Page 95 - IJPS-11-4

International Journal of
Population Studies Health disparities and older adults well-being in China

a value of 0 if they faced difficulty in any of these activities
and a value of 1 if they could perform all these actions
without impediment. This classification aligns with prior
research (Gu & Dupre, 2008).
For the assessment of mental health, we rely on the
Center for Epidemiological Studies Depression Scale
(CESD). CESD comprises various dimensions, including
assessments of depressed mood, feelings of guilt and
worthlessness, hopelessness, psychomotor retardation,
changes in appetite, and sleep disturbances. A higher
total CESD score is indicative of more severe depressive
Figure 4. Public support ratio of China symptoms, with a CESD total score of 16 or above
Source: National Transfer Accounts using 2009 as the base year. signifying depression. A few surveys use the short version
of CESD, called CESD-10, due to the regular version being
longitudinal survey. too lengthy for certain respondents. CHARLS uses the
short version CESD-10, with a total score of 10 or above
CHARLS, as a rich longitudinal resource, primarily signifying depression (Fu et al., 2022). We acknowledge that
focuses on middle-aged and older-aged cohorts. It aligns CESD scores may vary among individuals, influenced by
itself with international best practices and serves as a factors such as age, gender, and education level. Typically,
valuable benchmark for cross-country comparisons. Its studies have found a positive association between CESD
global counterparts include the Health and Retirement scores and age, with old-age individuals reporting higher
Study in the United States; the English Longitudinal scores. Moreover, old-age women often exhibit higher
Survey of Ageing in the United Kingdom; the Survey CESD scores than their male counterparts. Educational
on Health, Aging, and Retirement in Europe covering attainment also plays a role, as higher education levels
continental Europe; and the Japanese Study on Aging and are often associated with lower CESD scores (Wallace &
Retirement and the Korean Longitudinal Study of Aging in Ohara, 1992; Kimberlin & Pendergast, 1998; Everson-Rose
Asia. The extensive CHARLS questionnaire covers a gamut et al., 2005). To facilitate interpretation and reporting, we
of domains, including personal demographics, familial reversed the original CESD scores, such that higher scores
structure and financial support, health status, employment, indicate lower levels of depression and better mental health
retirement and pension details, income and consumption among the older people. Furthermore, Schuch et al. (2018)
patterns, as well as assets and savings. Notably, within argue that poorer physical health in older adults tends to be
the domain of health status assessment, CHARLS delves associated with higher CESD scores. To explore the impact
into fundamental health and disease records, disability of physical health on the mental health of the older-aged,
assessments, cognitive function and mental health we incorporated IADLs as an explanatory variable in an
evaluations, as well as self-reported health assessments. alternative model (Model 4).
For more detail insights into CHARLS’s design and sample
methodology, please refer to Zhao et al. (2014). Finally, we employed the Mini-Mental State
Examination (MMSE) score to assess cognitive ability
2.2. Variables and health assessment and represent cognitive health in our regression model.
In this study, we employed a range of variables to Developed in 1975, the MMSE offers a comprehensive
comprehensively assess the health of the old-age participants. assessment of cognitive function, with a total score of 30
We began by employing ADLs and instrumental ADLs points. A score of 23 or lower is indicative of dementia.
(IADLs) as indicators of physical health. ADLs encompass The prevalence of dementia is on the rise among the older
fundamental daily activities such as eating, getting in and adults due to increasing life expectancy. Nevertheless,
out of bed or a chair, dressing, toileting, bathing, and Western countries such as the United States, the
mobility within the home. On the other hand, IADLs assess United Kingdom, and France have observed lower
the executive functioning involved in more complex daily dementia incidence among more recent generations,
tasks, including independent travel, shopping for daily attributed to advancements in education, socioeconomic
necessities, managing personal finances, making telephone factors, health care, and lifestyle changes (Livingston
calls, performing heavy household chores, and engaging in et al., 2020). Conversely, East Asian countries or regions,
general housework. In this study, both ADLs and IADLs including Japan, South Korea, Hong Kong, and Taiwan,
were treated as binary variables, with individuals assigned have witnessed apparent increases in age-specific

Volume 11 Issue 4 (2025) 89 https://doi.org/10.36922/ijps.2035