate women did not differ from their illiterate counterparts in loneliness. CONCLUSION: This study revealed a gendered pattern in the interaction between widowhood and education on loneliness and demonstrated the complexity of the mechanisms. Furthermore, it highlighted the importance of considering the role of education and gender simultaneously in a Chinese context.

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