成功老龄化研究--以北京老年人为例

本文利用北京老龄化多维纵向研究数据,对北京老年人的成功老龄化状况进行了分析.分析结果表明,年龄、性别、受教育程度和家庭经济状况等因素影响着成功老龄化.属于成功老龄化范畴的老年人主要是低年龄、男性、受教育时间长、拥有较多家庭财产或月收入的老年人.上述因素并不只对某一个年龄组产生影响,它们对老年的各个阶段都有影响.年龄的增长与老年人身体、心理和社会功能有着紧密的联系,在控制了年龄、性别、教育和收入变量之后,老年人之间的差异依然存在.     

Refining the association between education and health: The effects of quantity, credential, and selectivity

We refine the established association between education and health by distinguishing three aspects of a person's education (quantity, credential, and selectivity) and by examining the mechanisms through which they may correlate with health. Data are from the 1995 Aging, Status, and the Sense of Control Survey, a representative U.S. national telephone survey of 2,593 respondents aged 18 to 95, with an oversample of elderly. Results show that physical functioning and perceived health increase significantly with years of formal education and with college selectivity for those with a bachelor's or higher degree, adjusting for age, sex, race, marital status, and parental education. The credential of a college degree has no net association with physical functioning and perceived health beyond the amount attributable to the additional years of schooling. Of the three aspects of education, years of schooling has the largest effect. Most of that association appears attributable to its correlation with work and economic conditions, social psychological resources, and health lifestyle. A large portion of the net association of college selectivity with physical functioning and perceived health appears attributable to health lifestyle.     

Perspectives on antenatal education associated with pregnancy outcomes: Systematic review and meta-analysis

BackgroundMany studies on the relation between maternal health and infant health, including the effect of structured antenatal education, have been published and expanded over the years.AimInvestigate the impact of various antenatal education programmes on pregnancy outcomes to aid the development of future guidelines related to maternal and foetal health.MethodsBibliographic databases (Cochrane, PubMed, EMBASE, CINAHL, Korean Studies Information Service System) were searched up to November 2018, following the PICO criteria: population (pregnant women), intervention (antenatal education), comparison (not specified), and outcome (maternal and foetal outcome including physical or mental health components).FindingsWe included 23 eligible studies consisting of 14 controlled trials and 9 observational studies. The maternal physical outcomes depending on participation in antenatal education were not significantly different; however, the caesarean birth rate was lower in the antenatal education group (relative risk, RR, 0.90; 95% confidence interval, CI, 0.82–0.99), as was the use of epidural anaesthesia (RR, 0.84; 95% CI, 0.74–0.96). The maternal mental health outcomes of stress and self-efficacy significantly improved in the antenatal education group, although there was no difference in anxiety and depression. The foetal outcomes of birth weight or gestational age at birth were also not different between the groups.ConclusionAntenatal education can reduce maternal stress, improve self-efficacy, lower the caesarean birth rate, and decrease the use of epidural anaesthesia; however, there is limited evidence of its effects on maternal or foetal physical outcomes. Therefore, antenatal education should be standardised to elucidate its actual mental and physical health effects.     

Cumulative Childhood Adversity,Educational Attainment,and Active Life Expectancy Among U.S. Adults

Studies of the early-life origins of adult physical functioning and mortality have found that childhood health and socioeconomic context are important predictors, often irrespective of adult experiences. However, these studies have generally assessed functioning and mortality as distinct processes and used cross-sectional prevalence estimates that neglect the interplay of disability incidence, recovery, and mortality. Here, we examine whether early-life disadvantages both shorten lives and increase the number and fraction of years lived with functional impairment. We also examine the degree to which educational attainment mediates and moderates the health consequences of early-life disadvantages. Using the 1998–2008 Health and Retirement Study, we examine these questions for non-Hispanic whites and blacks aged 50–100 years using multistate life tables. Within levels of educational attainment, adults from disadvantaged childhoods lived fewer total and active years, and spent a greater portion of life impaired compared with adults from advantaged childhoods. Higher levels of education did not ameliorate the health consequences of disadvantaged childhoods. However, because education had a larger impact on health than did childhood socioeconomic context, adults from disadvantaged childhoods who achieved high education levels often had total and active life expectancies that were similar to or better than those of adults from advantaged childhoods who achieved low education levels.     

Beliefs About Diet and Health:

Low income older women (N = 20) in South Carolina were recruited from congregate meal sites for qualitative interviews to assess beliefs about general health, physical functioning, and preventive health behaviors. A loosely structured interview guide of topics was used to encourage free expression of informants' ideas. The Ethnograph analysis package was used for data analysis. In response to open-ended questions, the women spontaneously shared their beliefs about diet and health. Implications for health promotion in rural areas are discussed.     

