The dyadic effects of family resilience and social support on quality of life among older adults with chronic illness and their primary caregivers in multigenerational families in China: A cross-sectional study.

Older adults with chronic illness, as well as their primary caregivers in multigenerational families, may experience a complex interplay of factors that affect their quality of life (QOL). However, this interplay is not yet well-characterized for Chinese multigenerational families in particular. In this study, we analyzed how family resilience and social support affect the QOL of both older adults and caregivers in multigenerational Chinese families specifically. We enrolled 258 pairs of older adults with chronic illness and their primary caregivers in a multicenter cross-sectional study conducted in southern China in December 2021. Using the Actor-Partner Interdependence Model (APIM), we then examined the correlation between family resilience, social support, and QOL in dyadic analysis and found that QOL, family resilience, and social support for primary caregivers were better than those of older adults with chronic illness (t = 3.66-16.3, p＜0.01). These factors were found to be positively correlated (r = 0.22-0.60, p＜0.05), except for the family resilience of primary caregivers and the QOL of older adults with chronic illness (r = -0.14, p = 0.04). Additionally, actor effect results showed that when a dyadic member has high family resilience and objective social support, they tend to have a better QOL (ß = 0.5-1.48, P < 0.01). However, partner effect results showed that when the primary caregiver has high family resilience, this is associated with a worse QOL for the older adult (ß = -1.06, P < 0.01). Furthermore, we found that objective social support of dyads does not significantly influence their partner's QOL (ß = 0.88/0.31, P＞0.05) for any pair. This suggests that medical staff should pay attention to the impact of family resilience on the QOL of older adult and caregiver dyads and explore health management plans that focus on binary coping in multigenerational families.

Factors associated with perceived caregivers' willingness to provide care among older adults with disabilities in China.

Objective: The aim of this study was to analyze the status quo and associated factors of care recipients' perceptions of caregivers' willingness to provide care among disabled older adults in China. Thus, this study contributes to our understanding of vulnerable older populations who are at a high risk of receiving support from informal caregivers who are unable or unwilling to take the caregiver role. Methods: We analyzed the cross-sectional data of 3,539 disabled older adults who received informal care at home from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression models were used to examine the variables associated with the respondents' perceived caregivers' willingness to care from five aspects: respondents' sociodemographic attributes, health-related data, family endowment, access to health care services and community-based long-term care services (CBLTCS). Results: This study found that the majority of disabled older adults (90.9%) had a positive attitude toward their caregivers' willingness to care and the care they received; however, 7.0% of the adults were concerned about their caregivers' ability to handle the care. Moreover, there was a small number of disabled older people (2.1%) who felt that their caregivers were reluctant to care or lacked patience. The results from the multiple logistic regression showed that disabled older adults with socioeconomic disadvantages (living in rural areas, being poor and with no children who frequently visited) or high demand (with severe disabilities or cognitive impairment) were more likely to consider that their caregivers needed respite care. Those adults with anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were more likely to report that their caregivers were reluctant to administer care. Conclusion: This study found that living in rural areas, being poor, with no children who frequently visited, severe disabilities or CI were positively associated the care recipients' perception that caregivers needed respite care. While anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were significantly associated with care recipients' perception of caregivers' reluctance to care. Our findings highlight the awareness of monitoring informal carers' willingness to care or capability to enact caring tasks.

Subjective well-being patterns in older men and women without someone to confide in: a latent class analysis approach.

Objective: This study aimed to identify the latent subtypes of subjective well-being (SWB) and associated factors in older adults without a confidant in China. Methods: The data came from the most recent (seventh) wave (2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). This cross-sectional study included 350 older adults who lacked a close confidant. We utilized latent class analysis and multiple logistic regression models to examine the latent SWB subtypes and associated factors. Results: Three distinct patterns of SWB were identified: the very low SWB class (32%), the medium-low SWB class (46%), and the low evaluative and high affective SWB class (22%). The results indicated that compared to the low evaluative and high affective SWB class, respondents who self-rated their health as not good, currently drank alcohol and rated their financial status as poor/very poor were more likely to be in the very low SWB class, while those who participated in social activities were less likely to be in the very low SWB class. Respondents who had limitations in instrumental activity of daily living (IADL) and rated their financial status as poor/very poor were more likely to be in the medium-low SWB class. However, gender did not affect SWB patterns. Conclusion: Our findings highlight awareness of the heterogeneity of SWB in older adults without close confidants and provide valuable information for the development of tailored intervention programs to improve their well-being.

