Resilience, ADL, and Cognitive Functioning Among Male Older Adults in Poverty in Rural Long-Term Care Facilities in China

Background and Purpose

Older adults in poverty in rural China are referred to as “three-no people”: no working ability, no income source, and no children or legal supporters. The majority of residents in government-funded long-term care (LTC) facilities in rural China are male older adults in poverty. The concept of resilience garnered considerable attention in improving health, but less studies have investigated the association between resilience and cognitive function in older adults in China. The purpose of this study was to identify whether increased levels of resilience predict better cognitive function among male older adults in poverty in rural LTC facilities in China, and whether this effect varies by age and activities of daily living (ADL).

Methods

A cross-sectional study was conducted with 1,427 residents living in rural LTC facilities funded by the government from Anhui province during 2019. The study sample was limited to 711 male respondents aged 60 years and above who reported their functional status and cognitive function. Cluster sampling method was used to randomly select two rural LTC facilities specific for adults in poverty from the list of all LTC facilities in each city of all of the 16 cities in Anhui province. Resilience was assessed by the Chinese version of Connor-Davidson Resilience Scale (CD-RISC), mini-mental State Examination (MMSE) was utilized to examine the cognitive function, and functional status was measured by Barthel Index (BI) of ADL. Hierarchical multiple regression analysis was utilized to examine the association between resilience and cognitive function within subgroups with and without ADL disability. The interaction item of age and resilience was also included in the model.

Results

The average age of the sample was 74.57 years (SD=7.03). Over half were illiterate (67.23%), had chronic disease (64.88%), lived in facilities more than 5 years (63.71%), lived without roommates (54.71%), had ADL disability (57.52%), and rated their health poor to fair (66.10%). The vast majority were unmarried (95.33%), had no religion (89.73%), contacted with relatives in the last year at least once (73.80%), and had a mental disorder (78.17%). The total score of MMSE was 21.24 (SD=5.46), and 60.34% of the participants reported cognitive impairment (60.34%, MMSE score<24). The total score for resilience was 36.25 (SD=13.34). In older respondents without ADL disability (BI=100), resilience was not identified to be significantly associated with cognitive function (B=0.001, p=0.989). However, resilience was the second strongest significant predictor for better cognitive function (B=0.095, p< .001) in older respondents with ADL disability (BI<100), accounting for an additional 3.4% of variance in cognitive function (ΔR²=0.034, p< .001). Resilience by age interaction was not detected.

Conclusions and Implications

Among male older adults in poverty in LTC facilities in China, resilience levels are relatively low, and resilience is a stronger protective factor against cognitive impairment in older adults with disability. Age was not identified to modify the effects between resilience and cognitive function. Resilience-building intervention can be offered to older adults in LTC facilities to improve their cognitive function, particularly to male older adults in poverty with disability.