Zhenmei Zhang

Elder Abuse in Nursing Homes: An Ecological Perspective

Population trends suggest that the next 20 years will witness a dramatic increase in the adult population aged 65 and older. Projected increases in the elderly population are expected to significantly increase the stress on family and professional caretakers. Stress, in the context of caregiving relationships, is a risk factor associated with increased prevalence of elder abuse in familial and institutional settings. As increasing numbers of older adults are moved from family caregiving to nursing home care settings, it becomes important to identify the pattern of elder abuse risk factors in nursing home facilities. An ecological model is proposed for better understanding the risk factors associated with elder abuse in nursing homes and the complex interaction of individual/person characteristics and contextual factors in institutional elder abuse. An ecological perspective to institutional elder abuse provides a framework for guiding and informing future research on the risk factors of nursing home abuse and, in turn, for the development of effective interventions and relevant social policies.

Physical Abuse of Older Adults in Nursing Homes: A Random Sample Survey of Adults With an Elderly Family Member in a Nursing Home

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.

Access to healthcare services makes a difference in healthy longevity among older Chinese adults

The positive impact of access to healthcare on health and survival among older adults is well-documented in Western societies. However, whether the pattern still holds in developing countries where healthcare coverage is more limited is largely unknown. China, a developing country with the largest population in the world, has been transforming its antiquated healthcare system during the past few decades in response to rapid population aging. Yet, in recent years the lack of access to healthcare has been identified as the top concern by most citizens in China. We used the Chinese Longitudinal Healthy Longevity Survey and the community-level data sources from the National Bureau of Statistics of China to examine the impact of current as well as childhood access to healthcare services on subsequent three-year survival and healthy survival at old ages from 2002 to 2005 under a multilevel context. Healthy survival was measured by a cumulative deficit index calculated from thirty-nine variables pertaining to various dimensions of health. Our analyses showed that access to healthcare at present and during childhood improved the odds of subsequent three-year survivorship by 13-19% and 10%, respectively, controlling for various confounders. But the effect of access to healthcare at present was no longer statistically significant once baseline health status in 2002 was controlled for. Access to healthcare at present increased odds of healthy survival by 22-68%, while access to healthcare in childhood increased odds of healthy survival by 18%. All patterns held true for both men and women, for urban and rural areas, across ages, as well as across socioeconomic statuses. Our findings suggested that positive inputs such as access to healthcare services over the life course make a substantial difference in healthy longevity, which has implications for the establishment of the universal healthcare system.

Childhood nutritional deprivation and cognitive impairment among older Chinese people

Late-life cognitive impairment may have its origins in childhood. Here, we examine the associations between markers of childhood nutritional deprivation and cognitive impairment in older adults. We made use of the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey to examine these associations for persons aged 65-105 (N=15,444). Anthropometric measures (arm length, knee height) and self-reported hunger were used to measure early-life nutritional deficiencies. Cognitive impairment was measured using the Chinese version of the Mini Mental State Examination. Results from multivariate logistic regression models show that both anthropometric measures and self-report markers of early-life nutritional status were significantly associated with the odds of cognitive impairment at baseline for both men and women after controlling for age and ethnicity. Adjustments for childhood and adulthood socioeconomic status, adulthood health, and lifestyle habits had little effect on these associations except for the effect of hunger among men. Results from multinomial logistic regression models show that during the three-year follow-up period, arm length was significantly associated with the onset of cognitive impairment after controlling for various confounders in men, but not in women. Our findings suggest that early-life nutritional deprivation may contribute to cognitive impairment among older Chinese adults.