中国老年人隔代照料与 健康后果的实证研究及政策思考

在中国家庭代际关系的研究中,隔代照料这一选题极为重要,隔代照料也是老年和家庭福利政策制定的重要影响因素。老年人隔代照料与健康问题日益受到国内学者的关注,但对两者相关性的深入实证考察较少,仅有的研究也未就隔代照料产生的健康后果达成共识,政策应对亦存局限。为此,本文基于2014年中国老年社会追踪调查(CLASS)截面数据,探讨中国老年人照料孙子女对自身健康产生的后果及几个主要变量之间的交互作用,对其进行量化研究并通过稳健性检验。研究得出三项基本结论:隔代照料的健康后果受到照料强度、子女特征、居住模式及老年人自身罹患慢性疾病状况的影响,在不同的特征状况下呈现不同的健康结果;照料者受教育程度、照料者性别、健在子女数等变量间的交互作用对被解释变量(照料者健康)产生了不同程度的调节作用,成年子女向上的代际支持也对老年照料者的健康发挥了调节作用;使用工具变量(照料者是否享受老年优待政策)进行因果识别在一定程度上克服了解释变量与被解释变量间的内生性问题。最后,本文基于上述实证研究的结果从代际关系视角、社会性别视角和老年婚姻社会功能等方面提出公共政策的应对思考,以期为制定相应的老年和家庭福利政策提供策略和依据。     

Differentials in Adult Mortality and Activity Limitation by Years of Education in the United States at the End of the 1990s

This study examines mortality differentials and health disparities between educational groups within the 1998 adult population (ages 25 and older) in the United States. Mortality differentials are measured using average life expectancy and health disparities by expected years without activity limitation. The results indicate that for both sexes, higher education is associated with higher life expectancy. Those with higher levels of education also have higher life expectancy without activity limitation. Adults with higher education can also expect to enjoy a greater percentage of their expected lives free of any form of activity limitation. At each level of education, adult females have a higher level of activity limitation compared to adult males. At the same level of education, adult females expect to enjoy smaller percentages of their remaining lives free of activity limitation compared to adult males of the same age.     

The education effect on population health: a reassessment

Demographic research frequently reports consistent and significant associations between formal educational attainment and a range of health risks such as smoking, drug abuse, and accidents, as well as the contraction of many diseases, and health outcomes such as mortality—almost all indicating the same conclusion: better-educated individuals are healthier and live longer. Despite the substantial reporting of a robust education effect, there is inadequate appreciation of its independent influence and role as a causal agent. To address the effect of education on health in general, three contributions are provided: 1) a macro-level summary of the dimensions of the worldwide educational revolution and a reassessment of its causal role in the health of individuals and in the demographic health transition are carried out; 2) a meta-analysis of methodologically sophisticated studies of the effect of educational attainment on all-cause mortality is conducted to establish the independence and robustness of the education effect on health; and 3) a schooling-cognition hypothesis about the influence of education as a powerful determinant of health is developed in light of new multidisciplinary cognitive research.     

Determinants of Self-Rated Health Among Canadian Seniors Over Time: A Longitudinal Population-Based Study

Self-rated health has been found to be an effective and inexpensive measure of people’s overall health. Although cross-sectional studies have identified determinants of self-rated health (SRH), there is a limited insight into the determinants of SHR overtime and their impact on the change of SRH overtime. This present study compares determinants of SRH among a large community-dwelling cohort of Canadian seniors (N = 3255) at three points in time (1991, 1996, and 2001), and examines the effects of determinants on change in SRH over a 10-year period. Data analyzed were from the Canadian Study of Health and Aging—a large-scale longitudinal population-based study conducted between 1991 and 2001. The results showed that most seniors (over 80 %) rated their health as good, and their SRH remained surprisingly constant over time. Only a person’s physical and instrumental functioning and the number of chronic diseases were consistently associated with SRH at each point in time (1991, 1996, and 2001). Factors including cognition, daily functioning, chronic disease, and availability of help were significantly linked to self-rated health over time. These determinants should be considered important stimuli for improving health among seniors.     