Perceived unmet needs for community-based long-term care services among urban older adults: A cross sectional study.

The purpose of this study was to explore the perceived unmet needs for community-based long-term care services among older urban adults in China. We analyzed the cross-sectional data of 5,201 urban community respondents ≥65 years of age from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The chi-squared automatic interaction detection technique was used to examine the variables associated with older adults' unmet needs for four common types of community-based services: personal care, grocery shopping, home visits, and psychological consulting. We found that the majority of the older adults perceived that they needed the four services, but only 9%-27.4% of the respondents reported that their perceived needs were met. There was a high prevalence of unmet community-based service needs (51.3%-55.5%) among urban older adults in China. Factors associated with unmet needs included depression status, ADL (activities of daily living) limitations, self-rated health, number of surviving children, educational attainment, and marital status. The results suggest that policy makers should develop services targeting specific segments of the older population, increasing the adequacy of services provided.

Nursing students' perceived value of the work environment: A discrete choice experiment.

The purpose of this study was to elicit graduating undergraduate nursing students' perceived value of the work environment in aged care. Applying a cross sectional design, an electronic questionnaire was sent to 625 graduating undergraduate nursing students from three schools of nursing in Jiangsu Province, China. A discrete choice experiment questionnaire with eight choice-set questions was performed. In total, 267 nursing students (42.7%) responded to the questionnaire. We found that nursing students valued excellent working conditions the highest (OR = 3.632 [2.846~4.635]), followed by adequate formal professional development activities (OR = 2.252 [1.907~2.660]), good/excellent safety management (OR = 2.214 [1.828~2.682])/ (OR = 2.202 [1.758~2.759]), and 10% higher earnings (OR = 1.615 [1.360~1.919]). Based on these findings, the study provided information to improve the recruitment of nursing students to work with older adults. Findings suggest that students may be 44.07~73.41% more likely to choose working with older people when valued job characteristics are present.

microRNA-608 inhibits human hepatocellular carcinoma cell proliferation via targeting the BET family protein BRD4.

Over-expression of the bromodomain and extraterminal (BET) family protein BRD4 is associated with hepatocellular carcinoma (HCC) progression. In the present study, we indentified a novel putative anti-BRD4 microRNA: microRNA-608 ("miR-608"). In HepG2 cells and primary human HCC cells, over-expression of miR-608, using a lentiviral construct, induced BRD4 downregulation and proliferation inhibition. Conversely, transfection of the miR-608 inhibitor increased BRD4 expression to promote HepG2 cell proliferation. Our results suggest that BRD4 is the primary target gene of miR-608 in HepG2 cells. shRNA-mediated knockdown or CRSIPR/Cas9-mediated knockout of BRD4 mimicked and overtook miR-608's actions in HepG2 cells. Furthermore, introduction of a 3'-untranslated region (3'-UTR) mutant BRD4 (UTR-A1718G) blocked miR-608-induced c-Myc downregulation and proliferation inhibition in HepG2 cells. In vivo, HepG2 xenograft tumor growth was significantly inhibited after expressing miR-608 or BRD4 CRSIPR/Cas9-KO construct. Importantly, BRD4 mRNA was upregulated in human HCC tissues, which was correlated with downregulation of miR-608. Together, we conclude that miR-608 inhibits HCC cell proliferation possibly via targeting BET family protein BRD4.

What determines the preference for future living arrangements of middle-aged and older people in urban China?

OBJECTIVE: Living arrangements are important to the elderly. However, it is common for elderly parents in urban China to not have a living situation that they consider ideal. An understanding of their preferences assists us in responding to the needs of the elderly as well as in anticipating future long-term care demands. The aim of this study is to provide a clear understanding of preferences for future living arrangements and their associated factors among middle-aged and older people in urban China. METHODS: Data were extracted from the CHARLS 2011-2012 national baseline survey of middle-aged and elderly people. In the 2011 wave of the CHARLS, a total of 17,708 individual participants (10,069 main respondents and 7,638 spouses) were interviewed; 2509 of the main respondents lived in urban areas. In this group, 41 people who were younger than 45 years old and 162 who had missing data in the variable "living arrangement preference" were excluded. Additionally, 42 people were excluded because they chose "other" for the variable "living arrangement preference" (which was a choice with no specific answer). Finally, a total of 2264 participants were included in our study. RESULTS: The most popular preference for future living arrangements was living close to their children in the same community/neighborhoods, followed by living with adult children. The degree of community handicapped access, number of surviving children, age, marital status, access to community-based elderly care centers and number of years lived in the same community were significantly associated with the preferences for future living arrangements among the respondents. CONCLUSION: There is a trend towards preference for living near adult children in urban China. Additionally, age has a positive effect on preference for living close to their children. Considerations should be made in housing design and urban community development plans to fulfill older adults' expectations. In addition, increasing the accessibility of public facilities in the residential area was important to the elderly, especially for those who preferred living in proximity to their children rather than co-residing with their children. We found that more surviving children were associated with a lower likelihood of choosing "institutionalization", and it positively contributed to preference for intergenerational living arrangements in our study. As expected, compared with their married counterparts, people who were separated/divorced/widowed preferred living with adult children rather than living independently. A relatively shorter length of residence in the same community was an important indicator of preference for independent living; this finding might require further research.