Coresidence With Elderly Parents in Contemporary China: The Role of Filial Piety, Reciprocity, Socioeconomic Resources, and Parental Needs

This paper examines how adult children’s expressed filial piety, receipt of help from parents, socioeconomic resources, and parents’ needs are associated with the likelihood of parent–child coresidence in contemporary China. Drawing on the 2002 wave of the Chinese Survey of Family Dynamics and the 2002 wave of the Chinese Longitudinal Healthy Longevity Survey, we used logistic regression to analyze correlates of coresidence with parents of 3,938 married adult children, aged 35 to 65. Results show that the stronger the filial piety expressed by adult children, the higher their likelihood of coresiding with their parents. Married adult children are also more likely to coreside with elderly parents who have provided intensive grandchild care and financial support or with those who need financial, physical, and emotional support. However, adult children who own homes are significantly less likely to live with their parents than are those who do not. These findings suggest that coresidence in contemporary China is influenced not only by parents’ needs but also by children’s values, socioeconomic resources, and past receipt of parental help.

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.

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.

Is There a Hispanic Epidemiologic Paradox in Later Life? A Closer Look at Chronic Morbidity

This study examined the morbidity patterns of foreign-born Hispanics, U.S.-born Hispanics, Blacks, and Whites aged 53 years and older using seven self-reported physician-diagnosed chronic diseases as well as six biomarkers. Drawing on the 2006 Health and Retirement Study and its biomarker data, the authors found that foreign-born Hispanics had comparable or lower rates of high blood pressure, heart disease, cancer, arthritis, chronic lung disease, and stroke, controlling for age and gender. The health advantages were robust when socioeconomic conditions and health behaviors were controlled. Foreign-born Hispanics were not significantly different from U.S.-born Hispanics except for a lower risk for arthritis. In terms of biomarkers, foreign-born Hispanics were not statistically different from Whites except for having higher risks of high systolic blood pressure and blood glucose. Future research should explore multiple factors contributing to the lower rates of major chronic diseases among older Hispanics who have faced social disadvantages over the life course.

Life Course Pathways to Racial Disparities in Cognitive Impairment among Older Americans

Blacks are especially hard hit by cognitive impairment at older ages compared to whites. Here, we take advantage of the Health and Retirement Study (1998–2010) to assess how this racial divide in cognitive impairment is associated with the racial stratification of life course exposures and resources over a 12-year period among 8,946 non-Hispanic whites and blacks ages 65 and older in 1998. We find that blacks suffer from a higher risk of moderate/severe cognitive impairment at baseline and during the follow-up. Blacks are also more likely to report childhood adversity and to have grown up in the segregated South, and these early-life adversities put blacks at a significantly higher risk of cognitive impairment. Adulthood socioeconomic status is strongly associated with the risk of cognitive impairment, net of childhood conditions. However, racial disparities in cognitive impairment, though substantially reduced, are not eliminated when controlling for these life course factors.

Racial-ethnic differences in subjective survival expectations for the retirement years

Prior research finds a race anomaly in subjective life expectancy such that Blacks expect to live longer than Whites even though their actual life expectancy is lower, but it does not include other racial-ethnic groups. Using data from the 1998 Health and Retirement Study (n = 8,077), the authors find that the race anomaly in subjective survival expectations can be extended to Mexican Americans: Mexican Americans, regardless of their nativity, expect a lower chance of living to ages 75 and 85 than do Whites net of age and gender even though their actual life expectancy is higher. In addition, foreign-born Mexican Americans expect a lower chance of survival to older ages than native-born Mexican Americans, which is also opposite of actual mortality patterns.We also find that education and wealth interact with race-ethnicity to influence subjective survival expectations.Prior research finds a race anomaly in subjective life expectancy such that Blacks expect to live longer than Whites even though their actual life expectancy is lower, but it does not include other racial-ethnic groups. Using data from the 1998 Health and Retirement Study (n = 8,077), the authors find that the race anomaly in subjective survival expectations can be extended to Mexican Americans: Mexican Americans, regardless of their nativity, expect a lower chance of living to ages 75 and 85 than do Whites net of age and gender even though their actual life expectancy is higher. In addition, foreign-born Mexican Americans expect a lower chance of survival to older ages than native-born Mexican Americans, which is also opposite of actual mortality patterns. We also find that education and wealth interact with race-ethnicity to influence subjective survival expectations. Research on Aging 31(6) 688 –709