The Association Between the Fear of Crime,and Mental and Physical Wellbeing in New Zealand

Researchers have provided clear evidence that the fear of crime can lead to various mental health-related issues including anxiety and psychological distress. However, studies on the effects of fear of crime on physical health are limited. Adding to and extending this literature, we evaluated the association between fear of crime and mental and physical health outcomes in a new setting (New Zealand) and at a national scale. As an added contribution to the literature, we examined whether the fear of crime is independently associated with mental and physical wellbeing, regardless of neighbourhood crime rates. Using data from the New Zealand General Social Survey, the 2006 census and the New Zealand Police, we fitted linear and two-level hierarchical linear models regression models to assess the impact of fear of crime on mental and physical health, at varying stages of individual and area-level confounder adjustment. Even after adjusting for a number of individual- and area-level factors that are related to social inequalities in health in the country, a significant effect of increased fear of crime on lower mental and physical wellbeing was detected. We did not, however, detect significant independent effects for neighbourhood crime rates for either outcome. Our findings indicate that fear of crime, rather than recorded crime rates, was associated with detrimental mental and physical health outcomes. As such, efforts to not only reduce crime but perceived risk of crime could yield public health and social wellbeing benefits.     

Residential independence among older persons: community and individual factors

The objective of this study is to evaluate an expanded version of the resource model of living arrangements among older persons. This expanded model includes community-level measures of geriatric health services and housing market conditions. We employ the first two waves of the National Survey of Families and Households to test static and longitudinal fixed effects models of residential living arrangements. We find that residing in areas with higher levels of geriatric health care services increases the likelihood of residential independence, net of other contextual factors and individual characteristics. Our results show that housing market conditions are not related to levels of or changes in residential independence when control variables are included in the models. The results for the individual-level resource variables show that persons with greater economic resources, more children, and better functional status are better able to maintain independence and are less likely to die or live in a nursing home. This study shows the utility of expanding on micro-level approaches to understanding community living arrangements among older persons. Future investigations should include measures of the policy environment, transportation constraints and opportunities, and a more complete array of indicators of health and social services oriented toward helping elderly persons maintain their independence.     

The Latent Dimensions of Poor Self-Rated Health: How Chronic Diseases,Functional and Emotional Dimensions Interact Influencing Self-Rated Health in Italian Elderly

Self-Rated Health (SRH) is becoming one of the most popular indicator of population health. Nevertheless, a limited understanding still remains about the elements to which individuals refer when evaluating their health and how those elements act and interact in the evaluation process. In this study we use a structural equation model with latent variables to identify direct and indirect influences of various health dimensions (chronic morbidity, functional abilities and emotional health) and socio-demographic covariates (age, gender and education) on poor SRH. The sample consists of 25,183 Italian elderly aged 65 years and over, interviewed in the 2005 National Health Interview Survey. The results have pointed out the higher direct effect of psychological and emotional health on SRH, while the higher total effect is caused by chronic morbidity, which influences SRH both directly and altering functional and emotional health. Growing older, being a woman and having a low education negatively impacts on SRH. However, this is almost completely the result of the indirect effect exerted by the covariates, while their direct effect is not significant (gender), negative (age) or very modest (education).     

Do Measured and Unmeasured Family Factors Bias the Association Between Education and Self-Assessed Health?

The association between educational attainment and self-assessed health is well established but the mechanisms that explain this association are not fully understood yet. It is likely that part of the association is spurious because (genetic and non-genetic) characteristics of a person’s family of origin simultaneously affect one’s educational attainment and one’s adult health. In order to obtain an unbiased estimate of the association between education and health, we have to control for all relevant family factors. In practice, however, it is impossible to measure all relevant family factors. Sibling models are particularly appropriate in this case, because they control for the total impact of family factors, even if not all relevant aspects can be measured. I use data on siblings from a US study (MIDUS) and Dutch study (NKPS) to assess the total family impact on self-assessed health and, more importantly, to assess whether there is a family bias in the association between educational attainment and self-assessed health. The results suggest that there is a substantial family effect; about 20% of the variation in self-assessed health between siblings can be ascribed to (measured and unmeasured) family factors. Measured family factors, such as parental education and father’s occupation, could account only for a small part of the family effect. Furthermore, the results imply that it is unlikely that there is substantial bias due to family effects in the association between education and self-assessed health. This strengthens the conclusions from prior studies on the association between education and self-assessed health.     

Sleep Behaviors in Older African American Females Reporting Nonmalignant Chronic Pain: Understanding the Psychosocial Implications of General Sleep Disturbance

This study examined factors that influence sleep quality in older African American women (N = 181) reporting chronic pain. Participants completed a series of questions assessing demographic and behavioral characteristics, health status, pain intensity, and sleep disturbance. Findings indicated that younger participants and those experiencing poorer physical functioning reported more difficulty sleeping due to pain. Similarly, participants who reported being awakened from sleep due to pain were younger and experienced greater pain intensity. Understanding the relationship between sleep and pain in this group of women may be useful in promoting effective disease management and sleep awareness among patients, caregivers, and healthcare professionals.     

