Interaction between home and community-based services and PM(2.5) on cognition: A prospective cohort study of Chinese elderly.

PM2.5 and home and community-based services (HCBSs) had been shown to affect cognition, but the evidence on their joint effects was limited. Aimed to study the joint effects of HCBSs and PM2.5 on cognition, we utilized the follow-up data of participants in the Chinese Longitudinal Health Longevity Survey (CLHLS) who were 65 years of age or older and had normal cognitive function at baseline for the 2008-2018, 2011-2018, and 2014-2018 waves. 16,954, 9,765, and 7192 participants from each of these three waves were initially recruited, respectively. The PM2.5 concentration data of each province in China from 2008 to 2018 was obtained from the Atmospheric Composition Analysis Group. Participants were asked what kind of HCBSs were available in their community. The cognitive status of the participants was evaluated by the Chinese version of Mini-Mental State Examination (CMMSE). We applied the Cox proportional hazard regression model to investigate the joint effects of HCBSs and PM2.5 on cognition and further stratified the analysis according to HCBSs. Hazard ratio (HR) and 95% confidence interval (95% CI) were calculated based on Cox models. During a median follow-up period of 5.2 years, 911 (8.8%) participants with normal baseline cognitive function developed cognitive impairment. Compared to participants without HCBSs and exposed to the highest level of PM2.5, those with HCBSs and exposed to the lowest level of PM2.5 had a significantly reduced risk of developing cognitive impairment (HR = 0.428, 95% CI: 0.303-0.605). The results from the stratified analysis revealed that the detrimental effect of PM2.5 on cognition was more pronounced in participants without HCBSs (HR = 3.44, 95% CI: 2.18-5.41) compared with those with HCBSs (HR = 1.42, 95% CI: 0.77-2.61). HCBSs may attenuate the harmful impact of PM2.5 on cognitive status in the elderly Chinese and the government should further promote the application of HCBSs.

Zhang H ，Ni R ，Cao Y ，Chen Y ，Fang W ，Hu W ，Pan G ... -  《-》

Longitudinal association between home and community-based services provision and cognitive function in Chinese older adults: Evidence from the Chinese Longitudinal Healthy Longevity Survey.

Few studies have assessed the impact of home and community-based services (HCBSs) provision on cognitive function among older adults over time. This study examined the longitudinal association between HCBSs provision and cognitive function in Chinese older adults. The study included 5,134 participants aged 65 years and older in the Chinese Longitudinal Healthy Longevity Survey from 2008 to 2014. The Mini-Mental State Examination (MMSE) was used to evaluate cognitive function over the same time period. Participants were asked what kind of HCBSs were provided in his or her community. However, they were not asked whether services were utilised. The study used the number of HCBSs provided each wave to represent the strength of HCBSs, and used the MMSE score of each wave to represent the older adults' cognitive function status. A latent growth model was used to explore the relationship between HCBSs provision and cognitive function of older adults. The number of HCBSs provided was positively associated with older adults' cognitive function (2008: β = 0.03, p = 0.031; 2011: β = 0.06, p < 0.001; 2014: β = 0.06, p < 0.001) after controlling for gender, age, residence, education, income, medical insurance, activities of daily living disability, instrumental activities of daily living disability, serious illness, living arrangement and marital status. Results provided longitudinal evidence that an increase in HCBSs provision at a national level can result in better cognitive function in Chinese older adults.

Yu Y ，Yuan C ，Zhang Q ，Song C ，Cui S ，Ye J ，Zhang X ，Chen C ... -  《-》

Association between home and community-based services and depressive symptoms in Chinese older adults: a multilevel analysis.

As the phenomenon of ageing continues to intensify, home and community-based services (HCBSs) have been increasingly important in China. However, the association between HCBSs utilization and depressive symptoms in older adults in China is unclear. Consequently, this study aimed to examine the association between HCBSs utilization and depressive symptoms in Chinese older adults. This study included 7,787 older adults (≥ 60 years old) who were recruited within the framework of the 2018 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10). HCBSs utilization was assessed via the question, "What kind of HCBSs were being utilized in their community?". Data were analyzed using binary logistic regression models and generalized hierarchical linear models (GHLM). Of the 7,787 participants, 20.0% (n = 1,556) reported that they utilized HCBSs, and 36.7% (n = 2,859) were evaluated that they had depressive symptoms. After adjusting for individual- and province-level covariates, the HCBSs utilization was found to be associated with depressive symptoms (OR = 1.180, 95% CI: 1.035-1.346, p < 0.05). Additionally, the depressive symptoms were significantly associated with gender, residence, educational level, marital status, number of chronic diseases, self-rated health (SRH), smoking, and provincial Gross Domestic Product (GDP) per capita. This study found HCBSs utilization might be a protective factor against depressive symptoms in Chinese older adults. It is of utmost significance for the government to provide targeted HCBSs at the community level to address the unmet care needs of older adults, which can reduce the occurrence of negative emotions, consequently contributing to less severe depressive symptoms.

Xu T ，Huang Z ，Huang Y ，Wang S ，Zhang X ，Hu Y ，Zhu Y ，Cheng D ，Fu Y ，Zhang X ，Chen C ... -  《BMC PUBLIC HEALTH》

Association between home and community-based services utilization and self-rated health among Chinese older adults with chronic diseases: evidence from the 2018 China Health and Retirement Longitudinal Study.

Xu T ，Huang Z ，Li B ，Jin H ，Zhang J ，Yang H ，Huang Y ，Zhang X ，Chen C ... -  《BMC PUBLIC HEALTH》

Interaction between plant-based dietary pattern and air pollution on cognitive function: a prospective cohort analysis of Chinese older adults.

Air pollution is a risk factor for poor cognitive function, while a plant-based dietary pattern is associated with better cognitive function. We aimed to explore their interaction with cognitive function among older adults. We used a prospective cohort of old individuals, including 6525 participants of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), aged 65-110 years and with normal cognition at baseline. Air pollution measurement was derived using satellite-derived annual average fine particulate matter (PM2.5) concentrations based on residential locations. Plant-based diet index (PDI) was calculated using survey responses to assess the dietary pattern. Repeated measures of the Mini-Mental State Examination (MMSE) were utilized to assess cognitive function. We applied the Cox proportional hazard regression to explore the associations and further stratified the analysis by PDI. During a median of 5·6-year follow-up, 1537 (23·6%) out of 6525 participants with normal cognition at baseline developed poor cognitive function (MMSE <18). Living in areas with the highest quintile of cumulative PM2.5 was associated with a 46% increase in the risk of developing poor cognitive function (hazard ratio (HR): 1·46, 95% confidence interval (CI): 1·20, 1·77), compared to those living in areas with the lowest quintile. We observed a significant interaction between cumulative PM2.5 and PDI (p-interaction: 0·04), with the corresponding associations of cumulative PM2.5 being more pronounced among participants with lower PDI (HR: 1·68, 95% CI: 1·26, 2·24) than those with higher PDI (HR: 1·28, 95% CI: 0·98, 1·68). Plant-based dietary pattern may attenuate detrimental impacts of PM2.5 on cognitive function among older adults. Adherence to the plant-based dietary pattern could be used to prevent adverse neurological effects caused by air pollution, especially in developing regions.

Zhu A ，Chen H ，Shen J ，Wang X ，Li Z ，Zhao A ，Shi X ，Yan L ，Zeng Y ，Yuan C ，Ji JS ... -  《-》