Electroacupuncture improves cognitive deficits and activates PPAR-γ in a rat model of Alzheimer's disease.

BACKGROUND: Alzheimer's disease (AD) is an age-associated neurodegenerative disorder that is associated with a progressive impairment of cognition. Acupuncture has protective effects, although the molecular mechanisms are largely unknown. The activation of peroxisome proliferator activated receptor γ (PPAR-γ) has an impact on the pathogenesis of AD. OBJECTIVE: To test the hypothesis that electroacupuncture (EA) confers therapeutic benefits through activation of PPAR-γ in a rat model of AD. METHODS: 80 male Sprague-Dawley rats were randomly divided into four groups (n=20 each): Control (healthy control group), Sham (sham-operated group), AD (untreated AD model group), and AD+EA (AD model group treated with EA). The AD model was induced in the latter two groups by injection of amyloid-ß (Aß)1-40 into the hippocampal CA1 area bilaterally. EA was administered at GV20 and BL23 six times per week for 4 weeks. The rats' behaviour was examined using the Morris water maze test, and protein expression of Aß, hyperphosphorylated tau protein (p-Tau), PPAR-γ, and hyperphosphorylated p38 mitogen activated protein kinase (p38MAPK) in the hippocampal CA1 region was examined by immunohistochemistry and Western blotting. RESULTS: EA significantly improved cognitive deficits and reduced Aß and p-Tau Ser404 protein concentrations in the hippocampal CA1 region. AD decreased PPAR-γ and increased p-p38MAPK, while EA significantly upregulated PPAR-γ expression and significantly downregulated p-p38MAPK expression. CONCLUSIONS: Acupuncture at GV20 and BL23 might have a beneficial effect on rats with AD via activation of PPAR-γ and inhibition of p-p38MAPK expression.

Qigong Yi Jinjing Promotes Pulmonary Function, Physical Activity, Quality of Life and Emotion Regulation Self-Efficacy in Patients with Chronic Obstructive Pulmonary Disease: A Pilot Study.

PURPOSE: The purpose of this pilot study was to examine the effect of a Chinese traditional exercise program, Qigong Yi Jinjing (QYJJ), on patients with chronic obstructive pulmonary disease (COPD). METHODS: One hundred and thirty eligible COPD patients were randomly divided into three groups: the QYJJ group (n = 42), the self-management exercise group (n = 43), and the control group (n = 45). Data were collected and analyzed at baseline and again at one, three, and six months. A pulmonary rehabilitation index, consisting of pulmonary function, six-minute walk test, Regulatory Emotion Self-Efficacy questionnaire, and exercise of the COPD Assessment Test widely used to evaluate health-related quality of life (HRQL) in participants with COPD, was measured. RESULTS: Compared with the other groups, participants in QYJJ group had significantly better lung function (forced expiratory volume in one second: F = 8.96, p = 0.000; forced expiratory volume in one second/forced vital capacity: F = 11.55, p = 0.000; the percentage of forced expiratory volume in one second in prediction: F = 24.27, p = 0.000); walked a longer distance (F = 152.52, p = 0.000), and had more satisfactory HRQL (F = 14.08, p = 0.000). QYJJ training also contributed to improving the ability of emotion regulation (F = 36.56, p = 0.000). There were significant positive changes in expressing positive affect (F = 56.25, p = 0.000) and managing despondency/distress (F = 21.58, p = 0.000), apart from the ability to regulate anger/irritation (F = 1.20, p = 0.305). The longer QYJJ is practiced, the more effective the influence is on the pulmonary rehabilitation-related index measures. CONCLUSIONS: These results indicate that QYJJ exercise produced positive effects on pulmonary function, physical activity, emotion regulation self-efficiency (modulating the expression of despondency or distress and experiencing and expressing positive affect), and HRQL in patients with COPD.