Lydia W. Li

Change in Depressive Symptoms Among Daughter Caregivers: An 18-Month Longitudinal Study

This longitudinal study investigates, over an 18-month period, the caregiving experience of a probability sample of 115 daughters who provided care to an aging parent. The levels of depressive symptoms manifested by these daughters were relatively low, with only 23.5% scoring in the clinical range during the study. Nevertheless, there was substantive change in depressive symptoms among the daughters during the 18 months. Daughters with higher levels of mastery were more likely to use problem-focused coping strategies, which led to reductions in depression, whereas daughters with lower levels of mastery were more likely to use emotion-focused coping, which led to increased levels of depression. Mastery was higher when the caregiving role was shared with a sibling: it was lower if the daughter had other caregiving responsibilities and if the parent care recipient had elevated levels of behavior problems.

Age Variation in the Relationship Between Community Socioeconomic Status and Adult Health

Research demonstrating that socioeconomic status (SES) differentials in health are smaller at older ages often considers only individual SES measures (e.g., income, education) but not community SES measures (e.g., community poverty rate), although the gerontological literature suggests that community context may be particularly salient in the lives of older adults. This study uses two national surveys of adults, each matched with census data about respondents’ communities, to examine whether the association between community SES and individual health is stronger at consecutively older age groups. The association between community SES and health is nonexistent or weak during younger adulthood, stronger through middle ages, strongest at ages 60 to 69, and weak again at ages 70 and older. At ages 60 to 69, community SES effects are stronger than or comparable to individual SES effects. Community SES should be considered an important dimension of SES when exploring the impact of SES on health over the life course.

Health among the oldest-old in China: Which living arrangements make a difference?

This study aims to (1) examine the association of living arrangements and health among oldest-old Chinese, and (2) investigate gender differences in the association of living arrangements and health. Data were from the first two waves of the Chinese Longitudinal Healthy Longevity Survey, which included 9093 Chinese averaging 92 years old. Living arrangements had six mutually exclusive categories: living alone, with spouse, with children, with spouse and children, with others and in institutions. Using multinomial logistic regression, we found that baseline living arrangements are significantly associated with mortality, activities of daily living (ADL) disability, and self-rated health at Wave 2, controlling for baseline health, sociodemographic characteristics and availability of children. Further, the linkages between living arrangements and mortality vary by gender. Among the different living arrangements, having a spouse in the household (either with a spouse only or with both a spouse and children) provides the best health protection. Living alone and living with children are associated with both health advantages and disadvantages. Institutional living lowers mortality risk for men but not women. Living with others provides the least health benefits. Our study has extended the research on living arrangements and health to a unique population-the oldest-old in China-and clarified the health advantages and disadvantages of different living arrangements. Future research should examine the mechanisms linking living arrangements and health, and the experience of institutional living for men and women in China.

Social exchanges and subjective well-being among older chinese : Does age make a difference?

The authors examined the effects of social support and negative interactions on life satisfaction and depressed affect among older Chinese, and age differences in these associations. The sample consisted of 2,943 Chinese elders who were 60-94 years of age. Structural equation modeling results suggest that both social support and negative interactions have significant contributions to life satisfaction and depressed affect. Social support has stronger effects than negative interactions on life satisfaction; their effects on depressed affect are comparable. Further, depressed affect of old-old (70+ years) Chinese reacts more strongly to both social support and negative interactions than the young-old (60-69 years).

Effects of Changes in Depressive Symptoms and Cognitive Functioning on Physical Disability in Home Care Elders

BACKGROUND This study sought to investigate the effect of changes in depression status on physical disability in older persons receiving home care, examine whether the effect is due to concomitant changes in cognitive status, and test whether affective state and cognitive ability interact to influence physical disability. METHODS Multilevel analyses were conducted using longitudinal data collected about every 3 months from older participants in Michigans community-based long-term care programs (N = 13,129). The data set provided an average of nine repeated measures of depressive symptoms, cognitive functioning, and physical disability. We estimated the lag effects of within-person changes in depression and cognitive status, and their interaction, on physical disability measured by activities of daily living (ADL) and instrumental activities of daily living (IADL), controlling for health-related events that occurred in the interim. RESULTS Changes between not having and having depressive symptoms, including subsyndromal symptoms, are critical to physical disability for home care elders. The effects are independent of concomitant changes in cognitive status, which also have significant adverse effects on physical disability. There is some evidence that improvement of depression buffers the adverse effect of cognitive decline on IADL disability. CONCLUSIONS Providers should monitor changes in depression and cognitive status in home care elders. Early detection and treatment of subthreshold depression, as well as efforts to prevent worsening of cognitive status in home care elders, may have a meaningful impact on their ability to live at home.

Predictors of ADL Disability Trajectories Among Low-Income Frail Elders in the Community

In this study, the author examined the effects of psychosocial and health factors on the ADL disability trajectory of low-income frail elders living in the community. She analyzed three-year longitudinal data with a maximum of 15 repeated observations from a cohort of elderly participants in Michigan’s Medicaid Waiver Program (N=3,161), using the hierarchical linear modeling approach. Baseline data of this cohort were taken in 1999; a reassessment was conducted about every three months. The analysis shows that major risk factors for a poor activity of daily living (ADL) disability trajectory include being Black, older, living with nonspouse others, and no confidence in functional improvement. Presence of arthritis, cancer, and cognitive limitation had significant and modest effects on ADL disability trajectories. The findings have implications to community-based intervention programs for frail elderly persons in the community.

Parent Care, Intergenerational Relationship Quality, and Mental Health of Adult Daughters

This study examined the effects of parent care on the quality of adult daughter-aging parent relationships and the effects of these relationships on the mental health of daughters. One hundred ninety-six daughters who participated in the first two waves (18 months apart) of a longitudinal study of women in Wisconsin were included in this analysis. Structural equation modeling results show that providing care to a parent with both cognitive and physical impairments, but not to a parent with physical impairments only, takes a toll on the quality of the daughter-parent relationship. The quality of the daughter-parent relationship was found to be negatively associated with depressive symptoms in the daughter, and this association is largely accounted for by the daughters self-esteem.

Understanding Rural–Urban Differences in Depressive Symptoms Among Older Adults in China

Objective: Studies have reported that rural elders in China have higher levels of depression than their urban peers. We aimed to examine the extent to which four sets of factors (socioeconomic status [SES], health care access, health status, and social support and participation) account for such rural–urban differences. Method: Cross-sectional data from the 2011 China Health and Retirement Longitudinal Study were analyzed. A representative sample (N = 5,103) of older Chinese (age 60+) was included. Depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Multilevel linear regression was conducted. Results: Rural elders had more depressive symptoms than urban elders. When SES at the individual, household, and community level was simultaneously controlled, the rural–urban difference lost its statistical significance. Health status, social support, and social participation accounted for some, whereas health care access explained almost none, of the rural–urban difference. Discussion: Results suggest that SES is the predominant factor accounting for the rural–urban depression gap in China.

Pain and Self-Injury Ideation in Elderly Men and Women Receiving Home Care

OBJECTIVES: To investigate the associations between self‐injury ideation and pain severity, pain control, and their combination in older adults receiving home care and to examine sex differences in the associations.

Late-life depression in Rural China: do village infrastructure and availability of community resources matter?

This study aimed to examine whether physical infrastructure and availability of three types of community resources (old‐age income support, healthcare facilities, and elder activity centers) in rural villages are associated with depressive symptoms among older adults in rural China.