Gender differences in psychosocial predictors of self-perceived health status in the elderly: Evidence from a Brazilian community study

ABSTRACT

This article aims to identify the psychosocial factors associated with self-perceived health status in the Brazilian elderly population and to present differences related to gender. The data were collected by questionnaire, including sociodemographic and behavioral questions, and scales for psychological dimensions. Self-perceived health status is related to level of education, physical activity, and self-efficacy in the total population. Regarding gender differences, self-rated health status among men is related to education level and self-efficacy and in women to level of education, physical activity, social support, and self-efficacy. These results can inform future health promotion interventions.     

Dimensions of women’s autonomy and the influence on maternal health care utilization in a north indian city

The dimensions of women's autonomy and their relationship to maternal health care utilization were investigated in a probability sample of 300 women in Varanasi, India. We examined the determinants of women's autonomy in three areas: control over finances, decision-making power, and freedom of movement. After we control for age, education, household structure, and other factors, women with closer ties to natal kin were more likely to have greater autonomy in each of these three areas. Further analyses demonstrated that women with greater freedom of movement obtained higher levels of antenatal care and were more likely to use safe delivery care. The influence of women's autonomy on the use of health care appears to be as important as other known determinants such as education.     

Changes in functional limitation and survival among older Taiwanese, 1993, 1996, and 1999

Using data from the Survey of Health and Living Status of the Elderly in Taiwan, we investigate changes in difficulties in walking and climbing stairs, tasks that represent basic lower-body movements less likely to be influenced by changes in environment and social roles than are activities and instrumental activities of daily living. Results are shown for unadjusted prevalence rates and rates adjusted for changes in population composition. The findings indicate that Taiwan does not appear to be experiencing the improvements in functioning witnessed recently in the United States. Prevalence of functional limitation increased between 1993 and 1996 and between 1996 and 1999. One possible reason is the change in old-age survival, which appears to have benefited those who have functional limitations, especially in a severe form. The Universal Health Insurance programme, established in 1995, may have increased access to care and thus the survival of those in poorest health.     

The health-schooling relationship: evidence from Swedish twins

Health and education are known to be highly correlated, but the mechanisms behind the relationship are not well understood. In particular, there is sparse evidence on whether adolescent health may influence educational attainment. Using a large registry dataset of twins, including comprehensive information on health status at the age of 18 and later educational attainment, we investigate whether health predicts final education within monozygotic (identical) twin pairs. We find no evidence of this and conclude that health in adolescence may not have an influence on the level of schooling. Instead, raw correlations between adolescent health and schooling appear to be driven by genes and twin-pair-specific environmental factors.     

Changes in functional limitation and survival among older Taiwanese, 1993, 1996, and 1999

Using data from the Survey of Health and Living Status of the Elderly in Taiwan, we investigate changes in difficulties in walking and climbing stairs, tasks that represent basic lower-body movements less likely to be influenced by changes in environment and social roles than are activities and instrumental activities of daily living. Results are shown for unadjusted prevalence rates and rates adjusted for changes in population composition. The findings indicate that Taiwan does not appear to be experiencing the improvements in functioning witnessed recently in the United States. Prevalence of functional limitation increased between 1993 and 1996 and between 1996 and 1999. One possible reason is the change in old-age survival, which appears to have benefited those who have functional limitations, especially in a severe form. The Universal Health Insurance programme, established in 1995, may have increased access to care and thus the survival of those in poorest health.     

Adjusting Life Expectancy to Account for Disability in a Population: A Comparison of Three Techniques

Sullivan (1971) first suggested weighting life expectancy (LE) to account for the health of a population using a single indicator. Known as disability free life expectancy (DFLEs), this measure was somewhat limited due to a overly simplistic weighting scheme. Its introduction, however, spurred the development of a whole new class of measures known as health expectancy indicators. One of the first, disability-adjusted life expectancy (DALEs) (Wilkins and Adams, 1983), identified the period of time in a particular level of disability and weighted each level accordingly. While the weighting allowed for a health related quality-of-life distinction to be introduced into the DALE measure, the weights, by level of disability, were arbitrarily chosen and fixed for all ages and gender. To overcome this limitation, a health-adjusted life expectancy (HALE) was developed based in large part on the DALE methodology but utilizes more refined weights. The McMaster Health Utility Index Mark III (HUI3)) scores health on a continuum from 0 to 1 and when included on a national health survey, provides estimates that reflect important age, gender, and socio-economic factors. All three measures were calculated for the years 1986, 1991, and 1994 (household and institutional populations). Analysis revealed that HALEs were more appropriate for policy purposes due to their ability to account for indirect morbidity in both a disabled and non-disabled population.